{"instruction": "Generate impression based on findings.", "input": "Abdominal pain right upper quadrant, assess for cholecystitis or cholangitis LIVER: Liver measures 15 cm with increased echogenicity suspicious for hepatic steatosis. No intrahepatic biliary duct dilatation. Portal vein demonstrates normal flow directionality and patency measuring up to 0.2 m/s. No focal liver lesions noted. GALLBLADDER, BILIARY TRACT: Gallbladder is well distended with sludge noted within the bladder. No evidence of gallstones. Multiple small punctate hyperechoic areas within known artifacts noted in the fundus of the gallbladder most likely representing cholesterolosis/polyps. No evidence of pericholecystic fluid. Common hepatic duct measuring up to 3 mm within normal limits.PANCREAS: No significant abnormalities noted.KIDNEY: Right kidney measures 10.1 cm with normal echotexture. No hydronephrosisLimited evaluation of the left upper quadrant due to overlying bowel gas. Left kidney measures 9.5 cm.OTHER: Spleen measures 10.2 cm with normal echotexture.Mild Ascites noted.Bilateral pleural effusion noted", "output": "Hepatic steatosis without any focal liver lesion.Multiple gallbladder cholesterolosis/polyps and sludge. No evidence of gallstonesBilateral pleural effusion.Limited evaluation of the left upper quadrant due to overlying bowel gas."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: Mildly coarse echogenic liver echotexture without worrisome mass. 1.9 x 2.3 x 2.4 benign cystic focus right lobe of liver. Liver length 17.5 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.2 cm in length.OTHER: Spleen 10.6 cm in length. No ascites.", "output": "Mildly coarse echogenic liver echotexture suggestive for fatty infiltration without worrisome mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with question thyroid nodule. RIGHT LOBE MEASUREMENTS: 5.6 x 1 x 1.7 cmLEFT LOBE MEASUREMENTS: 6.7 x 2.2 x 1.5 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Homogeneous in echotexture. Arising from the lower pole is a predominantly solid, isoechoic mass with some internal cystic change in small punctate echogenic foci. This measures approximately 0.6 x 0.7 x 1.3 cm with a somewhat lobulated margin on transverse imaging.LEFT LOBE: Homogeneous in echotexture. Presumably arising from the lower pole of the left lobe is a very large, solid, well-defined and heterogeneous mass measuring 2.1 x 2.3 x 3.2 cm. Portions of this are hyperechoic.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral thyroid masses with an indeterminate appearance."}
{"instruction": "Generate impression based on findings.", "input": "History bladder cancer status post cystectomy with acute renal insufficiency RIGHT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 9.9 cm in lengthLEFT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 10.4 cm in lengthOTHER: Bladder nondistended", "output": "Mildly echogenic renal parenchyma raises the possibility of medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Recurrent abdominal pain status post MALS surgery LIVER: Normal parenchymal echogenicity without mass. Liver length 16.2 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.5 cm in lengthOTHER: Left kidney 10 cm in length. Spleen 12 cm in length. No ascites.", "output": "Negative right upper quadrant ultrasound. No evidence for hepatobiliary abnormality."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old female with right upper quadrant pain. Evaluate for cholecystitis. LIVER: The liver is normal in morphology with slightly coarsened echotexture. It measures 21 cm in craniocaudal dimension. No focal hepatic lesion or intrahepatic biliary ductal dilatation. Normal hepatopetal portal venous blood flow at 20 cm/sec.GALLBLADDER, BILIARY TRACT: Sludge and gallstone at the neck of a normally distended gallbladder. No wall thickening, pericholecystic fluid or focal tenderness. The common bile duct is mildly prominent up to 10 mm without obstructing stone or lesion identified.PANCREAS: Partially visualized pancreas is unremarkable.RIGHT KIDNEY: Dense calcification in the superior pole of the right kidney, unchanged. No hydronephrosis.OTHER: The left kidney measures 9.7 cm in length with mild upper pole pelviectasis. No shadowing nephrolithiasis is apparent. The spleen is normal in size, measuring 10.9 cm.", "output": "Gallbladder sludge, gallstones and mild extrahepatic biliary ductal dilatation. No common bile duct stone is evident. No evidence of acute gallbladder inflammation. "}
{"instruction": "Generate impression based on findings.", "input": "Hepatic cirrhosis with TIPS LIMITED ABDOMENLIVER: Cirrhotic morphology again noted without worrisome mass. 2.7 x 1.9 cm hypoechoic focus adjacent to gallbladder fossa stable; favor benign etiology. Liver length 16.1 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 12.6 cm in length RIGHT KIDNEY: No significant abnormalities noted. 11.5 cm in length OTHER: Left kidney 12.7 cm in length. No ascites.", "output": "Stable cirrhotic morphology without mass or ductal dilatation. Patent TIPS catheter with patent hepatic vessels with expected directional flow. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "70 years, Male. Reason: r/o obstruction History: nausea and vomiting There is patchy opacification of the ascending and transverse colon by contrast material from the patient's endoscopic ultrasound dated 11/25/2015. A dilated loop of small bowel in the left abdomen measures up to 3.8 cm in diameter and is felt to represent a focal ileus. There is no evidence of intraperitoneal free air. A left upper quadrant surgical drain and numerous surgical staples and suture material overlie the abdomen.", "output": "A dilated loop of small bowel in the left abdomen measures up to 3.8 cm in diameter and is felt to represent a focal ileus."}
{"instruction": "Generate impression based on findings.", "input": "76 year old male with metastatic thyroid cancer. Evaluate for lymph nodes. RIGHT LOBE MEASUREMENTS: 4.5 cm x 1.9 cm x 1.7 cmLEFT LOBE MEASUREMENTS: 10.0 cm x 4.8 cm x 2.5 cm.ISTHMUS MEASUREMENTS: 3 mm in thicknessRIGHT LOBE: Hypoechoic subcentimeter nodule at the mid to lower pole measuring to up 6 mm. LEFT LOBE: Diffusely heterogeneous in echotexture. ISTHMUS: No significant abnormality noted.ILYMPH NODES: No suspicious lymphadenopathy. Right neck level 2 lymph node with fatty hilum measuring 2.0 cm x 0.5 cm 1.2 cm. Left neck level 2 lymph node with fatty hilum measuring 1.6 cm x 0.6 cm x 0.8 cm.", "output": "1. Diffusely heterogeneous left thyroid lobe likely reflecting patient's known primary thyroid malignancy. Additional hypoechoic subcentimeter nodule is seen in the right thyroid lobe. 2. Bilateral lymph nodes with fatty hila, may be reactive. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: history of liver disease, ?cirrhosis History: abnormal liver function tests LIVER: The liver measures 15.8 cm in length. The liver demonstrates increased parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.31 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 7.9 cm in length. RIGHT KIDNEY: Kidney measures 9.8 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.6 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No ascites.", "output": "Increased hepatic echogenicity suggestive of parenchymal dysfunction/fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old female with forearm lump. There is thickening in the subcutaneous tissues with some increased echogenicity in small amount of edema which may be due to cellulitis. On several views there is a 4-5 mm complex fluid collection in this region. I cannot exclude small abscess. No larger collections are identified.", "output": "Findings presumably related to cellulitis. There is a very small associated fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Jackson submitted outside mammograms dated 7/25/2011 and 7/2/2013 and outside ultrasounds dated 5/31/2012 and 7/2/2013 from Little Company of Mary Hospital. Submitted outside studies were compared to the current mammogram dated 9/8/2016. The breast parenchyma is heterogeneously dense, which may obscure small masses (BiRads Density Category C), unchanged in pattern and distribution. Previously identified partially obscured masses in bilateral breasts are either stable to slightly decreased in size when compared to prior mammograms, compatible with benign involuting cysts.The mammographic findings correspond to the prior ultrasound examinations demonstrating multiple benign simple cysts.", "output": "Bilateral benign involuting cysts. No mammographic evidence of malignancy. Physical examination is of increased importance for a patient with dense breast. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually, due in September 2017. BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Chronic renal disease RIGHT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 10.9 cm in lengthLEFT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 10.7 cm in length.OTHER: Bladder nondistended.", "output": "Mildly echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Male 65 years old; Reason: r/o liver lesion History: HCV LIVER: The liver measures 13.2 cm in length. There is a coarse echotexture of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 22.5 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.6 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 3.9 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.5 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.3 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 12.1 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "Nonspecific coarse echotexture of the liver, which is compatible with chronic liver dysfunction. No worrisome masses are seen."}
{"instruction": "Generate impression based on findings.", "input": "Male 63 years old Reason: possible MPGN, has low c3c4 , cryo levels pending History: anasarca Ultrasound guidance and technical assistance was provided for a negative right kidney. 3 passes using an 18-gauge needle were obtained at Dr. Cunningham The procedure was successfully completed.", "output": "Successful ultrasound guided biopsy of the right kidney."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female with chronic kidney disease, stage III. Biopsy guidance", "output": "Ultrasound guidance as noted above"}
{"instruction": "Generate impression based on findings.", "input": "Ms. Smith is a 59-year-old female with a personal history of right lumpectomy and sentinel lymph node biopsy in 2009 for IDC, grade 3, ER/PR positive. The patient currently reports breast tenderness and tightness on the right. On Arimidex. Upon physical exam at the mammographic area of concern, no discrete mass was appreciated.Targeted ultrasound of the right breast 6:00 position was performed, demonstrating a hypoechoic mass with irregular margins and internal calcifications 6 cm from the nipple measuring 0.7 x 0.6 x 0.8 cm, with mildly increased vascularity peripherally.", "output": "New suspicious mass in the right breast 6:00 position, for which ultrasound-guided biopsy is recommended. All results and recommendations were discussed with the patient. The patient is not on any blood thinning medications.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Rising LFTs status post gallbladder drain placement LIVER: Mildly coarse echogenic liver echotexture again noted without mass. Liver length 17.5 cmBILIARY TRACT: Gallbladder collapsed around percutaneous catheter. No pericholecystic fluid collection. No loculated fluid collection.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9.7 cm in lengthRIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 12.6 cm in lengthOTHER: Left kidney 12.3 cm in length. Echogenic left renal parenchyma without mass, stone, or hydronephrosis No ascites.", "output": "Mildly coarse echogenic liver character echotexture again noted suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Gallbladder collapsed around percutaneous catheter without pericholecystic fluid collection or other loculated fluid collection.Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "27 years old, Female, Reason: AKI, assess for hydro, obstructing stone History: as above Technically difficult exam due to patient's body habitus.RIGHT KIDNEY: Kidney measures 14.3 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 13.2 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.BLADDER: Incompletely distended with no significant abnormalities. OTHER: No significant abnormalities noted.", "output": "1.Normal echotexture of the kidneys bilaterally without evidence of hydronephrosis or shadowing calculus."}
{"instruction": "Generate impression based on findings.", "input": "Reason: HCV, Hepatitis B carrier. Evaluate for HCC History: HBV carrier. LIVER: The liver is normal in size, echogenicity, and contour, measuring 11.3 cm in length. No focal hepatic lesion is identified.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. No gallbladder wall thickening, cholelithiasis, or sonographic Murphy sign. Gallbladder sludge is noted.PANCREAS: Pancreatic tail is obscured by overlying bowel gas. Otherwise, no abnormality is identified.SPLEEN: The spleen is normal in size, measuring 8 cm in length.RIGHT KIDNEY: The right kidney measures 9.6 cm in length. No evidence of renal stone or hydronephrosis. OTHER: The left kidney measures 8.8 cm in length. No evidence of renal stone or hydronephrosis.", "output": "No focal hepatic lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female with history of thyroid nodule. RIGHT LOBE MEASUREMENTS: 1.6 x 1.8 x 4.0 cmLEFT LOBE MEASUREMENTS: 0.9 x 1.5 x 3.7 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: 5-mm hypoechoic solid inter-polar nodule without specific suspicious sonographic features. Otherwise, the background thyroid gland is minimally coarse.LEFT LOBE: The left thyroid lobe is minimally coarse without a dominant nodule.ISTHMUS: Within the right aspect of the isthmus is a 1.5 x 1.0 x 1.9 cm complex solid and cystic lesion without associated microcalcifications, or vascularity. The contour is slightly lobulated. The appearance and size is relatively stable.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Relatively stable 1.9-cm right Isthmus complex solid and cystic lesion is amenable to FNA if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old male with history of cystic lesion seen on cervical spine MRI. RIGHT LOBE MEASUREMENTS: 5.0 x 2.7 x 1.2 cmLEFT LOBE MEASUREMENTS: 5.4 x 2.1 x 1.2 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: A 1.6 x 1.1 x 0.7 cm cystic lesion is noted posteriorly and inferiorly to the right thyroid lobe. There is a clear fat plane separating this structure from the thyroid. The lesion is completely cystic without internal solid components or significant internal vascularity.", "output": "Cystic lesion posterior and inferior to the right thyroid lobe without internal solid component or internal vascularity. Differential considerations include simple cyst vs cystic parathyroid adenoma."}
{"instruction": "Generate impression based on findings.", "input": "Male 58 years old Reason: 58M s/p OLT 10/2 now with elevated LFTs s/p liver biopsy. History: Elevated LFTs LIVER: Background liver echogenicity is within normal limits. Stent or drain is partially visualized.BILIARY TRACT: Mildly prominent intrahepatic ducts without significant dilatation of the common bile duct which measures up to 6 mm.OTHER: No significant abnormalities noted.", "output": "Mildly prominent intrahepatic ducts without significant common bile duct dilatation, possibly related to cholestasis."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female with palpable abnormalities in the right breast for one week. Patient reports they feel linear. Limited physical examination of the right breast 11 and 8 o'clock positions in the patient's palpable area of concern was unremarkable. No mass was palpated.A targeted right ultrasound was performed for the patient\u2019s palpable area of concern in the 11 and 8 o'clock positions, 5 cm from the nipple. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy. The patient may be palpating the Cooper's ligaments. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Female 83 years old; Reason: Parathyroid adenoma in the setting of hypercalcemia and high PTH levels History: Hypercalcemia RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.4 x 2.4 x 1.9 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.3 x 2.1 x 1.6 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.1 cm.RIGHT LOBE: The right thyroid lobe is heterogeneous. No dominant nodules are identified.LEFT LOBE: The left thyroid lobe is heterogeneous. No dominant nodules identified.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted. There is a right level 3 lymph node visualized with a fatty hilum measuring 1.4 cm 1.5 cm x 0.4 cm.", "output": "1.No evidence of a parathyroid adenoma visualized on this study. This ultrasound is partially limited due to patient's positioning/movement.2. Thyroid gland is heterogeneous but no dominant nodules are identified. No suspicious lymphadenopathy is seen."}
{"instruction": "Generate impression based on findings.", "input": "Ms. ELAINE MCKENNEY is a 62 years old female with a personal history of right lumpectomy in June 2014 for IDC. She also has history of benign biopsy in March 2014 at outside hospital. She presents today with intermediate palpable concern in the left breast, same area as found one month ago. In the left breast upper inner quadrant, approximately 10:00 location, there is ink marker to indicate the palpable concern by the surgical clinic staff. Patient's palpable area of concern is slightly inferior to the ink marker at approximately 9:00 position.A targeted left ultrasound was performed at areas of palpable concern. Normal breast tissues are noted in both 10:00 and 9:00 location, 2 cm from the nipple. There is no solid or cystic mass to correspond to the palpable concerns.", "output": "No sonographic findings to account for patient's palpable concern. Routine annual diagnostic mammograms are recommended, due in March 2016. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Female 67 years old; Reason: assess for progression in size of thyroid nodules History: none RIGHT LOBE MEASUREMENTS: 5 x 1.7 x 2.1 cmLEFT LOBE MEASUREMENTS: 7.5 x 3.9 x 2.4 cmISTHMUS MEASUREMENT: 1.2 cmRIGHT LOBE: There are two right thyroid nodules. The superior nodule measures 1.7 x 1.3 x 1.6 cm, previously, 2.3 x 1.2 x 1.2 cm.; This nodule is mostly solid.The inferiorly located nodule measures 2.0 x 1.2 x 1.6, previously, 9 x 9 x 7 mm previously.LEFT LOBE: There are at least two left thyroid nodules.The largest nodule is in the lower pole and measures 4.7 x 3.1 x 4.0 cm, previously, 4.2 x 3.9 x 3.5 cm. It is mostly solid with some cystic areas.ISTHMUS: Isthmus nodule measures 1.7 x 1.1 x 1.8 cm, previously, 2.5 x 1.2 x 2.2 cm previously. It is mostly solid.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Stable to slight increase in the size of the inferior right pole and inferior left thyroid pole nodules.2.The remainder of the nodules are stable in size."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Echogenic coarse parenchyma again noted without mass. Liver length is 16.6 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis again noted without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right kidney 9.6 cm in length.OTHER: Left kidney 12 cm in length. Spleen 7.9 cm in length. No ascites", "output": "Coarse echogenic liver parenchyma again noted consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation; this finding is unchanged. Cholelithiasis without acute inflammation again noted. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old female with bilateral thyroid nodules. RIGHT LOBE MEASUREMENTS: 6.4 x 3.4 x 2.8 cmLEFT LOBE MEASUREMENTS: 4.5 x 2.7 x 2.0 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Dominant solid right thyroid nodule measures 7.0 x 1.2 x 1.1 cm with peripheral hypervascularity. Two smaller hypoechoic nodules measure 4.2 x 2.4 x 3.0 cm and 1.1 x 1.1 x 0.7 cm.LEFT LOBE: Multiple thyroid nodules. An anterior hypoechoic nodule with peripheral calcification measures 1.0 x 0.6 x 0.5 cm. A more posteriorly located hyper-isoechoic nodule measures 1.5 x 1.5 x 0.9 cm. Two smaller adjacent colloid appearing nodules measure up to 1.5 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multinodular thyroid as detailed above, which was subsequently biopsied. Please see separately dictated biopsy report for complete description of procedural findings."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Hx of sudden gross hematuria with AKI History: As above RIGHT KIDNEY: The right kidney measures 10.6 cm in length. Echogenic renal parenchyma. No shadowing renal calculi, hydronephrosis, or focal mass.LEFT KIDNEY: The left kidney measures 10.2 cm in length. Echogenic renal parenchyma. No shadowing renal calculi, hydronephrosis, or focal mass.OTHER: The bladder is decompressed by a Foley catheter, limiting its evaluation, however the bladder wall appears thickened and intraluminal mass cannot be excluded.", "output": "1. Bladder wall thickening, similar to that seen on CT dated 2/22/2016; intraluminal mass cannot be excluded.2. Echogenic renal parenchyma, consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "HCV LIVER: Cirrhotic morphology without mass. Liver length 17 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.5 cm in lengthOTHER: Left kidney 10.4 cm in length. Spleen 10.7 cm in length. No ascites.", "output": "Cirrhotic morphology without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "67 year-old female with a history of papillary thyroid cancer. Please evaluate. RIGHT LOBE MEASUREMENTS: 4.6 x 1.8 x 1.9 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.4 x 1.2 cmISTHMUS MEASUREMENTS: 2 mm.RIGHT LOBE: Note is made of multiple subcentimeter nodules, which are too small to accurately characterize. Nodule 1: Mid body of the right lobe of the thyroid gland. There is a 1.7 x 1.1 x 14 cm, oval, heterogeneous, and partially solid partially cystic well-circumscribed nodule with peripheral and internal vascularity, and probable microcalcification. Indeterminant with suspicious characteristics.Nodule 2: Mid body of the left lobe of the thyroid gland. There is a round, well-circumscribed isoechoic nodule with peripheral calcification, measuring 0.7 x 0.7 x 0.6 cm. There is no internal vascularity or microcalcification. Indeterminant.LEFT LOBE: Note is made of multiple subcentimeter nodules, which are too small to accurately characterize. Nodule 1: Mid body of the left lobe of the thyroid gland. There is a 0.7 x 0.9 x 0.8 cm, oval, well circumscribed, spongiform nodule with foci of apparent ring down artifact suggestive of a benign colloid nodule. There is internal vascularity. Probably benign.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Note is made of multiple nonspecific subcentimeter lymph nodes in the soft tissues of the right lateral neck.OTHER: No significant abnormality noted.", "output": "1. Multiple indeterminate nodules in the right lobe of the thyroid gland, the largest of which measures 1.7 cm and demonstrates suspicious characteristics. Clinical correlation as well as submission of prior examinations is recommended, given the stated history of known thyroid carcinoma. If no priors are available, further evaluation with FNA of the dominant nodule could be considered.2. Nonspecific subcentimeter lymph nodes in the soft tissues of the right lateral neck."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female with tender nodule in the right upper quadrant, evaluate consistency and rule out abscess, liver/gallbladder pathology. LIVER: Measures 20.3 cm in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: No cholelithiasis. No gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilation. PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Unremarkable in size and echogenicity. KIDNEY: Increased renal echogenicity without hydronephrosis. Lobulated contour of the left kidney without discrete mass. Cyst in the left mid polar region measures 1.2 cm, without septation or solid component.OTHER: Sonographic examination of the patient's superficial palpable nodule in the right upper quadrant demonstrates a hypoechoic lesion which appears contiguous with rib both medially and laterally, and may represent a chronic rib fracture with associated callus formation. The patient was not tender to palpation and denies known history of trauma to that location, however a neoplasm cannot be entirely excluded sonographically.", "output": "1. Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease. No evidence of cholecystitis, biliary obstruction, or abscess.2. Increased renal echogenicity consistent with medical renal disease without hydronephrosis. Lobulated contour of the left kidney without discrete mass.3. Hypoechoic superficial lesion in the area of the patient's palpable nodule appears contiguous with rib both medially and laterally, and may represent a chronic rib fracture with associated callus formation. However, a neoplasm cannot be entirely excluded sonographically. If further imaging evaluation is warranted, dedicated rib series radiographs or CT may be considered."}
{"instruction": "Generate impression based on findings.", "input": "Reason: eval for HCC lesions; eval for cirrhosis; eval for clot in portal vein or hepatic vein or IVC; hx Hep C multiple hypodensities seen on ct in left kidney LIMITED ABDOMENLIVER: The liver measures 14.1 cm in length. Mildly coarse, echogenic hepatic parenchyma. Questionable mild nodularity of the hepatic contour. No focal masses.BILIARY TRACT: No significant abnormalities noted. No biliary ductal dilatation. The gallbladder wall measures 0.2 cm. The common bile duct measures 0.4 cm.PANCREAS: Not visualized.SPLEEN: There is an anechoic lesion in the mid pole of the spleen representing a simple cyst. The spleen measures 7.5 cm in length. RIGHT KIDNEY: The right kidney measures 5.0 cm in length. Echogenic renal parenchyma. Several anechoic cystic lesions are noted in the upper and mid poles. No hydronephrosis or shadowing stones.LEFT KIDNEY: The left kidney measures 7.3 cm in length. Echogenic renal parenchyma Large multicystic lesion in the mid pole of the left kidney with multiple thin septations measures approximately 3.1 x 2.3 x 2.4 cm. No hydronephrosis or shadowing stones.OTHER: No ascites.", "output": "1. Mildly echogenic liver, consistent with hepatic parenchymal dysfunction or chronic liver disease.2. Patent hepatic vasculature with normal directional flow as described above.3. Echogenic renal parenchyma, consistent with advanced medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Hamlish is a 56-year-old female with a personal history of bilateral mastectomy in 2003 for multifocal IDC on the left. Presenting with palpable mass in the left upper chest wall. A targeted left breast ultrasound was performed for the palpable area of concern. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy. The patient should follow up with her primary care physician as clinically warranted, presuming these results are concordant with the physical exam findings. All results and recommendations were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "20 years old, Male, Reason: s/p Right inguinal hernia repair, 1 day h/o right groin pain History: groin pain and bulgin reminiscent of inguinal hernia pain before repair No evidence of bowel or fat in an inguinal hernia. No evidence of other type of hernia in this area. Benign-appearing lymph nodes are noted within the inguinal area measuring up to 1.1 cm. Inguinal hernia was unable to be produced on standing and Valsalva.", "output": "No evidence of hernia sac despite valsalva and manipulation. No specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "75-year-old female patient with new ascites. Evaluate for cirrhosis. LIVER: The liver measures 16.0 cm in length. No focal hepatic lesion is identified and the liver contour is grossly normal. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is filled with stones. There is no significant gallbladder wall thickening. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 4 mm in diameter.PANCREAS: The pancreas is poorly visualized secondary to overlying bowel gas.RIGHT KIDNEY: The right kidney measures 10.3 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.8 cm in length. No evidence of hydronephrosis. Renal cortical echogenicity is increased.The spleen measures 10.5 cm in length.There is moderate ascites.", "output": "1. Moderate ascites. No focal hepatic lesion is identified.2. Medical renal disease. 3. Cholelithiasis. "}
{"instruction": "Generate impression based on findings.", "input": "The patient submitted outside mammogram dated 2/6/08. Submitted outside study was compared to the current mammogram dated 11/12/14. A circumscribed mass at 11 o'clock position in the left breast is stable when compared to the prior study. The other mass at retroareolar region in the left breast is not confirmed on the prior study; however, this mass appears a simple cyst on ultrasound study.", "output": "No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female; patient is bacteremic. There is a clinical concern for perinephric abscess. RIGHT KIDNEY: Right kidney measures 13.1 cm. The cortex has normal echogenicity. No shadowing calculi, hydronephrosis, or worrisome mass.LEFT KIDNEY: Left kidney measures 13.0 cm. The cortex is normal echogenicity. No shadowing calculi, hydronephrosis, or worrisome masses. There is an approximately 4.7 x 3.3 m hypoechoic well-defined lesion with posterior acoustic enhancement, compatible with benign renal cyst.BLADDER: Bladder is not distended and there is a Foley catheter in place.OTHER: No hypoechoic fluid collection suggestive of abscess seen in the perinephric space.", "output": "Normal limited ultrasound of the kidneys without perinephric abscess, stone, mass, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for etiology of transaminitis as well as rising Cr with known h/o hydronephrosis and hydroureter - 75 yo M with recently diagnosed bladder cancer and now with GNR bacteremia History: GNR bacteremia, transaminitis, AKI LIVER:Diffusely echogenic liver, suggestive of hepatic steatosis, measuring 18 cm. Normal portal venous blood flow.GALLBLADDER, BILIARY TRACT: No significant abnormality noted. Common bile duct measures 0.6 cm.PANCREAS: No significant abnormality noted.SPLEEN: Spleen measures 14.5 cm. Numerous calcified granulomata.KIDNEYS: Right kidney measures 14.4 cm. Persistent mild hydronephrosis and hydroureter despite right ureterovesicular stent placement. No left hydronephrosis or hydroureter.ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Well-distended bladder with mild wall thickening and intraluminal debris. Ureterovesicular stent visualized in the bladder lumen.", "output": "Mild right hydronephrosis and hydroureter despite indwelling ureteral stent. No left sided hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "US GUIDED FNA; 3/11/2016 9:58 AM RIGHT LOBE MEASUREMENTS: 1.4 x 1.6 x 4.5 cmLEFT LOBE MEASUREMENTS: 3.1 x 3.3 x 7.8 cm.ISTHMUS MEASUREMENTS: 1.5 cmRIGHT LOBE: There are several nodules in the right lobe which appears spongiform with comet tail artifact consistent with colloid nodules. For reference, a mid right lobe nodule measures 0.4 x 0.8 x 0.9 cm.LEFT LOBE: Within the posterior aspect of the left lobe there is a poorly defined, solid and heterogeneous mass. Margins are inconspicuous and the mass approximates 2.6 x 2.7 cm. There is some vague shadowing seen as well which may be due to calcification. Cannot exclude extrathyroidal extension.ISTHMUS: Large complex mass or adjacent masses in the isthmus are solid but heterogeneous, measuring 0.6 x 1.6 x 1.9 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There are 2 large left cervical nodes identified. These are abnormal in morphology as well. Level 2-3 node measures 4.2 x 2.1 x 4.9 cm. Level 3-4 node measures 2.3 x 2.4 x 3.1 cm.OTHER: No significant abnormality noted.", "output": "Malignant--appearing left thyroid mass with possible extrathyroidal extension.Malignant--appearing adenopathy left neck.Indeterminant mass in the isthmus.Benign-appearing right thyroid masses."}
{"instruction": "Generate impression based on findings.", "input": "62 years old, Female, Reason: 62 yo female with history of mucinous cervical versus ovarian cancer, s/p chemotherapy, with single liver cyst on 1/5/15 CT A/P, further characterize liver lesion History: single liver cyst on 1/5/15 CT LIVER: The liver measures 14.2 cm in length. Echogenicity of the liver is within normal limits. Hyperechoic lesion measuring 1.3 x 1.8 x 1.5 cm which correlates to the lesion seen on most recent CT scan and likely represents a hemangioma given imaging characteristics on both studies. A small hepatic cyst is identified in the right hepatic lobe. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. Small gallbladder polyp is identified measuring up to 0.3 cm. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 10.2 cm in length. RIGHT KIDNEY: Kidney measures 11.0 cm in length. Lower pole the right kidney is not identified due to overlying bowel gas. Normal echotexture. No hydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 11.8 cm in length. Normal echotexture. No hydronephrosis or shadowing calculus.OTHER: No significant abnormalities noted.", "output": "1.Hyperechoic lesion has imaging characteristics most compatible with a hemangioma.2.Very small gallbladder polyp."}
{"instruction": "Generate impression based on findings.", "input": "Female; 26 years old. Reason: r/o goiter, nodules History: enlarge thyroid RIGHT LOBE MEASUREMENTS: 4.6 x 1.7 x 1.7 cmLEFT LOBE MEASUREMENTS: 3.9 x 1.4 x 1.0 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Heterogeneous thyroid with innumerable small hypoechoic nodules. There is no dominant nodule. The background gland is hypervascular.LEFT LOBE: Heterogeneous thyroid with innumerable small hypoechoic nodules. There is no dominant nodule. The background gland is hypervascular.ISTHMUS: Heterogeneous thyroid with innumerable small hypo echoic nodules. There is no dominant nodule. The background gland is hypervascular.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Prominent left level 3 lymph node measures 2.1 x 0.6 x 0.3 cm with a fatty hilum.OTHER: No significant abnormality noted.", "output": "1.Hypervascular, heterogeneous thyroid gland with innumerable small hypoechoic nodules compatible with thyroiditis.2.Prominent left level 3 lymph node has a normal ultrasound appearance and is likely reactive in etiology."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old male with history of appendectomy thyroid cancer and positive lymph nodes. Prior surgery and radioactive iodine therapy. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: Within the right thyroid bed there is a solid 0.7 x 1.1 x 2.3 cm mass. This contains several bright reflectors which could represent calcification.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Mass in the right thyroid bed corresponding to the I-131 findings."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant abdominal pain LIVER: Coarse echogenic liver echotexture without mass. Liver length 22 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.2 cm in length OTHER: Left kidney 11.3 cm in length. Spleen 9.7 cm in length. No ascites.", "output": "Mild to moderate hepatomegaly with coarse echogenic parenchyma consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Provided history of cirrhosis. Patient with sickle cell disease and schizophrenia. LIVER: The liver contour is lobular. The parenchyma is heterogeneously coarse compatible with stated history of chronic liver disease. No suspicious lesion is identified.Normal hepatopedal portal venous blood flow at 14 cm/s.BILIARY TRACT: The gallbladder is partially collapsed. The gallbladder wall measures 2 mm, within normal limits. No pericholecystic fluid or focal tenderness. Note is made of small gallstones. Adjacent to the gallbladder fundus is a 2.6 x 2.1 x 2.2 cm fluid collection which appears separate from the bowel and is of uncertain etiology. It may communicate with the gallbladder fundus.No intra or extrahepatic biliary ductal dilatation.PANCREAS: The visualized portions of the pancreatic head and proximal body are unremarkable. Adjacent to the proximal body is a 2.5 x 1.4 x 2.5 cm hypoechoic lesion, previously measuring 1.8 x 1.7 cm.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.4 cm in length without hydronephrosis, shadowing nephrolithiasis or suspicious lesion. A small cyst is noted. OTHER: The left kidney measures 10.6 cm in length without hydronephrosis, shadowing nephrolithiasis or suspicious lesion. The spleen measures 6.5 cm in length.", "output": "1. Findings compatible with stated history of chronic liver disease without a focal lesion evident.2. Cholelithiasis without evidence of acute cholecystitis. Nonspecific 2.6 cm fluid collection adjacent to the gallbladder fundus is of uncertain etiology. 3. Enlarging 2.5 cm peripancreatic lesion may represent a large lymph node. A MR or CT is recommended for further characterization of this lesion and the fluid collection described above."}
{"instruction": "Generate impression based on findings.", "input": "87 year old female with left breast invasive lobular carcinoma (two sites), on neoadjuvant Arimidex. Evaluate response to treatment. No family history of breast cancer. MAMMOGRAM: Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is decreased asymmetry in the left upper outer breast, adjacent to the coil-shaped clip. There is redemonstration of a winged shaped clip within the left retroareolar region. There has been no significant mammographic change within the left retroareolar region.ULTRASOUND: A targeted left ultrasound was performed. At the 2:00 position of the left breast, 5 cm from the nipple, there is redemonstration of the irregular hypoechoic mass today measuring 0.6 x 0.6 x 0.9 cm (previously 1.3 x 0.8 x 1.2 cm), with adjacent Hydromark clip.Within the left retroareolar region, there is redemonstration of a heterogeneous, hypoechoic lobulated mass today measuring 2.7 x 1.2 x 2.2 cm (previously 4.3 x 2.0 x 3.4 cm). Increased peripheral vascularity is present surrounding this mass.", "output": "Interval decrease in size of biopsy proven breast carcinomas within the retroareolar and two o'clock positions of the left breast.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female with papillary thyroid carcinoma. RIGHT LOBE MEASUREMENTS: 2.2 x 2.3 x 5.3 cmLEFT LOBE MEASUREMENTS: 2.1 x 1.9 x 4.9 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Right lobe is diffusely heterogeneous in echotexture. In the midportion of the right lobe there is a poorly defined hypoechoic area with dense associated calcification measuring at least 0.4 x 0.8 x 1 cm. Posterior margin cannot be adequately visualized due to shadowing from calcification.LEFT LOBE: Left lobe is diffusely heterogeneous in echotexture without focal mass.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Ill-defined right lobe mass with calcification. No adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old male with hyperparathyroidism, history of thyroidectomy. RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: Echogenic material in the thyroid bed favored to represent post surgical scarring.LEFT LOBE: Echogenic material in the thyroid bed favored to represent post surgical scarring.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No discrete lesions to indicate parathyroid adenoma identified. LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Status post thyroidectomy. Echogenic material in the thyroid bed favored to represent post surgical scarring.2. No discrete parathyroid adenoma identified. Please refer to concurrently performed nuclear medicine examination for further characterization. "}
{"instruction": "Generate impression based on findings.", "input": "Chronic renal disease RIGHT KIDNEY: Echogenic parenchyma again noted without worrisome mass, stone, or hydronephrosis. Stable right renal cyst. Right kidney 8.5 cm in length.LEFT KIDNEY: Echogenic parenchyma again noted without mass, stone, or hydronephrosis. Left kidney 8.7 cm in length.OTHER: Bladder nondistended", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction again noted without worrisome mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old female with history of incompletely characterized subcentimeter mass within the left central breast. Patient is asymptomatic. No family history of breast cancer. A left ML view in addition to a CC and 2 mL spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses(BiRads Density Category C), unchanged in pattern and distribution. 8 mm oval well-circumscribed mass is reidentified within the left central breast.Focal asymmetry within the left lower outer quadrant, disappears on spot compression views.ULTRASOUND:Targeted left breast ultrasound at 12:00 posterior to the nipple demonstrates a well circumscribed anechoic avascular mass with posterior enhancement measuring 7 x 5 x 6 mm, compatible with a simple cyst. This finding correlates with previously described well-circumscribed mass within the left central breast identified on mammography.", "output": "Simple cyst in central left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "73 year-old female with thyroid nodules. Evaluate for growth or lymphadenopathy. RIGHT LOBE MEASUREMENTS: 4.6 cm x 1.2 cm x 1.4 cm.LEFT LOBE MEASUREMENTS: 6.5 cm x 5.3 cm x 4.5 cmISTHMUS MEASUREMENTS: 5 mm in thicknessRIGHT LOBE: Solid nodule at the lower pole measures 1.2 cm x 0.9 cm x 0.7 cm, previously measured 0.9 cm x 0.6 cm x 0.7 cm.LEFT LOBE: Left lobe is replaced by two large solid nodules, one of which is located in upper pole measuring 4.9 cm x 3.4 cm x 4.7 cm, previously 4.8 cm x 4.7 cm x 4.2 cm. Second nodule in the lower pole measures 3.3 cm x 4.1 cm x 4.5 cm, previously measured 1.7 cm x 4.0 cm x 4.3 cm.ISTHMUS: Subcentimeter nodule measures 3 mm x 2 mm x 4 mm, previously measured 3 mm x 2 mm x 2 mm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral solid nodules slightly increased in size compared to prior study. Dominant nodules in the left lobe were previously biopsied with benign histology. "}
{"instruction": "Generate impression based on findings.", "input": "Right renal cell carcinoma. Partial nephrectomy. RIGHT KIDNEY: 8.7 cm in length. Postsurgical changes are noted at the superior pole. No definite suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 11.0 cm in length. Normal renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Postsurgical changes at the right renal superior pole, without definite mass seen. Evaluation for recurrence is limited by ultrasound, and CT or MRI follow-up is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. 10.1 cm in lengthLEFT KIDNEY: Echogenic renal parenchyma without significant hydronephrosis. Left ureteral stent in anatomic location. No mass. No stone. Left kidney 10.8-cm in lengthOTHER: Bladder nondistended.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without significant obstruction, mass, or stone. Left ureteral stent in anatomic location."}
{"instruction": "Generate impression based on findings.", "input": "75-year-old female with pancreatic adenocarcinoma with known liver metastases, now with abdominal swelling, evaluate for ascites. There is large four quadrant abdominal ascites. Incompletely visualized bilateral pleural effusions.Coarse echotexture and nodular contour of the visualized liver consistent with cirrhotic liver morphology.", "output": "1. Large four quadrant abdominal ascites and bilateral pleural effusions. 2. Cirrhotic liver morphology. "}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female with history of hepatitis C, screening for HCC and cirrhosis LIVER: Measures 17.8 in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: No cholelithiasis. No gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilation. PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Unremarkable in size and echogenicity. KIDNEY: Atrophic kidneys with markedly increased echogenicity. 1.6 cm right superior pole cyst without septation or nodular component. No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "1. Increased hepatic echogenicity consistent with chronic liver disease, without discrete focal lesion. 2. Atrophic kidneys with markedly increased echogenicity consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "History of a thyroid nodule. RIGHT LOBE MEASUREMENTS: 5.8 x 2.6 x 2.7 cmLEFT LOBE MEASUREMENTS: 3.3 x 1.1 x 1.1 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: Complex partially cystic predominately solid inferior nodule measuring 3.2 x 2.5 x 2.6 cm compared to 3.5 x 2.4 x 3.0 cm previously, not significantly in size accounting for differences in measurement technique. Associated possible calcifications and comet-tail artifact. No significant hyperemia. The remainder of the right thyroid lobe demonstrates normal echogenicity.LEFT LOBE: The left thyroid lobe is normal in size and echogenicity.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Complex partially cystic predominant solid right thyroid lobe nodule with suggestion of coarse calcifications and comet-tail artifact is not significantly changed from 2005."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C. LIVER: Cirrhotic liver morphology. Mildly coarsened parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Normal appearance of the gallbladderPANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 10.9 cm in length. The left kidney is 10.3 cm in length. The renal parenchyma is echogenic bilaterally. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9.5 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites is identified.", "output": "1. Cirrhotic liver morphology, without suspicious lesion identified.2. Echogenic renal parenchyma, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. Right kidney 10.8 cm in length.LEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. Left kidney 11.9 cm in lengthOTHER: Distended bladder with left bladder diverticulum.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female patient with HCV carrier on Gleevec with LAM for suppressive therapy. Evaluate for HCC. LIVER: The liver measures 14.5 cm in length. Hepatic parenchymal echogenicity is increased. There is a 1.7 x 1.6 x 1.5 cm left hepatic cyst, previously 2.0 x 1.8 x 1.5 cm. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 2 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 10.6 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.1 cm in length. No evidence of hydronephrosis.The spleen measures 8.9 cm in length.", "output": "Increase hepatic parenchymal echogenicity which can be seen with hepatic steatosis/hepatic parenchymal dysfunction. No suspicious hepatic lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old female with history of bilateral thyroid nodules. Nodules suspicious for malignancy. Preoperative lymph node mapping. RIGHT LOBE MEASUREMENTS: 1.7 x 1.7 x 5.1 cmLEFT LOBE MEASUREMENTS: 4.4 x 2.0 x 1.9 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: There is right thyroid gland nodule with irregular borders, increased vascularity, and calcifications measures 1.1 x 1.3 x 1.4 cm.LEFT LOBE: There is a bunch of form left thyroid lobe nodule which measures 1.8 x 1.3 x 1.1 cm most likely a colloid nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level 1 lymph node measures 1.2 x 0.9 x 0.4 cm.Right level 2 lymph node measures 1.6 x 0.5 x 0.3 cm.Left level 1 lymph node measures 1.3 x 1.7 x 0.6 cm.Left level 2 lymph node measures 1.3 x 0.5 x 0.3 cm.Left level 3 lymph node measures 0.9 x 0.4 x 0.4 cm.Left level 5 lymph node measures 0.8 x 0.5 x 0.2 cm.OTHER: No significant abnormality noted.", "output": "1.Suspicious right thyroid lobe nodule.2.Benign-appearing left thyroid lobe nodule.3.Bilateral enlarged lymph nodes."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. History of right mastectomy for ILC in 2011. 3-D whole breast ultrasound was performed for left breasts and images were reviewed on an independent workstation. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male patient with new diagnosis of cirrhosis and transaminitis. Evaluate for cirrhosis and/or clots in the venous system. LIMITED ABDOMENLIVER: The liver measures 11.1 cm in length, demonstrates increased parenchymal echogenicity, and is nodular in contour. No focal hepatic lesion is identified.BILIARY TRACT: The gallbladder is contracted without definite shadowing gallstone. There is no intra or extrahepatic biliary ductal dilatation. The common duct measures 3 mm in diameter.PANCREAS: The head and proximal body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 15.0 cm in length. RIGHT KIDNEY: The right kidney measures 11.3 cm in length and demonstrates increased cortical echogenicity. There is minimal prominence of the right renal collecting system.OTHER: The left kidney measures 11.1 cm in length. No evidence of hydronephrosis.There is mild to moderate ascites.", "output": "1. Cirrhotic morphology of the liver with patent hepatic vasculature.2. Mild to moderate ascites.3. Right medical renal disease and minimal pelvocaliectasis."}
{"instruction": "Generate impression based on findings.", "input": "Left upper quadrant discomfort and popping sensation along the angle of the rib cage No abdominal wall defects, hernia, or soft tissue abnormalities are visualized in the area of the patient's described discomfort.", "output": "Negative examination, as above."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Edwards submitted outside mammogram/ultrasound examinations dated 7/3/2014, 8/15/2014, and 8/29/2014, from Northwestern Memorial Hospital. Submitted outside studies were compared to the current mammogram dated 11/4/2016. The breast parenchyma is composed of scattered fibroglandular density (BiRads Density Category B), unchanged in pattern and distribution.Previously identified circumscribed mass in the right lower inner breast is stable when compared to prior examinations (mammograms + ultrasounds) dating back to 7/2014 and with a benign pathology result of UDH/fibroadenomatous change (per outside pathology report).Previously identified asymmetry in the left upper breast is also stable when compared to prior mammogram from 07/2014.There is no significant change between these studies.", "output": "Benign biopsy of the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually, due next in November 2017.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Female; 53 years old. Reason: Patient s/p paracentesis in RLQ with pain at paracentesis site; evaluate for hematoma Scanning was performed over the right lower quadrant in the area of the paracentesis site. Within the subcutaneous tissues is edema and small areas of fluid, measuring up to 4 mm. There is no drainable collection otherwise.", "output": "Small edema/fluid in the ventral subcutaneous tissues measuring up to 4 mm. There is no drainable collection otherwise. These findings are compatible with postprocedural sequela/small hematoma. Correlation with physical exam is recommended to exclude cellulitis."}
{"instruction": "Generate impression based on findings.", "input": "Male 54 years old Reason: r/o recurrence History: h/o medullary thyroid cancer. Some subjective abnormality in left upper neck. MEASUREMENTS: Patient is status post thyroidectomy.RIGHT THYROIDECTOMY BED: No significant abnormality noted. No abnormal tissue or evidence of recurrence.LEFT THYROIDECTOMY BED: No significant abnormality noted. No abnormal tissue or evidence of recurrence.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable examination without evidence of disease recurrence."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD. The breast parenchyma is composed of scattered fibroglandular density (BiRads Density Category B), unchanged in pattern and distribution. Diffuse scattered calcifications in both breasts particularly in the upper outer quadrants are not changed.", "output": "No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal swelling. Evaluate for ascites. No ascites identified.", "output": "No ascites identified."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old female status post right mastectomy for DCIS in 2011 presents with 2 palpated lumps in the right implant. ULTRASOUND", "output": "Two palpable lumps in the right reconstructed breast, with suspicious sonographic features. Results were discussed with Dr. Barrera.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Female 63 years old; Reason: please evaluate for malignancy, progression of cirrhosis, portal HTN History: 63 yo F with NAFLD and Hep C cirrhosis LIMITED ABDOMENLIVER: The liver measures 20.8 cm in length. The liver has a micronodular contour. The parenchyma is echogenic with coarsened echotexture which limits the evaluation for focal mass. Within this limitation, no suspicious mass is identified. Again seen within segment 2 of the liver is a portosystemic shunt, unchanged. There is no ascites. The portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.3 m/sec. BILIARY TRACT: The gallbladder is absent. Common duct measures 0.3 cm. There is no intrahepatic biliary ductal dilatation.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 9.8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 9.7 cm. The cortex is normal in echogenicity. There is a 1.4-cm nonobstructing, shadowing stone in the inferior aspect of the kidney. There is no hydronephrosis. SPLEEN: The spleen measures 10.8 cm. in length.", "output": "1.Hepatomegaly with micronodular contour and coarse, echogenic parenchyma compatible with cirrhosis. Within the limitations of the exam, no suspicious liver mass is identified.2.No change in segment two intrahepatic portosystemic shunt. 3.Nonobstructing left renal stone."}
{"instruction": "Generate impression based on findings.", "input": "50 year-old male with history of acute kidney failure. Evaluate for renal obstruction. RIGHT KIDNEY: No hydronephrosis or hydroureter. The right kidney measures approximately 11 cm in length.LEFT KIDNEY: No hydronephrosis or hydroureter. The left kidney measures approximately 11.4 cm in length.OTHER: Small amount of abdominal ascites. The bladder is within normal limits, and there is a Foley catheter in place.", "output": "No hydronephrosis or hydroureter, or other findings of urinary obstruction."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old male with hepatitis C. Evaluate for hepatocellular carcinoma. LIVER: Liver is relatively small but normal in morphology. The parenchyma is mildly and coarsely echogenic. No focal hepatic mass is identified. No gross evidence for cirrhosis.BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: Limited by bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Mildly and coarsely echogenic liver without mass or overt cirrhotic morphology."}
{"instruction": "Generate impression based on findings.", "input": "Lymphadenopathy. Enlarged lymph nodes. 26-year-old medical student with periauricular nodule and level 5 lymph node The right level 5 lymph node measures 1.6 x 0.3 cm and has a fatty hilum suggesting a benign etiology. The periauricular nodule measures 1.7 x 0.3 cm and has a nonspecific appearance on ultrasound.", "output": "Right level 5 lymph node with a benign appearance. Nonspecific soft tissue periauricular nodule."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female with hyperparathyroidism. RIGHT LOBE MEASUREMENTS: The right lobe measures 5.3 x 1.8 x 1.7 cm. No dominant nodules.LEFT LOBE MEASUREMENTS: The left lobe measures 1.9 cm x 1.4 cm x 4.5 cm. ISTHMUS MEASUREMENTS: The isthmus measures 0.3 cm.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: There is a subcentimeter hypoechoic nodule measuring 0.5 cm x 0.5 cm x 0.6 cm in the left superior thyroid lobe.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: There is an extrathyroidal hypoechoic nodule inferior and posterior to the left thyroid gland measuring 0.6 cm x 0.5 cm x 0.6 cm.LYMPH NODES: No concerning adenopathy is noted.", "output": "1. There is an extrathyroidal inferior/posterior nodule inferior and posterior to the left thyroid gland consistent with clinically suspected parathyroid adenoma.2. There is a round subcentimeter hypoechoic nodule within the left superior thyroid lobe.3. No regional adenopathy"}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for whole breast ultrasound for dense breast screening. Personal history of left cyst aspiration in 2006. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. No suspicious cystic or solid mass is identified in the breast. Bilateral simple and complex cysts are identified. Note is made of a prominent left axillary lymph node, measuring approximately 13 x 9 mm.", "output": "Prominent left axillary lymph node. A dedicated left axillary ultrasound is recommended for further evaluation.BIRADS: 0 - Incomplete.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required. "}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female with asymmetry on screening mammogram. Three standard views of the left breast with exaggerated CC and spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. The previously seen asymmetry in the posterior outer breast on the cc view disperses somewhat with spot compression, and ultrasound was performed for further evaluation.ULTRASOUND", "output": "No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "8-month-old female with hydronephrosis. BLADDER  Wall Thickness: Normal  Contents: Not adequately distended Distal Ureter -- SFU Grade**  Right: 0  Left: 0   Ureteral Jets Right: Not observed  Left: Not observedKIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 1 Left: 0  Length*** Right: 4.9 cm Left: 4.7 cm   Mean for age: 6 cm  Range for age: 4.5 - 7.5 cmADDITIONAL OBSERVATIONS: None", "output": "Kidneys are lower limits of normal for size.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469"}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male with central venous catheter, question of clot or thrombus at catheter site. Grayscale and color ultrasound of the right neck soft tissues surrounding the central venous catheter demonstrates trace adjacent fluid, but no discrete fluid collection or other significant abnormality surrounding the catheter along its subcutaneous course.", "output": "No significant soft tissue abnormalities or collections surrounding the catheter. If there is continued concern for catheter thrombosis, the catheter may be interrogated by interventional radiology as warranted clinically. "}
{"instruction": "Generate impression based on findings.", "input": "Female 25 years old Reason: history of right sided thyroid nodule History: neck pain RIGHT LOBE MEASUREMENTS: 2.4 x 1.5 x 5.6 cm.LEFT LOBE MEASUREMENTS: 1.9 x 1.5 x 5.5 cm.ISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: Primarily anechoic nodule with with some internal echogenicity in the midportion of the right thyroid measures 0.7 x 0.4 x 0.8 cm. Echogenicity of the background thyroid is normal.LEFT LOBE: Small cyst in the mid left thyroid measures 0.3 x 0.2 x 0.47 m. Normal background thyroid.ISTHMUS: In the right portion of the isthmus there is a spongiform-appearing nodule with mildly echogenic internal septa measuring 0.8 x 0.4 x 0.9 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Spongiform-appearing nodules in the isthmus and right thyroid lobe. Likely small cyst in left thyroid lobe as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma again noted without mass or stone. Minimal right hydronephrosis. Right kidney 8.1 cm in lengthLEFT KIDNEY: Echogenic parenchyma again noted without worrisome mass, stone, or hydronephrosis. Mid pole cyst. Left kidney 9.8 cm in length.OTHER: Bladder collapsed around Foley.", "output": "Echogenic renal parenchyma again noted consistent with medical renal disease/parenchymal dysfunction without worrisome mass or stone. Minimal right hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "55 year old female with fever, elevated GGT, elevated alkaline phosphatase. Evaluate for liver/gallbladder pathology. LIVER: Coarse echotexture of the liver measuring 12.6 cm in length. No focal hepatic lesions. Main portal vein is patent the directional flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Mild gallbladder wall thickening. No evidence of cholelithiasis or sludge. No pericholecystic fluid. Common duct measures 3 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Distal body and tail of the pancreas are obscured by overlying bowel gas. The remaining visualized portions are unremarkable.RIGHT KIDNEY: Increased echogenicity measuring 11.7 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Increased echogenicity of the left kidney measuring 7.8 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "1. Mild gallbladder wall thickening with no evidence of cholelithiasis or cholecystitis.2. Coarse echotexture of the liver suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesions."}
{"instruction": "Generate impression based on findings.", "input": "Reason: r/o recurrence History: h/o thyroid cancer RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: No evidence of recurrent/residual tumorLEFT LOBE: No evidence of recurrent/residual tumorISTHMUS: No evidence of recurrent/residual tumorPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Left level 3 node seen on the prior exam is not identified. A normal-appearing right level 3/4 node measures 0.9 x 0.4 x 1.3 cm, previously 1.3 x 0.4 x 1.4 cmOTHER: No significant abnormality noted.", "output": "No evidence of residual/recurrent disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Renal transplant with elevated creatinine RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality noted. 10.3 cm in length. COLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels Transplant renal vasculature appears patent without evidence for inflow or outflow compromise. Diastolic dampening again noted. Iliac vessels not well visualized due to overlying gas.OTHER: No significant abnormality noted", "output": "Stable examination. Specifically, patent right iliac fossa renal transplant vasculature without inflow or outflow compromise. Persistent diastolic dampening suggestive for increased parenchymal resistance pattern."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old male with prior left thyroidectomy for microfollicular adenomatous nodule. RIGHT LOBE MEASUREMENTS: 3.8 x 2.4 x 1.3 cmLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No massISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No mass within the thyroidectomy bed or right lobe. No suspicious adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with history of right breast mass found in 1/15. Ultrasound findings suggested a cluster of cysts. This is a 6 month followup diagnostic mammogram. Three standard views of the right breast and 2 spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. At the 2:00 position approximately 4 cm from the nipple there is redemonstration of a 7 mm focal asymmetry which is stable to slightly smaller in size when compared to the original asymmetry that triggered this follow up on the prior study.", "output": "Stable to slightly smaller right breast asymmetry corresponding to a cluster of cysts previously demonstrated on ultrasound. Given the stability to slightly improved appearance, a benign etiology is favored. A diagnostic mammogram is recommended in 6 months to confirm stability. Patient's scheduled annual left breast mammogram can also be obtained at this time. Results and plan discussed with patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female with acute hepatitis. LIVER: Measures 19.2 cm in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Collapsed gallbladder. No gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilation. PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Not well visualized due to bowel gas. KIDNEY: 1.0 cm right renal cyst without septation or solid component No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "1. Mild hepatomegaly and increased echogenicity may represent hepatic steatosis or parenchymal disease. 2. Patent portal vein. "}
{"instruction": "Generate impression based on findings.", "input": "26-year-old female with a history of papillary carcinoma thyroid status post resection RIGHT LOBE: Status post thyroidectomy without massLEFT LOBE: Status post thyroidectomy without massISTHMUS: Status post thyroidectomy without massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal appearing lymph nodes are identified in the right neck, superior to the surgical bed, not significantly changed.OTHER: No significant abnormality noted.", "output": "Stable negative examination. No evidence for recurrence or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Renal carcinoma status post right nephrectomy RIGHT KIDNEY: Status post nephrectomyLEFT KIDNEY: Subcentimeter lower pole cyst. No worrisome mass, stone or hydronephrosis. Left kidney 11.1 cm in length.OTHER: Bladder nondistended.", "output": "Status post right nephrectomy. Unremarkable left kidney without worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "HCV cirrhosis LIVER: Cirrhotic morphology again noted without mass. Liver length 15 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.3 cm in lengthOTHER: Left kidney 11.1 cm in length. Spleen 13.3 cm in length. No ascites.", "output": "Stable cirrhotic morphology without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old female with pericholecystic fluid on CT, abdominal pain, and fevers. LIVER: No significant abnormalities noted. Portal venous flow is hepatopetal. No intra- or extrahepatic biliary ductal dilation is visualized.GALLBLADDER, BILIARY TRACT: The gallbladder is contracted, thus limiting evaluation. Multiple stones are visualized within the gallbladder. There is no evidence of gallbladder wall thickening or pericholecystic fluid.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Contracted gallbladder with numerous stones."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female with right upper quadrant pain with food. Evaluate for gallstones. LIVER: Increased echogenicity of the liver measuring 19.6 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Small gallstones within the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. The sonographic Murphy's sign is negative. Common bile duct measures 2 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: Right partial nephrectomy. Kidney measures 11.7 cm in length and is normal in echogenicity. No hydronephrosis or shadowing calculi are noted.OTHER:Normal echogenicity of the left kidney measuring 12.3 cm in length. No hydronephrosis or shadowing calculi are noted. Cyst at the upper pole measures 3.6 cm x 3.6 cm x 3.9 cm. Cyst at the lower pole measures 2.4 cm x 1.7 cm x 2.5 cm.Normal echogenicity of the spleen measuring 9.4 cm in length.", "output": "1. Hepatomegaly with increased echogenicity suggestive of parenchymal dysfunction/fatty infiltration.2. Cholelithiasis without evidence of cholecystitis.3. Left renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Plesniak is a 29-year-old with a personal history of bilateral breast reduction at age of 19. She presents today with palpable abnormality in the right breast lower outer quadrant. Family history of breast cancer in paternal grandmother. On physical exam, there is a palpable mass in the right breast 8:00 location corresponding to the site of clinical concern.A targeted right gray scale and color Doppler ultrasound was performed for the palpable area of concern. In the right breast 8:00 position 6 cm from nipple, there is a 1.4 x 0.8 x 1.0 cm hypoechoic mass with rim calcification and marked posterior acoustic shadowing. This corresponds to the palpable abnormality and is consistent with an oil cyst. No suspicious solid or cystic masses are seen elsewhere in the right lateral breast.", "output": "1.4 cm benign oil cyst corresponding to the palpable abnormality in the right breast. No sonographic evidence for malignancy. As long as the patient's physical exam remains unchanged, annual screening mammogram is recommended, starting at the age of 40. The finding and recommendations were discussed with the patient at a time of the exam.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter RIGHT LOBE MEASUREMENTS: 7.5 x 3.3 x 1.7 cmLEFT LOBE MEASUREMENTS: 6.7 x 3 x 2.2 cmISTHMUS MEASUREMENTS: 1 cmRIGHT LOBE: Diffusely heterogeneous lobe unchanged. Stable multiple nodules. Reference midpole nodule measures 0.8 x 0.8 x 0.3 cm.LEFT LOBE: Diffusely heterogeneous lobe unchanged. Stable nodules. Reference low module measures 1.3 x 0.8 by 1.2 cm.ISTHMUS: Diffusely heterogeneous lobe unchangedPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No significant change in heterogeneous thyroid gland with multiple thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old male patient with multinodular goiter. RIGHT LOBE MEASUREMENTS: Status post right thyroidectomy.LEFT LOBE MEASUREMENTS: 4.7 x 1.8 x 1.6 cm, previously 5.1 x 1.7 x 1.6 cm.ISTHMUS MEASUREMENTS: No significant abnormality noted.RIGHT LOBE: A 1.4 cm focus of residual thyroid tissue within the right thyroidectomy bed is not significantly changed.LEFT LOBE: There is heterogeneity of the parenchyma. A previously noted biopsy-proven benign left midpole thyroid nodule has decreased in size and now measures less than 1 cm. No dominant thyroid nodule is identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Interval decrease in size of a now subcentimeter path-proven benign left midpole thyroid nodule.2. No dominant thyroid nodule is identified. "}
{"instruction": "Generate impression based on findings.", "input": "80-year-old male with transaminitis. Evaluate liver. This exam is severely limited by technical factors.LIVER:Most of the liver is not able to be imaged on this study. There is increased echogenicity of the parenchyma. No ascites.GALLBLADDER, BILIARY TRACT: The gallbladder is partially visualized. It appears mildly distended without other secondary signs of cholecystitis.PANCREAS: Unable to visualized pancreas on this study.SPLEEN: Measures 11.4 cm without sonographic abnormality.KIDNEYS: Unable to accurately measure kidneys. Appear to have normal echogenicity. No gross hydronephrosis.", "output": "1. Exam severely limited due to technical factors. Please refer to details as above."}
{"instruction": "Generate impression based on findings.", "input": "Hyperthyroidism RIGHT LOBE MEASUREMENTS: 2.1 x 2.0 x 5.2 cm. LEFT LOBE MEASUREMENTS: 1.8 x 1.3 x 3.7 cm.ISTHMUS MEASUREMENTS: No significant abnormality noted.RIGHT LOBE: Heterogeneous in echotexture. 7 mm densely peripherally calcified solid nodule identified, LEFT LOBE: Heterogeneous in echotexture, without definite discrete nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Heterogenous thyroid gland echotexture, which is nonspecific though may be seen in the setting of thyroiditis. Correlation with clinical symptoms and thyroid function tests is recommended.2. 7 mm rim calcified right thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "Reason: HBV carrier, evaluate for hepatocellular carcinoma. LIVER: The liver measures 18.8 cm in length. The liver demonstrates increased parenchymal echogenicity and appears heterogeneous. Redemonstration of a cyst in the left lobe measuring 1.4 x 1.2 x 1.8 cm, similar to prior. No additional focal hepatic lesions are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.23 m/s.BILIARY TRACT: Gallbladder surgically absent. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 5 mm in diameter.PANCREAS: Not well visualized.SPLEEN: No significant abnormalities noted. The spleen measures 10.1 cm in length. RIGHT KIDNEY: Kidney measures 10.2 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.7 cm in length. Normal cortical echotexture. No hydronephrosis. Superior pole cyst, similar to prior.OTHER: No significant abnormalities noted.", "output": "Coarse, echogenic liver with mild hepatomegaly suggestive of chronic liver disease without suspicious focal lesions identified."}
{"instruction": "Generate impression based on findings.", "input": "Reason: HCV cirrhosis, HCC screening History: HCV cirrhosis LIVER: The liver measures 14 cm in length. Mildly coarse, echogenic hepatic parenchyma. No focal mass. The main portal vein is patent with normal directional hepatopetal portal venous blood flow, peak velocity 45.2 cm/s.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. No cholelithiasis or biliary ductal dilatation. The common bile duct measures 0.1 cm. The gallbladder wall measures 0.2 cm.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 11.0 cm in length. No hydronephrosis or shadowing stones.LEFT KIDNEY: The left kidney measures 10.9 cm in length. No hydronephrosis or shadowing stones.OTHER: The spleen measures 13.4 cm in length, upper limit of normal in size to mildly enlarged. No ascites. Trace right pleural effusion.", "output": "1. Mildly coarse echogenic hepatic parenchyma, consistent with hepatic parenchymal dysfunction. No focal mass or other evidence of cirrhosis.2. Splenic size mildly increased.3. Trace right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. Family history of breast cancer in mother, diagnosed at the age of 63. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. There is no suspicious solid or cystic mass identified.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Female 57 years old; Reason: R/O liver lesions History: Hx of HCV LIVER: The liver measures 20.5 cm cm in length. There is increased, coarse, and heterogenous echogenicity of the liver parenchyma. . There is a round well-defined hyperechoic lesion noted in the portal hepatis that appears similar to the prior ultrasound dated March 2016 favored to be an area of focal fat. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 23 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall appears normal but was unable to be measured. Gallstones are seen. Negative Murphy's. No pericholecystic fluid. The common bile duct measures 6.5 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.0 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.9 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.4 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.", "output": "1. Coarse echogenic liver consistent with chronic liver disease/parenchymal dysfunction with no suspicious focal lesions. No ascites.2. Hyperechoic focus at the porta hepatis favored to be an area of focal fat.3. Gallstones without evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Right breast ultrasound performed, patient scheduled first stereotactic biopsy of right breast calcifications in the upper inner quadrant. A targeted right ultrasound was performed for the mammographic area of concern, in the central and upper inner breast. Multiple simple and clustered cyst identified in the right breast 12:00 position, clustered cyst measuring 1.2 x 0.5 cm and a small complex cyst measuring 4 x 3 mm.No suspicious solid mass or a correlate to the cluster of calcifications in the upper inner quadrant identified.", "output": "No definite ultrasound correlate identified to the cluster of calcifications in the right breast. Simple and clustered cyst identified in the right breast 12:00 position. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "41 years old, Female, Reason: 41 yo with HCV History: none LIVER: The liver measures 14.8 cm in length. The liver parenchymal echotexture is heterogeneous. No focal hepatic lesion identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.1 m/s. No evidence of ascites.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 10.5 cm in length. RIGHT KIDNEY: Kidney measures 11.2 cm in length. No hydronephrosis. LEFT KIDNEY: Kidney measures 11.5 cm in length. No evidence of hydronephrosis.", "output": "1.No focal hepatic lesion identified. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: Rule out HCC History: HCV, cirrhosis LIVER: Coarse, echogenic hepatic echotexture. The liver measures 14.3 cm in length. The portal vein is patent with normal directional hepatopedal portal venous blood flow, peak velocity of 18.0 cm/s. No focal masses.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. The gallbladder wall measures 0.2 cm. The proximal common bile duct measures 0.4 cm and the distal duct measures 0.6 cm. No biliary ductal dilatation or shadowing stones.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 12.5 cm in length. No hydronephrosis, masses, or shadowing calculi.LEFT KIDNEY: The left kidney measures 12.3 cm in length. Non-obstructing 1.0 cm stone in the lower pole of the left kidney. No hydronephrosis or masses.SPLEEN: The spleen measures 14.5 cm in length.OTHER: No ascites.", "output": "1. Findings consistent with chronic liver disease, hepatic parenchymal dysfunction, or hepatic steatosis without significant interval change. No focal masses.2. 1.0 cm non-obstructing left lower pole renal calculus."}
{"instruction": "Generate impression based on findings.", "input": "History of nonalcoholic steatohepatitis. History of kidney cancer status post partial nephrectomy. Gallbladder polyp. LIVER: The liver is heterogeneous coarse and echogenic, limiting evaluation for a discrete lesion. Note is made of a 1.5 cm septated cyst, unchanged. No focal suspicious lesion. No intrahepatic biliary ductal dilatation. It measures 18.5 cm in length. Normal hepatopedal portal venous blood flow at 22 cm/s.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 3 mm.Normally distended gallbladder. There are 2 non-shadowing avascular nonmobile sessile foci one of them measuring 8 mm and the other measuring 5 mm.No shadowing gallstones, wall thickening, pericholecystic fluid or focal tenderness.PANCREAS: The visualized portions of the pancreatic head and body are unremarkable. The distal body and tail are obscured by overlying bowel gas.SPLEEN: The spleen measures 8.5 cm without a focal lesion.RIGHT KIDNEY: The right kidney measures 9.5 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. The cortex is echogenic. Contour changes from partial nephrectomy.OTHER: The left kidney measures 10.5 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. The cortex is echogenic.", "output": "1. Heterogeneous coarsened echogenic liver parenchyma may reflect fatty infiltration and/or parenchymal dysfunction. No focal suspicious lesion.2. Two subcentimeter non-shadowing avascular nonmobile sessile gallbladder foci. Differential considerations include multiple polyps, non-shadowing adherent gallstones and/or sludge. Continued follow-up is suggested.3. Findings suggestive of medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Renal cysts RIGHT KIDNEY: 9.8 cm in length. No hydronephrosis. No suspicious lesion identified.LEFT KIDNEY: 8.9 cm. No hydronephrosis. The anechoic left midpole cyst measures 1.2 x 1.4 x 1.2 cm, unchanged in size and appearance. The hypoechoic left inferior pole cystic nodule measures 1.9 x 1.7 x 1.6 cm, unchanged in size and appearance.OTHER: No significant abnormalities noted.", "output": "Unchanged renal cysts. The lower pole cyst appears simile. The midpole cyst is less sharply defined, but unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Cystectomy with neobladder. Elevated creatinine. RIGHT KIDNEY: 12.5 cm in length. Mildly echogenic renal parenchyma. No suspicious lesions identified. No hydronephrosis. LEFT KIDNEY: 13.5 cm in length. Mildly echogenic renal parenchyma. 3.7 cm simple appearing collecting system cyst in the inferior pole, as seen on the prior CT. No suspicious lesions identified. No hydronephrosis.BLADDER: Neobladder not well visualized. OTHER: No significant abnormalities noted.", "output": "Mildly echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old male post thyroidectomy for papillary carcinoma. Evaluate for recurrent disease. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massesLEFT LOBE: No massesISTHMUS: No massesPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No evidence for recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for whole breast ultrasound for dense breast screening. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. No suspicious cystic or solid mass is identified.This exam was interpreted by two radiologists.", "output": "No sonographic evidence for malignancy.Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms are submitted, then comparisons will be made for future exams. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female with chills and sensation. RIGHT LOBE MEASUREMENTS: 5.4 x 2 x 1.8 cmLEFT LOBE MEASUREMENTS: 3.8 x 1.5 x 1.1 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Normal-appearing thyroid without thyromegaly or mass."}
{"instruction": "Generate impression based on findings.", "input": "NASH staging per intercept, 303 protocol LIVER: Liver measures 17.2 cm with increased echogenicity and coarseness consistent with fatty infiltration not significant changed from prior examination. Limited Doppler interrogation of the main portal vein demonstrates normal flow directionality and patency, 21.4 cm/s.BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. Gallbladder appears unremarkable. No evidence of gallstones. Common hepatic duct measures up to 3 mm.PANCREAS: Head of pancreas as visualized appears slightly hyperechoic probably fatty infiltration. Body and tail of pancreas is not visualized due to overlying bowel gas.SPLEEN: Spleen measures 10.3 cm without any abnormality.RIGHT KIDNEY: Right kidney measures 11.2 cm left kidney measures 11 cm. No hydronephrosis OTHER: No ascites", "output": "Moderate fatty infiltration of the liver unchanged from prior examination. No ascites"}
{"instruction": "Generate impression based on findings.", "input": "73-year-old female patient with abdominal pain with lipase elevation. Evaluate for bleed, inflammation. LIVER: The liver measures 16.8 cm in length and demonstrates increased parenchymal echogenicity. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is filled with stones. No significant pericholecystic fluid or gallbladder wall thickening is identified. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 2 mm in diameter.PANCREAS: A majority of the pancreas is not visualized secondary to overlying bowel gas.RIGHT KIDNEY: The right kidney measures 11.0 cm in length. No evidence of hydronephrosis. There is a 1.5 x 1.6 cm right upper pole renal cyst.OTHER: The left kidney measures 11.1 cm in length. No evidence of hydronephrosis.The spleen is not visualized on this examination.", "output": "1. Increased hepatic parenchymal echogenicity, which is likely related to hepatic steatosis.2. Poorly visualized pancreas; contrast enhanced CT is better means of evaluation for pancreatitis.3. Cholelithiasis without sonographic evidence of acute cholecystitis.4. Right renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old male with hypothyroidism and thyroid nodules for follow-up. RIGHT LOBE MEASUREMENTS: 5.5 x 1.8 x 1.6 cmLEFT LOBE MEASUREMENTS: 5.0 x 1.6 x 1.5 cmISTHMUS MEASUREMENTS: 0.2 cm RIGHT LOBE: vague, solid and heterogeneous nodule in the posterior midportion of the right lobe measures 0.8 x 1 x 0.8 cm without change.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable right thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Lopez is a 39-year-old female presenting for short term ultrasound follow-up for known right chest wall lipoma. Family history of breast cancer in both maternal and paternal great aunts. Personal history of lupus. Upon physical exam at the patient's area of concern, a superficial soft mobile mass is appreciated.A targeted right breast ultrasound was performed for the patient\u2019s area of concern. In the right breast 9:00 location, approximately 9 cm from the nipple, there is revisualization of an oval isoechoic mass measuring 2.4 x 0.5 x 1.3 cm, previously measuring 2.4 x 0.5 x 1.2 cm. Sonographic findings are compatible with a benign lipoma.In the right breast 10:00 location, approximately 5 cm from the nipple, there is a round anechoic lesion identified, measuring 0.5 x 0.3 x 0.6 cm. Sonographic findings are compatible with a simple cyst. In the right axillary region, at least four enlarged right axillary lymph nodes are again identified, appearing stable when compared to the prior ultrasound examination from July 2015.", "output": "(1) Benign lipoma of the right lateral chest.(2) Simple cyst of the right upper outer breast.(3) Enlarged but stable right axillary lymph nodes, likely related to patient's personal history of lupus.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old male with elevated LFTs and renal failure. LIVER: The liver measures 18.2 cm in the craniocaudal dimension. There appears to be periportal cuffing. The liver contour is relatively smooth. The parenchyma is mildly coarsened. No focal hepatic lesion or intrahepatic biliary ductal dilatation. Normally oriented portal venous blood flow at 50 cm/sec is slightly pulsatile, which may be seen in the setting of right-sided heart failure. GALLBLADDER, BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common bile duct measuring up to 4 mm. No gallstones are evident, however, the gallbladder is distended with moderate diffuse gallbladder wall thickening and pericholecystic fluid, findings that are nonspecific in the setting of ascites. PANCREAS: The pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen is moderately enlarged, measuring 15.6 cm in length without a discrete abnormality.KIDNEYS: The right kidney measures 12.8 cm in length without hydronephrosis. Note is made of a 2.3 x 2.1 x 2 x 1 cm multiseptated cystic lesion with calcification suspected in the septi. The left kidney is suboptimally visualized, measures 12.8 cm in length without hydronephrosis. There is a 1.5 cm interpolar simple appearing cyst. The renal cortices are mildly hyperechogenic.ABDOMINAL AORTA: The proximal aorta measures 2.2 cm in AP dimension. The mid-distal aorta is not visualized due to overlying bowel gas shadowing.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: The urinary bladder almost entirely contracted around a Foley catheter.Pleural effusions and small volume ascites is present.", "output": "1. Hydropic gallbladder with nonspecific gallbladder wall thickening in the setting of ascites. If there is continued clinical concern for acute cholecystitis, a HIDA scan may be considered. 2. Heterogeneous liver parenchyma may represent diffuse fatty infiltration/parenchymal dysfunction.3. Echogenic renal cortices, compatible with medical renal disease.4. Ascites and pleural effusions. 5. Bilateral simple and minimally complex renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "Male 61 years old Reason: acute cholecystitis and assess CBD stent for occlusion History: RUQ abd pain, jaundice, elevated LFTs LIVER: Normal echogenicity of the liver. Liver measures 13.4 cm.GALLBLADDER, BILIARY TRACT: Gallbladder wall is thickened with small amount of pericholecystic fluid. These findings are suspicious for acute cholecystitis. There is pneumobilia. Small amount of sludge is noted within the gallbladder. Mild intrahepatic biliary dilatation is present. Common bile duct measures 8 mm.PANCREAS: Not well visualized due to overlying bowel gas.RIGHT KIDNEY: Increased echogenicity of the right kidney without evidence of hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Gallbladder wall thickening and pericholecystic fluid with small amount of sludge and possible stone in the gallbladder. These findings are suspicious for acute cholecystitis.Mild intra and extra hepatic biliary dilatation with minimal pneumobilia."}
{"instruction": "Generate impression based on findings.", "input": "27-year-old male with elevated liver function tests. LIVER: Measures 14.5 in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Collapsed gallbladder with known cholelithiasis, but not clearly demonstrated on this study. No biliary ductal dilation. PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Unremarkable in size and echogenicity. KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: Mild-to-moderate pericardial effusion.", "output": "1.Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease.2.Mild to moderate pericardial effusion."}
{"instruction": "Generate impression based on findings.", "input": "Recurrent pyelonephritis with CVA tenderness; pregnant RIGHT KIDNEY: Slight interval increase in degree of moderate hydronephrosis. No worrisome mass or stone. No perinephric collection. Right kidney 13.2 cm in length.LEFT KIDNEY: No significant abnormalities noted. 12.7 cm in lengthOTHER: Intrauterine pregnancy. Bladder nondistended.", "output": "Slight interval increase in degree of right moderate hydronephrosis. No worrisome mass, stone, or abscess."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old with palpable right breast mass for the last several weeks. A targeted right ultrasound was performed for the palpable area of concern. There is a mixed echogenicity but predominately hypoechoic mass at the right breast 10:00 position measuring 0.9 x 0.9 cm. Peripheral vascularity is noted.", "output": "9 mm right breast mass. At this point, bilateral diagnostic mammography and referral to a breast surgeon for consideration of palpably guided sampling are recommended. The patient declined mammography today despite extensive discussions regarding its potential benefits for her. The patient voiced understanding that mammography may detect breast cancer that is not seen on ultrasound in this setting.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Mildly echogenic renal parenchyma without mass, stone, or hydronephrosis. 15.1 cm in length.LEFT KIDNEY: AbsentOTHER: Bladder nondistended", "output": "Mildly echogenic right renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for a left axillary lymph nodes. Known left breast cancer. A targeted left ultrasound was performed for the axillary region. Multiple lymph nodes with uniformly thickened cortices, retained hila and retained hilar blood flow are seen. There is no suspicious morphology lymph node or solid or cystic mass identified.", "output": "No suspicious morphology axillary lymph node. The patient will be seeing Dr. Chhablani again today.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old female with conjugated hyperbilirubinemia who presents with evaluation for hepatobiliary pathology LIVER: The liver is normal in echogenicity and measures 21 cm in length.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. The common bile duct measures 0.3 cm in diameter. There is a septated complex fluid collection inferior to the liver, adjacent to the gallbladder. Pericholecystic fluid and gallbladder wall thickening measuring 5 mm is most likely secondary to the adjacent fluid collection. No evidence of cholelithiasis.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen is normal in echogenicity and measures 10.6 cm in length.KIDNEYS: The right kidney measures 12.3 cm in length and the left kidney measures 13.9 cm in length without evidence of hydronephrosis. OTHER: Partially visualized right pleural effusion.", "output": "1.Complex pericholecystic fluid collection adjacent to the gallbladder. 2.Edematous gallbladder wall is likely secondary to the adjacent complex fluid collection as above.3.Partially visualized right pleural effusion.4.Hepatomegaly."}
{"instruction": "Generate impression based on findings.", "input": "21-year-old with history of bilateral breast fibroadenomas. Interval follow up exam to assess for stability. History of breast cancer in the patient's mother diagnosed at age 51 and the patient's maternal grandmother. A whole breast ultrasound was performed for the palpable areas of concern. In the 11 o'clock position in the right breast 1 cm from the nipple is a 1.2 x 1.3 x 1.2 centimeters (previously 1.2 x 1.1 x 1.2 cm) round nearly isoechoic mass with circumscribed margins and through transmission. At the 9 o'clock position in the right breast 3 cm from the nipple a 1.1 x 0.6 x 1.6 cm (previously 1.2 x 0.6 x 1.7 cm) oval, parallel hypoechoic mass is present.At the 3 o'clock position of the left breast 1 cm from the nipple a 0.7 x 0.4 x 0.6 cm (previously 0.7 x 0.9 x 0.4 cm) parallel hypoechoic mass is present.No significant internal vascularity is noted in any lesion.", "output": "Stable bilateral masses most likely are presenting fibroadenomata. Continued follow-up with repeat bilateral breast ultrasound in one year is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Female; 55 years old. Reason: evaluate for abdominal wall abscess History: abdominal wall erythema In the subcutaneous tissues superior to the liver along the midline of the abdomen is a complex, loculated fluid collection. This collection measures 3.4 x 1.1 x 2.3 cm and demonstrates no vascularity on color Doppler.", "output": "3.4 x 1.1 x 2.3 cm loculated subcutaneous fluid collection . A benign etiology such as a seroma or resolving hematoma is favored. Abscess is considered less likely."}
{"instruction": "Generate impression based on findings.", "input": "Urosepsis RIGHT KIDNEY: 11.0 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 10.6 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: Not distended.OTHER: No significant abnormality noted.", "output": "No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Recurrent UTIs. RIGHT KIDNEY: 9.7 cm in length. Echogenic renal parenchyma. No focal lesions, renal stones, or hydronephrosis.LEFT KIDNEY: 9.2 cm in length. Echogenic renal parenchyma. No focal lesions, renal stones, or hydronephrosis.BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Echogenic renal parenchyma without stones or hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Male, 63 years old. Hyponatremia and AKI RIGHT KIDNEY: The right kidney measures 10.9 cm in length, with normal echotexture. An exophytic lower pole cystic structure measures 1.5 x 1.4 x 1.7 cm. Mild hydronephrosis. No shadowing stones.LEFT KIDNEY: The left kidney measures 11.7 cm in length, with normal echotexture. Mild hydronephrosis. No shadowing stones.OTHER: The bladder is distended, without significant wall thickening.", "output": "Mild bilateral hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Painless jaundice with a large liver LIVER: No obvious discrete liver mass. Liver length 18.5 cm.GALLBLADDER, BILIARY TRACT: Severe bilobar intrahepatic ductal dilatation associated with severe extrahepatic ductal dilatation. Debris versus tumor within the extrahepatic duct noted. Associated with large porta hepatis mass measuring approximately 4.6 x 3 x 3 cm.PANCREAS: Atrophy of pancreatic body. The pancreas head is not well visualized due to overlying gas.RIGHT KIDNEY: Echogenic parenchyma with multiple cysts. No stone, worrisome mass, stone, or hydronephrosis. Right kidney 9.6 cm in length.OTHER: No ascites. Spleen 7.7 cm in length.", "output": "Severe bilobar intrahepatic as well as extrapelvic biliary dilatation secondary to obstruction by large porta hepatis mass. Differential diagnosis includes malignancy either of pancreatic or biliary origin. Would recommend correlation with dedicated cross-sectional imaging.Echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without worrisome mass, stone, or obstruction.Dr. Woodruff notified of findings 2/13/2015; 11:30 am."}
{"instruction": "Generate impression based on findings.", "input": "Known bilateral breast masses presents for follow-up. A targeted bilateral ultrasound was performed for the known masses. The left breast mass at 1:00 currently measures 2.8 x 1.1 x 2.2 cm, previously 2.1 x 0.9 x 2.2. Left breast mass at 6:00 currently measures 2.4 x 1.0 x 1.7 cm, previously 1.7 x 0.7 x 1.4 cm. Right breast mass at 10:00 currently measures 1.2 x 0.7 x 1.4 cm, previously 1.5 x 0.6 x 1.9 cm.", "output": "Slight interval enlargement in the known left breast masses. No significant change in the right breast mass. These continue to most likely represent fibroadenomata. The patient will follow-up with Donna Christian in surgery clinic today for further evaluation.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female with history of right upper quadrant pain. Evaluate for gallstones. LIVER: No significant abnormalities noted. The liver measures 16 cm in length.BILIARY TRACT: No significant abnormalities noted. No gallstones, gallbladder wall thickening or pericholecystic fluid.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. The spleen measures 10.5 cm in length.RIGHT KIDNEY: No significant abnormalities noted. The right kidney measures 11.9 cm.OTHER: No significant abnormalities noted. The left kidney measures 13.1 cm.", "output": "No cholelithiasis, or findings of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old male with right upper quadrant pain. LIVER: Liver is normal in size and mildly echogenic. Although nonspecific this could be due to steatosis. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal veinGALLBLADDER, BILIARY TRACT: Gallbladder is well-visualized and is normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: Head and body appear normal. The tail was not well seen.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Small left renal cyst. Spleen appears unremarkable.", "output": "Mildly echogenic liver. No evidence for gallbladder abnormality."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old female with dyspnea on exertion. Rule out nodules. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 6.3 x 2.1 x 1.9 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 6.4 x 1.8 x 1.9 cm.ISTHMUS MEASUREMENTS: The isthmus measures 0.6 cm in thickness.RIGHT LOBE: The right thyroid lobe has a heterogenous multinodular echotexture. The largest nodule is in the lower pole measuring 2.5 x 2.2 x 1.8 cm and has a spongiform appearance.LEFT LOBE: The left thyroid lobe has a heterogenous multinodular echotexture. The largest nodule is in the left lower pole measuring 2.9 x 2 x 2.6 cm and has a spongiform appearance.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No suspicious cervical lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Multinodular goiter."}
{"instruction": "Generate impression based on findings.", "input": "52 year old female with history of thyroid gland malignancy and metastases. Evaluate amount of abdominal ascites, possible paracentesis. LIVER: Limited evaluation of the liver reveals a nodular contour and heterogeneous appearance, similar to prior.OTHER: Minimal abdominal free fluid, likely not amenable to future paracentesis given the small amount.", "output": "Heterogeneous/nodular liver, similar to prior, and minimal ascites. "}
{"instruction": "Generate impression based on findings.", "input": "Abnormal coagulation profile LIVER: Coarse echogenic liver echotexture without mass. Liver length 25 cm. Limited interrogation of main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 13 cm in lengthOTHER: Left kidney 12.8 cm in length. Spleen 18.8 cm in length.", "output": "Hepatosplenomegaly with coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. Family history of breast cancer in mother, diagnosed at the age of 30. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. Bilateral saline implants are identified. No suspicious solid or cystic mass is seen.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Stevens is a 66 year old female with known multicentric right breast cancer with metastatic axillary lymphadenopathy. She presents today for imaging evaluation to assess treatment response. Targeted right breast ultrasound was performed for the known areas of malignancy.In the right breast 9:00 location, approximately 7 cm from the nipple, there is revisualization of the biopsy-proven malignancy with associated biopsy marker clip now measuring approximately 2.2 x 1.7 x 1.8 cm, previously measuring 2.8 x 2.1 x 2.9 cm.In the right breast 9:00 location, approximately 5 cm from the nipple, there is revisualization of the second biopsy-proven malignancy with associated biopsy marker clip now measuring approximately 0.9 x 0.3 x 0.9 cm, previously measuring 1.0 x 1.2 x 1.0 cm.Of note, the two sites of malignancy at the 9:00 location are confluent on today's examination.In the right breast 8:00 location, approximately 7 cm from the nipple, there is revisualization of the third biopsy-proven malignancy now measuring approximately 0.9 x 0.7 x 0.7 cm, previously measuring 0.9 x 0.6 x 0.8 cm.", "output": "Stable to slight interval improvement in known multifocal right breast malignancy, measurements as above. Patient should continue to follow up with her breast surgeon/medical oncologist for further evaluation. All results recommendations were discussed with the patient and Dr. Nanda.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": " LIVER: The liver measures 7.2 cm in length, and grossly normal in appearance.The main portal vein is patent, with flow velocity of 23 cm/s.BILIARY TRACT: Mobile sludge is seen within the gallbladder. No biliary dilatation or gallbladder wall thickening.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen is normal in appearance, and measures 5 cm.RIGHT KIDNEY: The right kidney measures 6.2 cm, and demonstrates grade 4 pelvocaliectasis.OTHER: The left kidney measures 5.5 cm, and is grossly normal in appearance.", "output": "1. Gallbladder sludge, without additional significant abnormality of the liver or biliary system.2. Right kidney Grade 4 pelvicaliectasis."}
{"instruction": "Generate impression based on findings.", "input": "Male, 61 years old. Hypodense lesions in both kidneys on CT scan. Pre kidney transplant evaluation RIGHT KIDNEY: The right kidney measures 10.6 cm in length, with increased cortical echogenicity. Multiple small hypoechoic structures are noted. A lower pole hypoechoic structure measures 1.7 x 1.4 x 2.3 cm, predominantly cystic in appearance, nonvascular. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.7 centimeters in length, with increased cortical echogenicity. Multiple small hypoechoic structures are noted. A lower pole cystic appearing lesion measures 1.3 x 1.4 x 2.5 cm, nonvascular. The hypodense lesion seen on CT in the upper pole are not well visualized. No shadowing stones or hydronephrosis.OTHER: The bladder is decompressed.", "output": "Multiple cystic-appearing lesions in the bilateral kidneys. Left upper pole hypodense lesions are not well visualized on ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old female with right upper quadrant pain and elevated bilirubin. LIVER: Liver is mildly enlarged and homogeneous in echogenicity. No focal hepatic abnormality.GALLBLADDER, BILIARY TRACT: Visualized portions of the biliary tract are normal in caliber. On decubitus imaging there is a gallstone in the neck of the gallbladder which does not appear freely mobile. The gallbladder is not greatly distended, there is no wall thickening or pericholecystic fluid. The patient was highly tender over the gallbladder.PANCREAS: Body and tail appear normal. The head is not well seen.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Limited views left kidney demonstrate no abnormality. Spleen is normal in size.", "output": "Gallstone, likely impacted in the gallbladder neck"}
{"instruction": "Generate impression based on findings.", "input": "Reason: HCC screening, GFR too low for cross sectional imaging History: Cryptogenic cirrhosis LIVER: The liver measures 15.1 cm in length and is nodular in morphology. The liver demonstrates increased parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.15 m/s.BILIARY TRACT: Gallbladder surgically absent. The common bile duct is mildly prominent measuring up to 10 mm in diameter, not unexpected status post cholecystectomy and similar to prior cross-sectional imaging.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 11.3 cm in length. RIGHT KIDNEY: Kidney measures 9.5 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 8.9 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: Mild upper abdominal ascites.", "output": "Cirrhotic liver without suspicious focal hepatic lesions identified. Ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 62 years old; Reason: thyroid nodules History: thyroid nodules RIGHT LOBE MEASUREMENTS: 5.5 x 1.8 x 1.8 cm.LEFT LOBE MEASUREMENTS: 5.3 x 1.4 x 1.5 cm.ISTHMUS MEASUREMENT: 0.4 cm.RIGHT LOBE: There are two nodules on the right.Nodule #1: an ovoid, hyperechoic nodule in the midpole of the right lobe measuring approximately 1.1 x 0.8 x 1.2 cm. This appears similar in appearance to the prior study.Nodule #2: There is a small, spongiform nodule measuring approximately 0.8 x 0.7 x 0.9cm that appears similar to the prior study. LEFT LOBE: There is one nodule on the left.Nodule #1: Measures approximately 0.4 x 0.4 x 0.3 cm. It is mildly echogenic with a hypoechoic rim. This may represent an intrathyroidal lymph node.ISTHMUS: There is an approximately 1.6 x 1.0 x 1.9 cm heterogenous slightly hypoechoic ovoid nodule at the left aspect of the isthmus. This is similar in appearance to the prior study. LYMPH NODES: No suspicious adenopathy noted. OTHER: No significant abnormality noted.", "output": "1.Multinodular thyroid as above grossly stable since the prior study."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old male with congestive heart failure, precardiac transplant. Evaluate for malignancy. Exam is very limited by body habitus and patient inability to cooperate.LIVER:Limited without gross, focal abnormality. Liver appears somewhat echogenic which is nonspecific but could be due to fatty liver. Liver is enlarged, measuring 21 cm in length. Limited evaluation of the portal vein demonstrates appropriate flow direction and pulsatile waveform consistent with heart failure.GALLBLADDER, BILIARY TRACT: Small non--- dependent, nonmobile echogenic focus in the gallbladder consistent with a 4 mm polyp. Biliary tract is normal in caliber.PANCREAS: LimitedSPLEEN: Enlarged without gross, focal abnormality. Focus of accessory splenic tissue noted.KIDNEYS: Right kidney measures 11.1 cm in length without gross abnormality. Left kidney measures 11.6 cm in length without gross abnormality. ABDOMINAL AORTA: LimitedINFERIOR VENA CAVA: Limited with ECMO catheter notedOTHER: Right pleural effusion.", "output": "Very limited exam with hepatosplenomegaly and gallbladder polyp. Right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Blue is a 17-year-old female presenting with a palpable left breast mass for the past 3 months. Patient is two months postpartum. Upon physical exam at the patient's area of concern, a superficial soft mobile mass is appreciated.A targeted left breast ultrasound was performed for the patient\u2019s area of concern. In the left breast 8:00 location, approximately 10 cm from the nipple, there is a superficial hypoechoic lesion identified measuring 0.7 x 0.4 x 0.7 cm. Sonographic findings are compatible with an epidermal inclusion cyst. There are no suspicious solid or cystic findings identified.", "output": "Benign epidermal inclusion cyst of the left breast. No sonographic evidence for malignancy. The patient should follow up with her primary care physician as clinically warranted, presuming these results are concordant with the physical exam findings. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male patient with nausea, weight loss, right upper quadrant pain. Question of cholecystitis, liver disease. LIVER: The liver measures 15.8 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder wall is mildly thickened measuring up to 4 mm with comet tail artifact indicative of adenomyomatosis. No gallstones or pericholecystic fluid is identified. Sonographic Murphy's sign is negative. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 3 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 7.9 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. A 1 cm cyst is noted within the right upper pole.OTHER: The left kidney measures 9.8 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. A subcentimeter left lower pole renal cyst is noted.The spleen measures 9 cm in length.", "output": "1. Increased renal cortical echogenicity consistent with medical renal disease/parenchymal dysfunction.2. Bilateral renal cysts.3. Gallbladder adenomyomatosis. "}
{"instruction": "Generate impression based on findings.", "input": "77-year-old male with shortness of breath. Evaluate for ascites, liver congestion. LIVER: Normal echogenicity of the liver measuring 16.4 cm in length. There is a subcentimeter calcified granuloma. Portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/sec.BILIARY TRACT: Thickened gallbladder wall measuring 6 mm in thickness. There is a shadowing stone measuring up to 1.4 cm. No pericholecystic fluid. Sonographic Murphy sign is negative. Mild intrahepatic biliary ductal dilatation is noted. Common bile duct measures 3 mm in caliber.PANCREAS: Normal echogenicity of the visualized pancreas.SPLEEN: Normal echogenicity of the spleen measuring 13.7 cm. Accessory splenule is noted measuring 1.4 cm x 1.5 cm x 1.3 cm.RIGHT KIDNEY: Enlarged measuring 18.4 cm in length. Renal parenchyma is replaced by innumerable cysts, some of which are complex appearing with internal debris.OTHER: Left kidney is also enlarged measuring 16.5 cm in length. Renal parenchyma is also replaced by innumerable cysts, some of which are complex appearing with internal debris.Left pleural effusion.", "output": "1. Gallbladder wall thickening cholelithiasis with no pericholecystic fluid. This may be related to heart disease or renal failure.2. Mild intrahepatic biliary ductal dilatation, with normal caliber of the common bile duct however.3. Left pleural effusion. 4. Bilateral innumerable renal cysts, some of which are complex and contain internal debris. "}
{"instruction": "Generate impression based on findings.", "input": "Male 47 years old Reason: r/o hydronephrosis, pyelonephriits History: AKI, leukocytosis LIVER:Echogenic liver, compatible with fatty infiltration. Liver is enlarged measuring 18 cm. No focal liver lesions.GALLBLADDER, BILIARY TRACT: No significant abnormality noted. No evidence of intra or extrahepatic biliary dilatation. Gallbladder is contracted, therefore, cannot be optimally evaluated.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: Spleen measures 7 cm.KIDNEYS: Bilateral slightly echogenic kidneys. Right kidney measures 11.1 cm. Left kidney measures 10.4 cm. No evidence of hydronephrosis or focal lesions. ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Small right-sided pleural effusion.Doppler findings:Hepatic veins and IVC are patent. Main portal vein and its branches are patent with normal flow direction. Hepatic artery is patent.", "output": "Mild hepatomegaly and echogenic liver. Bilateral echogenic kidneys.Normal Doppler findings."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male with acute lymphoblastic leukemia and stem cell transplant, now with abnormal liver function. LIVER: Liver is moderately to markedly echogenic which is non--- specific. There is no focal hepatic abnormality identified. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: No gallstones, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: There is a 3 cm complex cyst arising from lower pole of the right kidney with multiple relatively fine septations. This was identified on prior CT scan.OTHER: No significant abnormalities noted.", "output": "Echogenic liver without focal abnormality. Patent main portal vein.Complex cyst right kidney."}
{"instruction": "Generate impression based on findings.", "input": "Ms Mason is a 66-year-old woman who returns for further imaging evaluation of 2 round masses in the left breast. Full field ML and compression CC and ML views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. In the left lower inner quadrant there are 2 circumscribed round masses of typically benign morphology. Scattered benign calcifications are noted bilaterally. ULTRASOUND", "output": "Typically benign mammographic masses correspond to 2 probable complicated cysts in the left breast 7:00 position 3 cm from the nipple. Unilateral left diagnostic mammogram in 6 months is recommended to ensure stability. Findings and recommendation were discussed with Ms. Mason, who agrees with the plan. Notably, Ms. Mason today states that she is currently experiencing her first menstrual period since completing menopause 14 years ago. She was strongly encouraged to see her gynecologist or primary care physician promptly for evaluation of this and she stated that she would make arrangements to be seen today.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "Reason: cirrhosis, HCC screen LIVER: The liver measures 13 cm in length and is nodular in contour. The liver demonstrates increased parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.24 m/s.BILIARY TRACT: Status post cholecystectomy. No intrahepatic biliary ductal dilatation is present. The common bile duct measures 8 mm in diameter, unchanged.PANCREAS: Pancreas not well visualized.SPLEEN: No significant abnormalities noted. The spleen measures 11.4 cm in length. RIGHT KIDNEY: Kidney measures 11.0 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 11.5 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Cirrhotic liver morphology without focal lesions identified. Mild splenomegaly. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate left renal cyst RIGHT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. Right kidney 11.3 cm in lengthLEFT KIDNEY: Stable minimally complex left renal cyst measuring 6.9 x 6 x 5.4 cm. Normal parenchymal echogenicity without worrisome mass, stone, or hydronephrosis. Left kidney 13.1 cm in length.OTHER: No significant abnormalities noted.", "output": "Stable minimally complex left renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "Female 49 years old; Reason: RUQ pain, cholecysitis vs. gallstone History: ruq pain The gallbladder wall measures 3.1 mm. An echogenic shadowing foci seen within the gallbladder fundus. This was also visualized on prior CT within the distal fundal fold. No pericholecystic fluid is seen. The common bile duct measures 3.0 mm in diameter. The portal vein is patent with hepatopetal flow. The liver is only partially visualized however no worrisome masses or intrahepatic ductal dilation are seen.", "output": "Small echogenic foci within the gallbladder fundus either represents a small gallstone or milk of calcium. This was seen on prior CT. No sonographic evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "42 year old male with right cervical lymphadenopathy. Evaluate lymph nodes, soft tissue In the right lateral neck at the area of palpation noted by the patient there is a lymph node measuring 1.2 cm x 0.6 cm x 1.1 cm with suggestion of a prominent fatty hilum and central vascularity favoring a reactive etiology. There are multiple additional smaller lymph nodes in the right lateral neck which are benign in appearance. In the left neck there is a prominent lymph node measuring 0.8 cm x 0.4 cm x 2.0 cm which is elongated in contour with prominent fatty hilum and nonspecific heterogeneity of the cortex. Additional smaller benign appearing lymph nodes are also present.", "output": "Bilateral lymph nodes as described above felt to be most likely reactive in etiology. "}
{"instruction": "Generate impression based on findings.", "input": "Male; 63 years old. Reason: ascites History: distention Cirrhotic liver morphology. Mild ascites, redistributed but overall stable to slightly decreased from prior.", "output": "Mild ascites, stable to slightly decreased from prior."}
{"instruction": "Generate impression based on findings.", "input": "38 years old, Female, Reason: evaluate GB History: RUQ pain Exam is limited due to patient's body habitus.LIVER: The liver measures 18.5 cm in length. Increased echogenicity of the liver suggestive of fatty infiltration. No focal hepatic lesion identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.3 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 9.6 cm in length. RIGHT KIDNEY: Kidney measures 11.3 cm in length. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.6 cm in length, kidney not well visualized.", "output": "1.Normal gallbladder and biliary tract with no evidence of cholelithiasis or acute cholecystitis.2.Increased echogenicity of the liver is consistent with fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "Female 69 years old; Reason: 69 y.o. F with a history of HPT \\T\\ thyroid nodules. Please evaluate History: HPT RIGHT LOBE MEASUREMENTS: The thyroid is surgically absent.LEFT LOBE MEASUREMENTS: The thyroid is surgically absent.ISTHMUS MEASUREMENT: The thyroid is surgically absent.RIGHT LOBE, LEFT LOBE, ISTHMUS: The thyroid is surgically absent.LYMPH NODES: No adenopathy noted. OTHER: No significant abnormality noted, specifically no masses.", "output": "1.Surgical changes of a thyroidectomy without masses or adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old male patient with history of HCV. HCC screening. LIVER: The liver measures 11.8 cm in length and demonstrates coarsened hepatic echotexture. There is a new 1.9 x 1.3 x 2.1 cm area of hypoechogenicity within the left hepatic lobe which appears to be bulging the liver contour; this is not seen on prior CT. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 2 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 9.1 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.3 cm in length. No evidence of hydronephrosis.The spleen measures 9.0 cm in length.", "output": "1. Hypoechoic lesion within left hepatic lobe concerning for HCC; dedicated contrast enhanced CT/MRI of the liver is recommended further evaluation.2. Coarsened hepatic echotexture consistent with chronic liver disease."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female patient with right upper quadrant abdominal pain, worse after meals, in patient with obesity and prediabetes. Evaluate for cholelithiasis, cholecystitis, liver pathology. LIVER: The liver measures 21.1 cm in length. Hepatic parenchyma echogenicity is increased. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. The patient is mildly tender with palpation near the neck of the gallbladder. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 2 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 10.4 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.8 cm in length. No evidence of hydronephrosis.The spleen measures 8.5 cm in length.", "output": "1. No cholelithiasis or sonographic evidence of acute cholecystitis. However, the patient is mildly tender with sonographic palpation of the gallbladder neck; HIDA scan can be considered for further evaluation if clinically indicated.2. Hepatic steatosis. "}
{"instruction": "Generate impression based on findings.", "input": "Status post open cholecystectomy with left lateral segmentectomy elevated LFTs LIMITED ABDOMENLIVER: Status post left lateral segmentectomy. Diffusely coarse and echogenic liver echotexture without mass.BILIARY TRACT: No significant abnormalities noted.OTHER: No ascites", "output": "Abnormal coarse and echogenic liver echotexture consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Patent hepatic vessels with normal directional flow. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 45 years old Reason: Thyroid nodule History: hx of thyroid nodule RIGHT LOBE MEASUREMENTS: 6.3 x 2.3 x 2.0 cmLEFT LOBE MEASUREMENTS: 6.3 x 1.9 x 1.7 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Diffusely heterogeneous thyroid echotexture. Within the superior/midpole of the right thyroid lobe there is a 1.1 x 1.1 x 1.2 cm predominantly solid hypoechoic nodule.LEFT LOBE: Diffusely heterogeneous thyroid echotexture. No discrete measurable thyroid nodule.ISTHMUS: Diffusely heterogeneous echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous echotexture throughout a mildly enlarged thyroid gland with a predominantly solid 1.2-cm hypoechoic nodule within the superior/mid pole of the right thyroid lobe. The appearance is suggestive a dominant nodule within a diffuse multinodular goiter. Correlation with previous outside hospital imaging would be helpful to ensure stability. No significant lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "32 year-old female with right upper and lower quadrant pain, early satiety, anorexia. Evaluate for appendicitis. The appendix is visualized and appears normal in caliber and echogenicity and is compressible. No free fluid or lymphadenopathy.The visualized liver appears normal in echogenicity. There as stones in the gallbladder with no evidence of cholecystitis. No gallbladder wall thickening. No pericholecystic fluid. No intra-or extrahepatic biliary ductal dilatation.", "output": "1. Cholelithiasis with no evidence of cholecystitis.2. No evidence of appendicitis."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old female with history of renal stones. RIGHT KIDNEY: Right kidney measures 12 cm, and has mild pelvic caliectasis. No significant cortical thinning. There is an approximately 1 cm renal calculus in the pelvis.LEFT KIDNEY: The left kidney measures approximately 12.4 cm, and there is no hydronephrosis on the left. No left renal calculus are seen.OTHER: Bladder is within normal limits, and both ureteral jets are seen. The uterus presses against the wall of the bladder, causing some mass effect. Likely uterine fibroid.", "output": "Mild right pelvic caliectasis and renal pelvic calculus as above."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old female complains of abdominal pain. She has an elevated gtt. Evaluate for biliary pathology. LIVER:The liver measures 16.8 cm. There is coarse, increased, and heterogeneous echotexture of the liver. No masses or ascites. No intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended. No evidence of stones or sludge. The gallbladder wall measures approximately 2.9 mm. No pericholecystic fluid. The common bile duct measures approximately 2.7 mm.PANCREAS: Evaluation of the pancreas limited by overlying bowel gas.SPLEEN: The spleen measures 7.9 cm. No radiographic abnormalities are noted.KIDNEYS: The right kidney measures 11.1 cm. The cortex has normal echogenicity. No shadowing calculi or hydronephrosis. The left kidney measures 11.4 cm. The cortex has normal echogenicity. No shadowing calculi or hydronephrosis. OTHER: No significant abnormality noted.", "output": "1. Coarse, increased, and heterogeneous echotexture of the liver consistent with chronic liver disease/parenchymal dysfunction. No masses or ascites.2. No biliary pathology such as cholelithiasis noted."}
{"instruction": "Generate impression based on findings.", "input": "Ms. McGhee is a 27-year-old female presenting with palpable lump in the right breast, and complaining of transient bilateral breast pain over the last few months. Family history is positive for breast cancer in paternal cousin diagnosed at 40 years of age. Mobile smooth lump is present within the right upper outer quadrant on the physical exam.A targeted ultrasound was performed for the patient\u2019s area of concern in the right breast at the 11:00 position, approximately 5 cm from the nipple, which revealed no focal sonographic correlate. No suspicious cystic or solid mass is identified.Targeted ultrasound was also performed of bilateral breasts in the 3:00, 6:00, 9:00, 12:00 and retroareolar positions. There is no solid or cystic mass identified.", "output": "Normal sonographic evaluation of bilateral breasts. Palpable area of concern is associated with dense fibroglandular tissue within the right axillary tail. The patient should follow up with her primary care physician as clinically warranted, presuming these results are concordant with the physical exam findings. All results and recommendations were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old female with thrombocytopenia, evaluate spleen. The spleen appears normal in size measuring 10.4 cm in length, without discrete focal lesion. No perisplenic fluid or collection is identified.", "output": "No splenomegaly or discrete lesion. "}
{"instruction": "Generate impression based on findings.", "input": "History of islet cell transplant one year prior. Evaluate portal venous flow. LIVER: The liver is mildly echogenic, unchanged. No perihepatic fluid. Echogenic ring structures are unchanged. No focal suspicious lesion. The main portal vein demonstrates a normal spectral waveform, normal hepatopedal blood flow with peak systolic velocity of 0.4 m/s. The right and left portal veins are patent. The hepatic veins are patent and demonstrate normal orientation blood flow.BILIARY TRACT: No biliary ductal dilatation with the common duct measuring 4 mm. Normally distended gallbladder without wall thickening, gallstones, pericholecystic fluid or focal tenderness.PANCREAS: The visualized portions of the pancreas are unremarkable.SPLEEN: The spleen measures 9.9 cm without a focal lesion.RIGHT KIDNEY: The right kidney measures 9.5 cm without hydronephrosis, shadowing nephrolithiasis or discrete lesion. OTHER: The left kidney measures 10.2 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion.", "output": "Normal hepatopedal portal venous blood flow."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Stable cirrhotic morphology without worrisome mass. Liver length 15.3 cmGALLBLADDER, BILIARY TRACT: No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Stable angiomyolipomas. No worrisome mass, stone, or hydronephrosis. Right kidney 10.8 cm in lengthOTHER: Left kidney 10.4 cm in length. Stable left angiomyolipomas. Spleen 12.1 cm in length. No ascites.", "output": "Stable cirrhotic morphology without mass or ductal dilatation. No ascites. Stable bilateral renal angiomyolipomas."}
{"instruction": "Generate impression based on findings.", "input": "Male 26 years old; Reason: Look for evidence of tumor has positive paraneoplastic antibody History: Multiple neurological symptoms. RIGHT TESTIS: The right testicle measures 1.9 cm x 2.7 cm x 4.9 cm. The right testicle is homogenous with arterial and venus doppler flow present and symmetric throughout. No mass is seen. No significant abnormalities noted.LEFT TESTIS: The left testicle measures 2.0 cm x 2.9 cm x 4.9 cm. The left testicle is homogenous with arterial and venus doppler flow present and symmetric throughout. No masses seen. No significant abnormalities noted.RIGHT EPIDIDYMIS: Right epididymis measures 0.9 cm x 1.1 cm x 4.1 cm. There is a round anechoic lesion at the medial end of the epididymis measuring 1.1 cm x 1.0 cm x 0.9 cm.LEFT EPIDIDYMIS: The epididymis measures 0.8 cm x 1.5 cm x 4.4 cm. No significant abnormalities noted.", "output": "1. Negative testicular ultrasound. No masses were seen bilaterally.2. Hypoechoic lesion seen in the right epididymis represents an epididymal cyst or a spermatocele."}
{"instruction": "Generate impression based on findings.", "input": "Fever pain and elevated creatinine; renal transplant Right iliac fossa renal transplant demonstrates unremarkable parenchymal echogenicity without perinephric collection. No worrisome mass, stone, or hydronephrosis. 13.3 cm in length.Bladder nondistended", "output": "Unremarkable right iliac fossa renal transplant without perinephric collection, mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Left testicular pain. Evaluate for torsion. RIGHT TESTIS: 5.6 x 2.3 x 3.8 cm. Normal vascularity. No focal lesions.LEFT TESTIS: 5.6 x 3.6 x 2.7 cm. Normal vascularity. No focal lesions.RIGHT EPIDIDYMIS: 9 x 10 x 12 mm. Normal vascularity.LEFT EPIDIDYMIS: 8 x 8 x 13 mm. Normal vascularity.OTHER: No significant abnormalities noted. No hydrocele or varicocele.", "output": "No evidence of torsion or specific abnormality otherwise to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Male 64 years old Reason: increasing creatinine History: elevated creatinine Ultrasound guidance and technical assistance was provided for a renal allograft in the left iliac fossa. 4 passes were made by Dr. Cunningham using an 18-gauge Bard needle. The procedure was successfully completed.", "output": "Successful ultrasound guided biopsy of the allograft in the left iliac fossa."}
{"instruction": "Generate impression based on findings.", "input": "History renal stones RIGHT KIDNEY: Normal parenchymal echogenicity without mass, stones, or hydronephrosis. Right kidney 10.4 cm in lengthLEFT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. Left kidney 11.2 cm in length.OTHER: Bladder nondistended", "output": "Negative renal ultrasound. No evidence for mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old male with history of right adrenal mass and bilateral renal cysts. RIGHT KIDNEY: The right kidney measures approximately 10.4 cm, and demonstrates no hydronephrosis or shadowing stones. Several small cysts are seen. No internal vascularity, and no significant interval change.LEFT KIDNEY: Left kidney measures approximately 11.8 cm, without renal calculus or hydronephrosis. Several small cysts are again noted. No internal vascularity, and no significant interval change.OTHER: Urinary bladder is within normal limits, unchanged.Right adrenal nodule measures approximately 3.8 x 3 x 2.6 centimeters, nonspecific but likely myelolipoma and is unchanged.", "output": "Multiple bilateral renal cysts and right adrenal myolipoma, unchanged."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old male with transaminitis. Evaluate for steatosis, gallbladder sludge. LIVER: The liver measures 19.6 cm in length. Diffusely increased echogenicity consistent with hepatic steatosis. No superimposed discrete focal lesion. Patent main portal vein.GALLBLADDER, BILIARY TRACT: There is layering sludge within the gallbladder. There is no cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No sonographic Murphy sign could be elicited during the examination due to patient condition.PANCREAS: The pancreas is not well-visualized due to patient body habitus and bowel gas.KIDNEYS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "1.Limited examination demonstrating hepatic steatosis and gallbladder sludge.2.No evidence of acute cholecystitis or biliary obstruction."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old female with history of microscopic thyroid cancer status post lobectomy. Evaluate for adenopathy/recurrence. RIGHT LOBE MEASUREMENTS: 3.4 x 1.2 x 0.9 cmLEFT LOBE MEASUREMENTS: Status post left thyroidectomyISTHMUS MEASUREMENTS: 0.1 cmRIGHT LOBE: Two subcentimeter hypoechoic nodules in the right thyroid measuring 0.6 x 0.5 x 0.3, and 0.2 x 0.2 x 0.1 cm are without significant interval change since the prior study. The larger of the two nodules has somewhat ill-defined margins. LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A heterogeneous hypoechoic lymph node measuring 0.6 x 0.6 x 0.7 cm in the right level II station not seen on the prior study has a suspicious rounded morphology and echotexture. Other scattered cervical lymph nodes on the right and left have overall benign morphologic features.OTHER: No significant abnormality noted.", "output": "1. A morphologically abnormal right level II lymph node not seen on prior studies raises suspicious for nodal metastasis. 2. Right thyroid nodules without significant interval change. "}
{"instruction": "Generate impression based on findings.", "input": "63 years old, Male, Reason: right testicular mass RIGHT TESTIS: There is a dominant solid lesion in the right testis which is heterogeneous and mostly isoechoic to background testicular tissue. This lesion has vascular flow and is highly suspicious for malignancy. There is normal vascularity and Doppler flow within the visualized normal tissue of the right testicle.LEFT TESTIS: Patient status post left orchiectomy with prosthesis.RIGHT EPIDIDYMIS: Right epididymal cyst measuring 1.0 x 0.7 cm.LEFT EPIDIDYMIS: No significant abnormalities noted.", "output": "Dominant solid right testicular lesion with vascularity, highly suspicious for malignancy."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Mildly heterogeneous liver without mass. Liver length 15.7 cm.BILIARY TRACT: Cholelithiasis with mild diffuse wall thickening. No pericholecystic fluid. No positive Murphy's sign. No ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9.1 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.3 cm in lengthOTHER: Left kidney 10.6 cm in length. No ascites.", "output": "Mildly heterogeneous liver raises the possibility of fatty infiltration/parenchymal dysfunction without mass. Cholelithiasis with mild diffuse wall thickening without pericholecystic fluid or Murphy's sign. While there is no evidence for acute cholecystitis, chronic inflammation cannot be excluded. No ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old female with history of palpable breast mass and new right breast abnormality on screening mammogram. Patient has a history of right chest wall injections for pain as recently as 7/2/2015. Physical exam demonstrated a palpable mobile mass in the right breast at the 12 o'clock position approximately 10 cm from the nipple. The patient reported a palpable mass in the right breast 12 o'clock position approximately 6 cm from the nipple. A targeted right ultrasound was performed in the aforementioned locations.At the 12 o'clock position approximately 10 cm from the nipple, an oval, cystic lesion with internal echogenic foci and linear septations was present measuring 1.8 x 0.8 x 1.7 cm. There was no internal vascularity.At the 12 o'clock position approximately 6 cm from the nipple in the area of the patient's reported palpable mass, normal breast tissue is appreciated. No suspicious masses identified.", "output": "1. Cystic lesion with internal echogenic foci and septations likely representing an injection granuloma from recent pain injection. Follow-up ultrasound in 3 months and surgical consult is recommended.2. In the area of the patient's pain at the 12:00 position of the right breast 6 cm from the nipple, no suspicious masses or abnormalities were noted.Results and plan were discussed with the patient at length.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female status post ICD implant with onset of pain in the left axilla No evidence for a fluid collection or edema are seen in the area of the patient's concern. Over the area where the patient feels discomfort a shadowing density seen in the soft tissue.", "output": "In the area where the patient feels discomfort, a shadowing density is seen likely representing the ICD wire. No discrete evidence for edema or fluid collection are seen."}
{"instruction": "Generate impression based on findings.", "input": "Female 65 years old Reason: 65 yo with cirrhosis please screen for HCC LIVER: Nodular contour of the liver compatible with known cirrhosis. No focal hepatic mass. Liver measures 13.9 cm. Main portal vein is patent with normal directional flow and a peak velocity of 32 cm/s.BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. The common bile duct measures 3 mm. No significant gallbladder wall thickening. There is a shadowing gallstone present within the gallbladder. No evidence of acute inflammation of the gallbladder.PANCREAS: Pancreas is normal in appearance. The distal tail the pancreas is secured by overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 8.5 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 10.1 cm. Left kidney measures 10.5 cm. OTHER: No significant abnormalities noted.", "output": "1.Nodular contour of the liver compatible with cirrhosis without evidence of a focal mass.2.Cholelithiasis without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old male with hepatitis B. Evaluate for cirrhosis and HCC. LIVER: The liver is normal in morphology, echogenicity and size, measuring 16.5 cm in length. The liver capsule is smooth. No focal lesion or intrahepatic biliary ductal dilatation is evident. Normal hepatopetal portal venous blood flow at 30 cm/sec.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 3 mm. A normally distended gallbladder is present without wall thickening, gallstones, pericholecystic fluid or focal tenderness.PANCREAS: The poorly visualized pancreatic body and head are unremarkable.SPLEEN: The spleen measures 10.8 cm in length without a discrete abnormality.RIGHT KIDNEY: The right kidney measures 10.8 cm in length without hydronephrosis, shadowing calculus or discrete lesion. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 11.4 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow.", "output": "No focal hepatic lesion or specific stigmata of cirrhosis."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Metcalf submitted outside study for review. Submitted for review is:-Right breast ultrasound: 1/11/2016 This examination was performed at Ingalls Memorial Hospital. Static ultrasound images are submitted for interpretation. In the right retroareolar region, approximately 1 cm from the nipple, there is a lobulated hypoechoic mass identified measuring 2.9 x 1.2 cm. There is minimal associated vascularity.", "output": "Sonographic findings most suggestive of a fibroadenoma. Given patient's age and palpability, a surgical consultation is recommended at this time for further evaluation and for consideration of palpably-guided FNA. Alternatively, the patient may return for a short term 6 month ultrasound follow-up examination to confirm stability as long as the mass is unchanged. BIRADS: 3 - Probably benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old male with elevated bilirubin. Evaluate for gallstones common ascites. LIVER: Increased echogenicity of the liver measuring 18.0 cm in length. No hepatic lesions. Portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Gallbladder is contracted containing stones. Gallbladder wall is mildly thickened measuring 4 mm in thickness. No pericholecystic fluid. Sonographic Murphy's sign is negative. Common bile duct is normal in caliber measuring 4 mm. No intra-extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are normal in echogenicity.RIGHT KIDNEY: Increased echogenicity of the right kidney measuring 11.5 cm in length. Focal echogenic focus in the lower pole is noted.OTHER: Normal echogenicity of the spleen measuring 13.9 cm in length. Increased echogenicity of the left kidney measuring 12.2 cm in length. Non obstructing 5-mm calculus is noted in the mid to upper pole.Abdominal ascites.Bilateral pleural effusions.", "output": "1. Increased echogenicity of the liver compatible with fatty infiltration.2. Contracted gallbladder with cholelithiasis. Mild thickening of the gallbladder wall is nonspecific in the setting of ascites. No pericholecystic fluid. Sonographic Murphy's sign is negative.3. Increased echogenicity of the kidneys suggestive of parenchymal dysfunction. Nonspecific echogenic focus in the lower pole of the right kidney may be a small AML or non shadowing stone. Nonobstructing calculus in the left kidney.4. Abdominal ascites and bilateral pleural effusions. "}
{"instruction": "Generate impression based on findings.", "input": "81-year-old male with history of cholecystectomy, continued right upper quadrant and right lower quadrant pain. LIVER: Normal echogenicity of the liver measuring 19.7 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. Mild intra-and extrahepatic biliary ductal dilatation is again seen. PANCREAS: Distal body and tail of the pancreas are obscured by overlying bowel gas. The remaining visualized portions are unremarkable.RIGHT KIDNEY: The right kidney is atrophic and increased in echogenicity measuring 11.8 cm in length with moderate to severe hydronephrosis and debris worse when compared to prior CT dated 1/20/2015. No shadowing calculi are noted.OTHER: Left kidney is increased in echogenicity measuring 13.5 cm in length. Cyst in the midpole measures 2.5 cm x 3.6 cm x 2.6 cm. No hydronephrosis or shadowing calculi are noted.Normal echogenicity of the spleen measuring 13.6 cm in length.", "output": "1. Increased renal echogenicity bilaterally suggestive of parenchymal dysfunction. The right kidney is atrophic with moderate to severe hydronephrosis and debris worse when compared to prior CT. No hydronephrosis in the left kidney. No evidence of nephrolithiasis bilaterally. 2. Mild intra and extrahepatic biliary ductal dilatation is again seen and appears stable. "}
{"instruction": "Generate impression based on findings.", "input": "24-year-old with 2 palpable areas of concern in the left breast which are marked by the clinical service for ultrasound. A targeted left ultrasound was performed for the 2 palpable areas of concern marked by the clinical service. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy. Clinical follow-up as needed is recommended.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "84-year-old female with HCV, cirrhosis. Evaluate for HCC LIVER: Cirrhotic liver morphology. Liver measures 14.8 cm in length. Focal echogenic focus along the anterior aspect of the right hepatic lobe measures 5 mm x 4 mm x 5 mm. Additional hepatic cyst measures 6 mm x 6 mm x 6 mm. Portal vein is patent with appropriate directional flow.BILIARY TRACT: Contracted gallbladder containing multiple shadowing stones. No pericholecystic fluid. No gallbladder wall thickening. The common bile duct measures 9 mm in caliber, pancreatic duct measures 4 mm in caliber. PANCREAS: Visualized portions of pancreas are normal in caliber.SPLEEN: Normal echogenicity of the spleen measuring 7.1 cm in length.RIGHT KIDNEY: Status post right nephrectomy.OTHER: No significant abnormality noted.", "output": "1. Cirrhotic liver morphology. Stable hyperechoic focus in the right hepatic lobe not significantly changed and may represent a hemangioma or fat within a fissure. Continued follow up recommended. Additional subcentimeter hepatic cyst is noted. 2. Stable prominence of the common bile duct. 3. Contract gallbladder containing stones with no evidence of cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 87 years old. Decreased UOP. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 10.4 cm in length, with mildly increased cortical echogenicity. A midpole simple cyst measures 4.5 x 5.4 x 4.6 cm. A lower pole lesion measures 3.3 x 3.9 x 3.0 cm, heterogeneous and hypoechoic with internal vascularity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.6 cm, with mildly increased cortical echogenicity. An upper pole simple cyst measures 2.3 x 2.6 x 2.7 cm. No shadowing stones or hydronephrosis.OTHER: The bladder is incompletely distended.", "output": "1. A 3 to 4 cm hypoechoic right lower pole renal lesion corresponds with an enhancing mass seen on recent CT imaging, and likely reflects renal cell carcinoma. Additional bilateral renal cysts.2.No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with lump in the posterior knee. Grayscale and color ultrasound examination of the left posterior popliteal region demonstrates a circumscribed solid lesion measuring 3.5 x 2.0 x 3.5 cm with internal linear regions of increased echogenicity and no significant vascularity.", "output": "Sonographic findings as described above are most suggestive of a lipoma. Cross-sectional imaging may be performed for further evaluation if warranted clinically."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury. History of TIPS. RIGHT KIDNEY: 12.3 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 11.2 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: Collapsed post voidOTHER: Cirrhotic liver morphology, partially imaged. Moderate to large amount of ascites identified.", "output": "1. No hydronephrosis.2. Cirrhosis with ascites."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old male with hematuria. RIGHT KIDNEY: The right kidney measures 13.8 cm in length. No hydronephrosis. Numerous cysts are again seen some with minimal internal complexity. No definite solid lesion is identified. No shadowing calculi.LEFT KIDNEY: The left kidney measures 13.1 cm in length. No hydronephrosis. Multiple cysts are again seen, some with minimal internal complexity. No definite solid lesion is identified. No shadowing calculi.URINARY BLADDER: No acute abnormality of the urinary bladder.OTHER: No significant abnormalities noted.", "output": "Multiple bilateral renal cysts. No dominant mass is identified. Consider further evaluation with CT or MRI as the multiplicity of nodules makes any single nodule difficult to evaluate."}
{"instruction": "Generate impression based on findings.", "input": "Male 33 years old; Reason: 33 y.o. M with metastatic papillary thyroid cancer in a left level III lymph node History: PTC 3 left neck lymph nodes were localized under sonographic guidance. 0.1 cc of methylene blue was injected.The lesions where left level 3 superior, left level 3 mid and left level 3 inferior/level 4.Surface markings were performed by the service.", "output": "1.Intraoperative methylene blue localization of left lymph nodes."}
{"instruction": "Generate impression based on findings.", "input": "Oliguria. Rising creatinine. Status post sigmoid colectomy. Please note that the examination is limited by poor acoustic penetrationRIGHT KIDNEY: 7.6 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 8.5 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: Not well visualized due to abdominal wounds and bandages.OTHER: No significant abnormality noted.", "output": "Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "21-year-old female with postprandial pain and nausea/vomiting, evaluate for gallstone disease. LIVER: Normal echogenicity of the liver measuring 14.2 cm in length. No focal hepatic lesion. Main portal vein is patent with appropriate directional flow, however with elevated velocity up to 60 cm/s which is nonspecific on this nondedicated exam.GALLBLADDER, BILIARY TRACT: Gallbladder is normal in echogenicity with no evidence of gallstones. No gallbladder wall thickening. No pericholecystic fluid. Sonographic Murphy's sign is negative. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: The visualized portions of the pancreas are normal in echogenicity with no evidence of pancreatic ductal dilatation.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 11.6 cm in length. No hydronephrosis.OTHER: Normal echogenicity of the left kidney measuring 11.2 cm in length. No hydronephrosis. Normal echogenicity of the spleen measuring 10.2 cm in length.", "output": "1. Elevated main portal vein velocity which is nonspecific on this nondedicated exam. 2. No evidence of cholelithiasis. "}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female with history of thyroid cancer status post resection. Evaluate for adenopathy, recurrence. RIGHT LOBE MEASUREMENTS: Surgically absentLEFT LOBE MEASUREMENTS: Surgically absentISTHMUS MEASUREMENTS: Surgically absentRIGHT LOBE: No suspicious lesions in the right thyroid bed. No significant interval change in hyperechoic tiny foci seen on the prior study.LEFT LOBE: No suspicious lesions in the left thyroid bed.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered cervical lymph nodes with benign morphologic features. No new lymphadenopathy.OTHER: No significant abnormality noted.", "output": "No sonographic evidence of recurrent disease or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for routine screening mammography. History of right breast benign biopsy. Family history of breast cancer in mother diagnosed in her 60's and maternal grandmother diagnosed in her 50's. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD. The breast parenchyma is heterogeneously dense, which may obscure small masses (BiRads Density Category C), unchanged in pattern and distribution. New asymmetry is present in the superior posterior right breast best seen on MLO view. Stable scattered bilateral benign calcifications. Previously described ill-defined mass previously confirmed to be a cyst on ultrasound in the left lower outer breast is not visualized on the current exam compatible with a waxing and waning cyst. No suspicious masses, microcalcifications are present.", "output": "New asymmetry in the superior posterior right breast best seen on MLO view which further evaluation with spot compression views and possibly ultrasound is recommended. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EC - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "The patient submitted outside mammogram dated 3/21/2014, from Mount Sinai. Submitted outside study was compared to the current mammogram and ultrasound dated 7/1/2015. There is no significant change between these two studies.", "output": "Unchanged left retroareolar intraductal papilloma. Please see the addendum to the diagnostic mammogram and ultrasound for details. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "33 year old female with right upper quadrant pain. LIVER: Measures 17.9 cm in length, upper limits of normal, and is normal in echogenicity.BILIARY TRACT: Status post cholecystectomy. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are normal echogenicity with no evidence of pancreatic ductal dilatation.SPLEEN: Normal echogenicity of the spleen measuring 10.3 cm in length RIGHT KIDNEY: Measures 11.27 m in length and is normal in echogenicity with no evidence of hydronephrosis.OTHER: Left kidney measures 10.7 cm in length and is normal in echogenicity with no evidence of hydronephrosis.", "output": "No significant abnormality noted to account for the patient's symptoms. "}
{"instruction": "Generate impression based on findings.", "input": "76 years old, Female, Reason: 76 yo F, New onset kidney failure History: elevated Cr, lactic acid RIGHT KIDNEY: Kidney measures 10.3 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. There is trace perinephric fluid on the right. Right superior simple-appearing cyst measures 4.5 x 3.0 x 3.6 cm appearing similar to the recent CT study. Right renal stone measures up to 1.3 cm. No evidence of hydronephrosis.LEFT KIDNEY: Kidney measures 8.8 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. Left renal cyst measures 2.6 x 2.9 x 3.4 cm. Nonobstructing left renal stone measures up to 0.7 cm. No evidence of hydronephrosis.OTHER: Trace ascites.", "output": "1.Increased echogenicity of the kidneys bilaterally is consistent with medical renal disease.2.Nonobstructing nephrolithiasis bilaterally.3.Bilateral renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Calle is a 60 year old female with a personal history of right breast mastectomy for ILC in 2009 followed by radiation and tamoxifen therapy. She presents today for a physician palpated superficial lump in her right axilla. On physical examination, a superficial mass is palpated in the right axilla.A targeted right axillary ultrasound was performed for the palpable area of concern. There is a superficially located, round anechoic lesion with layering echogenic material measuring 6 x 4 x 8 mm. There is no internal vascular flow. Sonographic findings are consistent with a benign oil cyst with calcifications.", "output": "Benign oil cyst of the right axilla corresponding to the palpable area of concern. No sonographic evidence for malignancy in the right axilla. As long as the patient's physical examination remains normal, left breast unilateral diagnostic mammogram is recommended annually, due next in June 2017. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Male 68 years old Reason: transplant kidney eval, cholecsytitis, free fluid, infrarenal aneurysm as best as able History: ruq abdominal pain, h/o renal transplant and 3 cm infrarenal aortic aneurysm and cholelithiasis LIVER: Liver measures 18.2 cm, enlarged. No focal liver lesions.BILIARY TRACT: Significant gallbladder wall thickening with small amount of pericholecystic fluid. There are multiple gallstones. These findings are compatible with acute cholecystitis. No evidence of intra or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: Spleen measures 10.8 cm.RIGHT KIDNEY: No evidence of hydronephrosis bilaterally. Right iliac fossa transplant kidney measures 11.6 cm, unremarkable. Bilateral native kidneys are not well seen due to their increased echogenicity. 1.5 cm simple cyst within the echogenic left kidney. AORTA:No evidence of aortic aneurysm. IVC:Unremarkable.OTHER: No significant abnormalities noted.", "output": "Cholelithiasis with acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Male 51 years old Reason: Post Liver Transplant. Please evaluate all vessels for patency History: Liver Transplant LIMITED ABDOMENLIVER: Transplanted liver measures 22 cm, enlarged. No focal liver lesions.BILIARY TRACT: No evidence of intra or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: Mild splenomegaly.", "output": "Patent hepatic vasculature. Main portal vein is patent but not well visualized and a partial thrombus cannot be excluded. Increased velocity of the hepatic artery with decreased RI values. Clinical correlation and if necessary a follow-up Doppler study may be helpful for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "34-year-old male history of papillary carcinoma and prior surgeries. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomy ISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massesLEFT LOBE: No massesISTHMUS: No massesPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No abnormal lymph nodesOTHER: No significant abnormality noted.", "output": "No evidence for recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "Flank pain, hematuria, evaluate renal stones RIGHT KIDNEY: Measures 12.5 cm. No hydronephrosis or nephrolithiasis.LEFT KIDNEY: Measures 12.1 cm. No hydronephrosis. Nonobstructive renal pelvis stone measures up to 0.9 cm. Multiple simple renal cysts measuring up to 2.3 cm.OTHER: The bladder is partially distended with dependent debris.", "output": "Nonobstructive left renal pelvis stone. No hydronephrosis. Debris in the bladder."}
{"instruction": "Generate impression based on findings.", "input": "Female 51 years old; Reason: eval for cholelithiasis, biliary dilation, ascites History: AMS, hx of etoh cirrhosis, elevated bili and lipase LIVER: The liver measures 21.60 cm in length. There is coarse and heterogeneous echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow. GALLBLADDER/BILIARY TRACT: The gallbladder is surgically absent. The common bile duct measures 0.24 cm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 17.50 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 12.6 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 13.3 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.", "output": "1. No sonographic signs of cholecystitis.2. Marked splenomegaly of uncertain etiology but perhaps could be sequelae of portal hypertension."}
{"instruction": "Generate impression based on findings.", "input": "Female 29 years old Reason: HTN in a 29 year old female, please evaluate for renal artery stenosis History: HTN in a 29 year old female, please evaluate for renal artery stenosis ULTRASOUND KIDNEYSRIGHT KIDNEY: 8.9 cm in length. No hydronephrosis. Normal echogenicity.LEFT KIDNEY: 9.6 cm in length. No hydronephrosis. Normal echogenicity.Small echogenic focus near the pole measuring 0.6 x 0.7 x 0.9 cm possibly angiomyolipoma.OTHER:No significant abnormalities noted.", "output": "Small kidneys. No definite evidence of renal artery stenosis but the renal artery origins were not well seen.Small echogenic lesion left upper pole consistent with angiomyolipoma"}
{"instruction": "Generate impression based on findings.", "input": "29-year-old male with history of thyroid cancer, evaluate for change in nodules, lymph nodes. RIGHT LOBE MEASUREMENTS: Surgically absentLEFT LOBE MEASUREMENTS: Surgically absentISTHMUS MEASUREMENTS: Surgical absenceRIGHT LOBE: 0.6 x 0.4 x 0.3 cm hypoechoic focus in the right thyroid bed is unchanged since the prior study. No new suspicious lesions are identified.LEFT LOBE: 0.7 x 0.4 x 0.4 hyper/hypoechoic focus in the left thyroid bed is unchanged since the prior study. No new suspicious lesions are identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: 1.4 cm left level II lymph node with overall benign morphologic features is not significantly changed. No new suspicious lymphadenopathy.OTHER: No significant abnormality noted.", "output": "No significant interval change since the prior study. No new suspicious nodules or lymphadenopathy. "}
{"instruction": "Generate impression based on findings.", "input": "31-year-old female with right-sided abdominal pain. LIVER: Measures 13.7 in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: No cholelithiasis. No gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilation. PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Unremarkable in size and echogenicity. KIDNEY: 0.5 cm right lower pole renal stone without hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1. Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease. No evidence of cholelithiasis or cholecystitis. 2. Nonobstructive right nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain with nausea. LIVER: 13.1 cm in length. Non-cirrhotic liver morphology. Normal parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Normal appearance of the gallbladderPANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 10.1 cm in length, with a 2.2 cm benign-appearing cyst at the inferior pole.. The left kidney is 11.4 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9.7 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid identified.", "output": "No acute intra-abdominal abnormality identified."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old female post thyroidectomy with small nodule right thyroid bed. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: In the right thyroidectomy bed, there is again noted a somewhat high for occult area with surrounding hypoechoic rim, measuring 0.4 x 0.5 x 0.7 cm without significant change. A slightly more caudal, hypoechoic region measuring 0.3 x 0.3 by 0.4 cm is unchanged.LEFT LOBE: Slightly asymmetric hypoechoic region in the left bed measuring 0.4 x 0.4 x 0.5 cm is unchanged and could represent scarring.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Morphologically normal lymph nodes bilaterally OTHER: No significant abnormality noted.", "output": "Stable examination. Given stability and small size of the abnormality in the inferior right bed comment continued follow up warranted."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with abdominal distention, ascites. Evaluate for portal vein thrombosis. History of metastatic breast cancer. LIVER: Measures 21.7 cm in length. Diffusely abnormal echotexture with several subtle lesions is consistent with diffuse hepatic metastases seen on prior studies.The portal vein is well visualized at the porta hepatis, and is patent in this location with antegrade flow measuring 0.1 m/s. The right and left portal vein branches are also patent. BILIARY TRACT: Collapsed gallbladder with secondary wall thickening. PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.KIDNEY: No significant abnormalities noted. OTHER: Mild ascites.", "output": "1. Limited examination of the portal vein as detailed above demonstrates patency at the porta hepatis. Slow portal venous flow in this region may be secondary to widespread hepatic metastatic disease. 2. Hepatomegaly with diffusely abnormal hepatic echotexture consistent with hepatic metastases seen on prior studies. 3. Mild ascites. "}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Male 65 years old Reason: Hx esophageal cancer; study -related tissue biopsy right lower lobe liver. Kit provided; 4 cores needed 18-gauge; one in formalin; 3 snap-frozen Contact person: Sneha Solanki 2-1834/4564.IRB 15-0209. History: None Written informed consent was obtained. Patient was prepped and draped in sterile fashion. A lesion in the inferior aspect of the right lobe which measured about 4 cm amenable to subcostal approach biopsy was selected.Under ultrasound guidance 5 passes were obtained using 18-gauge core biopsy needle. Some passes yielded scant the tissue. One sample was placed in buffered formalin and 4 samples were placed in containers provided.Less than 5 cc blood loss.Patient was observed in nurse holding vital signs remained stable and the patient was discharged to home in good condition.Samples were picked up bySneha Solanki.", "output": "Successful ultrasound-guided biopsy of liver mass. "}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Non-cirrhotic liver morphology. Increased parenchymal echogenicity. 20 cm in length. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Several subcentimeter gallstones noted. The gallbladder is collapsed, which limits evaluation for wall thickening. Trace pericholecystic fluid is nonspecific in the setting of liver dysfunction. Negative sonographic Murphy's sign reported.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 10.8 cm in length. The left kidney is 10.4 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 10.6 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.", "output": "1. Cholelithiasis without specific evidence of cholecystitis. Trace pericholecystic fluid present, nonspecific in the setting of liver dysfunction. The gallbladder is collapsed, which limits evaluation. Negative sonographic Murphy's sign reported. If further clinical suspicion for cholecystitis persists, nuclear medicine HIDA scan may be helpful.2. Increased hepatic echogenicity, compatible with parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Hodgkin's lymphoma status post chemoradiation with thyroid nodules RIGHT LOBE MEASUREMENTS: 6 x 1.2 x 1.3 cmLEFT LOBE MEASUREMENTS: 5 x 1.2 x 1.6 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Diffusely heterogeneous gland. Multiple subcentimeter benign-appearing colloid cysts.LEFT LOBE: Diffusely heterogeneous gland. Multiple subcentimeter benign-appearing colloid cysts.ISTHMUS: Diffusely heterogeneous glandPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland with multiple bilateral subcentimeter benign-appearing colloid cysts. No worrisome mass lesion. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female patient with history of goiter. Now with thyroid tenderness, possible subacute thyroiditis which did not respond to steroids. Question of masses or other lesions. RIGHT LOBE MEASUREMENTS: 2.3 x 2.7 x 6.7 cm, previously 2.2 x 1.9 x 6.17 cm.LEFT LOBE MEASUREMENTS: 2.2 x 3.1 x 8.3 cm, previously 3.0 x 3.0 x 7.7 cmISTHMUS MEASUREMENTS: 7 mm in thickness.RIGHT LOBE: A solid nodule with cystic spaces within the right midpole measures 1.6 x 1.2 x 1.0 cm, previously 1.3 x 1.0 x 1.5 cm. A spongiform-appearing nodule near the isthmus measures 1.0 x 0.4 x 1.1 cm, previously 1.2 x 0.5 x 1.0 cm.LEFT LOBE: A dominant left lower pole complex solid nodule is similar in appearance to the prior study measuring 3.7 x 2.4 x 2.8 cm, previously 3.6 x 2.4 x 2.8 cm. An additional hypoechoic nodule within the posterior medial aspect of the lower pole is similar in size measuring 0.9 x 0.8 x 0.4 cm, previously 0.8 x 1.1 x 0.5 cm. However, the appearance has changed now with a more defined cystic component and nodular solid component which could be related to hemorrhage.ISTHMUS: A predominately solid nodule with cystic spaces within the isthmus measures 1.0 x 0.6 x 1.1 cm, previously 1.2 x 1.0 x 1.3 cm. PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Bilateral neck lymph nodes are noted.OTHER: No significant abnormality noted.", "output": "Similar size and appearance of multiple bilateral thyroid nodules except for a hypoechoic left lower pole nodule which has more defined cystic and solid components."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with history of papillocarcinoma post thyroidectomy and lymph node dissection x 2. RIGHT LOBE MEASUREMENTS: PostatherectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massesLEFT LOBE: In the left bed immediately adjacent to the carotid artery there is a hypoechoic region measuring 0.6 x 0.7 x 0.9 cm. I cannot exclude local recurrent disease although this could represent scarring from recent bed dissection. There is no associated calcification.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Asymmetric hypoechoic region in the left thyroidectomy bed. Scar versus recurrent tumor.No evidence for nodal recurrence."}
{"instruction": "Generate impression based on findings.", "input": "Female 50 years old Reason: rule out thyroid nodules RIGHT LOBE MEASUREMENTS: 6.1 x 1.7 x 1.9 cmLEFT LOBE MEASUREMENTS: 5.7 x 2.0 x 1.9 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Mildly heterogeneous echotexture of the right thyroid lobe. No nodules are identified.LEFT LOBE: Mildly heterogeneous echotexture of the left thyroid lobe. No nodules are identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small normal-appearing right level 3 lymph nodes are visualized.OTHER: No significant abnormality noted.", "output": "Mildly heterogeneous appearing thyroid which may be due to very small colloid nodules or minimal thyroiditis, recommend correlation with lab values. No discrete nodules are identified."}
{"instruction": "Generate impression based on findings.", "input": "43 year old female who was recalled from screening mammogram for a partially circumscribed oval mass in the right lower central breast. Mammogram: An ML view and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B). 24 mm oval circumscribed isodense mass persist in the right lower outer quadrant. No associated calcifications noted.Ultrasound: Targeted right lower outer quadrant ultrasound was performed that showed an oval circumscribed benign morphology hypoechoic mass with central hyperechogenicity that measures 1.8 x 0.6 x 1.2 cm corresponding to the mammographic abnormality. Mass is located at 7:00 position, 5 cm from the nipple. No definite blood flow is identified within the mass. This could either represent a benign intramammary lymph node or fibroadenolipoma.", "output": "Benign morphology mass in the right breast 7:00 position on mammogram and ultrasound.No mammographic evidence of malignancy. As long as patient's physical examination remains unchanged, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "The patient submitted outside mammogram dated 10/10/2013 and 7/30/2013, from Saint Anthony Hospital. Submitted outside study was compared to the current mammogram dated 8/18/2015. Focal asymmetry within the lower central left breast is new from prior studies and needs further evaluation with spot compression views with possible ultrasound.", "output": "Focal asymmetry within the lower central left breast is new from prior studies and needs further evaluation with spot compression views with possible ultrasound.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "19 year old with history of left breast mass, biopsy proven as fibroadenoma. A targeted left ultrasound was performed for the area of concern. At the left breast 4 o'clock position, the known mass is slightly increased in size, today measuring 3.6 x 1.8 x 2.6 cm. Previous measurements from August were 3.2 x 1.6 x 2.5 cm.", "output": "Continued interval increase in the left breast mass. Surgical consultation is recommended and the patient will see Dr. Chhablani today.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Male; 72 years old. Reason: assess for mass or cyst, suspect RCC History: increasing hemoglobin RIGHT KIDNEY: Right kidney measures 9.2 cm in length. The cortex is echogenic. There is no hydronephrosis or shadowing renal stone. No renal mass is identified on ultrasound.LEFT KIDNEY: Left kidney measures 10.0 cm in length. The cortex is echogenic. There is no hydronephrosis or shadowing renal stone. No renal mass is identified on ultrasound.OTHER: The bladder is decompressed. A right ureteral jet is visualized.", "output": "1.Echogenic kidneys, compatible with medical renal disease.2.No renal mass is identified on ultrasound imaging. If there is continued concern for renal cell carcinoma, dedicated contrast enhanced cross-sectional imaging would be more sensitive and is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Sepsis, pyuria, urinary retention, evaluate for hydronephrosis RIGHT KIDNEY: Status post right nephrectomy many years ago as per the patient. Kidney is not visualized in the right renal bed.LEFT KIDNEY: Left kidney measures 14 cm with normal echotexture. No hydronephrosis noted. No focal lesions noted.OTHER: No significant abnormalities noted.", "output": "Status post right nephrectomy.No hydronephrosis in the left kidney."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. Multiple cysts are present in both breasts.There is no solid mass identified.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evidence of biliary dilation, stones; eval for liver echotexture History: rising bilirubin, possible cirrhosis LIVER: The liver measures 15.7 cm in length. Mildly increased parenchymal echogenicity is suggestive of fatty infiltration/parenchymal dysfunction. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.3 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 11.1 cm in length. RIGHT KIDNEY: Kidney measures 11.9 cm in length. Increased parenchymal echogenicity. No hydronephrosis, shadowing calculus or massLEFT KIDNEY: Kidney measures 11.4 cm in length. Increased parenchymal echogenicity. No hydronephrosis, shadowing calculus or massOTHER: Right pleural effusion. Ascites.", "output": "1.No evidence of acute cholecystitis or biliary ductal dilatation.2.Increased hepatic echogenicity suggestive of chronic hepatic disease. 3.Increased renal echogenicity suggestive of medical renal disease.4.Right pleural effusion. Ascites."}
{"instruction": "Generate impression based on findings.", "input": "Papillary carcinoma status post resection now with local recurrence RIGHT LOBE: Status post thyroidectomy without massLEFT LOBE: Status post thyroidectomy. Multiple hypoechoic nodules within the left thyroid bed. A level 3 nodule measures 0.6 x 0.9 x 0.7 cm. Slightly more inferior level 3 nodule measures 0.8 x 0.2 x 1.3 cm. A level 4 nodule measures 1.7 x 1.7 x 1.3 cm. However, the inferior extent of this level 4 nodule extends into the thoracic inlet and its size is probably under estimated.ISTHMUS: Status post thyroidectomy without mass.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple hypoechoic nodules within the left thyroid bed spanning levels 3 and 4 consistent with suspected local recurrence. The inferior level 4 nodule extends into the thoracic inlet and is therefore not completely visualized. No regional cervical lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Right medial knee soft tissue mass, assess for growth, change versus September 20, 2015, patient has no pain Redemonstrated is a circumscribed large oval superficial hypoechoic mass, predominantly cystic with debris within it and few septations without peripheral blood flow, measures 8.8 x 4.7 x 6.8 cm, mostly unchanged from prior study when it measured 9.9 x 3.4 x 6.2 cm given difference in technique and operator dependence. The lesion is located in the right medial knee soft tissue and appears indeterminate, less likely to be a evolving hematoma given no definite change in morphology or size.", "output": "Indeterminate right medial knee predominantly cystic soft tissue mass, mostly unchanged in size with new septation and debris within it. This is less likely to be a hematoma given no definite change in size. FNA can be helpful for further evaluation. "}
{"instruction": "Generate impression based on findings.", "input": "Female 58 years old; Reason: hepatobiliary pathophysiology History: Rising Alk Phos and bile seen around G-tube in setting of prior cholestasis LIVER: The liver measures 18.2 cm in length. There is increased, coarse, and heterogenous echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow. No ascites.GALLBLADDER/BILIARY TRACT: There is diffuse gallbladder wall thickening measured at 3.8 mm. No stones are seen. There is dependent echogenic material in the lumen of the gallbladder consistent with sludge. No pericholecystic fluid. Sonographic Murphy's sign equivocal. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.RIGHT KIDNEY: The right kidney measures 11.3 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 13.2 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.", "output": "1. Gallbladder sludge with abnormal diffuse wall thickening raising possibility of chronic inflammation. Equivocal Murphy's sign raises the possibility of acute on chronic inflammation. No ductal dilatation2. Coarse echotexture of the liver consistent with chronic liver disease / parenchymal dysfunction. No mass or ascites.3. Mild hepatomegaly."}
{"instruction": "Generate impression based on findings.", "input": "History of RCC status post left nephrectomy RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 11.2 cm in length.LEFT KIDNEY: Status post nephrectomy.OTHER: Bladder nondistended", "output": "Echogenic right renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Male, 42 years old. Hematuria. RIGHT KIDNEY: The right kidney measures 10.3 cm in length, with normal cortical echotexture. A few scattered punctate nonshadowing echogenic foci are noted. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 12.3 cm in length with normal cortical echotexture. A few scattered punctate nonshadowing echogenic foci are noted. No shadowing stones are identified. No hydronephrosis.OTHER: The bladder is incompletely distended.", "output": "A few scattered punctate nonshadowing echogenic foci bilaterally correspond with punctate areas of calcification as seen on prior CT imaging. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Female 36 years old; Reason: soft tissue US of epigastric History: unusual protuberance of the epigastric area with out any tenderness over the past few months. zero obv lipoma as such and does not have features of hernia. Please help evaluate this further. ? localizedPLEASE NOTE:\u00a0 THIS REPORT HAS BEEN ADDENDED FOR CHANGE IN ORDERED EXAMINATION.\u00a0 THE REPORT IS CORRECT AS DICTATED.Report Electronically Signed: 6/16/2015 6:20 PM Stephen Thomas, MDAddended on 6/16/2015 6:20:30 PM by Stephen Thomas, MD.US SOFT TISSUE CHEST WALL/UPPER BACK, 6/9/2015 10:45 AM Sonographic images of the subcutaneous tissues underlying the epigastric region show no focal mass in the area of palpable concern. Specifically, no cystic or solid lesion is identified. There is prominent subcutaneous fat. Underlying tissues are within normal limits. No free fluid.", "output": "No specific findings to account for the patient's symptoms in the area of palpable concern."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. Personal history of bilateral cyst aspiration approximately 10-15 years ago. Family history of breast cancer in sister, diagnosed at the age of 52. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. There is no solid or cystic mass identified. This examination was interpreted by both Dr. Sheth and Dr. Schacht.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "56 year old male with history of cirrhosis, evaluate for any concerning lesions. LIVER: Coarse liver echotexture, with subtle nodularity of the contour consistent with history of cirrhosis. No identifiable masses. Main portal vein is patent, with peak flow approximately 0.2 m/sec.GALLBLADDER, BILIARY TRACT: No significant biliary dilatation, with the common bile duct measuring approximately 0.4 cm. Gallbladder within normal limits.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures approximately 11 cm in length. No hydronephrosis or other significant abnormality.OTHER: Left kidney measures approximately 11.6 cm in length, without hydronephrosis or other significant abnormality. Spleen is slightly enlarged, at 16 cm, unchanged.", "output": "Cirrhotic liver morphology without identifiable mass, and unchanged splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Primary hyperparathyroidism RIGHT LOBE MEASUREMENTS: 3.6 x 0.9 x 1.2 cmLEFT LOBE MEASUREMENTS: 2.9 x 1 x 1 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Heterogeneous and atrophic right thyroid gland without noduleLEFT LOBE: Heterogeneous and atrophic thyroid gland. 0.4 x 0.6 x 1 cm hypoechoic lesion; it is unclear whether not this nodular focus arises from the posterior aspect of the mid atrophic right thyroid gland or is extrathyroidal.ISTHMUS: Heterogeneous and atrophic glandPARATHYROID GLANDS: 0.7 x 0.4 x 0.8 cm hypoechoic focus projecting inferior and posterior to the atrophic right thyroid gland.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Hypoechoic focus projecting inferior and posterior to the atrophic right thyroid gland; while this may represent a parathyroid adenoma candidate, it is unclear whether this may represent a thyroid nodule arising from the atrophic gland. Similarly, there is a hypoechoic lesion arising from the posterior aspect of the mid atrophic right thyroid gland which may represent a thyroid nodule or parathyroid adenoma candidate. Correlation with nuclear medicine scan recommended."}
{"instruction": "Generate impression based on findings.", "input": "Renal stone RIGHT KIDNEY: Mildly echogenic renal parenchyma without worrisome mass, stone, or hydronephrosis. Stable upper pole cyst. Right kidney 10.1 cm in length.LEFT KIDNEY: Mildly echogenic renal parenchyma with multifocal scarring and atrophy. Stable multiple cysts. No hydronephrosis. Subcentimeter lower pole calculus measuring 0.6 cm. In diameter again noted.OTHER: Bladder nondistended", "output": "Stable subcentimeter nonobstructing left lower pole calculus. No hydronephrosis. Mildly echogenic renal parenchyma bilaterally suggestive for medical renal disease/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Male; 67 years old. Reason: eval for cirrhosis History: pt with GAVE vs portal hypertension on endoscopy in a LIVER: The liver measures 17.2 cm in length. The liver surface is smooth. Liver parenchyma demonstrates a mildly coarsened echotexture. No focal hepatic lesion is identified.The main portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.2 m/sec.BILIARY TRACT: The gallbladder is normal in appearance. There is no gallbladder wall thickening or pericholecystic fluid. The common duct measures 4 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreas is not well evaluated due to overlying bowel gas.SPLEEN: The spleen measures 9.8 cm in length.KIDNEYS: The right kidney measures 9.0 cm in length, the left kidney measures 9.4 cm in length. The renal cortex is normal in echogenicity bilaterally. There is no hydronephrosis or shadowing renal stone. OTHER: No significant abnormalities noted.", "output": "Mildly coarsened hepatic echotexture but no definite evidence of cirrhosis. No focal hepatic lesion."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal failure; chronic renal disease RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 8.4 cm cm in lengthLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 11.3 cm in lengthOTHER: Bladder nondistended", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis"}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs, presence of fatty liver or other liver pathology LIVER: Liver measures 16.1 cm with increased echogenicity consistent with hepatic steatosis. No focal lesions noted. No intrahepatic biliary ductal dilatation. Portal vein demonstrates normal flow directionality and patency.GALLBLADDER, BILIARY TRACT: Gallbladder is well distended with multiple gallstones that are mobile in nature. No evidence of gallbladder wall thickening or pericholecystic fluid. Common hepatic duct measures up to 2 mm without any stones within it.PANCREAS: No significant abnormalities noted.KIDNEY: Right kidney measures 11.1 cm and left measures 10.5 cm. No hydronephrosis. Normal echo texture. No focal lesions. OTHER: Spleen measures 8.8 cm without any focal lesions.", "output": "Cholelithiasis without evidence of cholecystitis.Mild Hepatic steatosis"}
{"instruction": "Generate impression based on findings.", "input": "87-year-old female. Left breast cancer undergoing neoadjuvant hormonal therapy. Follow-up ultrasound to evaluate treatment response. A focused left breast ultrasound at the 2 o'clock location, approximately 4 to 5 cm from the nipple, showed a 1.6 x 1.1 cm hypoechoic irregular mass, previously 1.4 x 1.2 cm, not significantly changed allowing for differences in technique.", "output": "No significant interval change in the known left breast cancer.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Reason: HCC surveillance History: HCV cirrhosis LIVER: The liver measures 14.2 cm in length. Coarse, echogenic hepatic parenchyma with a nodular contour, consistent with cirrhotic morphology. Round hypoechoic lesion with ill-defined borders in the anterior segment of the right hepatic lobe measures 2.3 x 2.5 x 2.5 cm. The main portal vein is patent with normal directional hepatopedal flow, peak velocity 21.5 cm/s.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. The gallbladder wall measures 0.1 cm. The common hepatic duct measures 0.4 cm. No biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.4 cm in length. Normal echogenicity. No hydronephrosis or shadowing stones.LEFT KIDNEY: The left kidney measures 9.8 cm in length. Normal echogenicity. No hydronephrosis or shadowing stones.OTHER: No ascites.", "output": "New lesion in the right hepatic lobe is highly concerning for hepatocellular carcinoma and should be further evaluated with a dedicated contrast enhanced liver protocol CT or MRI.These findings were communicated to ordering physician Elizabeth Boyle at 10:00 on 2/24/16"}
{"instruction": "Generate impression based on findings.", "input": "HCV LIVER: Multiple bilobar hepatic cysts again noted. No worrisome mass lesion. Liver length 13.4 cmGALLBLADDER, BILIARY TRACT: Gallbladder absent. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.4 cm in lengthOTHER: Left renal cyst. Left kidney 9.8 cm in length. Spleen 8 cm in length. No ascites.", "output": "Stable bilobar hepatic cysts. No worrisome hepatic mass. No ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Reason: patient with epigastric pain, r/o gallbladder disease History: abdominal pain, N/V LIVER: The liver measures 15.8 cm in length. The liver parenchymal echotexture is normal. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.19 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 5 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 9.0 cm in length. RIGHT KIDNEY: Kidney measures 9.8 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 9.6 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "No evidence of acute cholecystitis, biliary ductal dilatation, or other findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with history of thyroid carcinoma. Evaluate for recurrent disease. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No mass in the bedLEFT LOBE: No mass in the bedISTHMUS: No mass in the bedPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No evidence for recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "Male 55 years old Reason: RUQ pain History: RUQ pain This study is limited due to patient's bandages and scars across the abdomen.LIVER: Liver has slightly increased echogenicity, nonspecific. No focal liver lesions.BILIARY TRACT: There is sludge in the gallbladder. No evidence of gallbladder wall thickening or pericholecystic fluid. No evidence of intra or extrahepatic biliary dilatation. Sonographic Murphy sign could not be elicited.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 9.9 cm.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Slightly increased echogenicity of the liver. Sludge in the gallbladder. No sonographic evidence of acute cholecystitis or biliary dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Reason: kidney stone History: stone RIGHT KIDNEY: Right kidney measures 12.24 cm. There is severe right-sided hydronephrosis with parenchymal thinning. There are multiple renal stones throughout the right kidney, the largest in the right lower pole measuring 1.7 x 1.3 x 1.8 cm, previously 1.1 cm in greatest dimension on the prior CT. No suspicious renal lesions. There is been interval removal of right-sided nephrostomy tube and stent.LEFT KIDNEY: The left kidney measures 11.6 cm. There are no suspicious lesions or stones on the left.BLADDER: Bilateral jets are observed.OTHER: No significant abnormalities noted.", "output": "Severe right-sided hydronephrosis with multiple stones, the largest measuring up to 1.8 cm."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old male patient with history of lymphoma, now with pancreatitis. Evaluate for stones or biliary dilation. Abdominal pain. LIVER: The liver measures 19.2 cm in length and demonstrates increased parenchymal echogenicity. There is a mildly complex right hepatic cyst measuring 1.5 x 1.6 x 1.6 cm. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: There are gallstones, but no gallbladder wall thickening, or pericholecystic fluid.. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 4 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate similar echogenicity compared to the prior study. The tail is not visualized secondary to overlying bowel gas.RIGHT KIDNEY: The right kidney measures 11.3 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. OTHER: The left kidney measures 11.6 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis.The spleen measures 9.4 cm in length.Bilateral pleural effusions are noted. Free fluid is noted in the pelvis.", "output": "1. Cholelithiasis without sonographic evidence of acute cholecystitis.2. Echogenic hepatic parenchyma which can be seen with hepatic parenchymal dysfunction/hepatic steatosis.3. Echogenic kidneys suggestive of medical renal disease.4. Bilateral pleural effusions and pelvic ascites. "}
{"instruction": "Generate impression based on findings.", "input": "64 years old, Female, Reason: stones History: stones RIGHT KIDNEY: Kidney measures 9.3 cm in length. Normal echotexture. Nohydronephrosis or shadowing calculus. Simple appearing right renal cyst measures 0.9 x 0.8 x 1 cm.LEFT KIDNEY: Kidney measures 10.6 cm in length. Normal echotexture. Nohydronephrosis or shadowing calculus.Bladder: No evidence of calculus within the bladder.", "output": "1.No definite evidence of renal calculus.2.Simple appearing right renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "21 years old, Male, Reason: Hx of stem cell transplant with new AKI of unknown cause RIGHT KIDNEY: Kidney measures 9.9 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.8 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass. Subcentimeter hypoechoic focus in the inferior pole of left kidney is too small to accurately characterize on this examination but most likely represents a cyst. BLADDER: No significant abnormalities. OTHER: No significant abnormalities noted.", "output": "1.No evidence of hydronephrosis or nephrolithiasis to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old female patient with right upper quadrant pain, apparent gallstones on bedside ultrasound, elevated transaminases. Evaluate for choledocholithiasis, cholelithiasis, cholecystitis. LIVER: The liver measures 20.7 cm in length. Hepatic parenchymal echogenicity is increased and coarsened in echotexture. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There are gallstones without gallbladder wall thickening or pericholecystic fluid. No intrahepatic biliary ductal dilatation is seen. The visualized common duct measures 5-6 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas. A small peripancreatic lymph node is noted.RIGHT KIDNEY: The right kidney measures 10.5 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.5 cm in length. No evidence of hydronephrosis.The spleen measures 9.9 cm in length.", "output": "1. Increased hepatic parenchymal echogenicity which can be seen with hepatic steatosis/hepatic parenchymal dysfunction.2. Cholelithiasis without sonographic evidence of acute cholecystitis. Mild prominence of the common bile duct, depending on the patient's last meal. "}
{"instruction": "Generate impression based on findings.", "input": "Elevated liver enzymes LIVER: Mildly heterogeneous liver echotexture without mass. Liver length 13.7 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9.3 cm in lengthRIGHT KIDNEY: Absent OTHER: Echogenic left renal parenchyma with multiple cysts. Left kidney 12.1 cm in length. No hydronephrosis. No ascites.", "output": "Mildly heterogeneous liver echotexture suggestive for parenchymal dysfunction/fatty infiltration without mass or ductal dilatation. No ascites. Echogenic left renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without evidence for obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant abdominal pain. History of cholecystectomy, per patient. LIVER: Non-cirrhotic liver morphology. Mildly coarsened and increased parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Status post cholecystectomy.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 10.1 cm in length. The left kidney is 10.8 cm in length. No suspicious renal lesions are evident. Echogenic renal parenchyma bilaterally. No hydronephrosis is seen.SPLEEN: 7.7 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No significant abdominal free fluid is identified.", "output": "1. Mildly increased hepatic echogenicity, compatible with parenchymal dysfunction. No specific findings otherwise to account for the patient's symptoms.2. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "87-year-old male with abnormal liver function. LIVER: The liver is normal in size and echotexture. There is no focal hepatic abnormality.GALLBLADDER, BILIARY TRACT: No biliary tract dilatation. The gallbladder is somewhat collapsed with multiple large, shadowing calcarine and sludge. The wall, however, is not thickened and the patient was not tender over the gallbladder.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Nephrolithiasis without hydronephrosis. Large, simple lower pole cyst. Second highly complex cystic mass arising from the midpole with relatively thick internal septation and wall nodularity measuring 4.2 cm in diameter is unchanged from prior examinations.OTHER: Left kidney demonstrates nephrolithiasis without hydronephrosis.Splenic size upper normal.Small amount of ascites.", "output": "Liver appears unremarkable.Borderline splenomegaly.Multiple gallstones and sludge within the gallbladder without obvious complication.Bilateral nephrolithiasis without obstruction.Highly complex right renal cystic mass unchanged.Simple right renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "Stem cell transplant with increasing LFTs LIVER: Echogenic coarse liver parenchyma without mass or ductal dilatation. Liver length 15.6 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 13.1 cm in lengthOTHER: Left kidney 12.5 cm in length. Spleen 13.1 cm in length. No ascites.", "output": "Coarse echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Follow-up gallbladder polyp LIVER: Normal liver echogenicity without mass. 13.4 cm in lengthBILIARY TRACT: Stable subcentimeter gallbladder polyp measuring 0.3 x 0.3 x 0.3 cm. No ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9.8 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.3 cm in lengthOTHER: Left kidney 9.2 cm in length. No ascites.", "output": "Stable subcentimeter gallbladder polyp."}
{"instruction": "Generate impression based on findings.", "input": "Follow-up gallbladder polyp LIVER: Normal parenchymal echogenicity without mass. Liver length 16 cmBILIARY TRACT: Stable gallbladder polyp measuring 0.7 x 0.6 x 0.6 cm. Midportion of common bile duct obscured by gas. No evidence for intrahepatic ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9.6 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.1 cm in lengthOTHER: Left kidney 10 cm in length. No ascites.", "output": "Stable gallbladder polyp."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C; Mantle cell lymphoma. LIVER: Coarse echogenic liver parenchyma without mass. Liver length 17.7 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.5 cm in lengthOTHER: Left kidney 12.1 cm in length. Spleen 12.7 cm in length. No ascites.", "output": "Coarse echogenic liver parenchyma consistent with chronic liver disease without mass or duct dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "53 y.o. male with SIRS but no source of infection. LIVER: Course, echogenic liver. No masses or intrahepatic ductal dilation. Small amount of ascites.GALLBLADDER, BILIARY TRACT: Gall bladder wall is within normal limits. Common bile duct measures 4.0 mm. No stones or sludge. Trace pericystic fluid is seen.PANCREAS: No significant abnormality noted.SPLEEN: Measures 14.3cm but not well visualized on this study. No abnormalities in the visualized portions of the spleen.KIDNEYS: Right kidney measures 12.2 cm. Normal echogenicity. No stones or hydronephrosis. Left kidney measures 12.7 cm. Normal echogenicity. No stones or hydronephrosis. ABDOMINAL AORTA: Measures between 2.0 and 2.4 cm in diameter. No abnormalities.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Coarse, echogenic liver consistent with diffuse parenchymal dysfunction / fatty infiltration.2. Trace pericholecystic fluid and edema.3. No sonographic signs of infection."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old male with Burkitt's tumor or lymphoma and each IV. Palpable mass at level of left knee. In the posterior medial soft tissues at the level of the knee joint there is a complex cystic mass measuring 1.5 x 2.5 x 3.3 cm corresponding to the couple abnormality. There is no surrounding abnormality in the soft tissues and no obvious vascularity.", "output": "Baker's cyst left knee is the most likely consideration. Hematoma or abscess less likely possibilities."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Dupart is a 54 year old female with a personal history of ovarian cancer now status post total abdominal hysterectomy and bilateral salpingooophorectomy who presents for imaging evaluation of a palpable mass in the right breast. Three standard views of both breasts plus an additional left MLO view and spot compression right CC and ML views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty (BiRads Density Category A), unchanged in pattern and distribution. A triangular marker overlies upper inner quadrant of the right breast, indicating the site of the palpable abnormality. There are four contiguous focal asymmetries in the right medial breast, which are better appreciated on the ML spot compression view, which together occupy a region measuring up to 3.7 cm. Scattered benign calcifications are noted bilaterally. A benign intramammary lymph node present in the right upper outer quadrant. ULTRASOUND", "output": "1 indeterminate structure within the right upper inner quadrant, for which ultrasound-guided biopsy is recommended to ensure benignity.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.Findings were discussed with the gynecology resident on call, Kathryn Hawley, on 9/15/2016 at approximately 2:15 PM."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C. Evaluate for cirrhosis and hepatocellular carcinoma. LIVER: Noncirrhotic liver morphology. No focal hepatic lesions evident. Normal portal venous blood flow.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Normal appearance of the gallbladder.PANCREAS: Normal sonographic appearance of the visualized pancreatic head, neck, and proximal body. The distal body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 10.4 cm in length. The left kidney is 9.9 cm in length. No focal renal lesions are seen. No hydronephrosis.SPLEEN: 8.4 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites identified.", "output": "No sonographic evidence of cirrhosis or findings suspicious for hepatocellular carcinoma."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain and mild lipase elevation. LIVER: The liver is mildly coarse and echogenic without a focal abnormality. No intrahepatic biliary ductal dilatation. It measures 14.5 cm in length. Normal hepatopedal portal venous blood flow at 26.7 cm/s.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 4 mm. Normally distended gallbladder without gallstones wall thickening, pericholecystic fluid or focal tenderness.PANCREAS: The visualized pancreatic body and head are unremarkable. The remainder of the pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 8.4 cm without a focal abnormality.RIGHT KIDNEY: The right kidney measures 10.7 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. OTHER: The left kidney measures 10.8 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion.", "output": "Mildly coarse echogenic liver parenchyma may represent fatty infiltration and/or parenchymal dysfunction without a focal abnormality. The visualized pancreatic body and head are unremarkable. No gallstones or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Male 55 years old Reason: incidental lesions in right kidney. Had ultrasound here in 2010, pleas compare RIGHT KIDNEY: Right kidney measures 9.7 cm. Renal cortical echogenicity is within normal limits. There are multiple cysts again seen in the right renal cortex. Within the lower pole of the right kidney there is a ill-defined, predominantly anechoic structure with an adjacent or peripheral calcification. Although this does not meet criteria for a simple renal cyst, it has not increased in size since the prior exam 6 years ago measuring 1.4 x 1.0 x 0.9 cm. A separate well-circumscribed anechoic right renal cyst near the superior pole measures 1.1 x 1.1 x 1.3 cm. No hydronephrosis.LEFT KIDNEY: Left kidney measures 10.5 cm. Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass.OTHER: No significant abnormalities noted.", "output": "1.Cyst in the lower pole the right kidney has ill-defined borders with an adjacent or peripheral calcification. Although this does not meet criteria for a simple renal cyst, it has not increased in size since the prior exam 6 years ago2.No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female with bilateral lower extremity edema, heart failure, chronic kidney disease now with decompensated heart failure and acute kidney injury. Last ultrasound in 2/2016. RIGHT KIDNEY: The right kidney measures 11.7 cm in length. There is a right upper pole renal cyst measuring 2.8 x 2.8 x 2.8 cm. Multiple anechoic small cysts are again seen. No hydronephrosis. Echogenic renal parenchyma. There is a new shadowing echogenic focus in the right mid pole measuring 1.2 x 0.9 x 1 cm compatible with a stone.LEFT KIDNEY: The left kidney measures 11.7 cm in length. Echogenic renal parenchyma. The known left lower pole renal cyst measuring 7.3 x 6.4 x 6.2 cm has increased in size (prior 5.9 x 5.7 x 4.9 cm). No hydronephrosis or shadowing renal calculi.URINARY BLADDER: The urinary bladder is drained by a Foley catheter.OTHER: No significant abnormalities noted.", "output": "1. Echogenic renal parenchyma compatible with medical renal disease.2. New nonobstructing stone of the right midpole.3. Bilateral renal cysts with the left lower pole cyst increasing in size."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 70-year-old man with hyperthyroidism. On anti-thyroid meds. Check thyroid anatomy. History: hyperthyroidism RIGHT LOBE MEASUREMENTS: 7.0 x 3.0 x 3.4 cm.LEFT LOBE MEASUREMENTS: 6.6 x 3.4 x 3.0 cm.ISTHMUS MEASUREMENTS: Up to 1.5 cm in thickness.RIGHT LOBE: Enlarged, heterogeneous gland containing multiple hyperechoic nodules. LEFT LOBE: Enlarged, heterogeneous gland containing multiple hyperechoic nodules. ISTHMUS: Enlarged, heterogeneous gland containing multiple hyperechoic nodules. PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Enlarged, heterogeneous thyroid gland with multiple hyperechoic nodules compatible with thyroiditis. No suspicious nodules identified."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with history of hepatitis C presents for evaluation of possible hepatocellular carcinoma. LIVER:Measures 16.3 cm. Increased echogenicity. No focal mass, intrahepatic biliary dilation, or ascites. Portal vein is patent with hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. The common bile duct measures 7.1 cm. The common hepatic duct measures 6.1 cm.PANCREAS: Evaluation the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 10.8 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 10.3 cm. Left kidney measures 11.1 cm. Echogenicity is unremarkable. No shadowing, hydronephrosis, or focal mass. OTHER: Known adrenal mass not well visualized on this study.", "output": "Echogenic liver consistent with chronic liver disease/parenchymal dysfunction. No focal mass or ascites."}
{"instruction": "Generate impression based on findings.", "input": "59 year-old female with abnormal LFTs. LIVER: Normal echogenicity of the liver measuring 15.6 cm in length. No focal hepatic lesion. Portal vein is patent with appropriate directional flow.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. No intra or extrahepatic biliary ductal dilatation.PANCREAS: The visualized portions of the pancreas are normal echogenicity with no evidence of pancreatic ductal dilatation.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 10.5 cm in length. No hydronephrosis.OTHER: Normal echogenicity of the left kidney measuring 10.2 cm in length. No hydronephrosis.Normal echogenicity of the spleen measuring 8.7 cm in length.", "output": "Unremarkable examination. "}
{"instruction": "Generate impression based on findings.", "input": "Obesity and history of fatty liver LIVER: Coarse and echogenic liver parenchyma again noted without mass. Liver length 14.6 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.5 cm in lengthOTHER: Left kidney 11.7 cm in length spleen 10.9 cm in length. No ascites", "output": "Coarse and echogenic liver parenchyma again noted without change consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female with recent normal screening mammogram dated 9/24/2015 presents to the diagnostic clinic to evaluate left breast focal pain. Pain is predominantly in the left breast from 9 to 10:00 position On physical examination, no discrete palpable mass noted.A targeted right ultrasound was performed for the patient\u2019s area of concern. Normal glandular tissue identified. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy corresponding to patient's area of pain in the left breast 9 to 10:00 position.Annual screening mammogram is recommended, due in September 2016.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Recurrence of left hip abscess History: neutropenic septic shock, ESBL bacteremia, history of E.coli abscess There is extensive subcutaneous edema and inflammation in the soft tissues overlying the left hip. No loculated fluid collections.", "output": "Extensive subcutaneous edema and inflammation without loculated fluid collection or abscess."}
{"instruction": "Generate impression based on findings.", "input": "29 year-old female with recent elevated liver enzymes and epigastric abdominal pain. LIVER: Normal echogenicity of the liver measuring 13.8 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.1 m/sec.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. Pericholecystic fluid. Common duct measures 2 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Measures 10.5 cm in length and is normal in echogenicity. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the spleen measuring 8.9 cm in length. Cyst measures 7 mm x 7 mm x 7 mm.Left kidney measures 10.8 cm in length and is normal in echogenicity. No hydronephrosis or shadowing calculi are noted.", "output": "Splenic cyst. Otherwise unremarkable examination."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old male patient with multinodular goiter. Evaluate nodule size, characteristics. RIGHT LOBE MEASUREMENTS: 3.2 x 1.5 x 1.8 cm.LEFT LOBE MEASUREMENTS: 3.5 x 1.3 x 1.6 cm.ISTHMUS MEASUREMENTS: 4 mm in thickness.RIGHT LOBE: The right thyroid lobe is heterogeneous in echogenicity. There is suggestion of a slightly hypoechoic, heterogeneous solid nodule within the lower pole measuring 0.9 x 0.9 x 1.3 cm. There is no significant increased vascularity over the background thyroid.LEFT LOBE: The left thyroid lobe is heterogeneous in echogenicity without dominant lesion.ISTHMUS: The isthmus is heterogeneous in echogenicity. There is a 0.7 x 0.4 x 0.9 cm isoechoic solid nodule with cystic components within the left aspect of the isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There are benign morphology lymph nodes within the left neck.OTHER: No significant abnormality noted.", "output": "1. Heterogeneous thyroid gland compatible with chronic thyroiditis.2. Non-specific small bilateral thyroid nodules. "}
{"instruction": "Generate impression based on findings.", "input": "48-year-old male with history of hepatitis C, evaluate for HCC and fibrosis. LIVER: Measures 19.9 in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: No cholelithiasis. No gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilation. 0.3 cm gallbladder polyp.PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Unremarkable in size and echogenicity. KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "Hepatomegaly with increased echogenicity consistent with chronic liver disease, without discrete focal lesion. "}
{"instruction": "Generate impression based on findings.", "input": "History of cirrhosis LIVER: 15.1 cm with diffuse coarse echotexture, cirrhotic morphology. No focal lesion noted. No intrahepatic biliary ductal dilatation. Portal vein demonstrates normal flow directionality and patency.BILIARY TRACT: Gallbladder is well-distended without any gallbladder wall thickening. No evidence of gallstonesPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. Mildly increased size of the spleen measures 13.1 cm.RIGHT KIDNEY: Right kidney measures 13.1 cm and left kidney measures 14.7 cm. No hydronephrosis. Normal echotexture. OTHER: No ascites", "output": "Cirrhotic morphology of the liver without suspicious lesion.Mild splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "History of multinodular goiter by biopsy, patient states slowly enlarging RIGHT LOBE MEASUREMENTS: 7 x 3 x 2.8 cm, enlarged and heterogenousLEFT LOBE MEASUREMENTS: 0.9 x 1.1 x 2.1 cmISTHMUS MEASUREMENTS: 11 mmRIGHT LOBE: Multiple heterogenous nodules throughout the right perihilar gland, mostly in the mid to inferior pole. The largest nodule with few cystic changes measures 5 x 3.1 x 5.3 cm.LEFT LOBE: A small hypoechoic nodule identified in the midpole of the left lobe that measures 1 x 0.6 x 0.8 cm.ISTHMUS: A heterogenous nodule noted within the isthmus and measures 2.4 x 1.2 x 1.3 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No abnormal lymph nodes identified in the neckOTHER: No significant abnormality noted.", "output": "Heterogenous multiple thyroid nodules predominantly in the right lobe and the isthmus most likely multinodular goiter. Comparison with prior ultrasound is recommended to confirm stability."}
{"instruction": "Generate impression based on findings.", "input": "Post heart transplant 2 weeks ago. Now with acute kidney injury. Evaluation limited by patient body habitus.RIGHT KIDNEY: Right kidney measures 9.5 cm. No hydronephrosis or renal calculus identified.LEFT KIDNEY: Left kidney measures 10.0 cm. No hydronephrosis or renal calculus identified.URINARY BLADDER: No significant abnormalities noted. Right ureteral jet is observed.OTHER: No significant abnormalities noted.", "output": "Limited evaluation, with no evidence of acute renal abnormality. No renal calculus or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with history of end-stage renal disease, multiple prior central venous access, and currently receiving dialysis via an upper arm graft on the left was recalled from her baseline screening mammogram for a small mass in the upper outer periareolar region of the right breast. No current breast related complaints. No prior breast biopsy seizure. No family history of breast cancer. An ML view and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 8.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. The asymmetry persists and has the appearance of a small mass at the periareolar 10:00 position of the right breast. Note is made of extensive distended venous collaterals in the right breast as well as arterial calcifications.Ultrasound: Targeted ultrasound performed the area of mammographic concern. There is a fairly circumscribed 0.6 x 0.3 x 0.4 cm hypoechoic mass with partially smooth curved margins and partially irregular angulated margins located at the 10:00 periareolar position of the right breast at mid depth. This corresponds in size, shape, and location to the asymmetry that triggered this exam. There is questionable marginal blood flow on color Doppler imaging.", "output": "Indeterminate mass at the 10:00 periareolar position of the right breast. Both benign and malignant etiologies are possible. Ultrasound-guided core biopsy recommended. The results and recommendations were discussed with the patient at the completion of the exam, and the patient elected to undergo the biopsy. She was instructed that our Department will contact her to arrange an appointment for the biopsy.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneus Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "48 year old female with abnormal liver function tests. LIVER: The liver measures 14.9 cm in length. Mildly increased parenchymal echogenicity is suggestive of fatty infiltration/parenchymal dysfunction. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 9.6 cm in length. RIGHT KIDNEY: Kidney measures 9.5 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass. Superior pole simple cyst measuring 1.8 x 1.5 x 1.9 cm. LEFT KIDNEY: Kidney measures 13.1 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis.2.Mildly increased parenchymal echogenicity is suggestive of fatty infiltration/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain and increasing LFTs.; pregnant with coagulopathy LIVER: Mildly heterogeneous liver echotexture without mass. Liver length 20.6 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.2 cm in lengthOTHER: No ascites", "output": "Hepatomegaly with mildly heterogeneous liver echotexture suggestive for parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 51F with no known history of kidney disease, now with rising creatinine RIGHT KIDNEY: The right kidney measures 13.8 cm in length. Mildly echogenic renal parenchyma. No focal mass, hydronephrosis, or shadowing stones.LEFT KIDNEY: The left kidney measures 13.8 cm in length. Mildly echogenic renal parenchyma. No focal mass, hydronephrosis, or shadowing stones. There is a simple cyst in the superior pole of the left kidney measuring 4.8 x 3.3 cm.OTHER: No significant abnormalities noted.", "output": "Mildly echogenic renal parenchyma, possibly consistent with medical renal disease. No evidence of obstruction."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old male. Elevated AST and ALT, elevated ACE level, lacrimal gland swelling. Evaluate liver for any changes suspicious for sarcoidosis. LIVER: Normal echogenicity of the liver, which measures 18 cm in length. No focal lesion. Hepatopetal portal venous flow.GALLBLADDER, BILIARY TRACT: No biliary ductal dilatation. Common duct is 4 mm in diameter, with the normal limits. No cholelithiasis or gallbladder wall thickening.PANCREAS: Visualized portions of the pancreatic head and neck show normal echogenicity. The rest of the pancreas is obscured by bowel gas.RIGHT KIDNEY: Normal echogenicity without focal mass. 11.3 cm in length. No hydronephrosis.OTHER: The spleen is 11.3 cm in length. Left kidney is 11.9 cm in length without hydronephrosis.", "output": "Normal appearance of the liver with no focal lesions."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old male with acute kidney injury, evaluate for obstruction. RIGHT KIDNEY: Measures 9.9 cm in length. No hydronephrosis, nephrolithiasis, or solid lesion. Normal echotexture.LEFT KIDNEY: Measures 9.8 cm in length. No hydronephrosis, nephrolithiasis, or solid lesion. Normal echotexture.URINARY BLADDER: Incompletely distended.OTHER: No significant abnormalities noted.", "output": "No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "24-year-old male with cholecystostomy tube, abdominal pain. Evaluate for tube position. LIVER: Liver appears mildly coarsely echogenic without focal abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein. Tracing is pulsatile which may be seen with congestive heart failure.GALLBLADDER, BILIARY TRACT: Gallbladder is nondistended. There is a portion of a drainage tube identified within the gallbladder. There are also moderately echogenic and non-shadowing foci which may be due to sludge or small amount of hemorrhage. No pericholecystic fluid.PANCREAS: Not visualized due to bowel gas.RIGHT KIDNEY: Atrophic with calcifications.OTHER: Ascites and right pleural effusion.", "output": "Echogenic liver.Drainage tube identified within the gallbladder.Ascites and right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "73 year old female who was recalled from outside screening mammogram for left breast asymmetry. MAMMOGRAM: An ML view and two spot compression views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Within the left breast, 12 o'clock position, the previously visualized asymmetry partially disperses on spot compression imaging, suggesting superimposition of fibroglandular tissues.Within the right breast, upper outer quadrant, there is a new 0.8-cm mass which persists on spot compression imaging.ULTRASOUND: A targeted left ultrasound was performed for the mammographic area of concern. A dense band of fibroglandular tissue is noted. There is no solid or cystic mass identified.A targeted right ultrasound was subsequently performed for the mammographic area of concern. At the 10 o'clock position of the right breast, 5 cm from the nipple, there is a well-circumscribed anechoic cyst mild posterior acoustic enhancement measuring 0.5 x 0.4 x 0.5 cm, likely corresponding to the finding on mammogram.", "output": "Dense fibroglandular tissue in the upper central left breast corresponding to the asymmetry on mammogram. Right simple breast cyst. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": " Ultrasound guidance was provided for biopsy of transplant kidney in the left iliac fossa. Two passes were performed.", "output": "Ultrasound guidance for renal transplant biopsy. "}
{"instruction": "Generate impression based on findings.", "input": "Male; 60 years old. Reason: h/o hemangioma, assess for interval change LIVER: The liver has a nodular contour. Liver measures 18.0 cm in length. The parenchyma is normal in echotexture. There is no focal hepatic mass identified.The portal vein is patent and demonstrates normal directional flow with a peak velocity of 0.25 m/sec.BILIARY TRACT: The gallbladder contains layering sludge. There is no cholelithiasis, wall thickening or pericholecystic fluid. Common duct measures 3 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 6.9 cm. The cortex is normal in echogenicity but thin. No shadowing calculi or hydronephrosis is present. 1.2 x 0.9 x 1.3 cm slightly hypoechoic structure is seen in the right kidney. There is no associated abnormally increased vascular flow. The left kidney measures 13.8 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 12.6 cm. in length. OTHER: Bilateral pleural effusions.", "output": "1.Hepatomegaly.2.No hepatic hemangioma is identified and no prior imaging was available for comparison at the time of this dictation.3.Right kidney lesion likely represents a prominent column of Bortan but follow up with contrast-enhanced CT or MRI is recommended to exclude underlying neoplasm.4.Bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Reason: heart transplant w/u History: see above LIVER:Mild increased echogenicity may suggest a stenosis. No focal hepatic lesions. Portal vein is patent. Increased pulsatility of the main portal vein may suggest right-sided heart failure. Liver measures 19.2 cm in craniocaudal dimension.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy.PANCREAS: Pancreas is partially obscured.SPLEEN: Spleen measures 11.9 cm in length.KIDNEYS: Simple appearing right mid pole cyst measures 1.6 x 1.7 x 1.9 cm. Exophytic simple appearing right upper pole cyst measures 6.7 x 2.2 x 3.6 cm. Simple appearing left mid to lower pole cysts measures 5.7 x 4.9 x 5.1 cm ABDOMINAL AORTA: The proximal abdominal aorta measures 2.4 x 1.7 x 1.4 cm. The mid abdominal aorta measures 2.0 cm but is partially obscured by overlying bowel gas. The distal abdominal aorta and iliac arteries not visualized due to bowel gasINFERIOR VENA CAVA: IVC is patent.OTHER: Small bilateral effusions.", "output": "1.Increased pulsatility of the main portal vein may suggest right-sided heart failure.2.Small bilateral effusions.3.Diffuse hepatic echogenicity suggestive of steatosis.4.Simple appearing bilateral renal cysts.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Multiple 1-2 cm gallstones identified. No gallbladder wall thickening or pericholecystic fluid. No sonographic Murphy's sign.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 8.9 cm in length. The left kidney is 10.3 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 9.9 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No significant free fluid identified.", "output": "Cholelithiasis without specific evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with right upper quadrant pain. LIVER:Measures 15.2 cm. Increased, coarse echogenicity of the parenchyma. No ascites or intrahepatic biliary dilation. There is an approximately 2.6 x 2.3 x 2.8 cm well-defined hyperechoic lesion in the posterior right lobe.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. The wall measures 1.9 mm. No pericholecystic fluid, sludge, or stones. Common duct measures 4.1 mm.PANCREAS: Evaluation the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 10.7 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 12.8 cm. Left kidney measures 13.1 cm. Unremarkable echogenicity. No shadowing calculi, hydronephrosis, or focal mass.OTHER: No significant abnormality noted.", "output": "1. Increased, coarse echogenicity of liver parenchyma consistent with chronic liver disease and fatty infiltration/parenchyma dysfunction. No ascites.2. Hyperechoic lesion as described above statistically most likely represents a benign etiology such as a hemangioma. If a malignancy is clinically suspected, then dedicated cross-sectional imaging may be indicated.3. No evidence of cholelithiasis or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess parathyroids History: hyperparathyroidism RIGHT LOBE MEASUREMENTS: 4.0 x 1.8 x 1.9 cmLEFT LOBE MEASUREMENTS: 2.8 x 1.5 x 1.8 cmISTHMUS MEASUREMENTS: 0.5 cm in the AP dimensionRIGHT LOBE: Homogeneous gland with several subcentimeter benign-appearing cystic nodules.LEFT LOBE: Homogeneous gland. Small cystic upper pole nodule measures 0.3 x 0.3 x 0.4 cm without internal calcifications or vascularity.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: None visualized.LYMPH NODES: No significant abnormality noted. No cervical lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Normal appearing thyroid with several subcentimeter colloid nodules. No parathyroid candidate is identified."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Rule out cirrhosis; HCC History: HCV diagnosed 30 years ago LIVER: The liver measures 16.47 m in length. Coarse, echogenic hepatic parenchyma. Mildly nodular hepatic contour. The portal vein is patent with normal directional hepatopedal flow, peak velocity is 25.8 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. No cholelithiasis. The gallbladder wall measures 0.4 cm and the common bile duct measures 0.5 cm. No biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.6 cm in length. No hydronephrosis, shadowing renal calculi, or focal mass. Small anechoic mid pole cyst measures 1.2 x 1.0 cm in the longitudinal plane.LEFT KIDNEY: The left kidney measures 11.1 cm in length. No hydronephrosis, shadowing renal calculi, or focal mass.OTHER: The spleen measures 12.3 cm in length. No ascites.", "output": "Coarse, echogenic liver with a mildly nodular contour, consistent with parenchymal dysfunction or chronic liver disease. No focal mass identified."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female with nontoxic goiter. RIGHT LOBE MEASUREMENTS: 1.5 x 1.2 x 5.1 cmLEFT LOBE MEASUREMENTS: 1.3 x 1.5 x 5.2 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Homogeneous echotexture. Small cyst with comet tail artifact consistent with colloid.LEFT LOBE: Homogeneous echotexture. Very small cysts identified. In the lower pole there is a mildly hypoechoic nodule with a somewhat spongiform appearance measuring 0.5 x 0.6 x 0.7 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Small cystic nodules bilaterally. Slightly larger left nodule may be spongiform."}
{"instruction": "Generate impression based on findings.", "input": "66 year old female with hyperparathyroidism. Evaluate for abnormal parathyroid glands and thyroid nodules. RIGHT LOBE MEASUREMENTS: 4.9 cm x 1.6 cm x 1.4 cm.LEFT LOBE MEASUREMENTS: 4.8 cm x 1.4 cm x 1.3 cm. ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: Heterogeneous echotexture. Several subcentimeter nodules are seen.LEFT LOBE: Heterogeneous echotexture. Several subcentimeter nodules are seen.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Hypoechoic nodular focus which appears separate from the left thyroid lobe inferiorly is seen measuring 4 mm x 4 mm x 3 mm.LYMPH NODES: Benign-appearing right neck level 5 lymph node measuring 1.1 cm x 0.4 cm x 0.6 cm.OTHER: No significant abnormality noted.", "output": "1. Hypoechoic nodular focus inferior to the left thyroid lobe is nonspecific but given history of hyperparathyroidism may represent a parathyroid adenoma. Please refer to same day nuclear medicine scintigraphic study for additional findings. A small lymph node is another differential consideration.2. Subcentimeter thyroid nodules. "}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female presents with a history of clear intermittent left nipple discharge for approximately 12 months. Inverted left nipple for approximately two years. The patient states that she has always had \"lumpy breasts\". Three standard views of both breasts and spot compression views of the left retroareolar breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses(BiRads Density Category C), unchanged in pattern and distribution. There is asymmetric glandular density in the left retroareolar breast, which disperses with spot compression.ULTRASOUND", "output": "No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female patient with known history of ADPKD and stage IV CKD. Evaluate for cysts in the liver. Evaluate size of kidneys. LIVER: The liver measures 20.1 cm in length. A 0.5 x 0.5 x 0.4 cm hyperechoic lesion is noted within the right hepatic lobe adjacent the gallbladder.. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 4 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 18.7 cm in length, is echogenic, and contains multiple cysts, some of which are complex. The largest within the right upper pole measures 6.3 x 4.7 x 6.1 cm. No evidence of hydronephrosis. OTHER: The left kidney measures 18.4 cm in length, is echogenic, and contains multiple cysts, some of which are complex. The largest measures 12.7 x 7.0 x 10.7 cm. No evidence of hydronephrosis.The spleen measures 9.9 cm in length.", "output": "1. No cysts identified in the liver. Subcentimeter hyperechoic right hepatic lobe lesion; this likely represents a hemangioma in the absence of chronic liver disease/abnormal liver morphology.2. Medical renal disease with bilateral renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "Primary biliary cirrhosis. Six-month screening per clinical trial. LIVER: Minimally nodular liver contours, compatible with chronic liver disease. 17.6 cm in length. Increased hepatic echogenicity, compatible with parenchymal dysfunction. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Normal appearance of the gallbladderPANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas. No pancreatic ductal dilation.KIDNEYS: The right kidney is 13.7 cm in length, with a 8 mm benign-appearing cyst. The left kidney is 12.1 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 10.0 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal ascites is identified.", "output": "Minimally nodular liver contours, compatible with cirrhosis."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old male with acute kidney injury. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 9.3 cm in length. No hydronephrosis, shadowing calculi, or suspicious lesions. Normal renal echogenicity.LEFT KIDNEY: The left kidney measures 12 cm in length. No hydronephrosis, shadowing calculi, or suspicious lesions. Normal renal echogenicity.URINARY BLADDER: The urinary bladder is collapsed and not well evaluated.OTHER: No significant abnormalities noted.", "output": "No hydronephrosis. "}
{"instruction": "Generate impression based on findings.", "input": "Colon carcinoma with bilateral hydronephrosis with ureteral stents with nausea vomiting and persistent diarrhea RIGHT KIDNEY: Echogenic renal parenchyma. Slight interval worsening of moderate right hydronephrosis. Right ureteral stent observed and in anatomic location. No worrisome renal mass or stone. Right kidney 12.6 in meters in length.LEFT KIDNEY: Echogenic renal parenchyma Stable mild left hydronephrosis. Ureteral stent in anatomic location. Stable left renal cyst. No worrisome mass or stone. Left kidney 12.1 cm in length.OTHER: Bladder nondistended. Questionable debris within the bladder noted.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction. Slight interval worsening of moderate right hydronephrosis. Stable left minimal hydronephrosis. Bilateral ureteral stents in anatomic location. Bladder not distended; questionable debris within the bladder."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old female with cardiomyopathy and possibly cirrhosis. Preheart transplant. LIVER:Overall hepatic size is within normal limits. The liver is very mildly echogenic consistent with parenchymal disease. No focal hepatic mass is seen. Limited spectral and color Doppler demonstrates patency and appropriate flow direction in the main portal vein. GALLBLADDER, BILIARY TRACT: The gallbladder appears somewhat distended. However, the gallbladder is otherwise normal without cholelithiasis, wall thickening or pericholecystic fluid. The visualized portions of the biliary tract are normal in caliber.PANCREAS: No significant abnormality noted.SPLEEN: Normal in size.KIDNEYS: The right kidney measures 9.7 cm in length and appears unremarkable. No hydronephrosis, shadowing calculus or mass. Left kidney is in adequately visualized on this study due to bowel gas. There is however no gross hydronephrosis. ABDOMINAL AORTA: Normal in caliber without aneurysm.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No fluid collections are seen.", "output": "Mildly echogenic liver..Gallbladder distention without other abnormality."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old with known left breast cancer and questionable left axillary lymphadenopathy on physician exam. A targeted left ultrasound was performed for the left axilla. Three lymph nodes as are seen in total. Two of these have completely normal morphology. The third node measuring 10 x 8 mm has a slightly eccentrically thickened cortex measuring only between two and 3 mm and preserved normal hilar blood flow.", "output": "Three axillary lymph nodes, two of normal morphology and the other of low suspicion. Findings were discussed with Dr. Jaskowiak. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female with biopsy proven fibroadenoma in the left breast presents for follow-up With focused ultrasound, there is a known hypoechoic mass, which is a biopsy proven fibroadenoma, with marker clip lateral to the mass at 12:00 position in the left breast. The lesion measures 0.9 x 0.5 x 1.1 cm (previously 0.9 x 0.5 x 1.2 cm).", "output": "No significant interval change in size of the biopsy-proven left fibroadenoma. No further imaging follow-up is needed.Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Right lower quadrant abdominal pain LIVER: Coarse echogenic liver echotexture without mass. Liver length 13.5 cmBILIARY TRACT: 0.3 x 0.3 x 0.2 cm subcentimeter gallbladder polyp. No ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 11 cm in lengthRIGHT KIDNEY: Right renal cyst. Right kidney 10.5 cm in lengthOTHER: Left kidney 9.5 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture suggestive for parenchymal dysfunction/fatty infiltration without mass or ductal dilatation. Subcentimeter gallbladder polyp. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Mr. Cochran is a 63-year-old man presenting for ultrasound-guided biopsy of a previously identified right high axillary mass. A targeted right axillary ultrasound was performed for the previously identified axillary mass on ultrasound from 11/11/2015. After thorough examination of the high right axillary region, no such mass was able to be reproduced on today's examination. In addition, a second radiologist confirmed the absence of this axillary mass.At this point, a decision was made to abort the exam as no such mass could be reproduced on today's examination.", "output": "No sonographic evidence of malignancy in the high right axillary region. The patient should follow up with his primary care physician as clinically warranted. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma again noted without worrisome mass or hydronephrosis. Multiple echogenic foci consistent with subcentimeter nonobstructing stones. Right kidney 7.2 cm in length.LEFT KIDNEY: Echogenic parenchyma again noted without worrisome mass or hydronephrosis. Multiple echogenic foci consistent with subcentimeter nonobstructing stones. Left kidney 8.2 cm in length.OTHER: Debris within bladder noted.", "output": "Echogenic parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass or hydronephrosis. Bilateral nonobstructing subcentimeter nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "84 year old female with abdominal pain. Evaluate lesion seen on same day CT exam. The study is limited by the patient's reported contracted state.RIGHT KIDNEY: The right kidney is atrophic and echogenic, measuring 8.4 cm in length. There is a 2.0 x 1.8 x 2.2 cm inferior pole hypoechoic complex lesion corresponding to the lesion seen on the same day CT.LEFT KIDNEY: The left kidney is atrophic and echogenic, measuring 7.9 cm in length. Mild nonspecific heterogeneity of the superior pole of the left kidney is noted. There appears to be a 8 x 5 x 8 mm lower pole hypoechoic lesion which is difficult to characterize on ultrasound, uncertain whether correlates to interpolar region 8 mm lesion seen on the same day CT.OTHER: The urinary bladder is partially distended with anechoic urine.", "output": "Limited study as described above.1. 2.2-cm right inferior pole hypoechoic complex mass, again suspicious for a renal cell carcinoma. Additional left renal findings as above.2. Given the patient's contracted state, future follow up of the aforementioned lesions may be better achieved with dedicated CT imaging."}
{"instruction": "Generate impression based on findings.", "input": "Female 64 years old; Reason: of liver screen for hcc. hbv History: same LIVER: The liver measures 15.2 cm in length. There is coarse increased echogenicity of the liver parenchyma. There is a nodular appearance of the liver No fluid worrisome masses. A simple appearing hepatic cyst is revisualized in the right lobe measuring 1.2 cm x 1.1 cm x 1.4 cm. This previously measured 1.7 cm x 0.8 cm x 1.4 cm. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 23.8 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder surgically absent. The common bile duct measures 2.8 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen is surgically absent.RIGHT KIDNEY: The right kidney measures 7.4 cm in length. The cortex has increased echogenicity and appears atrophic. No hydronephrosis, stones, or worrisome masses are seen.RENAL TRANSPLANT: The renal transplant is poorly visualized due to overlying bowel gas and is likely atrophic.LEFT KIDNEY: Not visualized due to overlying bowel gas, likely atrophic", "output": "1. The liver has coarse increased echogenicity with a nodular appearance compatible with cirrhotic morphology. No new worrisome masses are seen.2. Right and left kidneys as well as the prior renal transplant are all not well visualized on this ultrasound and are likely atrophic."}
{"instruction": "Generate impression based on findings.", "input": "History of right ureteral stone status post ureteroscopy. Evaluate for hydronephrosis or nephrolithiasis. RIGHT KIDNEY: 11.3 cm in length. The renal cortex is mildly thinned, likely within normal limits for age. Simple appearing cysts noted. No renal stones or suspicious lesions identified. No hydronephrosis is present.LEFT KIDNEY: 11.4 cm in length. The renal cortex is mildly thinned, likely within normal limits for age. Simple appearing cyst noted. No renal stones or suspicious lesions identified. No hydronephrosis present.BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "No nephrolithiasis or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid cancer status post surgery and I-131 RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: No significant abnormality noted.LEFT LOBE: The previously seen hypoechoic focus measuring 5 x 6 x 2 mm is unchanged, accounting for differences in technique.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not identified.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "No specific evidence of recurrent or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "52 year old female with lupus nephritis, needs ultrasound guidance for biopsy Ultrasound guidance was provided for right kidney biopsy performed by the renal service.", "output": "Ultrasound guidance was provided for right kidney biopsy performed by the renal service."}
{"instruction": "Generate impression based on findings.", "input": "45 year old female who was recalled from screening mammogram for focal asymmetry in the right upper outer breast. History of right breast second-degree burn at 12:00 position in may 2016. Mammogram: An ML , repeat MLO view and 3 spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty(BiRads Density Category A), unchanged in pattern and distribution. Focal asymmetry in the right upper-outer quadrant mid to posterior depth disperses into normal breast tissue. On repeat right MLO view it is not as conspicuous and most likely represents glandular tissue.Ultrasound: Targeted right upper-outer quadrant ultrasound was performed. No definite target identified on ultrasound.", "output": "Focal asymmetry in the right upper-outer quadrant which was seen on screening mammogram is not as conspicuous on diagnostic mammogram probably related to healing history of second degree burn involving the right breast. Right unilateral diagnostic mammogram is recommended in 6 months for confirmation.BIRADS: 3 - Probably benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "21-year-old female with right upper quadrant pain. LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: No cholelithiasis or biliary ductal dilation. No gallbladder wall thickening or pericholecystic fluid.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "No evidence of cholelithiasis or cholecystitis. No abnormalities identified to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "58 year old female with history of right upper quadrant pain and prior elevated LFTs, evaluate liver, gallbladder and pancreas. LIVER: No significant abnormalities noted. Liver measures 17.9 cm.GALLBLADDER, BILIARY TRACT: Cholelithiasis, with gallbladder wall thickening up to 0.5 cm. A small amount of pericholecystic fluid is also seen. The common bile duct is dilated up to 0.7 cm.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right kidney measures 11 cm.OTHER: No significant abnormalities noted. Left kidney is within normal limits, and measures 11.8 cm.", "output": "Findings of acute calculus cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for gallstones History: RUQ pain and bloating, worse after eating LIVER: Liver is normal in size, measuring 14 cm in length. Coarse hepatic echotexture is noted. No focal hepatic lesion is identified.GALLBLADDER, BILIARY TRACT: Cholelithiasis. No gallbladder wall thickening, pericholecystic fluid. Sonographic Murphy sign is clinical.PANCREAS: Pancreatic head and tail is obscured by overlying bowel gas. Visualized pancreas is unremarkable.RIGHT KIDNEY: Right kidney measures 9.6 cm in length. No renal stones, mass, or hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Cholelithiasis. Equivocal sonographic Murphy sign. No specific signs of cholecystitis.2.Coarse hepatic echotexture; correlate with liver function tests to exclude hepatic parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Renal failure. Oliguria. Please note that examination is significantly limited by the patient's body habitus.RIGHT KIDNEY: 8.2 cm in length. The renal parenchyma is echogenic. No hydronephrosis. No large focal lesions are evident.LEFT KIDNEY: 7.1 cm in length. The renal parenchyma is echogenic. No hydronephrosis. No large focal lesions are evident.BLADDER: Nondistended.OTHER: No significant abnormalities noted.", "output": "Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. She has a personal history of right breast cancer status post mastectomy in 06/2015 for IDC with disease positive nodes. Family history of breast cancer in paternal cousin, diagnosed at the age of 47. 3-D whole breast ultrasound was performed for the left breast and images were reviewed on an independent workstation. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy in the left breast.BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Male 80 years old Reason: Primary HPT RIGHT LOBE MEASUREMENTS: 2.0 x 1.2 x 3.9 cmLEFT LOBE MEASUREMENTS: 4.1 x 1.7 x 1.6 cmISTHMUS MEASUREMENTS: 0.18 cmRIGHT LOBE: No significant abnormality. Right thyroid lobe has normal echogenicity.LEFT LOBE: No significant abnormality. Left thyroid lobe has normal echogenicity.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Inferior to the right thyroid lobe there is a extrathyroidal rounded hypoechoic nodule consistent with a parathyroid adenoma measuring 1.2 x 0.9 x 0.9 cm.LYMPH NODES: Small benign appearing left level 3 lymph node measuring 0.6 x 0.3 x 1.4 cm.OTHER: No significant abnormality noted.", "output": "Hypoechoic nodule compatible with a parathyroid adenoma inferior to the right thyroid lobe."}
{"instruction": "Generate impression based on findings.", "input": "Asymmetric enlargement of the right thyroid lobe. RIGHT LOBE MEASUREMENTS: 7.1 x 2.2 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.0 x 1.2 x 1.3 cmISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: 3 discrete thyroid nodules are noted.The largest is in the inferior pole measuring 1.7 x 1.6 x 2.9 cm which is a complex predominantly solid nodule with well-defined margins and vascularity but no microcalcifications.An isoechoic more inferior 1.0 x 0.8 x 1.1 cm solid nodule is noted with poorly defined smooth margins.A mildly hypoechoic more superior 8 x 4 x 9 mm solid nodule is noted.LEFT LOBE: 3 subcentimeter left thyroid complex predominantly solid nodules with small cystic components are noted without specific suspicious sonographic features. The largest measures 1.0 x 0.9 x 0.9 cm in the mid inferior pole.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple bilateral thyroid nodules the largest of which measures 2.9 cm on the right and demonstrates complex predominantly solid morphology. These are amenable to FNA sampling."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female for follow-up thyroid nodules. RIGHT LOBE MEASUREMENTS: 8.5 x 4 x 3.5 cmLEFT LOBE MEASUREMENTS: 9.1 x 4.4 x 3.9 cmISTHMUS MEASUREMENTS: 1.7 cmRIGHT LOBE: Mildly and heterogeneously echogenic with a suggestion of underlying hyperechoic nodules as is seen with thyroiditis. There is again noted in the midportion of the right lobe is a well circumscribed, solid nodule with cystic component that is mildly and heterogeneously echogenic. This measures 1.5 x by 2.1 x 2.4 cm. When remeasuring the prior study, this is unchanged, appearing better marginated on today's exam.LEFT LOBE: Mildly and heterogeneously echogenic with suggestion of underlying hyperechoic nodules. The appearance is overall unchanged in the interim.ISTHMUS: Within the isthmus, there is a heterogeneous, solid mass which is reasonably well demarcated measuring 0.7 x 0.8 x 0.8 cm without change.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable thyromegaly with stable nodules."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Krich is a 54 year old female with known IDC and suspicious-appearing right axillary lymph nodes on outside MRI examination. Targeted grayscale and color ultrasound examination of the right axilla.Multiple abnormal right axillary lymph nodes are visualized, some of which appear with internal calcifications. For reference, a right axillary node with mild internal calcifications measures1.2 x 0.9 x 1.1 cm. Another reference node with internal calcification measures 2.1 x 1.1 x 1.8 cm. Three additional abnormal lymph nodes without calcifications by ultrasound are adjacent to the reference nodes mentioned above.", "output": "Multiple suspicious-appearing lymph nodes within the right axilla as above. The patient was sent to breast surgery clinic upon completion of ultrasound examination and results were immediately relayed to the breast surgery clinic.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Male 62 years old Reason: s/p renal transplant History: elevated CR Ultrasound guidance and technical assistance was provided for a renal allograft in the right iliac fossa. 3 passes were made by Dr. Cunningham. The procedure was successfully completed.", "output": "Successful ultrasound guided biopsy of the renal allograft in the right iliac fossa."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with right upper quadrant pain, fevers, nausea LIVER: Measures 15.4 in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Cholelithiasis with gallbladder wall thickening and pericholecystic fluid. No significant biliary ductal dilation. PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Unremarkable in size and echogenicity. KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "Findings consistent with acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male with chronic kidney disease and worsening renal function. RIGHT KIDNEY: Right kidney measures 11.5 cm in length. Echotexture is difficult to judge due to overlying ascites, cortex is at least moderately echogenic. There is a small cyst in the upper pole of the kidney. No hydronephrosis, shadowing calculus or solid mass.LEFT KIDNEY: The left kidney measures 12.7 cm in length. Cortex is moderately echogenic. No hydronephrosis, shadowing calculus or mass.URINARY BLADDER: No significant abnormalities noted.OTHER: Moderate ascites.", "output": "Echogenic kidneys with small right cyst. Overall, the appearance of the kidneys is little changed from prior exams.Moderate ascites."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old female patient with history of subacute thyroiditis with abnormal imaging, question of nodule. Previous painful, tender nodule on the right in April 2015, pain has resolved. Evaluate for nodules and other characteristics. RIGHT LOBE MEASUREMENTS: 1.2 x 1.2 x 4.4 cm, previously 2.3 x 2.5 x 4.3 cm.LEFT LOBE MEASUREMENTS: 0.9 x 1.1 x 3.9 cm, previously 1.4 x 1.0 x 4.3 cm.ISTHMUS MEASUREMENTS: 3 mm in thickness.RIGHT LOBE: The right thyroid lobe is slightly heterogeneous in echogenicity without focal lesion.LEFT LOBE: The left thyroid lobe is slightly heterogeneous echogenicity without focal lesion.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology lymph nodes are noted bilaterally laterally.OTHER: No significant abnormality noted.", "output": "Heterogeneous thyroid gland which can be seen with a history of thyroiditis. No focal thyroid lesion is identified."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old female called back from screening mammography for asymmetries in both breasts. No current breast complaints. Three standard views of both breasts and spot compression views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. Several small circumscribed asymmetries in both breasts persist with spot compression. Additional ultrasound was performed. ULTRASOUND", "output": "Benign subcentimeter cysts in both breasts correlating with areas of mammographic asymmetry. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "51 year old female who was recalled from screening mammogram for new mass in the left lower inner breast.. Mammogram: 2 ML views and two spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. 14 mm circumscribed oval hyperdense mass in the left lower inner quadrant posterior depth persist on spot compression views. No associated calcifications. Multiple other benign morphology masses elsewhere are stable.Ultrasound: Targeted left lower inner quadrant ultrasound was performed. A small 5 x 4 mm simple cyst was identified in the left breast 8:00 position, 10 cm from the nipple. This probably is an incidental finding and might not correspond to the 14 mm circumscribed oval benign morphology mass in the left breast on the mammogram.", "output": "High probability benign morphology 14 mm circumscribed oval mass in the left breast lower inner quadrant without definite sonographic correlate needs further evaluation with left unilateral diagnostic mammogram in 6 months to confirm stability.Incidentally noted 5 mm simple cyst in the left breast on ultrasound.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "16 year old with recent biopsy right breast with benign results presents for right retroareolar ultrasound to evaluate right nipple discharge, one episode before the biopsy. A targeted right retroareolar ultrasound was performed. There is no solid or cystic mass identified. Normal glandular tissue noted.", "output": "No sonographic evidence for malignancy. Follow up in 6 months to confirm stability of the benign fibroadenoma and surgical consultation.BIRADS: 1 - Negative.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B LIVER: Mildly heterogeneous liver echotexture without mass. Liver length 16.2 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right renal cyst. Right kidney 10.2 cm in lengthOTHER: Left kidney 9.7 cm in length. Spleen 8.1 cm in length. No ascites.", "output": "Mildly heterogeneous liver echotexture suggestive for chronic liver disease without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Male 51 years old Reason: eval transplant kidney History: transplant RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: Transplant kidney measures 11.3 cm. No evidence of hydronephrosis. Slightly echogenic kidney. Simple appearing cyst in the upper pole measuring 2 cm.COLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels No significant abnormality noted. Peak systolic velocity at the level of the anastomosis 110 cm/s. RI values range between 0.6 and 0.7. Transplant vein is patent.OTHER: No significant abnormality noted", "output": "Slightly echogenic renal transplant right iliac fossa. Normal Doppler study."}
{"instruction": "Generate impression based on findings.", "input": "59 year-old female with abdominal pain. Evaluate for ascites. Four abdominal quadrants were evaluated for the presence of ascites. No evidence of ascites is noted.Partially imaged liver is increased in echogenicity.", "output": "1. Increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. 2. No ascites. "}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status, heart failure, concern for congestive hepatopathy versus infectious process LIMITED ABDOMENLIVER: Liver measures 17 cm with normal with normal echotexture. Portal vein demonstrates normal flow directionality and patency.No focal lesions noted.BILIARY TRACT: No intrahepatic biliary ductal dilatation. Gallbladder is well-distended with normal gallbladder wall thickness without any focal lesions or stones.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. RIGHT KIDNEY: Right kidney measures 10.2 cm and left kidney measures 10 cm with mildly increased echogenicity consistent with chronic medical renal disease. No hydronephrosis or focal lesions.OTHER: No ascites", "output": "1. Bilateral echogenic kidneys consistent with chronic medical renal disease.2. Liver vasculature is patent."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Hashimoto's, history of subcentimeter thyroid nodules, assess need for FNA RIGHT LOBE MEASUREMENTS: 4.5 x 1.3 x 1.5 cm.LEFT LOBE MEASUREMENTS: 3.8 x 1.0 x 1.6 cm.ISTHMUS MEASUREMENTS: Up to 0.3 cm in thickness.RIGHT LOBE: Mildly heterogeneous background parenchymal echotexture. Multiple nodules. Superior pole heterogeneous but predominantly hyperechoic nodule measuring 0.9 x 0.7 x 1.1 cm. Midpole hypoechoic nodule with internal coarse calcification measuring 0.7 x 0.5 x 0.8 cm. Inferior pole hyperechoic nodule with hypoechoic halo measuring 0.8 x 0.7 x 0.8 cm. LEFT LOBE: Mildly heterogeneous background parenchymal echotexture. Multiple nodules. Midpole hyperechoic nodule measuring 1.2 x 0.8 x 1.1 cm. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Single benign morphology right level 2 cervical lymph node.OTHER: No significant abnormality noted.", "output": "1.Heterogeneous thyroid gland with multiple hyperechoic nodules compatible with clinical history of Hashimoto's thyroiditis.2.Subcentimeter hypoechoic nodule with coarse calcification in right midpole. Continued attention is recommended on subsequent follow-up examinations."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old male with chronic kidney disease. RIGHT KIDNEY: The right kidney measures approximately 7.6 cm in length. The kidney is moderately to markedly echogenic consistent with parenchymal disease, and this has progressed in the interim. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures approximately 8.5 cm in length. The kidney is moderately to markedly echogenic consistent with parenchymal disease, and this has progressed in the interim. No hydronephrosis or shadowing calculus. The previously noted hypoechoic, lobulated region in the lower pole of the left kidney is not visualized on today's exam.OTHER: No significant abnormalities noted.", "output": "Progressive increased echogenicity of both kidneys which are atrophic.Previously noted questionable mass on the left is not visualized."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury. Urinary retention. Please note that examination is limited due to poor acoustic penetration and inability to reposition the patient.RIGHT KIDNEY: 9.4 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: Evaluation of the left kidney is limited by inability to reposition the patient. No gross hydronephrosis is evident. BLADDER: Distended.OTHER: Numerous metastatic lesions identified in the liver, partially imaged.", "output": "No hydronephrosis. Distended bladder."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old male with pancreatitis, elevated bilirubin. LIVER: Measures 21.1 in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: No cholelithiasis. No gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilation. PANCREAS: Enlarged hypoechoic pancreas consistent with the clinical history of pancreatitis. Portions of the pancreatic tail are not well visualized due to bowel gas. No peripancreatic fluid collections are identified.SPLEEN: Unremarkable in size and echogenicity. KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "1.Hypoechoic enlarged pancreas consistent with the clinical history of pancreatitis.2.No cholelithiasis or evidence of cholecystitis.3.Hepatomegaly and increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female RUQ pain, tender, recent ERCP w/ stent placement & stone removal. Evaluate for cholecystitis, obstruction. LIVER: Normal echogenicity of the liver measuring 15.8 cm in length. No focal hepatic lesions.GALLBLADDER, BILIARY TRACT: Sludge noted within the gallbladder. No cholelithiasis. Gallbladder wall is mildly thickened measuring up to 4 mm in thickness. There is minimal surrounding pericholecystic fluid. Sonographic Murphy's sign is positive. Common bile duct is normal in caliber measuring 3 mm. No intra or extra hepatic biliary ductal dilatation. Possible common bile duct stent noted.PANCREAS: The distal pancreatic body and tail are obscured by overlying bowel gas. The remaining visualized pancreas is normal in echogenicity. No pancreatic ductal dilatation.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 10.6 cm in length. No nephrolithiasis or hydronephrosis. OTHER: The left kidney is normal in echogenicity measuring 10.6 cm in length. No nephrolithiasis or hydronephrosis. The spleen is normal in echogenicity measuring 7.3 cm in length.", "output": "Findings are suspicious for acute cholecystitis as described above.Findings were conveyed to Dr. Shah at pager 1597 at 4:04 PM. "}
{"instruction": "Generate impression based on findings.", "input": "Female 30 years old Reason: h/o goiter, 2 nodules detected on scan in NY 12/2015 RIGHT LOBE MEASUREMENTS: 5.9 x 2.4 x 1.7 centimetersLEFT LOBE MEASUREMENTS: 5.7 x 2.1 x 1.3 cmISTHMUS MEASUREMENTS: 0.2 centimetersRIGHT LOBE: Heterogeneous background echogenicity of the right thyroid lobe. No discrete nodules are identified.LEFT LOBE: Heterogeneous background echogenicity of the left thyroid lobe. Small, well-circumscribed, mildly hypoechoic, spongiform appearance and nodule in the inferior left thyroid with mild increased vascularity, without microcalcifications, measuring 0.7 x 0.8 x 0.6 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous echogenicity of the thyroid which could be due to tiny nodules or thyroiditis. Small spongiform nodule in the inferior left thyroid lobe without definite microcalcifications."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male with outside hospital Sestamibi scan showing a right inferior gland. Primary hyperparathyroidism. Assess for parathyroid adenoma. RIGHT LOBE MEASUREMENTS: 4.4 cm x 1.7 cm x 1.2 cmLEFT LOBE MEASUREMENTS: 3.2 cm x 1.1 cm x 1.0 cmISTHMUS MEASUREMENTS: 2 mm in thicknessRIGHT LOBE: No discrete nodules or masses are notedLEFT LOBE: No discrete nodules or masses are notedISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Hypoechoic extrathyroidal nodule posterior and inferior to the right thyroid lobe measures 9 mm x 6 mm x 4 mm. This corresponds to the uptake seen on outside hospital nuclear medicine Sestamibi scan and is consistent with suspected parathyroid adenoma. LYMPH NODES: Right neck benign appearing lymph node measures 8 mm x 8 mm x 4 mm. Left neck benign appearing lymph nodes are noted, largest measures 1.0 cm x 0.9 cm x 0.3 cm. OTHER: No significant abnormality noted.", "output": "Findings are consistent with suspected right parathyroid adenoma as described above."}
{"instruction": "Generate impression based on findings.", "input": "23-year-old male with dilated veins in left testicle. Rule out varicocele. The testicles are symmetric and normal in size, the right measuring 3 x 4.1 x 2 cm and the left measuring 2.9 x 3.7 x 2 cm. Testicular parenchyma is of normal homogeneous echogenicity bilaterally. Doppler exam shows unremarkable intratesticular arterial flow bilaterally.  The epididymal heads are normal in size, maximal diameter measuring 0.9 cm on the right and 1 cm on the left. Small bilateral epididymal head cysts are noted. Prominent veins are seen posterior to the left testicle measuring up to 0.4 cm in diameter that do not significantly increase with the Valsalva maneuver.", "output": "1. No acute testicular abnormality.2. Mild left varicocele."}
{"instruction": "Generate impression based on findings.", "input": "5-year-old female with right labial vascular lesion. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Within the subcutaneous soft tissues of the right labia, there is a 2.7 x 1.8 cm T1 hypointense, T2 hyperintense mass. The mass demonstrates avid fairly homogeneous arterial enhancement. Possible internal septations. It is supplied by mildly hypertrophied branches of the right pudendal artery. No early or enlarged draining vein is seen. OTHER: No significant abnormality noted.", "output": "Vascular mass within the right labia. Given the rapidity of filling in of the lesion on postcontrast imaging and the degree of vascularity demonstrated, a hemangioma is considered less likely as the appearance would be atypical. Among the differential considerations is a high flow AVM. While the mass appears to contain septations and otherwise appear fairly homogeneous on the current study, the sonographic appearance on the prior 5/26/15 ultrasound was much more heterogeneous. This raises concern for the possibility of a more rare, vascular tumor such as an angiomyxoma. Presurgical embolization is recommended prior to any future surgical intervention. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Los is a 70 year old female with a personal history of bilateral breast cysts. She complains today of focal right breast pain for the past 10 months. A targeted right breast ultrasound was performed for the patient\u2019s area of concern. In the right breast 10:00 location, approximately 4 cm from the nipple, a round anechoic lesion with layering echogenic material is identified measuring approximately 0.5 x 0.5 cm. Sonographic findings are compatible with a simple cyst with layering calcification.", "output": "Bilateral benign calcifications and benign cysts. No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Male 69 years old; Reason: Nodule size and characteristics History: thyroid nodules on CT RIGHT LOBE MEASUREMENTS: 4.6 x 2.0 x 1.5 cm.LEFT LOBE MEASUREMENTS: 3.7 x 0.9 x 1.2 cm.ISTHMUS MEASUREMENT: 0.5 cm.RIGHT LOBE: There is round solid complex nodule measuring 2.0 x 1.5 cm in the inferior aspect of the right lobe with foci of increased echogenicity. No other nodules are seen in the right thyroid.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.LYMPH NODES: No adenopathy noted. OTHER: No significant abnormality noted.", "output": "Complex nodule in right lobe of thyroid; recommend correlation with ultrasound-guided biopsy."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old female with ovarian cancer, increased left flank pain. RIGHT KIDNEY: Measures 10.4 cm in length with increased renal echogenicity. Right renal stent in place without hydronephrosis.LEFT KIDNEY: Measures 9.9 cm with increased renal echogenicity. No nephrolithiasis or hydronephrosis.OTHER: Partially collapsed.", "output": "1. Increased renal echogenicity consistent with medical renal disease. 2. No left hydronephrosis or nephrolithiasis. 3. Right ureteral stent in place without hydronephrosis. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: LUE wound with induration c/f abscess History: as above Limited ultrasound along the dorsal aspect of the left forearm was performed. There is a tubular structure within the subcutaneous tissues without flow which likely represents a thrombosed vein. The adjacent subcutaneous tissues are mildly echogenic which may reflect inflammatory change. No focal fluid collection is identified.", "output": "1.Superficial thrombophlebitis along the dorsal aspect of the left forearm.2.No underlying focal fluid collections."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid cancer status post surgery RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional lymphadenopathy.", "output": "Post surgical changes without regional lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain for several months LIVER: Non-cirrhotic liver morphology. Increased parenchymal echogenicity. 12.5 cm in length. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Normal appearance of the gallbladder. No cholelithiasis.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 9.8 cm in length. The left kidney is 10.3 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 7.6 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites.", "output": "Increased hepatic echogenicity compatible with parenchymal dysfunction and/or steatosis, without biliary ductal dilation."}
{"instruction": "Generate impression based on findings.", "input": "Female 77 years old; Reason: 77 yo with advanced fibrosis and GB polyps History: none LIVER: The liver measures 18.5 cm in length. There is coarse increased echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. A hepatic cyst is seen within the right lobe of the liver measuring 1.3 cm x 1.3 cm x 1.7 cm. The main portal vein is patent with normal hepatopetal flow measured at 14.9 cm/s. No ascites is seen.GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.6 mm. No stones are seen. No pericholecystic fluid. Negative sonographic Murphy sign. Several small gallbladder polyps are revisualized the largest measuring 0.5 cm x 0.3 cm x 0.4 cm. The common bile duct measures xx mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 8.7 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 9.1 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.1 cm in length. The cortex has normal echogenicity. Minimal hydronephrosis is present. No stones or worrisome masses are seen.", "output": "1. The liver has coarse increased echogenicity compatible with fatty infiltration/hepatocellular dysfunction. No ascites is seen. No worrisome hepatic lesions visualized.2. Several gallbladder polyps are revisualized. No evidence of cholelithiasis or acute cholecystitis are seen.3. Minimal hydronephrosis is present on the left."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female with HBV, HCC screening. LIVER: Coarse echotexture of the liver measuring 14.1 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. Common duct measures 2 mm in thickness. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Distal tail of the pancreas is obscured by overlying bowel gas. The remaining visualized portions are unremarkable.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring .8 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the left kidney measuring 9.6 cm in length. No hydronephrosis or shadowing foci are noted.Normal echogenicity of the spleen measuring 6.7 cm in length.", "output": "Coarse echotexture of the liver suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesions."}
{"instruction": "Generate impression based on findings.", "input": "Reason: r/o growth, adenopathy History: bilateral thyroid nodules. 1 year follow up study RIGHT LOBE MEASUREMENTS: 5.0 x 1.9 x 1.5 cm.LEFT LOBE MEASUREMENTS: 4.9 x 1.3 x 1.8 cm.ISTHMUS MEASUREMENTS: Up to 0.3 cm in thickness.RIGHT LOBE: Mid pole partially solid, partially cystic nodule measuring 1.5 x 1.6 x 1.4 cm, not significantly changed.LEFT LOBE: Upper pole predominantly solid, hyperechoic nodule measuring 1.5 x 0.6 x 1.0 cm, previously 1.3 x 0.9 x 0.8 cm, not significantly changed in size allowing for differences in technique. Overall, nodule is of low suspicion for neoplasm. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology left cervical lymph node.OTHER: No significant abnormality noted.", "output": "No significant change in bilateral thyroid nodules as described above."}
{"instruction": "Generate impression based on findings.", "input": "Male, 58 years old. Reason: Low urine output, rising creatinine. History of aortic dissection with ? limited blood flow to right kidney History: rising creatinine, oliguria RIGHT KIDNEY: The right kidney measures 10.5 cm, with mildly increased cortical echogenicity. No shadowing calculi or hydronephrosis.LEFT KIDNEY: The left kidney measures 13.6 cm, with mildly increased cortical echogenicity. No shadowing calculi or hydronephrosis.URINARY BLADDER: The bladder is not visualized.OTHER: No significant abnormalities noted.", "output": "Increased renal cortical echogenicity compatible with medical renal disease. Asymmetry in renal size with relatively small right kidney which may be related to a limited blood flow from chronic dissection.  No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Male 51 years old Reason: patient w/ severe right upper quadrant pain, lactic acidosis, eval for acute cholecystitis History: abd pain LIVER: Gallbladder is distended with multiple stones. There is gallbladder wall thickening and pericholecystic fluid. These findings are consistent with acute cholecystitis. Echogenic kidney compatible with fatty infiltration. No evidence of intra or extrahepatic biliary dilatation.", "output": "Sonographic findings consistent with cholelithiasis and acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male with history of microhematuria and 1.4-cm echogenic renal mass ABDOMEN:LUNG BASES: Subcentimeter nonspecific nodule in image number 5, series number 7 in the left lower lobe. Subsegmental atelectasis in the left lower lobe.Small right sided pleural effusion.LIVER, BILIARY TRACT: Multiple cysts throughout the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple stones within the left kidney, predominantly in the lower pole largest measuring 1.1-cm. No hydronephrosis. No stones in the right kidney. No evidence of ureteral stones.1.3-cm enhancing mass in the lower pole of the right kidney. This mass measures 53 HU on the noncontrast and measures 80 HU on the delayed phase images. This is suspicious for a renal cell carcinoma such as papillary variant. Subcentimeter lesion in the midpole of the right kidney, on image number 48, series number 9 measures 8 mm and demonstrates possibly 30 this enhancement.2.2 x 1.2 cm hypodense lesion in the upper pole of the left kidney likely representing a simple cyst. There are multiple other small hypodense lesions which are too small to adequately characterize.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: Mildly enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted", "output": "Left nephrolithiasis.Right lower lobe enhancing lesion suspicious for renal cell carcinoma. Another subcentimeter lesion within the right kidney, too small to accurate characterize but likely demonstrates heterogeneous enhancement.Left renal cyst. Multiple other subcentimeter lesions in both kidneys which are too small to characterize.Multiple hepatic cysts."}
{"instruction": "Generate impression based on findings.", "input": "23-year-old female with abdominal wall mass. Patient relates mass occurred after C-section. In the region of palpable abnormality to the left of midline there is a defect in the peritoneum with protrusion of fat and possibly a small portion of bowel loop consistent with hernia.", "output": "Anterior abdominal wall hernia."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female patient with history of hyperparathyroidism. Evaluate thyroid nodule size, location, and any abnormal lymph nodes. RIGHT LOBE MEASUREMENTS: 7.2 x 3.1 x 2.2 cm.LEFT LOBE MEASUREMENTS: 4.7 x 1.6 x 1.4 cm.ISTHMUS MEASUREMENTS: 6 mm in thickness.RIGHT LOBE: The right thyroid lobe contains multiple nodules with the largest complex cystic nodule measuring 2.4 x 1.1 x 2.0 cm in the lower pole. Either within or extrathyroidal and posterior to the lower pole there is a 2.2 x 1.7 x 2.5 cm hypoechoic, solid nodule that demonstrates internal vascularity.LEFT LOBE: The left thyroid lobe contains scattered cystic nodules and a dominant 1.8 x 1.1 x 1.4 cm solid nodule with a central cyst.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Either within or extrathyroidal and posterior to the right lower pole there is a 2.2 x 1.7 x 2.5 cm hypoechoic, solid nodule that demonstrates internal vascularity. There is a solid, hypoechoic nodule measuring 0.9 x 1.0 x 1.7 cm medial to the inferior pole of the left thyroid lobe may represent a parathyroid adenoma.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Solid, hypoechoic nodule which is either extrathyroidal and posterior to the right lower pole or within in. If this is extrathyroidal, a parathyroid adenoma is favored; correlate with nuclear medicine scan. If this does not correlate to a parathyroid adenoma on nuclear medicine scan and/or is intrathyroidal in location, then biopsy is recommended for further evaluation.2. Extrathyroid hypoechoic nodule medial to the left lower pole may represent a parathyroid adenoma.3. Bilateral thyroid nodules as described above. "}
{"instruction": "Generate impression based on findings.", "input": "25-year-old female with glomerular disease. Systemic lupus. Ultrasound guidance was performed for biopsy of right kidney.", "output": "Ultrasound guidance."}
{"instruction": "Generate impression based on findings.", "input": "Reason: history of isthmus nodule, please evaluate for interval change. RIGHT LOBE MEASUREMENTS: 5.1 x 1.3 x 1.5 cm.LEFT LOBE MEASUREMENTS: 4.9 x 1.4 x 1.7 cm.ISTHMUS MEASUREMENTS: Up to 0.6 cm in thickness.RIGHT LOBE: Mildly heterogeneous parenchymal echotexture without focal nodules.LEFT LOBE: Mildly heterogeneous parenchymal echotexture without focal nodules.ISTHMUS: Previously biopsied nodule within the right aspect of the isthmus has decreased in size measuring 1.5 x 2.1 x 0.8 cm, previously 2.6 x 1.2 x 3.3 cm. The nodule is predominantly solid with interval decrease in size of the cystic component following the 12/24/2015 biopsy. The nodule demonstrates internal vascularity. No suspicious microcalcifications are identified.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Interval decrease in size of previously biopsied isthmic nodule. No new nodules."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid cancer status post resection RIGHT LOBE: Status post thyroidectomy without massLEFT LOBE: Status post thyroidectomy without massISTHMUS: Status post thyroidectomy without massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy without worrisome mass or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": " RIGHT KIDNEY: Normal parenchymal echogenicity. No worrisome mass or hydronephrosis. Stable subcentimeter stone measuring subcentimeter stone measuring 0.8 x 0.9 x 0.5 cm. Right kidney 15.2 cm. in lengthLEFT KIDNEY: AbsentOTHER: Bladder nondistended", "output": "Stable nonobstructing subcentimeter right renal stone."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B LIVER: Mildly coarse echogenic liver echotexture again noted without mass. Liver length 15.1 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 6.3 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10 cm in lengthOTHER: Left kidney 11.1 cm in length. No ascites", "output": "Mildly coarse echogenic liver parenchyma consistent with chronic liver disease without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male with right upper quadrant pain. LIVER: Normal in size, contour and echogenicity. No focal hepatic abnormality.BILIARY TRACT: Biliary tract is normal in caliber. Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: Lobulation involving the midportion left kidney without underlying mass.", "output": "Normal gallbladder and biliary tract."}
{"instruction": "Generate impression based on findings.", "input": "Ms. MARY ZERVOS is a 50 years old female with biopsy proven left breast cancer, received neoadjuvant treatment, who presents today for ultrasound reevaluation of the treatment response. On physical examination, no discrete mass was palpated in the left upper inner quadrant. A targeted left ultrasound was performed at the site of biopsy proven cancer in left upper inner breast. The previously identified mass in the left breast at 10:00 location, 3 cm from the nipple has decreased in size and measures 10 x 2 x 4 mm versus 11 x 15 x 10 mm on the prior. This mass demonstrates more tubular and flat appearance with mild internal flow.", "output": "Interval decrease in size of the left breast biopsy-proven cancer. Continued follow-up with the surgical clinic for further evaluation is recommended. Results and recommendations were discussed with the patient. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Female 56 years old Reason: r/o growth of nodules, adenopathy, or suspicious features. please compare with prior ultrasound History: multiple thyroid nodules. Family history of thyroid cancer. RIGHT LOBE MEASUREMENTS: 2.1 x 1.5 x 5.7 cmLEFT LOBE MEASUREMENTS: 1.9 x 1.5 x 5 cmISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: Again noted multiple nodules are predominantly cystic many with evidence for colon, tail artifact which are unchanged from previous exam. Index cystic nodule in the upper pole measures 2.2 x 1.1 x 1.7 cm, slightly enlarged compared to previous study. No evidence of solid component.LEFT LOBE: Again noted multiple nodules again predominantly cystic with possible correlate. Index spongiform nodule in the mid inferior left lobe measures 7 x 4 x 6 mm, not significantly changed compared to previous study.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing lymph nodes are unchanged.OTHER: No significant abnormality noted.", "output": "Stable appearance of the thyroid with multiple nodules, most characteristics of colloid nodules."}
{"instruction": "Generate impression based on findings.", "input": "Viral hepatitis B LIVER: Mildly coarse liver echotexture. 1.5 x 1.4 x 1.7 cm hypoechoic focus within segment 2 of the left lobe of the liver not appreciated on the prior examination. Well-circumscribed echogenic foci consistent with hemangiomas again noted and unchanged. Liver length 14.1 cm. Limited Doppler interrogation the main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: Stable multiple gallbladder polyps. The largest again measuring 0.4 x 0.6 x 0.4 cm.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.2 cm in lengthOTHER: Left kidney 11.1 cm in length. Spleen 8.6 cm in length. No ascites.", "output": "Mildly coarse liver echotexture again noted consistent with chronic liver disease. Segment 2 left lobe hypoechoic lesion not clearly identified on prior examinations. Would recommend dedicated contrast enhanced cross-sectional imaging for further characterization. Benign hemangiomas again noted and unchanged. Stable subcentimeter gallbladder polyps. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "46 year old female patient with right upper abdominal discomfort. Evaluate for gallstones. LIVER: The liver measures 15.7 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: There is a single gallstone at the gallbladder neck. There is no significant pericholecystic fluid or gallbladder wall thickening. No intra- or extrahepatic biliary ductal dilatation is identified. Sonographic Murphy's sign is negative. The common duct measures 2 mm in diameter.PANCREAS: The pancreas is not visualized secondary to overlying bowel gas.RIGHT KIDNEY: The right kidney measures 10.5 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.9 cm in length. No evidence of hydronephrosis.The spleen measures 9.6 cm in length.", "output": "Cholelithiasis without sonographic evidence of acute cholecystitis. If clinical concern for cholecystitis continues, a HIDA scan may be considered for further evaluation. "}
{"instruction": "Generate impression based on findings.", "input": "Testicular pain RIGHT TESTIS: 5.2 x 3.3 x 2.3 cm. No intratesticular mass.LEFT TESTIS: 4.4 x 3.6 x 2.5 cm. No intratesticular massRIGHT EPIDIDYMIS: Benign-appearing epididymal head cystLEFT EPIDIDYMIS: Enlarged left epididymis with slight increase in vascularity.OTHER: Moderate size left varicocele. Doppler interrogation demonstrates bilaterally symmetric testicular flow.", "output": "Enlarged left epididymis with slight increase in vascularity raises the possibility of epididymitis. No evidence of abscess or testicular involvement. Moderate-sized left varicocele."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old male with cervical adenopathy with right anterior immobile mass. In the area of palpable abnormality in the right neck there are adjacent, dense calcifications which appear nodal. Although not grossly abnormal in shape, due to shadowing it is difficult to visualize margination of lymph nodes. These are similar rounded calcifications at level 2 and 3 as well as the right submandibular region.At level 2 on the left there is an area of densely shadowing calcification measuring 0.6 x 1.1 x 0.7 cm. This may represent calcified lymph node although underlying substance is obscured by shadowing calcification.Due to the calcification in lymph nodes, brief exam of the thyroid was performed. In the inferior right lobe there is a spongiform-appearing 0.7 x 0.7 x 0.8 cm nodule", "output": "Significant, bilateral neck calcifications likely nodal. Although portions of these regions are secured by shadowing from the calcification. An associated solid mass is not definitely visualized.CT May be preferable to evaluate the above findings."}
{"instruction": "Generate impression based on findings.", "input": "Cholelithiasis transferred from outside hospital with worsening of right upper quadrant pain. LIVER: The liver is mildly echogenic without a focal lesion. It is normal in size measuring 16.5 cm in craniocaudal dimension.BILIARY TRACT: Cholelithiasis at the gallbladder neck within a distended gallbladder with wall thickening and pericholecystic fluid consistent with acute cholecystitis. Lack of focal tenderness is likely due to pain medication. No intra or extrahepatic biliary ductal dilatation with the common duct measuring 4 mm.PANCREAS: Limited evaluation of the pancreas demonstrates no gross abnormality.SPLEEN: The spleen measures 8.4 cm without a focal lesion.RIGHT KIDNEY: The right kidney measures 11.3 cm without hydronephrosis or shadowing nephrolithiasis. OTHER: The left kidney measures 12.5 cm without hydronephrosis or shadowing nephrolithiasis.", "output": "Compared to the prior study the gallbladder is now distended with wall thickening and pericholecystic fluid consistent with acute cholecystitis. Lack of focal tenderness is likely due to patient's receipt of pain medication.Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease. No focal liver lesion."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old male with history of recurrent thyroid cancer with increased thyroglobulin and stable masses in the thyroid beds RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: In the inferior right bed there is again noted a hypoechoic mass measuring approximately 0.6 x 0.8 x 0.7 cm without significant change from the prior study. Hypoechoic nodule in the more superior bed measures 0.3 x 0.4 x 0.4 cm without interval change. Third hypoechoic focus in the superior, medial right bed measures 0.4 x 0.4 x 0.3 cm without significant change.LEFT LOBE: In the left thyroid bed there is again noted a hypoechoic nodule, measuring 0.3 x 0.5 x 0.4 cm in the inferior bed which is unchanged. Second nodular density with a hyperechoic center consistent with lymph node in the left bed measures 0.4 x 0.6 x 0.9 cm, not definite seen on the prior exam. Third hypoechoic area in the superior bed measures 0.3 x 0.3 x 0.6 cm without change.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable hypoechoic nodules in the thyroid beds. New lymph node left bed which has normal morphology."}
{"instruction": "Generate impression based on findings.", "input": "Islet transplant LIVER: Unremarkable parenchymal echogenicity without mass. Liver length 15.1 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Main portal vein velocity 23 cm/s.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.9 cm in lengthOTHER: Left kidney 12.5 cm in length. Spleen 13.8 cm in length. No ascites.", "output": "No hepatobiliary abnormality. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Reason: patient w/ etoh history, elevated LFTs, INR, evaluate for cirrhosis History: elevated LFTs LIVER: The liver measures 18.0 cm in length. The liver demonstrates increased parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.15 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common hepatic duct measures 3 mm in diameter.PANCREAS: Not well visualized.SPLEEN: No significant abnormalities noted. The spleen measures 9.5 cm in length. RIGHT KIDNEY: Kidney measures 13.5 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 12.2 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: Trace perihepatic ascites.", "output": "Increased hepatic echogenicity suggestive of parenchymal dysfunction/fatty infiltration. Trace perihepatic ascites."}
{"instruction": "Generate impression based on findings.", "input": "Fullness in the left axilla. FNA performed or earlier positive for malignancy in the left breast. A targeted left axillary ultrasound was performed. 3 lymph nodes are seen in the left axilla. The largest and most suspicious of these is located inferiorly and somewhat deep in the axilla and measures 1.5 x 1.8 cm. Normal hilar fat is not seen within this node. There is also an eccentrically thickened lymph node located more superiorly which measures up to 1.7 cm and has mild nonhilar blood flow, also somewhat suspicious. An additional normal morphology lymph node measuring 2.5 cm is seen further superiorly.", "output": "One highly suspicious and 1 moderately suspicious left axillary lymph node. The findings were discussed with the patient and Donna Christian. The surgical service will consider ultrasound-guided lymph node biopsy.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Male; 65 years old. Reason: elevated LFT History: as above LIVER: The liver measured 13.1 cm in length. The liver contour is smooth, the parenchyma is coarse in echotexture and diffusely increased in echogenicity. No worrisome mass is identified.The main portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.2 m/sec.BILIARY TRACT: There is no cholelithiasis or gallbladder wall thickening. The common duct measures 3 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreas is obscured by overlying bowel gas.SPLEEN: The spleen measures 9.0 cm in length.RIGHT KIDNEY: Right kidney measures 10.0 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone. No worrisome renal mass is identified. OTHER: The left kidney measures 11.1 cm in length. The renal parenchyma is normal in echogenicity. There is no hydronephrosis or shadowing renal stone. No worrisome renal mass is identified.", "output": "Echogenic liver compatible with hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old male with AML now with neutropenic fever, bacteremia, and elevated bilirubin. LIVER: The liver measures 18.5 cm in length. The parenchyma is moderately echogenic. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.3 m/s.BILIARY TRACT: The gallbladder is contracted without evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: The spleen measures 17 cm in length. RIGHT KIDNEY: Kidney measures 10.8 cm in length. The cortex is mildly echogenic. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 12.9 cm in length. The cortex is mildly echogenic. No hydronephrosis, shadowing calculus or mass. A simple cyst is present in the mid pole measuring 1.2 x 1.0 x 0.9 cm.OTHER: No significant abnormalities noted.", "output": "1.Echogenic liver suggestive of fatty infiltration.2.Splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old male with history of thrombocytopenia, hemolysis. Evaluate the spleen. Grayscale and color ultrasound demonstrates splenomegaly, with the spleen measuring up to 17.6 cm in diameter, without gross interval change compared with the recent study from 8/11/2015. Bilateral pleural effusions are also visualized.", "output": "Splenomegaly and bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Female 30 years old; Reason: r/o adenopathy, recurrence History: h//o thyroid cancer The patient is status post total thyroidectomy.POSTOPERATIVE BED: No suspicious lesions of recurrence are seen within the postoperative bed.LYMPH NODES: No suspicious adenopathy noted. OTHER: Parathyroids are not visualized.", "output": "Negative thyroid ultrasound status post total thyroidectomy. No areas suspicious for recurrence and no suspicious adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Two palpable areas of concern in the right breast. Previous left mastectomy for malignant phyllodes tumor. A targeted right ultrasound was performed for the 2 areas marked by the clinical service. At the more superior area marked by the service, multiple cysts are seen. A larger septated cyst measures 6 x 5 mm. A smaller adjacent cyst measures 3 mm. No internal vascularity is seen within the cysts. At the area marked by the clinical service closer to the nipple, a 9 x 9 mm hypoechoic mass with mild internal vascularity is seen. This is more consistent with a solid mass rather than a complicated cyst.", "output": "1. Right breast mass at the area closer to the nipple marked by the service measuring 9 mm is more consistent with a solid mass rather than a complicated cyst.2. Cysts are present at the more superior area marked by the clinical service.The patient is being seen today in surgery clinic, where palpably guided FNA will be considered. The solid mass would also be amenable to ultrasound-guided biopsy if clinically indicated.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old female with history of edema, back pain. Evaluate for intrinsic kidney disease, cysts. RIGHT KIDNEY: Measures 12.0 cm in length. Unremarkable echogenicity without hydronephrosis, nephrolithiasis, or solid mass. 0.6 x 0.5 cm right superior pole cyst without septation or solid component.LEFT KIDNEY: Measures 9.7 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. Left inferior pole cyst measures 1.3 x 1.2 cm without septation or solid componentURINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.", "output": "No nephrolithiasis, hydronephrosis, or suspicious mass. "}
{"instruction": "Generate impression based on findings.", "input": "Female 45 years old; Reason: r/o growth of nodules, adenopathy, worrisome characteristics History: multinodular goiter RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 3.4 x 3.0 x 6.9 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 2.7 x 3.1 x 7.2 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.7 cm.RIGHT LOBE: There are 3 nodules located within the right lobe which appear heterogeneous and iso to slightly hyperechoic with a hypoechoic rim. The first is located superiorly and measures 3.1 cm x 2.7 cm x 3.4 cm., Increased slightly in size. The second is located in the midportion of the right lobe and measures 2.6 cm x 2.5 cm x 2.2 cm., without changeThe third is located inferiorly and measures 2.2 cm x 1.9 cm x 2 cm., Without significant change.LEFT LOBE: There are 2 nodules located within the left lobe. The first is located superiorly and measures 2.4 cm x 1.9 cm 3.1 cm. ,without change.The second nodule is located superiorly and posteriorly, and measures 1.7 cm x 1.4 cm x 1.4 cm. Although not measured on the prior study, this was present and likely is unchanged.Additionally, a round poorly visualized hypoechoic mass is seen inferior to the left thyroid measuring 3.7 cm x 4.0 cm x 3.1 cm. This may extend below the clavicle, and although this wasn't seen on prior the study, it was visualized in the 2013 ultrasound.ISTHMUS: There is a heterogeneous nodule located within the isthmus and measures 2.2 cm x 1.9 cm x 2.1 cm.LYMPH NODES: No suspicious adenopathy noted.", "output": "1.Multinodular goiter as seen on prior ultrasound. The majority of the nodules, as described above, appear to be relatively stable in size. No suspicious adenopathy is seen.2.There is a poorly visualized hypoechoic nodule seen inferior to left thyroid that may extend below the clavicles. Further cross-sectional imaging can be considered if indicated. This was also not well visualized on the prior study but was present on the prior 2013 ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain. Fever. LIVER: Non-cirrhotic liver morphology. 17 cm in length. Mildly increased parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Normal appearance of the gallbladder. No gallstones identified. PANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney is 11.4 cm in length. The left kidney is 12.4 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 14.9 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid identified.", "output": "1. Increased hepatic echogenicity, compatible with parenchymal dysfunction.2. Mild splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant abdominal pain LIVER: No significant abnormalities noted. Liver length 12.6 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.2 cm in lengthOTHER: Left kidney 11 cm in length. Spleen 8.9 cm in length. No ascites.", "output": "Negative right upper quadrant ultrasound. No hepatobiliary abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Status post liver transplant with worsening liver enzymes LIMITED ABDOMENLIVER: Status post liver transplant. No intrahepatic mass. 10 x 6 x 8.4 cm heterogeneous perihepatic mass lesion posteriorly.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.OTHER: Trace ascites", "output": "Perihepatic mass consistent with hematoma. Patent hepatic vessels. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "23-year-old female undergoing renal biopsy. Ultrasound guidance provided for biopsy of left kidney.", "output": "Ultrasound guidance for renal biopsy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Prior history of right ureteral stone RIGHT KIDNEY: Interval resolution of previously noted mild right hydronephrosis. No evidence for worrisome mass or stone. Right kidney 10.5 cm in lengthLEFT KIDNEY: No mass, stone, or hydronephrosis. 10.5 cm in lengthOTHER: Bladder nondistended", "output": "Interval resolution of previously noted mild right hydronephrosis. No evidence for worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Female 64 years old Reason: assess for liver lesions History: HCV with SVR; cirrhosis LIVER: Hyperechoic coarse appearance of the liver is again seen. Nodularities consistent with cirrhosis. No focal hepatic lesion is seen. Main portal vein is patent with normal directional flow and a peak velocity of 22.9 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Common bile duct measures 4 mm. Gallbladder is normal in appearance. No gallstones.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are scattered by overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 7.2 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. In the right kidney there is a anechoic cyst measuring 2.3 x 1.4 x 2.2 cm. Within the left kidney there is a small cyst measuring 1.4 x 1.1 x 1.4 cm.OTHER: No significant abnormalities noted.", "output": "Cirrhotic morphology of the liver without focal hepatic lesion."}
{"instruction": "Generate impression based on findings.", "input": "64 year-old female with abdominal pain. Evaluate for pancreatitis, cholelithiasis/common bile duct dilatation/obstruction. LIVER: Increased echogenicity of the liver measuring 13.3 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate directional flow; peak velocity measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. No intra-or extra hepatic biliary ductal dilatation. Common bile measures 6 mm in caliber.PANCREAS: Visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: Increased echogenicity of the right kidney measuring 10.1 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Increased echogenicity of the left kidney measuring 9.1 cm in length. No hydronephrosis or shadowing calculi are noted.Normal echogenicity of the spleen measuring 8.97 m in length.", "output": "1. Increased echogenicity of the liver suggestive of fatty infiltration. 2. Increased echogenicity of the kidneys suggestive of cortical dysfunction.3. No evidence of cholelithiasis or cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female with multinodular goiter. Evaluate for stability. RIGHT LOBE MEASUREMENTS: 6.2 x 2.4 x 2.2 cmLEFT LOBE MEASUREMENTS: 6.2 x 2.9 x 2.1 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Multiple nodules again identified. The majority of these nodules have a spongiform or cystic appearance consistent with colloid. Selected for measurement are a nodule in the midportion of the right lobe measuring 0.7 x 1.2 x 1.1 cm, unchanged from the prior study. On the prior exam this had a classic spongiform appearance and on today's study has some increased peripheral soft tissue which may be due to interval hemorrhage. Poorly defined, predominantly solid area of nodularity in the inferior right lobe is incompletely visualized due to substernal extension, but appears smaller, measuring approximately 1.3 x 1.6 x 2.3 cm. Other areas are unchangedLEFT LOBE: Colloid nodule in the upper pole is stable in size and appearance. Larger nodule in the mid upper pole measures 1.5 x 2.6 x 2.7 cm, slightly increased in the interim. This appears somewhat less spongiform than on the prior study with larger internal cystic components. Again, this may be due to interval hemorrhage. Predominantly solid nodule in the medial, midportion of the left lobe measures 1.4 x 1.5 x 2 cm, increased in size in the interim. Inferior, poorly defined nodule which is predominantly solid with a cystic component measures 1 x 1.3 x 1.6 cm without significant change. This is incompletely visualized, extending into a substernal location. Other areas are unchanged.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multinodular goiter there is been an increase in a predominant solid nodule in the medial, midportion of the left lobe. Other nodules are stable although with some change in appearance which may be due to interval hemorrhage."}
{"instruction": "Generate impression based on findings.", "input": "Primary hyperparathyroidism; assess for nephrolithiasis RIGHT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 12.4 cm in length.LEFT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 12.2 cm in length.OTHER: Bladder nondistended. Incidental note made of echogenic liver parenchyma.", "output": "Negative renal ultrasound without evidence for mass, stone, or hydronephrosis. Incidental note made of echogenic liver parenchyma suggestive for hepatic fatty infiltration/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "60 year-old male with history of cardiomyopathy, requires baseline exam for heart transplant. LIVER: The liver measures approximately 15.3 cm in length. No focal liver lesions or intrahepatic biliary dilatation.GALLBLADDER, BILIARY TRACT: Cholelithiasis, without findings of cholecystitis.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted.KIDNEYS: Right kidney measures approximately 10 cm. Normal echogenicity, and there is no hydronephrosis. Left kidney measures approximately 10.5 cm. Simple left renal cyst measures approximately 3.7 x 2.7 cm, unchanged.ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Limited visualization of the bladder is within normal limits.", "output": "Cholelithiasis, without cholecystitis. Otherwise, no significant abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Sepsis, elevated LFTs, and right upper quadrant pain. Acute renal failure LIVER:Mildly heterogeneous echotexture without mass. Liver length 18.2 cmGALLBLADDER, BILIARY TRACT: Gallbladder sludge and stones without obvious acute inflammation. No ductal dilatation.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. 12.8 cm in lengthKIDNEYS: Mild left hydronephrosis and hydroureter. The inferior most aspect of the left hydroureter cannot be determined due to overlying gas within the pelvis.Echogenic renal parenchyma bilaterally. Bilateral renal cysts. Right kidney 12.4 cm in length. Left kidney 12.3 cm in length. ABDOMINAL AORTA: Mild aneurysmal dilatation of distal abdominal aorta with maximal diameter of 2.2 cm. Mild bilateral common iliac aneurysmal dilatation of approximately 1.4 cm in diameter.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Trace ascites. Left pleural effusion Marked diffuse thickening of the bladder wall. Foley catheter within bladder.", "output": "Mild hepatomegaly associated with mildly heterogeneous echotexture suggestive for parenchymal dysfunction without hepatic mass or ductal dilatation. Gallbladder sludge and stones without acute inflammation. Trace ascites. Left pleural effusion.Marked diffuse thickening of the bladder wall suggestive for either chronic inflammation or outlet obstruction. Associated with mild left hydronephrosis and hydroureter. The distal most aspect of the left hydroureter cannot be determined due to overlying gas in the pelvis. Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunctionMild aneurysmal dilatation of the abdominal aorta and common iliac arteries."}
{"instruction": "Generate impression based on findings.", "input": "Transaminitis with fibrosis noted at OSH, evaluate for liver disease. LIVER: The liver measures 12.1 cm in length and is nodular in contour. The liver parenchymal echotexture is coarse. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating somewhat pulsatile hepatopetal flow with a velocity of 0.25 m/s.BILIARY TRACT: Cholelithiasis without significant gallbladder wall thickening or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 2 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 8.5 cm in length. RIGHT KIDNEY: Kidney measures 9.7 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or massLEFT KIDNEY: Kidney measures 9.8 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or massOTHER: Bilateral pleural effusions.", "output": "1.Findings suggestive of chronic liver disease without focal lesions identified.2.Cholelithiasis without secondary evidence of acute cholecystitis.3.Bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female with abdominal pain. Unclear history of kidney stones. RIGHT KIDNEY: The right kidney measures 13.9 cm in length with no hydronephrosis, shadowing calculus or discrete lesion evident. Note is made of a prominent column of Bertin, symmetric bilaterally. Color Doppler demonstrates hilar blood flow.LEFT KIDNEY: The left kidney measures 13.4 cm in length with no hydronephrosis or shadowing calculus. There is a 1.4 x 1.2 x 0.8 cm hyperechoic, interpolar cortical lesion without significant associated shadowing.Note is made of a prominent column of Bertin, symmetric bilaterally. Color Doppler demonstrates hilar blood flow.URINARY BLADDER: The urinary bladder is normally distended with anechoic urine.OTHER: No significant abnormalities noted.", "output": "1. No hydronephrosis or shadowing nephrolithiasis. 2. Nonspecific 1.4-cm left interpolar hyperechoic lesion could represent an angiomyolipoma or fat. CT could help further characterize this lesion."}
{"instruction": "Generate impression based on findings.", "input": "7-year-old female with history of solitary right kidney and hydronephrosis BLADDER  Wall Thickness: The bladder is incompletely distended, but appears upper limits of normal in thickness. Contents: Incompletely distended. Distal Ureter -- SFU Grade**  Right: 0   Ureteral Jets Right: Not observed KIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Corticomedullary differentiation is normal in all but the posterolateral right lower pole   Pelvicaliceal System -- SFU Grade*  Right: 1  Length*** Right: 7.6 cm  Mean for age: 8 cm  Range for age: 7 - 9 cmADDITIONAL OBSERVATIONS: None", "output": "Solitary right kidney with grade 1 dilation. Persistent focal cystic dysplasia or segmental multicystic dysplasia in the lower pole.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469"}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male with rising creatinine Technical assistance provided for ultrasound-guided renal biopsy by the nephrology service. Two passes were performed.", "output": "Technical assistance provided for renal biopsy."}
{"instruction": "Generate impression based on findings.", "input": "81-year-old female patient with pain in right flank. Evaluate for abdominal mass. LIVER: The liver measures 14.9 cm in length. There is a 1.3 x 1.5 x 1.1 cm hyperechoic lesion within the right hepatic lobe which likely represents a hemangioma, seen on prior CT study. Hepatic parenchymal echogenicity is increased. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 3 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 10.4 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.8 cm in length. No evidence of hydronephrosis.The spleen measures 6.4 cm in length.", "output": "1. Increased hepatic parenchymal echogenicity which can be seen with hepatic steatosis/hepatic parenchymal dysfunction.2. Right hepatic lobe hemangioma, seen on prior CT."}
{"instruction": "Generate impression based on findings.", "input": "Post liver transplant, evaluate all vessels for patency LIVER: Increased parenchymal echogenicity suggested, nonspecific but may reflect underlying parenchymal dysfunction/steatosis. Hepatomegaly, liver measures up to 20 cm in craniocaudal dimension.GALLBLADDER, BILIARY TRACT: Not well assessed.PANCREAS: Not well seen.SPLEEN: Visualized splenic artery (artery not well seen due to patient's inability to sustain respiration) and vein patent.KIDNEYS: Not well seen.VASCULAR", "output": "Right portal and hepatic veins not well visualized. Power Doppler sonography needed to be utilized for evaluation of vasculature, may be related in part to slow flow. Visualized hepatic vasculature patent otherwise.Partially imaged right-sided pleural effusion and ovoid fluid collection related to left liver anteriorly.Additional findings as above."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male with hepatitis C presenting for hepatocellular carcinoma screening. LIVER: The hepatic parenchyma is mildly coarse and the liver capsule is nodular consistent with cirrhosis. No focal lesion is identified. The liver measures 15 cm in craniocaudal dimension. No intrahepatic biliary ductal dilatation. There is normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: The common bile duct measures 6 mm in caliber, within normal limits. Status post cholecystectomy.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen measures 11.7 cm.RIGHT KIDNEY: The right kidney measures 13.9 cm in length without hydronephrosis or shadowing calculus. There is a 1.4-cm hypoechoic lower pole lesion, characterized as a simple cyst on the prior MRI. Color Doppler demonstrates hilar blood flow.OTHER: Status post left nephrectomy.", "output": "Cirrhotic liver morphology without a discrete hepatic lesion."}
{"instruction": "Generate impression based on findings.", "input": "34-year-old male with a history of hepatitis C. Screening for clinical trial. LIVER: Note is made of a coarse liver echotexture. No focal mass lesions identified. The liver contour is smooth. The portal vein flow is hepatopetal. The liver measures 15.1 cm in length.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Coarsened liver echotexture consistent with the known history of chronic liver disease. No focal masslesion identified."}
{"instruction": "Generate impression based on findings.", "input": "On 56-year-old female with history of significant EtOH, hepatomegaly and abdominal pain, evaluate liver and for gallstones LIVER: Liver measures 14 cm with mild to moderate increased echogenicity consistent with hepatic steatosis. No focal lesions noted. No evidence of cirrhosis. Portal vein demonstrates normal flow directionality and patency.BILIARY TRACT: No intrahepatic biliary ductal dilatation. Common bile duct measures 3 mm within normal limits. Gallbladder is well-distended with normal gallbladder wall thickness. No focal lesions or stones noted. No pericholecystic fluid.PANCREAS: No significant abnormalities noted.SPLEEN: Spleen measures 7.6 cm without any focal lesions.RIGHT KIDNEY: Right kidney measures 10.1 cm left kidney measures 10.3 cm. Normal echotexture noted. No focal lesions. No hydronephrosis. OTHER: No significant abnormalities noted.", "output": "Mild to moderate hepatic steatosis.No evidence of cholecystitis or cholelithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for malignancy, worsening portal hypertension, 52-year-old male with hereditary hemachromatosis related cirrhosis LIVER: Liver measures 19.1 cm with nodular contour and increased coarse echogenicity consistent with cirrhotic morphology. Main portal vein is patent with normal flow directionality. No intra or extrahepatic ductal dilatation.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. Common duct measures up to 6 mm.PANCREAS: The liver parenchyma was not visualized due to overlying bowel gas. Body appears unremarkable. A lymph node in the ectatic head now measures 4.4 x 2.9 x 2.6 cm, previously measured 5.3 cm, reduced in size.Spleen and KIDNEY: Right kidney measures 12.6 cm and left kidney measures 13.3 cm. Normal echo texture. No focal lesions. A simple cyst noted in the left kidney that measures 0.9 x 0.9 x 1.4 cm.No hydronephrosisSpleen measures 16.7 cm, mildly centimeters without any focal lesion.OTHER: No ascites", "output": "Cervical morphology of the liver without any focal lesion. No ascites. Interval reduction in size of the lymph node seen in the pancreatic head, now measures 4.4 cmMild splenomegaly noted."}
{"instruction": "Generate impression based on findings.", "input": "42 year-old male with nephrotic range proteinuria. Ultrasound guided renal biopsy. Ultrasound guidance was provided to the clinical service. 5 passes were performed by the clinical service. On the final post procedural images, note is made of a small hematoma along the superior margin of the left kidney, measuring approximately 2.5 cm in diameter. Correlation with the procedural report is recommended.", "output": "Ultrasound guidance was provided to the clinical service for biopsy of the left kidney. Small postprocedural perinephric hematoma seen. "}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Coarse echogenic liver without mass. Liver length 14.9 cmGALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation. Mild bilobar intrahepatic as well as mild extrahepatic biliary dilatation. Maximal CBD diameter 0.9 cm. The distal bile duct cannot be assessed due to overlying gas.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right renal cyst. 9.6 cm in length.OTHER: Echogenic focus within the spleen; favor benign etiology such as hemangioma. Spleen length 10.2 cm. Left kidney 10.6 cm in length. Left renal cyst. No ascites.", "output": "Echogenic liver parenchyma consistent with chronic liver disease without mass lesion. Gallbladder sludge without acute inflammation. Mild bilobar intrahepatic and mild extra hepatic biliary dilatation. The distal bile duct cannot be assessed due to overlying gas and a distal obstructing lesion cannot be excluded on this study. Would recommend correlation with CT or M.R.C.P. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "60 year old female who was recalled from screening mammogram for Right breast mass. Mammogram: Three full-field views and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. 1 cm lobulated mass in question disperses into normal breast tissue in the right breast 12 o'clock position. On full-field views, the lesion in question could not be redemonstrated and could represent part of glandular tissue.Ultrasound: Targeted right breast ultrasound was performed. No suspicious cystic or solid mass was noted.", "output": "No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate biliary tree History: abdominal pain, nausea, h/o cholecystectomy BILIARY TRACT: Status post cholecystectomy. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 5 mm in diameter.", "output": "Limited examination. No biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Female 23 years old Reason: evaluate for appendicitis History: RLQ abdominal pain The appendix was not visualized. An intrauterine pregnancy was visualized on a single image.", "output": "1.Appendix not visualized."}
{"instruction": "Generate impression based on findings.", "input": "27 year old female patient with SBP. Evaluate ascites status post aspiration. There is mild to moderate ascites, decreased in comparison to recent CT accounting for differences in modality. There is splenomegaly and an accessory splenule.", "output": "Decreased mild to moderate ascites. "}
{"instruction": "Generate impression based on findings.", "input": "21 year old female with known bilateral fibroadenomas presents for follow up ultrasound of right breast. Ultrasound was performed for the known masses at two o'clock position and 6 o'clock position. At two o'clock position, fourth and technique judged from nipple, there is a oval hypoechoic mass measuring 19 x 6 x 16 mm (previous measurement: 17 x 5 x 17 mm). At 6 o'clock position, 2 cm from the nipple, there is a oval hypoechoic mass measuring 11 x 5 x 10 mm (previous measurement: 15 x 5 x 10 mm). There is no significant change in its appearance in both masses.", "output": "Benign masses at two o'clock position and 6 o'clock position in the right breast.  BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Nephrotic range proteinuria RIGHT KIDNEY: 13.1 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 14.0 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: No significant abnormality noted.OTHER: Left pleural effusion, partially imaged.", "output": "Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Chronic kidney disease RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 8.7 cm in lengthLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 11 cm in lengthOTHER: Bladder nondistended", "output": "Echogenic parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female for follow-up of thyroid nodules RIGHT LOBE MEASUREMENTS: 5.7 x 1.7 x 2 cmLEFT LOBE MEASUREMENTS: 5.7 x 1.7 x 2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Right lobe is diffusely heterogeneous. There is again noted a right mid thyroid nodule which is difficult to measure. This is hypoechoic and not well marginated. When attempting to measure as per prior exam this nodule measures 0.5 x 1.1 by 0.8 cm.LEFT LOBE: Left lobe is diffusely heterogeneous. A left mid thyroid nodule abutting the isthmus measures 2 x 1.5 x 0.7 cm without change. This nodule appears somewhat spongiform.Left lower lobe isoechoic nodule with a hypoechoic rim measures 1.1 x 0.7 x 0.8 cm without significant change.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable appearance the thyroid. No change in size of bilateral thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "Reason: increased FDG activity within the right thyroid lobe on PET/CT RIGHT LOBE MEASUREMENTS: 6.2 x 2.8 x 1.9 cm.LEFT LOBE MEASUREMENTS: 4.7 x 1.9 x 1.1 cm.ISTHMUS MEASUREMENTS: Up to 0.8 cm in thickness.RIGHT LOBE: Mildly heterogeneous background parenchymal echotexture. Midpole nodule measuring 2.7 x 1.4 x 1.9 cm which is predominantly solid, isoechoic to the thyroid gland, demonstrates mild internal vascularity, has a hypoechoic halo, and lacks suspicious microcalcifications. Overall, this nodule is of intermediate suspicion for neoplasm.LEFT LOBE: Mildly heterogeneous parenchymal echotexture including a couple subcentimeter hypoechoic nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Dominant nodule within the right thyroid gland corresponding to increased uptake on recent PET scan is of intermediate suspicion for neoplasm and would be amenable to fine-needle aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for hydronephrosis History: acute kidney injury RIGHT KIDNEY: The right kidney measures 11.0 cm in length. Unremarkable renal parenchymal echogenicity. No shadowing renal calculi or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.3 cm in length. Unremarkable renal parenchymal echogenicity. Mild left hydronephrosis without evidence of obstructing lesion. No shadowing renal calculi. The proximal and distal portions of the nephroureteral stent are visualized in the left renal pelvis and bladder.OTHER: The bladder is poorly distended, limiting its evaluation.", "output": "Mild left hydronephrosis without evidence of obstructing lesion."}
{"instruction": "Generate impression based on findings.", "input": "History melanoma with radiation exposure as a child. RIGHT LOBE MEASUREMENTS: 5.4 x 2.4 x 1.7 cmLEFT LOBE MEASUREMENTS: 7.2 x 4.2 x 3.2 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: 2.4 x 1.8 x 1.3 cm predominantly solid nodule with rim and possible internal calcifications and somewhat irregular borders.LEFT LOBE: 4.5 x 3.5 x 3.2 cm predominantly solid nodule occupying much of the left thyroid gland.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral dominant indeterminate thyroid nodules; both nodules are amenable to ultrasound-guided FNA biopsy. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Right breast mass 12:00 position with interval enlargement, biopsy recommended on 4/19/2016, patient refused and ultrasound-guided biopsy, now presents for a 3 month follow-up examination. Targeted right breast ultrasound was performed. Previously documented hypoechoic mass has minimally increased in size and now measures 2.3 x 1.4 x 1.6 cm, previously measured 2 x 1.4 x 1.4 cm.", "output": "Indeterminate right breast mass with interval increase in size, further evaluation with ultrasound-guided core biopsy is recommended. Findings and recommendations were discussed with the patient in detail.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male with AKI. RIGHT KIDNEY: The right kidney measures 11.4 cm in length. Mild parenchymal hyperechogenicity. No evidence of renal stone, mass, or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.6 cm in length. Mild parenchymal hyperechogenicity. No evidence of renal stone, mass, or hydronephrosis.OTHER: Foley catheter in the bladder. Bladder is decompressed, limiting evaluation. Splenule.", "output": "Mild bilateral parenchymal hyperechogenicity suggestive of medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "33 years old, Male, Reason: Vascularity to transplanted pancreas History: Hyperglycemia post op PANCREAS TRANSPLANT: Transplant pancreas is identified in the right lower quadrant of the abdomen. Pancreas demonstrates homogeneous echotexture. Vascular flow is evident within the parenchyma of the pancreas itself.PERITRANSPLANT TISSUES: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels. The SMA portion of the arterial graft demonstrates arterial waveforms with resistive index of 0.7 and a peak systolic velocity of 0.2 m/sec. Peak systolic velocity of the right internal iliac artery are 0.6 m/sec with a resistive index of 1.0.", "output": "Normal echotexture of the transplanted pancreas without evidence of vascular stenosis or thrombosis."}
{"instruction": "Generate impression based on findings.", "input": "86-year-old female with hematuria. RIGHT KIDNEY: The right kidney measures approximately 9.4 cm. There are several anechoic round areas with posterior acoustic enhancement, consistent with renal cyst. These measure approximately 1.6 x 1.8 x 2.1 cm in the midpole, 1.3 x 1.8 x 1.5 cm in the upper pole, and 1.5 x 1.3 x 1.4 cm in the midpole. There is increased echogenicity of the cortex and the kidney appears atrophic. No evidence of hydronephrosis, worrisome mass, or shadowing calculi.LEFT KIDNEY: The left kidney measures approximately 9.2 cm. The cortex has increased echogenicity and the kidney appears atrophic. No evidence of hydronephrosis, mass, or shadowing foci.URINARY BLADDER: The bladder is nondistended.OTHER: No significant abnormalities noted.", "output": "1. Right-sided simple renal cysts as above. No worrisome mass, hydronephrosis, or stones.2. Echogenic and atrophic kidneys consistent with medical renal disease/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate right thyroid nodule History: right thyroid nodule, benign RIGHT LOBE MEASUREMENTS: 6.4 x 3.0 x 2.2 cm.LEFT LOBE MEASUREMENTS: 6.1 x 2.1 x 1.3 cm.ISTHMUS MEASUREMENTS: Up to 0.3 cm in thickness.RIGHT LOBE: Normal background parenchymal echotexture. Mixed cystic, predominantly solid nodule involving the mid to lower pole measures 4.4 x 1.9 x 2.9 cm, not significant changed in size. Mild internal blood flow. No suspicious microcalcifications.LEFT LOBE: Mildly heterogeneous background parenchymal echotexture. No dominant left thyroid nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology left level 2 cervical lymph node.OTHER: No significant abnormality noted.", "output": "Dominant right thyroid nodule measuring up to 4.4 cm, not significantly changed in size."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old female patient with history of thyroid nodules. RIGHT LOBE MEASUREMENTS: 5.4 x 1.4 x 1.5 cmLEFT LOBE MEASUREMENTS: 4.4 x 1.2 x 1.5 cmISTHMUS MEASUREMENTS: 6 mm in thicknessRIGHT LOBE: The right thyroid lobe is heterogeneous in echogenicity without dominant thyroid lesion. The gland is hypervascular on color Doppler imaging, unchanged.LEFT LOBE: The left thyroid lobe is heterogeneous in echogenicity without dominant thyroid lesion. The gland is hypervascular on color Doppler imaging, unchanged. ISTHMUS: There is a ovoid, solid hypoechoic nodule within the right isthmus measuring 0.6 x 0.4 x 1.1 cm, previously 0.7 x 0.5 x 0.2 cm. An additional solid hypoechoic nodule within the left isthmus measures 0.4 x 0.2 x 0.2 cm, previously 0.6 x 0.5 x 0.3 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is a 1.3 cm right level 3/4 lymph node. There is a 0.4 x 0.4 x 0.8 cm lymph node inferior to the left thyroid lobe and left level II lymph node.OTHER: No significant abnormality noted.", "output": "1. Two solid hypoechoic nodules within the isthmus. 2. Hypervascular thyroid gland, which is unchanged; correlate with history of thyroiditis. "}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female patient with history of left thyroid cyst status post aspiration. RIGHT LOBE MEASUREMENTS: 1.7 x 1.3 x 5.2 cm.LEFT LOBE MEASUREMENTS: 2.2 x 1.9 x 5.6 cm.ISTHMUS MEASUREMENTS: 1 mm in thickness.RIGHT LOBE: The right thyroid lobe is homogeneous in echogenicity containing a spongiform-appearing nodule in the upper pole measuring 0.7 x 0.4 x 0.5 cm, previously 0.7 x 0.4 x 0.4 cm. Additional subcentimeter cystic nodules are again noted.LEFT LOBE: There is a 3.5 x 1.5 x 2.1 cm cystic nodule with a peripheral solid nodular component within the left lobe, which corresponds to a previously aspirated benign colloid nodule. Prior to near complete cyst aspiration, it measured approximately 3.7 x 2.0 x 2.6 cm. An additional smaller cystic nodule is also noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Reaccumulation of fluid within a previously aspirated benign cystic left thyroid nodule.2. Stable right upper pole thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male with abnormal liver function. LIVER: Liver is enlarged, measuring at least 24 cm in length and demonstrates significant and mildly heterogeneous increased attenuation due to fatty infiltration. There are areas of focal sparing about the gallbladder fossa. There is no focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Small amount of dependent sludge in the gallbladder. No gallstones or wall thickening. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Left kidney and spleen appear unremarkable.", "output": "Irregular fatty infiltration of the liver with hepatomegaly."}
{"instruction": "Generate impression based on findings.", "input": "48 years old, Male, Reason: Right Testicular pain History: Right testicular pain. Concern for epidydimitis RIGHT TESTIS: Echotexture of the right testicle is within normal limits. Arterial and venous color Doppler are within normal limits.LEFT TESTIS: Echogenicity and vascular flow in the left testicle is within normal limits.RIGHT EPIDIDYMIS: Right epididymis is not enlarged or hyperemic.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: 1 cm benign appearing lymph node in the right inguinal area.", "output": "Normal ultrasound examination of the testicles. No specific finding to account for patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male history of alcoholism presents with abdominal pain and hematemesis. LIVER:The liver measures 17.5 cm. There is increased, coarse, heterogeneous echotexture of the liver parenchyma. No masses, ascites, or intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder wall measures 0.2 cm, negative sonographic Murphy sign, no pericholecystic fluid, no stones or sludge. The common bile duct was not well seen on the study.PANCREAS: Evaluation the pancreas is limited by overlying bowel gas.SPLEEN: The spleen measures 7.5 cm without sonographic abnormalities.KIDNEYS: The right kidney measures 10.6 cm. The cortex has normal echogenicity. No shadowing calculi, mass, or hydronephrosis. Left kidney measures proximal 0.4 cm. The cortex has normal echogenicity. No shadowing calculi, mass, or hydronephrosis. OTHER: No significant abnormality noted.", "output": "1. Increased, coarse, and heterogeneous echotexture of the liver consistent with chronic liver disease/parenchymal dysfunction. No mass or ascites."}
{"instruction": "Generate impression based on findings.", "input": "Male 52 years old Reason: r/o thrombus History: elevated SCr ULTRASOUND KIDNEYSRIGHT ILIAC FOSSA KIDNEY: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass.OTHER: Fluid collection on the subcutaneous tissues measures 11.1 x 1.9 x 4.1 cm the width mildly complex fluid and no vascular flow.", "output": "1.Patent right iliac fossa renal transplant vasculature without evidence of inflow or outflow compromise.2.Fluid in the subcutaneous soft tissues, which may represent a postoperative seroma."}
{"instruction": "Generate impression based on findings.", "input": "55 year old female with multiple right breast masses and right axillary adenopathy who was recalled from interpretation of outside examination for left breast asymmetry. History of ovarian cancer in sister diagnosed at age 45. LEFT UNILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM: A ML view and 3 spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is redemonstration of a 1 cm mass in the the medial central left breast, which persists on compression imaging.LEFT BREAST ULTRASOUND: A targeted left ultrasound was performed for the mammographic area of concern. At the 9 o'clock position of the left breast, 3 cm from the nipple, there is a benign morphology intramammary lymph node measuring 0.7 cm, with normal color flow, corresponding to the finding on mammogram. At the 3 o'clock position of the left breast, 4 cm from the nipple, there is a 0.4 x 0.4 x 0.2 cm hypoechoic mass with ill-defined margins.", "output": "Ill-defined hypoechoic 0.4 cm mass at the 3 o'clock position of the left breast. While this may represent benign lesion, fine-needle aspiration with possible ultrasound guided core needle biopsy is recommended for definitive histologic diagnosis. Results and recommendations were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Female, 26 years old. Six months pregnant with twins. Back pain. RIGHT KIDNEY: The right kidney measures 12.6 cm in length, with normal cortical echotexture. Moderate hydronephrosis, without obstructing stone identified.LEFT KIDNEY: The left kidney measures 13.7 cm in length, with normal cortical echotexture. Moderate hydronephrosis, without obstructing stone identified.OTHER: Visualized portions of the urinary bladder unremarkable.", "output": "Moderate bilateral hydronephrosis, which may be physiologic."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female patient with medications, tremors. Evaluate for thyroid nodules or increased vascularity. RIGHT LOBE MEASUREMENTS: 7.1 x 2.6 x 1.9 cm.LEFT LOBE MEASUREMENTS: 6.6 x 2.4 x 1.5 cm.ISTHMUS MEASUREMENTS: 4 mm in thickness.RIGHT LOBE: The right thyroid lobe is homogeneous in echogenicity and contains a complex cystic nodule within the right upper pole measuring 0.6 x 0.5 x 0.8 cm. Vascularity on color Doppler imaging is within normal limits.LEFT LOBE: The left thyroid lobe is homogeneous in echogenicity without dominant lesion. Vascularity on color Doppler imaging is within normal limits.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Thyromegaly without dominant thyroid nodule identified."}
{"instruction": "Generate impression based on findings.", "input": "Weight loss nausea and abnormal LFTs and renal function LIVER: Coarse echogenic liver echotexture without mass. Liver length 15 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma without mass, stone, hydronephrosis. 12.8 cm in length.OTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. Left kidney 14.1 cm in length. Spleen 15.2 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Cholelithiasis without acute inflammation.Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with a history of cirrhosis. Evaluate for HCC. LIVER: Coarse echotexture and nodular morphology compatible with cirrhosis. The liver is mildly shrunken, measuring 13.8 cm in craniocaudal dimension. No focal hepatic lesion is identified. No intrahepatic biliary ductal dilatation. Normal hepatopetal portal venous blood flow at 20 cm/sec.GALLBLADDER, BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 4 mm. Cholelithiasis within a normally distended gallbladder. Mild gallbladder wall thickening is nonspecific in the setting of ascites. No focal tenderness.PANCREAS: The pancreas is obscured by overlying bowel gas shadowing.RIGHT KIDNEY: The right kidney is normal in size, measuring 9.8 cm without hydronephrosis, shadowing nephrolithiasis, or discrete lesion. The cortex is echogenic.OTHER: The spleen is normal in size, measuring 11.4 cm.The left kidney measures 10 cm without hydronephrosis, shadowing nephrolithiasis, or discrete lesion. The cortex is echogenic.Small volume ascites.", "output": "1. Cirrhosis without discrete hepatic lesion or biliary duct dilatation. Small volume ascites.2. Cholelithiasis without specific evidence of acute cholecystitis. 3. Medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "History of Hashimoto's thyroiditis. Choking sensation. RIGHT LOBE MEASUREMENTS: 5.2 x 1.7 x 1.5 cm, mildly enlarged in size.LEFT LOBE MEASUREMENTS: 5.5 x 1.6 x 1.6 cm, mildly enlarged in size.ISTHMUS MEASUREMENTS: 3 mm in AP dimension.RIGHT LOBE: The thyroid gland is diffusely heterogeneous without discrete nodules.LEFT LOBE: The thyroid gland is diffusely heterogeneous without discrete nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not identified.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "Minimally enlarged heterogeneous thyroid gland compatible with prior Hashimoto's thyroiditis. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: 41 y/o female with left calf pain for three weeks. Mild prominence. Left calf compared to Right. R/O Muscle Injury. Imaging through the soft tissues of the posterior lower leg demonstrates asymmetric prominence of the subcutaneous fat on the left compared with the right. However, no fluid collection or abnormality of the underlying muscle is evident.", "output": "Asymmetric prominence of the subcutaneous fat of the posterior left lower leg without fluid collection or evidence of underlying muscle abnormality."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old female presents for evaluation of her parathyroid. RIGHT LOBE MEASUREMENTS: 4.7 x 1.4 x 1.3 cm.LEFT LOBE MEASUREMENTS: 5.1 x 1.5 x 1.17 cm.ISTHMUS MEASUREMENTS: 0.4 cm.RIGHT LOBE: Homogenous parenchyma without nodule. Normal vascularity.LEFT LOBE : Homogenous parenchyma without nodule. Normal vascularity.ISTHMUS: Homogenous parenchyma without nodule. Normal vascularity.PARATHYROID GLANDS: Unable to identify parathyroid candidate.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Normal ultrasound of the thyroid without nodule. No definite parathyroid candidates."}
{"instruction": "Generate impression based on findings.", "input": "Chronic kidney disease RIGHT KIDNEY: Echogenic parenchyma. Questionable 5.7 x 5.4 x 5.9 cm complex mass lesion arising from the lower pole of the right kidney. No stone. Minimal hydronephrosis. Right kidney 9.9 cm in length.LEFT KIDNEY: Echogenic parenchyma. Benign appearing cyst. No stone or hydronephrosis. Left kidney 9.3 cm in length.OTHER: Bladder nondistended.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without significant obstruction or stone.Questionable right lower pole complex mass lesion versus partial duplication. The degree of echogenicity of the right kidney makes it difficult to differentiate between a mass lesion or partial duplication; noncontrast CT may be helpful for further characterization."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old male with hypercalcemia. Evaluate for parathyroid adenoma. RIGHT LOBE MEASUREMENTS: 6.3 cm x 2.1 cm x 2.7 cmLEFT LOBE MEASUREMENTS: 5.9 cm x 1.9 cm x 2.3 cmISTHMUS MEASUREMENTS: 3 mm in thicknessRIGHT LOBE: Normal homogeneous echotexture with no discrete nodules or masses are identifiedLEFT LOBE: Normal homogeneous echotexture with no discrete nodules or masses are identifiedISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing left neck level 2 lymph node measures 1.1-cm x 0.4 cm x 2.0-cm. No pathological lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Unremarkable examination. Specifically no sonographic evidence of parathyroid adenoma is noted."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male with hematuria. RIGHT KIDNEY: The right kidney measures 8.9 cm in length. Small to moderate hydronephrosis, unchanged. A simple cyst of the right upper renal pole is unchanged measuring 1.7 x 1.7 x 1.6 cm. Mildly echogenic renal parenchyma.LEFT KIDNEY: The left kidney measures 8.8 cm in length. No hydronephrosis. Multiple renal cysts are again seen. In the left lower renal pole, there is a complex cystic lesion with the cystic component measuring 4 x 3.8 x 4.4 cm and a mural nodule measuring 0.6 x 0.5 0.6 cm. The cystic component on the prior ultrasound measured 4 x 3.9 x 3.8 cm, however the mural nodule was not clearly identified. Mildly echogenic renal parenchyma.URINARY BLADDER: A Foley catheter and suprapubic catheter are in place. Intraluminal debris is noted within the bladder. OTHER: No significant abnormalities noted.", "output": "1. Suprapubic catheter and Foley catheter are in place. The urinary bladder contains intraluminal debris.2. Complex cystic nodule of the left lower renal pole containing a subcentimeter mural nodule. The cystic component is unchanged in size compared to 12/5/2014 ultrasound exam, however the mural nodule was not clearly identified. Attention on follow-up imaging is recommended.3. Stable mild to moderate right-sided hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with increased LFTs, evaluate for steatosis, fibrosis, portal hypertension. LIVER: Measures 18.6 cm in length. Markedly increased hepatic echogenicity without discrete focal lesion. Note that the hepatic echotexture limits penetration and evaluation of deeper structures on this examination. Patent main portal vein with antegrade flow measures 0.2 m/s.BILIARY TRACT: No cholelithiasis or gallbladder wall thickening, pericholecystic fluid, or sonographic Murphy sign. No biliary ductal dilation.PANCREAS: The pancreas is obscured by bowel gas. The imaged portions of the pancreas appear unremarkable.SPLEEN: No significant abnormalities noted.KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Increased hepatic echogenicity consistent with steatosis or parenchymal disease."}
{"instruction": "Generate impression based on findings.", "input": "Male 63 years old; Reason: eval for cause of hyperbilirubinemia, r/o clot with dopplers History: hyperbilirubinemia LIVER: The liver measures 16.6 cm in length. There is coarse increased echogenicity of the liver parenchyma. A vague a hyperechoic lesion is seen in the right lobe of the liver measuring 3.3 cm x 3.0 cm x 2.8 cm. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 26.1 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is contracted and the wall measures 3.9 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 4.2 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 16.1 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 15.4 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 14.7 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: Trace ascites is seen.", "output": "1. There is increased coarse echogenicity of the liver parenchyma compatible with fatty infiltration/hepatocellular dysfunction.2. A vague hyperechoic lesion is seen in the right lobe of the liver. A discrete mass cannot be excluded and recommend contrast enhanced cross-sectional imaging for further characterization of this lesion.3. Splenomegaly and trace ascites are present."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old male with history of abdominal distention. Evaluate for ascites. Limited abdominal ultrasound images demonstrate no abdominal ascites or discrete fluid collections.", "output": "No evidence of ascites."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female presents with abdominal pain. LIVER:Measures 15.8 cm. Normal echogenicity. No ascites, intrahepatic biliary dilation, or focal mass. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder wall measures 9.4 mm. There is echogenic material within the gallbladder is dependent and consistent with sludge. No stones. There is trace pericholecystic fluid. The common bile duct measures 7.1 mm. Positive sonographic Murphy's sign.PANCREAS: Evaluation the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 9.8 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 10.2 cm. Left kidney measures 10.9 cm. Normal echogenicity. No shadowing calculi, hydronephrosis, or focal masses. OTHER: No significant abnormality noted.", "output": "1. Gallbladder wall thickening, trace pericholecystic fluid, and positive sonographic Murphy's sign are consistent with acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Elevated lipase LIVER: Coarse echogenic liver echotexture again noted without obvious mass. Liver length 19.9 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: Pancreas could not be visualized due to overlying gas and bandages.RIGHT KIDNEY: No significant abnormalities noted. 12.1 cm in length OTHER: Left kidney and spleen could not be visualized due to overlying gas and bandages. Mild ascites.", "output": "Coarse echogenic liver echotexture suggestive for parenchymal dysfunction/fatty infiltration without obvious mass or ductal dilatation. Mild ascites. Pancreas could not be visualized due to overlying gas and bandages."}
{"instruction": "Generate impression based on findings.", "input": "Elevated lipase and LFTs with gallbladder wall thickening seen on recent CT LIVER: Mild hepatomegaly. Liver length 19.2 cm.BILIARY TRACT: Gallbladder wall thickening with pericholecystic fluid associated with numerous gallstones. A Murphy's sign could not be elicited. Prominent extra hepatic duct without obvious distal obstructing lesion or intrahepatic ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 8.4 cm in lengthRIGHT KIDNEY: Right renal cyst. Right kidney 9.2 cm in length. OTHER: Left kidney 10.4 cm in length.", "output": "Gallbladder wall thickening with pericholecystic fluid associated with cholelithiasis. Although a Murphy's sign could not be elicited, the ultrasonographic findings are suggestive for acute cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "66-year-old woman history of left breast cancer status post mastectomy presents for further evaluation of an area in right breast that was incompletely characterized on recent whole breast ultrasound. On physical exam, there is a a rounded palpable mass in the right retroareolar region.A targeted right breast ultrasound was performed area of concern in the upper quadrant of the right breast. Ultrasound of the right upper inner quadrant demonstrates normal fibroglandular tissue. No discrete solid or cystic mass is identified.Corresponding to the palpable mass is a 1.3 x 1.2 x 1.6 cm hypoechoic well-circumscribed mass in the right retroareolar region near the 9:00 location 1 cm from the nipple, with imaging findings suggestive of fibroadenoma. This is stable from ultrasound dated back to 6/17/2009.", "output": "No sonographic evidence for malignancy. Stable 1.6 cm right retroareolar mass, with imaging findings suggestive of a fibroadenoma. Right unilateral diagnostic mammogram is due June 2016.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Jones is a 55 year old female presenting for a short-term follow-up for a high probability benign morphology mass in the right breast. A targeted right breast ultrasound was performed at the right breast, 12:30 position, approximately 2 cm from the nipple. There is reidentification of a oval, hypoechoic mass measuring 0.3 x 0.3 cm, compared to 0.4 x 0.2 cm. This mass appears very similar in appearance to the sonographic images of 12/18/2012 and 5/14/2014. There is no new solid or cystic mass identified.", "output": "Stable benign morphology mass in the right breast. No sonographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually, due next in April 2015.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Low-attenuation renal foci seen on prior CT RIGHT KIDNEY: Multiple benign appearing cysts corresponding to the low attenuation foci seen on the recent CT. A representative upper pole cyst measures 2.5 x 2.4 x 2 cm. No stone or hydronephrosis. Right kidney 9.5 cm in length.LEFT KIDNEY: Multiple benign appearing cysts corresponding to low-attenuation foci seen on the recent CT. A representative lower pole cyst measures 2.2 x 2.3 x 2.5 cm. No stone or hydronephrosis. Left kidney 10.1 cm in length.OTHER: Bladder nondistended", "output": "Multiple bilateral benign-appearing cysts corresponding to low-attenuation foci seen on the recent chest CT. No worrisome mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Hyperbilirubinemia with elevated LFTs; patient with sickle cell disease status post stem cell transplant LIMITED ABDOMENLIVER: Moderate hepatomegaly. Liver length 21 cm. Normal parenchymal echogenicity without mass.BILIARY TRACT: Gallbladder not visualized. Mild prominence of extra hepatic duct without intrahepatic ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: Not visualized; presumably absent RIGHT KIDNEY: No significant abnormalities noted. 13.4 cm in length OTHER: Left kidney 12.9 cm in length. No ascites", "output": "Moderate hepatomegaly without mass or significant duct dilatation. No ascites. Patent hepatic vessels with normal directional flow."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B carrier LIVER: Heterogeneous coarse liver architecture again noted without mass. Liver length 13.3 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right kidney 11.1 cm in length.OTHER: Left kidney 10.8 cm in length. Spleen is 9.1 cm in length. No ascites.", "output": "Stable heterogeneous coarse liver echotexture consistent with chronic liver disease without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "26 year old with palpable right breast masses. Per the patient, these do not feel different in size compared to the time of the prior outside ultrasound. A targeted right ultrasound was performed for the patient\u2019s area of concern. Two solid masses and a cyst are seen. Near the right breast 12 o'clock position approximately 4 cm from the nipple, a 1.7 x 1.6 cm oval circumscribed mass is seen. Closer to the nipple and slightly more medially, a 1.4 x 1.0 cm mass with similar typically benign morphology is present. This is probably the mass labeled 12 o'clock on the prior outside ultrasound. Additionally, slightly lateral to the larger of the two solid masses is a 6-mm cyst.", "output": "Two likely benign masses in the right breast. The larger of the two solid masses is not seen on the images that were previously submitted. Surgical consultation is recommended. Palpably guided tissue sampling versus ultrasound guided biopsy can be considered to confirm a benign etiology, especially if there is a change detected on physical exam.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Follow-up thyroid cyst RIGHT LOBE MEASUREMENTS: 2.3 x 1.2 x 4.6 cmLEFT LOBE MEASUREMENTS: 1.7 x 1.4 x 5.3 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Stable 1.5 x 0.9 x 1.1 cm extrathyroidal cystic lesion projecting posterior inferior to the right thyroid lobe", "output": "Stable extrathyroidal cystic lesion projecting posterior and inferior to the right thyroid gland. No regional adenopathy. No thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "Left neck mass RIGHT LOBE MEASUREMENTS: 4 x 1.8 x 1.4 cmLEFT LOBE MEASUREMENTS: 4.5 x 1.4 x 1 cmISTHMUS MEASUREMENTS: 0.25 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: 0.8 x 0.5 x 0.7 cm well-circumscribed hypoechoic nodule upper pole ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Subcentimeter well-circumscribed hypoechoic upper pole left thyroid nodule. This lesion is amenable to ultrasound-guided percutaneous biopsy. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "49 year old female patient with significant ascites status post paracentesis. Heart transplant evaluation. LIVER:The liver measures 16.6 cm in length. No focal hepatic lesion is identified. Main portal vein is patent with hepatopetal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. There is no intra or extrahepatic biliary ductal dilatation. The common bile duct measures 3 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.SPLEEN: The spleen is enlarged measuring approximately 15.2 cm in length.KIDNEYS: The right kidney measures 9.5 cm in length and left kidney measures 10.8 cm in length. No evidence of hydronephrosis. ABDOMINAL AORTA: The proximal aorta measures approximately 1.6 x 1.5 cm in diameter and the mid aorta measures approximately 1.6 x 1.9 cm in diameter. The distal abdominal aorta and iliac vasculature are not visualized secondary to overlying bowel gas.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: There are bilateral pleural effusions and moderate ascites.", "output": "1. Moderate ascites and bilateral pleural effusions.2. Splenomegaly. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: ? Gallstones History: pancreatitis LIVER: The liver measures 15.5 cm in length. Coarse, echogenic hepatic parenchyma. The portal vein is patent with normal directional hepatopedal blood flow, peak velocity 21.6 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: Numerous echogenic stones and sludge are seen within the gallbladder lumen and neck. The gallbladder wall measures 0.2 cm. The common bile duct measures 0.2 cm. No significant biliary ductal dilatation. No pericholecystic fluid. Negative sonographic Murphy's sign.PANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney measures 10.4 cm in length. The left kidney measures 10.3 cm in length. Normal renal echogenicity. No shadowing stones or hydronephrosis.OTHER: No ascites.", "output": "1. Findings consistent with hepatic steatosis or hepatic parenchymal dysfunction.2. Cholelithiasis and gallbladder sludge without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodule RIGHT LOBE MEASUREMENTS: 5.2 x 2.0 x 1.8 cm, normal in size with normal background echotexture and vascularity.LEFT LOBE MEASUREMENTS: 5.7 x 1.5 x 1.5 cm, normal in size with normal background echotexture and vascularityISTHMUS MEASUREMENTS: 1-2 mm in AP dimension.RIGHT LOBE: Two subcentimeter hypoechoic nodules are noted with internal features suggestive of colloid.LEFT LOBE: Two subcentimeter hypoechoic are noted, one which appears cystic and the other with internal features suggestive of colloid.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not identified.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral subcentimeter thyroid nodules, without suspicious features evident."}
{"instruction": "Generate impression based on findings.", "input": "81 year old female with a history of thyroid nodules on CT scan at an outside institution. RIGHT LOBE MEASUREMENTS: 5.3 x 1.5 x 2.0 cm.LEFT LOBE MEASUREMENTS: 4.0 by 0.9 x 1.1 cm.ISTHMUS MEASUREMENTS: 5 mmThe thyroid gland is enlarged and diffusely heterogenous, which can be seen in thyroiditis.RIGHT LOBE: There is a 1.8 x 0.7 x 0.9 cm irregular lobulated heterogeneous, but predominantly hypoechoic nodule in the mid body of the right lobe of the thyroid gland. There is no internal vascularity or definite calcification. Indeterminant.LEFT LOBE: The mid portion of the left lobe of the thyroid gland is diffusely heterogenous with subcentimeter hypoechoic foci.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Cervical lymph node in the left lateral neck with nonspecific morphology, including a prominent cortex, measuring 1.2 x 0.6 x 1.4 cm. OTHER: No significant abnormality noted.", "output": "1. 1.8 cm indeterminate nodule in the mid body of the thyroid gland for which further evaluation with FNA is recommended.2. Indeterminate left cervical lymph node which could also be further evaluated with FNA if clinically indicated. 3. Heterogenous thyroid echotexture, nonspecific and may be seen in setting of thyroiditis. "}
{"instruction": "Generate impression based on findings.", "input": "Look for iliac vein patency and iliac bifurcation, look for thrombus Limited examination due to overlying bowel gas. Left and right iliac veins are patent. No evidence of thrombus.", "output": "Patent iliac veins without thrombus."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old female with right flank/upper quadrant pain. LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: Post cholecystectomy. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY:Known right staghorn calculus incompletely visualized. 2.2-cm cystic lesion in the upper pole of the right kidney. Complexity is difficult to evaluate.OTHER: No significant abnormalities noted.", "output": "No biliary tract abnormality.Shadowing staghorn calculus right kidney. Cystic lesion upper pole right kidney incompletely characterized."}
{"instruction": "Generate impression based on findings.", "input": "HCC screening, hepatitis B LIVER: Liver measures 14.8 cm, mild heterogenous echotexture noted. No focal lesions. No evidence of cirrhosis no intrahepatic biliary ductal dilatation.GALLBLADDER, BILIARY TRACT: Normal appearance of the gallbladder. Common bile duct measures less than 4 mm. No evidence of gallstonesPANCREAS: Head of the pancreas as visualized appears unremarkable. Body and tail is not visualized due to overlying bowel gas.KIDNEY: Right kidney measures 9.4 cm and left kidney measures 5.7 cm. Limited evaluation of the left kidney due to overlying bowel gas.Possible right upper pole caliectasis is noted. This appears more likely to be caliectasis than a simple cyst which was previously described on 7/20/2012.Limited evaluation of the left kidney however possible caliectasis noted.OTHER: No ascitesSpleen measures 7.5 cm without any focal lesions.", "output": "No evidence of cirrhosis or ascites.No focal lesions in the liver.Limited evaluation of the left kidney due to overlying bowel gas; Possible right upper pole and left renal caliectasis."}
{"instruction": "Generate impression based on findings.", "input": "Call back from screening mammogram for calcifications for both breasts. Three standard views of both breasts and two spot magnification views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. There are several clusters of coarse benign calcifications in the right breast. In the left breast, there are multiple small masses at 6:00 position - lower inner quadrant, with coarse benign appearing calcifications. Ultrasound for left breast was performed. There are several cysts, some of which contain calcifications inside at 6:00 position and 8:00 position. No suspicious findings or solid lesions are present.", "output": "High probability benign calcifications in the left breast, for which left unilateral diagnostic mammogram in 6 months is recommended. No mammographic evidence for malignancy in the right breast. Results and recommendations were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain; acute pancreatitis LIVER: No significant abnormalities noted.BILIARY TRACT: Unremarkable gallbladder. No ductal dilatation.", "output": "Unremarkable gallbladder. No ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Palpable right axillary lymph node and palpable left breast mass. The patient had left breast ultrasound-guided core biopsy several months ago which was benign and concordant. She feels the area in her left breast is somewhat increased since biopsy. A targeted bilateral ultrasound was performed for the patient\u2019s areas of concern. In the right axillary region, including at the site of patient concern, several normal morphology axillary lymph nodes are seen. The finding at the site of concern is equivocal for a lymph node, but in any case benign. It measures 6 x 5 mm. In the left breast 9:00 position, a hypoechoic mass with adjacent biopsy clip is noted. The mass measures 8 x 6 mm. As a hydromark clip was placed and is close to the skin surface, it is possible that the biopsy clip is also palpable.", "output": "1. Normal right axillary lymph nodes.2. Biopsy proven benign area in the left breast 9:00 position with adjacent biopsy clip. Given that the clip is close to the skin surface, it too may be palpable.The patient will follow-up with Dr. Jaskowiak today.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Abdominal U/S to help rule out gallstones; Ongoing pelvic and abdominal pain. Recent abdominal xray suggestive of gallstones. LIVER: The liver measures 14.7 cm in length. The liver parenchymal echotexture is normal. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.35 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 6.0 cm in length. RIGHT KIDNEY: Kidney measures 11.6 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 11.6 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "No evidence of cholelithiasis, acute cholecystitis, or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old male with hepatitis C. Screen for HCC. LIVER: Diffuse increased echogenicity of the liver measuring 16.5 cm in length. No focal hepatic lesion. Portal vein is patent with appropriate directional flow. GALLBLADDER, BILIARY TRACT: Comet tail artifact in the gallbladder consistent with adenomyomatosis of the gallbladder. No pericholecystic fluid. No gallbladder wall thickening. Common bile duct measures 4 mm in caliber. No intra or extrahepatic biliary ductal location.PANCREAS: The visualized portions of the pancreas are normal in echogenicity. No pancreatic ductal dilatation. RIGHT KIDNEY: Normal echogenicity of the right kidney measured 11.6 cm in length. No hydronephrosis.OTHER: Normal echogenicity of the left kidney measuring 10.7 cm in length. No hydronephrosis.Normal echogenicity of the spleen measuring 8.7 cm in length.", "output": "1. Diffuse increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesion.2. Adenomyomatosis of the gallbladder. "}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male with renal transplant and acute renal insufficiency. History of hydronephrosis. RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: Renal transplant measures 12.2 cm in length. There are multiple cortical and renal sinus cysts involving the transplanted kidney as previously noted. There is a mildly complex cyst in the mid upper pole with a single septation. There is no is for hydronephrosis, shadowing calculus or solid mass.COLLECTING SYSTEM/URETER: No hydronephrosis No significant abnormality notedURINARY BLADDER: Decompressed by Foley catheter.OTHER: No significant abnormality noted", "output": "No evidence for hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 8.6 cm in lengthLEFT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 9.3 cm in length.OTHER: Bladder nondistended", "output": "Mildly echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Female, 18 years old. Recurrent pyelonephritis and CT with ?area of focal pyelo versus renal mass. RIGHT KIDNEY: The right kidney measures 10.7 cm in length, with normal cortical echogenicity. No focal lesions or perinephric collections. No hydronephrosis or urinary stones identified. Note is made of a duplicated collecting system.LEFT KIDNEY: The left kidney measures 12.5 cm in length, with normal cortical echogenicity. No focal lesions or perinephric collections. No hydronephrosis or urinary stones identified.OTHER: The urinary bladder is incompletely distended.", "output": "No focal renal mass lesion or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for a left axillary lymph nodes. Known left breast cancer. A targeted left ultrasound was performed for the axillary region. Multiple lymph nodes with uniformly thickened cortices, retained hila and retained hilar blood flow are seen. There is no suspicious morphology lymph node or solid or cystic mass identified.", "output": "No suspicious morphology axillary lymph node. The patient will be seeing Dr. Chhablani again today.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Primary hyperparathyroidism RIGHT LOBE MEASUREMENTS: 4.7 x 1.6 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.5 x 1.5 x 1.2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No extrathyroidal focus consistent with a parathyroid adenoma candidate could be identified. No thyroid nodule. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "73 years old, Female, Reason: r/o thyroid enlargement History: neck enlargement RIGHT LOBE MEASUREMENTS: 4.4 x 2.4 x 2 cm.LEFT LOBE MEASUREMENTS: 5.7 x 2.1 x 3 cm.ISTHMUS MEASUREMENTS: 1.1 cm.RIGHT LOBE: No evidence of thyroid nodules. The size of the thyroid is within normal limits. Echogenicity of the thyroid is homogeneous. No significant abnormality noted.LEFT LOBE: No evidence of thyroid nodules. The size of the thyroid is within normal limits. Homogeneous echogenicity of the thyroid. No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Normal ultrasound evaluation of the thyroid without evidence of enlargement or nodules."}
{"instruction": "Generate impression based on findings.", "input": "50 year-old female with hematuria. Ultrasound guidance was provided for biopsy of left kidney", "output": "Ultrasound guidance"}
{"instruction": "Generate impression based on findings.", "input": "18-year-old-year-old female with 3 palpable lumps in the in the right breast. A targeted right ultrasound was performed in the palpable areas of concern. In the 11:00 location are again seen two adjacent round isoechoic masses with circumscribed margins. The more medial mass measures 1.5 x 1.2 x 1.7 cm, and the more lateral mass measures 1.5 x 1.3 x 1.7 cm. These are not significantly changed compared with the prior study. An additional isoechoic circumscribed mass is identified in the right breast 8:00 position which measures 1.4 x 1.2 cm.", "output": "No significant change in size and sonographic appearance of the two masses in the right upper outer breast, likely representing benign fibroadenomas. An additional palpable concern in the right lower outer breast also demonstrates imaging features most consistent with a benign fibroadenoma. Continued follow up at 6-12 months can be considered as warranted clinically. The patient will follow up in surgical clinic today. BIRADS: 3 - Probably benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "History of elevated alkaline phosphatase. Exam limited by positioning and patient body habitus. LIVER: The liver measures 15.5 cm in length. Numerous isoechoic hepatic lesions with hypoechoic halos are noted throughout the liver suspicious for metastases. An example lesion in the left lobe measures 3.4 x 4.8 x 3.3 cm. BILIARY TRACT: Cholelithiasis. No gallbladder wall thickening. The sonographic Murphy's sign is negative. The common bile duct measures 5 mm in diameter.PANCREAS: The pancreatic duct is mildly prominent measuring 4 mm in diameter. SPLEEN: No significant abnormalities noted. The spleen measures 9.3 cm in length. RIGHT KIDNEY: Kidney measures 10.9 cm in length. Multiple right calyceal calculi the largest of which measures 9mm. Resolved hydronephrosis.LEFT KIDNEY: Kidney measures 11.3 cm in length. Mild hydronephrosis with stent.OTHER: Ascites.", "output": "1.Multiple bilobar hepatic lesions suspicious for metastases. Example lesion in left lobe measures 3.4 x 4.8 x 3.3 cm. 2.Cholelithiasis without evidence of cholecystitis.3.Multiple right calyceal calculi the largest of which measures 9mm. Resolved hydronephrosis on right. 4.Mild left hydronephrosis with stent.5.Ascites. Discussed findings with Dr. Akoegbe at 11:00 a.m. on 2/13/2015. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: thyroid cancer s/p thyroidectomy and RAI History: thyroid cancer RIGHT LOBE: Status post resection. No residual soft tissue echogenicity.LEFT LOBE: Status post resection. No residual soft tissue echogenicity.ISTHMUS: Status post resection. No residual soft tissue echogenicity.PARATHYROID GLANDS: Not visualizedLYMPH NODES: No significant abnormality noted. No cervical lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy without evidence of recurrence or lymphadenopathy. Stable exam."}
{"instruction": "Generate impression based on findings.", "input": "23-year-old with small palpable mobile mass in the right breast near the axillary region. Strong family history of breast cancer. A targeted right ultrasound was performed for the patient\u2019s area of concern near the right axilla. There is an oval superficially located mass which is centrally echogenic and peripheral hypoechoic and very mild blood flow measuring 9 x 9 mm.", "output": "Benign morphology mass of the site of palpable concern is highly likely to be benign. Differential considerations include a small lymph node, lipoma or possibly fat necrosis. Given the highly likely benign appearance, a short term ultrasound follow-up in 3 to 6 months is recommended to ensure stability. However, if the area changes before then, intervention sooner would be warranted.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old female with generalized abdominal pain. LIVER: Liver echotexture appears within normal limits. There is hepatomegaly with the liver measuring approximately 21 cm in length as seen on prior CT. No focal hepatic abnormality. Patient has had wedge resection in the left lobe of the liver.Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Gallbladder contains several, small dependent shadowing echogenic foci consistent with gallstones. No wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Small gallstones. Persistent hepatomegaly."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female undergoing renal biopsy. Ultrasound guidance was provided for a renal biopsy by the nephrology service. 5 passes were made. A heterogeneous collection suspicious for postbiopsy hematoma is seen measuring approximately 5.1 x 5.6 x 1.6 cm.", "output": "1. Ultrasound guidance was provided for a renal biopsy by the nephrology service. Correlate with procedural report regarding possible hematoma."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female with history of hepatitis C virus cirrhosis. Evaluate for mass or ascites. LIVER: Liver is coarsely echogenic with a cirrhotic morphology. Focal, coarse calcifications again noted within the liver. Addition, complex cyst in the left lobe of the liver measures 1.6 x 2 x 2 cm. Right lobe hepatic cyst measures 2.6 x 3.9 x 4.1 cm. There is a less well-defined rounded, hypoechoic subcapsular nodule in the right lobe measuring 1 x 1 x 1.2 cm. This does have some evidence of cystic characteristics. This was not visualized with certainty on the prior exam. Previously noted vague nodular density not seen on today's study.BILIARY TRACT: Poorly tract is normal in caliber. The gallbladder may contain a small, nonshadowing polyp. In addition, there is some focal increased echogenicity in the region of the fundus. Given lack of stones or other fundal abnormality and prior studies, this may represent an adjacent hepatic calcification. There is not gross wall thickening or pericholecystic fluid.PANCREAS: The head and and body are normal. The tail was not well seen.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No ascites.", "output": "Cirrhotic liver with heterogeneous echotexture. No change in cysts within the liver or calcifications. Vague, subcapsular nodule may represent a complex cyst although difficult to assess in a liver that is this heterogeneous. Patient has had multiple cysts on prior MR exam as well as other noncystic nodules.Gallbladder polyp. See above."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old male with renal insufficiency. Real-time ultrasound guidance was provided for right renal biopsy. Fluid adjacent to the kidney noted on post procedure imaging.", "output": "Ultrasound guidance. Postprocedural perirenal fluid."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female with kidney stone. RIGHT KIDNEY: The right kidney measures 10.4 cm in length. No hydronephrosis. In the right lower pole, there is a 0.5 x 0.2 x 0.5 cm shadowing calculus (prior 0.6 x 0.7 x 0.9 cm). No other stones are identified. Increased parenchymal echogenicity.LEFT KIDNEY: The left kidney measures 10.3 cm in length. No hydronephrosis. Increased parenchymal echogenicity.URINARY BLADDER: The urinary bladder is partially distended without acute abnormality.OTHER: No significant abnormalities noted.", "output": "1. Slightly decreased size of the known nonobstructing subcentimeter stone of the right lower renal pole.2. Echogenic renal parenchyma suggestive of chronic medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old male patient with elevated transaminases. Evaluate for hepatosplenomegaly. LIVER: The liver measures 17.4 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: There are gallstones without significant pericholecystic fluid or gallbladder wall thickening. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 3 mm in diameter.PANCREAS: The pancreas is poorly visualized on this examination.RIGHT KIDNEY: The right kidney measures 10.1 cm in length. No evidence of hydronephrosis. OTHER: The left kidney is not visualized.The spleen measures 9.7 cm in length.A left iliac fossa transplant kidney is without hydronephrosis.", "output": "Cholelithiasis without sonographic evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Coarse echogenic liver echotexture again noted without mass. Liver length 15.6 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9 cm in length.RIGHT KIDNEY: No significant abnormalities noted. 9.6 cm in length.OTHER: Left kidney 9 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture again noted consistent with chronic liver disease without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant abdominal pain LIVER: No significant abnormalities noted. Liver length 17 cmBILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 17.2 cm in length RIGHT KIDNEY: No significant abnormalities noted. 12.3 cm in lengthOTHER: Left kidney 14.1 cm in length. No ascites.", "output": "Cholelithiasis without acute inflammation or ductal dilatation. Mild splenomegaly. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Rising bilirubin and jaundice LIVER: Coarse echogenic liver parenchyma without mass. Liver length 25.6 cmGALLBLADDER, BILIARY TRACT: Gallbladder absent. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.1 cm in length.OTHER: Left kidney 11.8 cm in length. Spleen is 15.4 cm in length. No ascites.", "output": "Moderately severe hepatomegaly associated with coarse echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Mild splenomegaly. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are bilateral diagnostic mammogram and left breast ultrasound dated 3/15/2016, left breast ultrasound-guided core biopsy with postprocedure mammogram dated 3/22/1960 performed at Porter regional Hospital Center for women's health, Valparaiso, Indiana. For comparison,none are available. Three standard views of both breasts were obtained. The breast parenchyma is heterogeneously dense, which limits the sensitivity of the mammogram . Triangular marker denoting palpable abnormality identified in the left upper-outer quadrant. Underneath the marker there is an irregular hyperdense focal asymmetry with few spiculations measuring 3 cm, with few associated faint calcifications. No dedicated spot compression or magnification views of this area obtained.A faint cluster of calcifications in the right breast 9:00 position measuring 12 mm needs further evaluation with spot magnification views. Few coarse benign morphology calcifications are seen elsewhere in the right breast. Benign right axillary lymph node is noted.Ultrasound demonstrates an irregular hypoechoic mass at 1:00 position approximately 5 cm from the nipple that measures 2.5 x 1.5 cm (on ultrasound dated 3/22/2016 which was on the day of the biopsy, this mass approximately measures 2.7 x 1.8 cm). In the left breast 1:00 position 2 cm from the nipple an oval benign morphology mixed echogenic mass is identified which could represent a benign intramammary lymph node although no definite blood flow is noted on ultrasound or definite focal asymmetry is noted on mammogram. It measures 5 x 7 x 3 mm and is located 1.5 cm anterior to the mass. Ultrasound-guided core biopsy of both these lesions was performed with clip placement. Good targeting noted of the larger of the 2 masses. 4 images have been submitted of the anterior smaller mass ultrasound-guided biopsy. Biopsy targeting appears suboptimal. Postprocedure mammogram demonstrated 2 clips in the left breast 1:00 position, distance between the clips is approximately 19 mm. Smaller of the 2 clips is within the center of the irregular spiculated mass. The longer of the 2 clips is within the anterior most likely benign morphology mass.Pathology results revealed left breast mass 1:00 2 cm from the nipple is fibrocystic change which appears concordant.Pathology results revealed left breast mass 1:00 position 5 cm from the nipple is IDC grade 2 which appears concordant.", "output": "Biopsy-proven IDC left breast 1:00 position posterior depth.12 mm cluster of indeterminate calcifications in the right breast need further evaluation with spot magnification views.4 images have been submitted of the ultrasound-guided core biopsy of the anterior smaller left breast mass. The results are benign and concordant however repeat ultrasound is recommended due to questionable targeting. Given the dense breast tissue, additional evaluation with breast MRI should be considered.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "86-year-old male with pain in cheek. Patient states left sided pain. Evaluate for submandibular gland or parotid gland stone. Right parotid gland appears unremarkable. Adjacent, prominent but morphologically normal lymph nodes identified.Left parotid gland with no sialectasis. In or immediately adjacent to the inferior aspect of the left parotid there is dense rim calcification measuring approximately 7 mm in transverse diameter. This obscures underlying tissue.", "output": "Rim calcified mass adjacent to inferior left parotid. The appearance is somewhat unusual but has been reported in pleomorphic adenoma. Other parotid masses typically produce only coarse calcifications.This could also be inflammatory or vascular in nature.This could represent a calcified lymph node."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Ada Louise Palmer is a 34 years old female with fibroadenoma in the left breast. Presents for questionable enlargement of the previously biopsied lump in the left breast. On physical examination, a mobile lobulated mass is palpated in the left subareolar region.A targeted left ultrasound was performed for the patient\u2019s area of concern. The previously biopsied circumscribed, lobulated, hypoechoic mass in the left subareolar area measures 3.2 x 1.8 x 3.8 cm (previously 3.4 x 2 x 4 cm), stable in size and morphology. Biopsy clip with the results of fibroadenoma is noted in the center of this mass.", "output": "No sonographic evidence for malignancy. Stable biopsy-proven fibroadenoma in the left subareolar region. Results and recommendations were discussed with the patient. The patient should follow up with her primary care physician as clinically warranted, presuming these results are concordant with the physical exam findings. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Male 54 years old with history of lymphoma and new palpable bilateral axillary adenopathy. A bilateral breast ultrasound was performed for the palpable areas of concern. Multiple enlarged lymph nodes at varying depths are noted bilaterally.In the right lower axilla the largest lymph node measures 3.6 x 1.8 x 2.6 cm without increased vascularity.In the right upper axilla the largest lymph node in measures 5.1 x 2.6 x 2.4 cm without increased vascularity.In the left lower axilla the largest lymph node measures up to 3.7 cm without increased vascularity.In the left upper axilla the largest done measures 4.7 x 3.0 x 3.3 cm without increased vascularity.", "output": "Multiple enlarged axillary lymph nodes bilaterally (in the lower axillary tail and higher axillary tail). Palpable masses in the bilateral lower axillary regions are necrotic axillary lymph nodes. The patient is scheduled to follow-up with surgery for excisional biopsy. Results and recommendations were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "85-year-old male with known solid right renal mass for follow-up. RIGHT KIDNEY: Right kidney measures 9.3 cm in length. Cortex echotexture likely within normal limits. There is no hydronephrosis. There are multiple simple and complex cysts identified as seen on the prior exam, some of the cysts with septation and some with presumed internal debris. Arising from the upper pole of the right kidney is again noted an ovoid, exophytic solid mass. This measures 2.2 x 3.5 x 2.8 cm, unchanged from the prior study. Please note, measurements provided in prior report were incorrect and should be noted as 2.1 x 3.5 x 2.8 cm.LEFT KIDNEY: The left kidney measures 10.3 cm in length. Cortical echotexture likely within normal limits. There is no hydronephrosis. There are again noted multiple simple and mildly complex cysts. No solid mass is seen.OTHER: Prostate is markedly enlarged and protrudes and deforms the posterior bladder wall. Bladder is incompletely distended but appears somewhat thick-walled.", "output": "Stable examination. In particular, no significant change in the solid right renal mass. Please note replacement measurements for prior exam given above."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female status post thyroidectomy. Evaluate. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: No evidence of residual or recurrent disease.LEFT LOBE: No evidence of residual or recurrent disease.ISTHMUS: No evidence of residual or recurrent disease.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small benign-appearing cervical lymph nodes are again noted. Benign-appearing right level 3 lymph node measures 1.9 x 1.3 x 0.4 cm, unchanged. OTHER: No significant abnormality noted.", "output": "No evidence of residual or recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "Transplant kidney. Rising creatinine. The ultrasound guidance was provided for the nephrology service for biopsy of a transplant kidney in the left iliac fossa.", "output": "Ultrasound guidance for transplant renal biopsy."}
{"instruction": "Generate impression based on findings.", "input": "History of ascites and abnormal liver architecture LIVER: Mildly coarse and heterogeneous liver echotexture without mass. Liver length 14.7 cm.GALLBLADDER, BILIARY TRACT: Gallbladder not visualized. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. 11.4 cm in lengthOTHER: Echogenic focus within spleen; favor benign etiology. Spleen length 10.8 cm. Echogenic left renal parenchyma without worrisome mass, stone, or hydronephrosis. Left renal cyst. Left kidney 10.1 cm in length. No ascites.", "output": "Mildly coarse and heterogeneous liver echotexture suggestive for chronic liver disease without mass or ductal dilatation. Gallbladder not visualized. No ascites.Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female. Callback from 5/6/2015 screening mammogram for adjacent masses in the lateral aspect of the right breast. RIGHT BREAST DIAGNOSTIC MAMMOGRAM: A standard ML view and three spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Again seen are two adjacent masses in the right breast upper outer quadrant that persist on spot compression views. The larger of the two masses is on the 9:00 radian, measures 1.5 cm in diameter and has microlobulated margins. The second mass is anterior and inferior to the first. The second mass has partially smooth margins. An asymmetry at the superficial margin of the fibroglandular tissue that was superior to both masses on the MLO view dispersed into normal fibroglandular tissue on the spot compression views. RIGHT BREAST ULTRASOUND: Targeted ultrasound of the right breast upper outer quadrant demonstrated an irregular 1.5 x 1.2 x 1.7 cm hypoechoic mass at 9 o'clock 4 cm from the nipple, corresponding to the larger of the two masses seen on the mammogram. The mass has microlobulated margins, an echogenic halo, and mild internal flow on color Doppler imaging.A second mass is seen at the 8 o'clock periareolar position, approximately 1.5 cm anteroinferior to the first mass. The second mass is a parallel hypoechoic circumscribed mass measuring 0.8 x 0.4 x 1 cm, corresponding to the second mass visualized on mammography. There is no definite internal flow on color Doppler imaging.", "output": "1. Right breast 9 o'clock mass with suspicious features. Ultrasound guided percutaneous biopsy is recommended. 2. Right breast 8 o'clock mass, approximately 1.5 cm away from the first mass, which has benign features, but which is non-specific. Ultrasound guided percutaneous biopsy is recommended. Results and recommendations were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Female 22 years old Reason: abnormal exam, please evalute for normal architecture History: none RIGHT LOBE MEASUREMENTS: 4.2 x 1.3 x 1.8 cm.LEFT LOBE MEASUREMENTS: 4.3 x 1.3 x 1.4 cmISTHMUS MEASUREMENTS: 0.2 cm.RIGHT LOBE: Right thyroid lobe is normal in appearance. No nodules.LEFT LOBE: Left thyroid lobe is normal in appearance. No nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small right benign-appearing level 2 lymph node measures 0.8 x 0.3 x 1.4 cm.OTHER: No significant abnormality noted.", "output": "Normal appearance of the thyroid. No nodules."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal failure RIGHT KIDNEY: Mildly echogenic renal parenchyma without mass, stone, or hydronephrosis. Ureteral stent present. Right kidney 10 cm in length.LEFT KIDNEY: Mildly echogenic renal parenchyma without mass, stone, or hydronephrosis. Ureteral stent present. Left kidney 12.6 cm in length.OTHER: Bladder nondistended.", "output": "Mildly echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction. Bilateral ureteral stents."}
{"instruction": "Generate impression based on findings.", "input": "Assess for hydronephrosis. Acute kidney injury RIGHT KIDNEY: Unremarkable echogenicity without mass or stone or hydronephrosis. 12.3 cm in lengthLEFT KIDNEY: Unremarkable echogenicity without mass, stone, or hydronephrosis. 11.6 cm in lengthOTHER: Asymmetrical polypoid wall thickening involving the left bladder wall reported previously is difficult to evaluate secondary to a Foley catheter decompressing the bladder.", "output": "No hydronephrosis of either kidney. Foley catheter decompresses the bladder which is not well evaluated."}
{"instruction": "Generate impression based on findings.", "input": "84-year-old female with right upper quadrant pain. LIVER: In the left hepatic lobe (segment 5) is a circumscribed cystic structure with a peripheral hyperechoic rim and shadowing internal calcifications or possibly internal stones which appears intrahepatic and separate from the adjacent gallbladder. The portal vein is patent.GALLBLADDER, BILIARY TRACT: The gallbladder is somewhat patulous in morphology, but no discrete gallbladder stone is identified. The gallbladder wall is normal in thickness.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: A right kidney cyst with thin internal septations measures 2.1 x 1.9 x 1.8 cm. There is no hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Cystic lesion in segment 5 as described above, for which differential considerations include a hepatic cyst with peripheral calcifications, focal intrahepatic biliary ductal dilation with stones, or less likely an accessory gallbladder.2.Otherwise, no evidence of cholelithiasis or acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Norfolk is a 65 year old female with known right breast IDC and metastatic right axillary lymph node. She presents for imaging evaluation to assess for response to hormonal therapy. Targeted grayscale and color ultrasound of the right breast and axilla.In the right breast 9:00 position, approximately 6 cm from the nipple, there is revisualization of an irregular hypoechoic mass with centrally located biopsy marker clip now measuring approximately 1.1 x 0.9 x 0.8 cm, previously 1.0 x 0.8 x 0.5 cm on outside examination. In the right axilla, previously biopsied axillary lymph node with centrally located clip now measures approximately 1.5 x 0.9 cm, previously 1.9 x 1.4 cm.", "output": "Known index malignancy in the right breast and metastatic right axillary lymph node are stable to slightly decreased when compared to prior imaging. Continued surgical consultation is recommended at this time. All results and recommendations were discussed with the patient.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are ultrasound images of right breast and right axilla (2/5/15), images from ultrasound guided biopsy (2/9/15) performed at DuPage Medical Group. ULTRASOUND IMAGES OF RIGHT BREAST AND RIGHT AXILLA (2/5/15):Irregularly shaped, microlobulated mass, measuring 23 x 19 x 22 mm, with increased blood fow is visualized at 10 o'clock in the right breast. This mass is highly suggestive for malignancy. An abnormal lymph node with asymmetric cortical thickening is present in the right axilla. One normal appearing lymph node is also present in the right axilla.IMAGES FROM ULTRASOUND GUIDED BIOPSY (2/9/15):A needle biopsy was performed for the right breast mass at 10 o'clock position with an appropriate needle placement. The annotation on the image states that a \"buckle clip\" is placed within the mass.Per outside pathology report, the biopsy result was malignant, invasive carcinoma grade 3.", "output": "Biopsy proven right breast carcinoma, with an abnormal right axillary lymph node. If mammogram has not been performed, it should be performed.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "42 year old female with epigastric pain, history of gallbladder polyp. LIVER: Normal echogenicity of the liver measuring 13.6 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Two subcentimeter polyps are noted along the nondependent portion of the gallbladder wall, one of which measures 3 mm x 2 mm x 3 mm and the second measures 5 mm x 4 mm x 5 mm. No gallbladder wall thickening. No cholecystic fluid. Common duct measures 4 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Tail of the pancreas is obscured by overlying bowel gas. The remaining visualized portions are unremarkable.RIGHT KIDNEY: Measures 10.2 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 9.7 cm in length. No hydronephrosis or shadowing calculi are noted.Spleen measures 8.4 cm in length and is normal in echogenicity.", "output": "Two subcentimeter gallbladder polyps. "}
{"instruction": "Generate impression based on findings.", "input": "Female 29 years old Reason: Study-related tissue biopsy; see below; hx. Sarcoma kidney History: None Written informed consent was obtained. Subcostal approach to the right of midline was chosen for free hand biopsy of the lesion in the left lobe of the liver.Skin was prepped and draped sterilely. Skin and liver capsule were anesthetized with lidocaine.Under ultrasound guidance three 18-gauge core biopsies were obtained:The first specimen yielded a solid core with a few whitish specks and reddish tissue. This was placed in empty container provided.Second specimen yielded a focal white core of tissue which was cut in half. Half placed in formalin and have placed the second container provided. Third specimen yielded heterogeneous solid tissue which was placed in buffered formalin.Due to patient pain and nausea after the first biopsy pass and considering tissue obtained, a fourth core was not done.No signs of hematoma bleeding by ultrasound immediately post procedure.Specimens were given to the clinical research assistant.Less than 5 cc blood loss.Patient was observed in nurse holding vital signs remained stable. Pain was mild to moderate and stable. A dose of Zofran was ordered for nausea.The patient was discharged to home in good condition.", "output": "3 core biopsies as described above. Complicated by mild to moderate pain and nausea."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency with history of chronic renal disease RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 11.2 cm in lengthLEFT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Left renal cyst. Left kidney 11.1 cm in lengthOTHER: Bladder nondistended", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old with right breast cellulitis. Right breast ultrasound was performed. There is an irregularly-shaped hypoechoic lesion with increased vascularity, measuring 36 x 23 mm at two o'clock retroareolar region, consistent with abscess formation. Diffuse skin thickening and edema is seen in the right breast.", "output": "Abscess formation at two o'clock retroareolar region in the right breast. Diffuse skin thickening and edema in the right breast.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Alexandridou submitted outside mammogram dated 06/12/2012 and two prior ultrasounds dated 06/12/2012 and 01/21/2013, from University of Illinois, Urbana. Submitted outside studies were compared to the current mammogram dated 10/14/2016. The breast parenchyma is heterogeneously dense, which may obscure small masses (BiRads Density Category C), unchanged in pattern and distribution. Previously identified mass in the right medial breast, far posterior depth, is new when compared to the prior mammogram from 2012.Previously identified mass in the left central breast, mid depth, appears to have increased in size when compared to the prior mammogram. In addition, prior ultrasound examination from 2012 may show a corresponding partly cystic/partly solid mass, which needs to be further evaluated.", "output": "Bilateral partially obscured incompletely characterized masses. Additional imaging, including spot compression views and possible ultrasound, are recommended for further evaluation.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EC - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Holly is a 22-year-old female with a biopsy-proven fibroadenoma in the left breast. She presents today for ultrasound evaluation to assess for possible growth of this fibroadenoma. Family history of breast cancer and maternal grandmother, three maternal cousins, and a maternal aunt. Upon physical exam at patient's area of concern, a soft mobile mass is appreciated.A targeted left breast ultrasound was performed for the palpable area of concern. In the left breast 6:00 location, approximately 2 cm from the nipple, there is reidentification of an oval hypoechoic mass measuring 2.4 x 1.3 x 2.9 cm, previously measuring 1.8 x 1.1 x 1.9 cm.", "output": "Interval increase in size of a biopsy-proven fibroadenoma in the left breast. Patient is scheduled to follow up with Joly Jose directly after the radiology appointment for further evaluation. All results and recommendations were relayed to the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Collected carcinoma with biliary stent with elevated bilirubin LIVER: Bilobar hepatic cysts unchanged.BILIARY TRACT: Interval improvement in degree of intrahepatic ductal dilatation. Biliary stents again noted.OTHER: Mild ascites again noted", "output": "Interval improvement in degree of intrahepatic ductal dilatation. Biliary stents again noted. Mild ascites again noted."}
{"instruction": "Generate impression based on findings.", "input": "39 years Female with history of bladder diverticulum, urinary tract infections, and hydronephrosis. RIGHT KIDNEY: Kidney measures 11.9 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.5 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.BLADDER: Bladder is incompletely distended but appears grossly unremarkable. No discrete bladder diverticuli are seen.OTHER: No significant abnormalities.", "output": "Unremarkable examination."}
{"instruction": "Generate impression based on findings.", "input": "Male 52 years old Reason: lung transplant pre evaluation, eval for liver disease LIVER: Liver echogenicity is within normal limits. No focal hepatic mass. The liver measures 13.7 cm in length.BILIARY TRACT: Gallbladder is minimally contracted. No intra or extrahepatic biliary ductal dilatation. No gallstones are identified. PANCREAS: Pancreas is obscured by overlying bowel gas.SPLEEN: Spleen is normal in appearance.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 12.4 cm. Left kidney measures 12.5 cm.ABDOMINAL AORTA: Normal abdominal aortic waveforms. Distal aorta measures 1.8 cm. Right iliac measures 1.1 cm in diameter. Left iliac measures 1.2 cm in diameter.INFERIOR VENA CAVA: Not well visualized secondary to overlying bowel gas.Bladder: Bladder is normal in appearance.", "output": "Normal appearing sonogram the abdomen. No significant abnormality. "}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are standard diagnostic mammogram (2/15/2016), bilateral breast ultrasound (2/15/2016), bilateral ultrasound-guided breast biopsy images (2/24/2016), and bilateral post-procedure mammogram (2/24/2016). These studies were performed at St. Anthony Breast Care Center in Crown Point, Indiana. Final pathology was benign for both breasts (PASH) as per Donna Christian, NP. Bilateral Diagnostic Mammogram (2/15/2016): Right CC view has been submitted only. The breast parenchyma is heterogeneously dense, which limits the sensitivity of the mammogram. Limited examination, please submit the remaining views.Bilateral Breast Ultrasound (2/15/2016): Targeted left breast ultrasound demonstrates a hypoechoic parallel mass with scattered cystic areas and some internal vascularity at the 12:00 position, approximately 4 cm from the nipple. The mass measures 4.9 x 1.1 x 5.4 cm and likely represents a fibroadenoma with cystic changes. Normal morphology lymph node is present in the left axilla.Targeted right breast ultrasound demonstrates a hypoechoic solid mass with cystic component and some internal vascularity at the 11:00 position, approximately 3 cm from the nipple. This mass measures 3.8 x 2.6 x 1.3 cm. Normal morphology lymph nodes are noted in the right axilla.Bilateral Ultrasound-Guided Breast Biopsy (2/24/2016): Core needle biopsy of the hypoechoic mass in the left breast, 12:00 position, is demonstrated with good targeting using a 14-gauge needle. 5 core specimens were obtained and a bowtie biopsy clip was placed.Core needle biopsy of the hypoechoic mass in the right breast, 11:00 position, is demonstrated with good targeting using a 14-gauge needle. 5 core specimens were obtained and a bowtie biopsy clip was placed.Bilateral Post-Procedure Mammogram (2/24/2016): CC and ML views of both breasts demonstrate heterogeneously dense parenchyma, which limits the sensitivity of the mammogram. Bowtie biopsy clips are noted in the upper outer quadrants of both breasts. No definite hematoma is identified in either breast.", "output": "Successful ultrasound-guided core needle biopsies of bilateral breast masses and clip placement. Final pathology was benign and concordant (PASH). Limited evaluation by mammography. Although the patient has heterogeneously dense breast, submission of left CC and bilateral MLO views is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid thyroid carcinoma status post thyroidectomy RIGHT LOBE: Status post thyroidectomy. Vague hypoechoic focus within the right thyroid bed measuring 0.5 x 0.4 x 0.6 cm.LEFT LOBE: Status post thyroidectomy. No worrisome massISTHMUS: Status post thyroidectomy. No worrisome massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy. Vague subcentimeter hypoechoic focus within the right thyroid bed; favor benign postoperative etiology. However, would pay special attention to this focus on future surveillance scans. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "65 years old, Male, Reason: evaluate for cirrhotic morphology History: HCV, prior HBV LIVER: The liver measures 14.1 cm in length. Echogenicity of the liver is within normal limits. No surface nodularity of the liver to suggest cirrhosis. No focal hepatic lesion identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 8 cm in length. RIGHT KIDNEY: Kidney measures 8.6 cm in length. Normal echotexture. No hydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 9.0 cm in length. Normal echotexture. No hydronephrosis shadowing calculus. Small cortical renal cyst measuring 0.7 x 0.5 x 0.5 cm.", "output": "No sonographic evidence of cirrhosis or focal hepatic lesion."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old male with deceased donor renal transplant and decreased urine output, evaluate for flow and hematoma. RENAL TRANSPLANT:LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No peritransplant fluid collection is seen.KIDNEY: No evidence of nephrolithiasis. The renal cortex appears within normal limits.COLLECTING SYSTEM/URETER: No evidence of hydronephrosis.URINARY BLADDER: The bladder was not well visualized on today's examination.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels. Inflow and outflow vasculature appear intact with appropriate directional flow. The resistive index in a segmental artery ranges from 0.62-0.69. The resistive index in arcuate arteries range from 0.55-0.61.OTHER: No significant abnormality noted", "output": "No significant abnormality related to the right iliac fossa renal transplant. No evidence of nephrolithiasis or hydronephrosis. Inflow and outflow vasculature appear patent with appropriate directional flow."}
{"instruction": "Generate impression based on findings.", "input": "History of hepatitis C. Evaluate for HCC. LIVER: The liver measures 14 cm in length. It is mildly coarse in echotexture. No focal lesion. No intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 0.2 cm/s.BILIARY TRACT: The gallbladder is normally distended. It contains an echogenic shadowing focus compatible with a small gallstone. The common duct measures 9 mm without choledocholithiasis.PANCREAS: The visualized portions of the pancreatic head and body are unremarkable.SPLEEN: The spleen measures 9.9 cm in length.RIGHT KIDNEY: The right kidney measures 10.1 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. OTHER: The left kidney measures 10.8 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion.", "output": "1. Mildly coarse hepatic echotexture without a discrete lesion.2. Cholelithiasis without cholecystitis. Mild prominence of the common bile duct; correlate with LFTs."}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine Left iliac fossa renal transplant again demonstrates moderate hydronephrosis and proximal moderate hydroureter unchanged from the prior study. No ureteral stent could be identified within the left iliac fossa collecting system. No worrisome mass, stone, or perinephric collection appreciated. Neobladder collapsed.", "output": "No change in moderate left iliac fossa hydronephrosis and proximal moderate hydroureter. No ureteral stent could be identified."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old female with right-sided thyroid nodule. RIGHT LOBE MEASUREMENTS: 6.2 x 2.5 x 2.2 cmLEFT LOBE MEASUREMENTS: 5.1 x 1.6 x 1.1 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Primarily solid nodule measures 4.7 x 4.0 x 1.7 cm, with inferior cystic component measuring 1.5 cm. This nodule is not significantly changed in size compared with the prior study from 2012, at which time it was biopsied.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Large right thyroid nodule without significant interval change."}
{"instruction": "Generate impression based on findings.", "input": "Female 73 years old Reason: ?AKI on CKD, eval for hydro. Limited by body habitus.RIGHT KIDNEY: Mildly increased echogenicity. 9 cm length. No hydronephrosis or hydroureter. Normal vascularity and limited color Doppler ultrasound imaging.LEFT KIDNEY: 10.8 cm in length. No hydronephrosis or hydroureter.URINARY BLADDER:Collapsed with Foley catheter in place.OTHER: No significant abnormalities noted.", "output": "Mild increased echogenicity suggestive medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Female 54 years old Reason: pls study liver, spleen in pt w severe CHF and 1 month h/o abd 'bloating' History: no periph edema; no crackles in lungs, but increasing upper abd fullness x 1 mo in pt w severe CHF LIMITED ABDOMENLIVER: Liver is enlarged measuring 15 cm. Hepatic veins and IVC are dilated. These findings are secondary to patient's known congestive heart failure. No evidence of focal liver lesions. Liver echogenicity is unremarkable.BILIARY TRACT: Gallbladder wall is thickened likely secondary to heart failure. No evidence of cholelithiasis.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: Spleen measures 12 cm. There is a hyperechoic area within the spleen measuring 7 mm likely representing a hemangioma. RIGHT KIDNEY: Right kidney measures 11.7 cm. Normal echogenicity. No focal lesions or hydronephrosis.OTHER: Left kidney measures 12 cm.", "output": "Hepatomegaly, dilated hepatic veins and IVC secondary to patient's known history of congestive heart failure. Mild splenomegaly. Likely a small hemangioma within the spleen."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female with abdominal pain and question calcification on an outside plain film. RIGHT KIDNEY: The right kidney measures 10.6 cm in length. Echotexture is normal. There is no hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 10.9 cm in length. There is a very small, septated cyst in the midportion of the left kidney. In the upper pole of the kidney extending to the periphery of the cortex there are shadowing calcifications. There is focal parenchymal loss adjacent to this. Findings are suggestive of chronic calyceal stones. No associated mass is identified.OTHER: Bladder is decompressed.", "output": "Calcifications left kidney associated with parenchymal cortical loss. Presumably, chronic stone disease."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old male with history of cirrhosis, evaluate for HCC. LIVER: Measures 15.8 in length. Cirrhotic morphology and increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: No cholelithiasis. No gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilation. Gallbladder polyps measuring up to 0.4 cm without acute interval change.PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Unremarkable in size and echogenicity. KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. 0.6 cm right renal cyst without significant change. 0.5 cm nonobstructive right renal calculus.OTHER: No significant abnormalities noted.", "output": "Cirrhotic hepatic morphology and increased echogenicity consistent with chronic liver disease, without evidence of discrete mass."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old female with a history of follicular thyroid carcinoma status post thyroidectomy presents for follow-up of nodules noted on prior ultrasound. RIGHT LOBE, LEFT LOBE, ISTHMUS MEASUREMENTS: The thyroid is absent.RIGHT LOBE: The thyroid is absent.LEFT LOBE: The thyroid is absent.ISTHMUS: The thyroid is absent.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Several lymph nodes are seen on the study.The previously seen node in level 2 on the right neck is not visualized on this study.Right neck level 3: An approximately 0.8 x 0.4 by is 1.6 cm node is seen with benign morphology.Right neck level 5: An approximately 1.0 x 0.4 x 1.3 cm node is seen with benign morphologyLeft node level 2: Previously seen lymph node is not visualized on this study.Left neck level 4: A previously seen 0.9 x 0.5 x 0.8 cm lymph node appears stable but is without definite benign characteristics.Left neck level 1: An approximately 1.0 x 0.3 x 1.5 cm lymph node is seen with benign morphologyOTHER: No significant abnormality noted.", "output": "1. Surgical changes of a thyroidectomy.2. Lymph nodes appears stable as described above. Specifically, left neck level IV lymph node is stable but without definite benign characteristics. Recommend continued follow up with ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "Male 61 years old Reason: rule out liver abscess History: sepsis LIMITED ABDOMENLIVER: The liver measures 18.1 cm. Heterogeneous hepatic parenchymal echotexture with multiple mixed echogenicity foci throughout the liver measuring up to 2 cm in the right hepatic lobe. The portal vein is patent with normal directional flow. Small volume perihepatic ascites.BILIARY TRACT: Moderate intrahepatic biliary ductal dilation. The extrahepatic biliary duct measures 4 mm. Status post cholecystectomy. No evidence of biliary ductal dilation.PANCREAS: No significant abnormality noted.KIDNEYS: The right kidney measures 10.6 cm. The left kidney measures 10.8 cm.SPLEEN: The spleen measures 17.8 cm. Perisplenic ascites.", "output": "1.Multiple mixed echogenicity foci throughout the liver as described above most consistent with liver abscesses as seen on comparison CT. The dominant right hepatic lobe abscess has decreased in size.2.Moderate intrahepatic biliary ductal dilation. 3.Hepatosplenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Female 78 years old; Reason: elevated LFTs, eval for hepatic lesions or abnormalities History: elevated LFT LIVER: The liver measures 17.1 cm in length. There is coarse increased echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 16.0 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.0 mm. No stones are seen. No pericholecystic fluid. Negative sonographic Murphy sign. The common bile duct measures 0.3 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 6.6 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.7 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.0 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen. A renal cyst is seen measuring 2.4 cm x 1.9 cm x 2.1 cm.", "output": "There is coarse increased echogenicity of the liver compatible with fatty infiltration/hepatocellular dysfunction. No worrisome masses are seen."}
{"instruction": "Generate impression based on findings.", "input": "52 year-old female with heart failure and ascites. LIVER: Liver echotexture coarsely echogenic and mildly heterogeneous fashion. Within the left lobe of the liver there is a mildly hyperechoic ovoid region measuring 1.3 x 2 . 5 x 2 cm which may have a central linear decrease echogenicity extending to the periphery. This would best be evaluated by dedicated liver CT. Overall hepatic size within normal limits. Venous distention consistent with congestive heart failure.GALLBLADDER, BILIARY TRACT: Dependent sludge within the gallbladder without shadowing gallstones. Gallbladder wall within normal limits.PANCREAS: Exclude a small cystic area in the pancreatic head although the associated pancreatic duct does not appear dilated. Again this could be evaluated by CT or preferably MRCP.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Marked ascites.", "output": "Ascites. Coarsened hepatic echotexture.Apparent hyperechoic mass within the liver although this could also represent focal fatty infiltration. Dedicated CT or MR of the liver recommended.Cystic area within the pancreas. M.R.C.P. recommended."}
{"instruction": "Generate impression based on findings.", "input": "Left testicular pain. RIGHT TESTIS: Right testis measures 4.1 x 2.7 x 2 cm. no focal lesions. Normal vascularity. Testicular microlithiasis.LEFT TESTIS: Left testis measures 3.9 x 2.3 x 2 cm. normal vascularity. Testicular microlithiasis. No focal lesions.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: Subcentimeter epididymal cyst.OTHER: Small left varicocele. Mild scrotal wall thickening, nonspecific.", "output": "Left varicocele. Bilateral testicular microlithiasis. Follow-up testicular imaging in one year is recommended. Mild nonspecific scrotal wall thickening."}
{"instruction": "Generate impression based on findings.", "input": "87-year-old male patient with excessive fatigue and anemia, concern for MDS. Also with evidence of CKD. Evaluate the spleen and kidneys. LIVER: The liver measures 18.9 cm in length and demonstrates increased parenchymal echogenicity. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 5 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 10.3 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.9 cm in length. No evidence of hydronephrosis.The spleen measures 7.7 cm in length.", "output": "1. Mild hepatomegaly with increased parenchymal echogenicity, likely secondary to hepatic steatosis.2. Spleen size within normal limits."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 66 y/o man with a right thyroid nodule. RIGHT LOBE MEASUREMENTS: 8.1 x 4.3 x 2.9 cm.LEFT LOBE MEASUREMENTS: 5.7 x 3.1 x 1.8 cm.ISTHMUS MEASUREMENTS: Up to 3 mm in thickness.RIGHT LOBE: Mildly heterogeneous background parenchymal echogenicity. Partially visualized heterogeneous predominantly hypoechoic solid nodule at the inferior pole measuring 4.5 x 4.0 x 4.0 cm which extends substernally. The nodule demonstrates some internal vascularity, and a single dystrophic appearing calcification is noted.LEFT LOBE: Mildly heterogeneous background parenchymal echogenicity. No discrete nodules identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Partially imaged dominant thyroid nodule in the right inferior pole extending substernally which is of intermediate suspicion for neoplasm."}
{"instruction": "Generate impression based on findings.", "input": "Female 49 years old Reason: gall stones History: epigastric pain LIVER: Heterogeneous background echogenicity of the liver. No definite focal mass is identified. Main portal vein is patent with normal directional flow and a peak velocity of 13.4 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. No gallbladder wall thickening or signs of acute inflammation. No gallstones are identified.PANCREAS: Pancreas is obscured by overlying bowel gasSPLEEN: Spleen is normal in appearance measuring 10.5 cm.RIGHT KIDNEY: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 10 cm. Left kidney measures 10.3 cm.OTHER: No significant abnormalities noted.", "output": "Normal appearance of the gallbladder without evidence of cholelithiasis or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant abdominal pain LIVER: Non-cirrhotic liver morphology. Enlarged, measuring 23 cm in length. Mildly coarsened parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Normal appearance of the gallbladderPANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 11.1 cm in length, with a 9 mm nonobstructing stone noted in the lower pole. The left kidney is 10.4 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.8 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No free fluid is identified.", "output": "1. Hepatomegaly with increased hepatic echogenicity compatible with steatosis.2. Nonobstructing right nephrolithiasis.3. No specific findings otherwise to account for the patient's symptoms. "}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female with cancer status post thyroidectomy and I-131. Evaluate for abnormal masses or nodes. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Hyperechoic nodule is seen in the right thyroidectomy bed measuring 8 mm x 6 mm x 3 mm. LEFT LOBE: Hypoechoic nodule in the left thyroidectomy bed measures 4 mm x 3 mm x 2 mm, unchanged accounting for differences in technique, previously measuring 3 mm x 3 mm x 2 mm. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Bilateral benign appearing lymph nodes in the neck, the largest on the right measures 1.7 cm x 1.0 cm x 0.5 cm. No pathologic lymphadenopathy. OTHER: No significant abnormality noted.", "output": "1. Hyperechoic subcentimeter nodule in the right thyroidectomy bed with appearance favoring a benign process. 2. Hypoechoic nodule in the left thyroidectomy bed is unchanged. "}
{"instruction": "Generate impression based on findings.", "input": "59 year old female presents for hepatocellular carcinoma screening. Participant in a clinical trial. LIVER: Subtle heterogeneous echogenicity of the liver, with contour nodularity consistent with early cirrhosis. No identifiable masses. The liver measures 20.7 cm.BILIARY TRACT: No biliary dilatation. Small amount of gallbladder sludge/debris. No pericholecystic fluid or gallbladder wall thickening.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. The spleen measures 10.7 cm.RIGHT KIDNEY: No significant abnormalities noted. The right kidney measures 12.3 cm.OTHER: No significant abnormalities noted. The left kidney measures 10.2 cm, and has a small superior pole exophytic simple cyst measuring 2.5 x 2.1 x 2.6 cm.", "output": "Findings of early hepatic cirrhosis, with no identifiable liver masses."}
{"instruction": "Generate impression based on findings.", "input": "Reason: RUQ History: r/o cholecystitis LIVER: The liver measures 14.8 cm in length. The liver parenchymal echotexture is normal. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.23 m/s.BILIARY TRACT: Status post cholecystectomy. The common bile duct measures up to 9 mm in diameter.PANCREAS: Not well visualized.SPLEEN: No significant abnormalities noted. The spleen measures 8.6 cm in length. KIDNEY: Native kidneys not visualized. Transplant kidney in the left iliac fossa measuring 12.9 cm in length without hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Status post cholecystectomy without evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Assess for thyroid enlargement/nodules History: 10lb weight loss, low TSH, high free T4 RIGHT LOBE MEASUREMENTS: 3.5 x 4.0 x 1.5 cmLEFT LOBE MEASUREMENTS: 3.3 x 0.9 x 1.0 cmISTHMUS MEASUREMENTS: 0.3 cm in AP dimensionRIGHT LOBE: Right lower pole nodule measures 0.3 x 0.2 x 0.3 cm and likely represents a benign colloid nodule. Otherwise homogeneous gland with no suspicious nodules or masses.LEFT LOBE: Homogeneous gland with no suspicious nodules or masses.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted. No cervical lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Subcentimeter thyroid nodule as described above. "}
{"instruction": "Generate impression based on findings.", "input": "58 year-old female with anemia. Mildly prominent renal collecting systems on prior study. A targeted ultrasound was performed of the 4 quadrants of the abdomen and midline. There is a moderate volume of ascites. Small effusions.", "output": "Moderate volume ascites. Ultrasound is inadequate for evaluation of a retroperitoneal bleed; CT is recommended when feasible if there is continued clinical concern of a retroperitoneal bleed. "}
{"instruction": "Generate impression based on findings.", "input": "79-year-old male with oliguria. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 10.9 cm in length. There is a 2.7 cm renal sinus cyst identified. No hydronephrosis, shadowing calculus or solid mass. Echotexture likely within normal limits.LEFT KIDNEY: The left kidney measures 10.6 cm in length. Echotexture is likely within normal limits. There is an exophytic 3 cm cyst arising from the left kidney which may be mildly complex. No hydronephrosis or shadowing calculus.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "No hydronephrosis. Echogenic kidneys with cysts. Left renal cyst may be mildly complex."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: No significant abnormalities noted. 17.4-cm in lengthGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.9 cm in lengthOTHER: Left kidney 11.2 cm in length. Spleen 10.2 cm in length. No ascites.", "output": "Negative for acute hepatobiliary abnormality. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Flank pain; end-stage renal disease RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 11.4 cm in length LEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 12.6 cm in lengthOTHER: Bladder nondistended", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "72 year old female patient with two episodes of right upper quadrant pain. LIVER: The liver measures 13.1 cm in length and demonstrates coarsened parenchymal echogenicity. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: There are gallstones. No pericholecystic fluid or gallbladder wall thickening is noted. Sonographic Murphy's sign is negative. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 3 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 8.8 cm in length. No evidence of hydronephrosis. There is a hypoechoic 1.5 cm lesion with low level internal echoes within the lower pole of the right kidney.OTHER: The left kidney measures 8.7 cm in length. No evidence of hydronephrosis.The spleen measures 5.9 cm in length.", "output": "1. Cholelithiasis without sonographic evidence of acute cholecystitis.2. Minimally complex right lower pole renal cyst; follow up ultrasound is recommended in 12 months. "}
{"instruction": "Generate impression based on findings.", "input": "Male 52 years old Reason: decompensated cirrhosis, eval hepatic artery \\T\\ portosystemic shunts History: check liver doppler ABDOMENLIVER: Diffusely coarse and echogenic nodular appearance of the liver compatible with cirrhosis. No focal hepatic mass.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Gallbladder is distended with mild gallbladder wall thickening measuring up to 4.6 mm, which may be seen in the setting of cirrhosis. Layering sludge is present within the gallbladder. No shadowing gallstones.PANCREAS: Pancreas is obscured by overlying bowel gas.SPLEEN: Spleen is enlarged measuring 19.1 cm. Normal background echogenicity. KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Left kidney measures 11.5 cm. Right kidney measures 10.9 cm.OTHER: Right pleural effusion and mild to moderate ascites are present.", "output": "1.Cirrhotic liver morphology, consistent with given history. Reversed flow (hepatofugal) in the main, left, and right portal veins.2.Splenomegaly.3.Right pleural effusion and mild to moderate ascites."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are screening mammogram dated 11/18/2015 and ultrasound-guided core biopsy right breast dated 12/16/2015 performed at Swedish dominant. For comparison,5/12/2014 are available. Screening mammogram dated 11/18/2015:2 standard views of both breasts and right exaggerated CC lateral view were obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. 12 mm focal asymmetry in the right breast 9:00 position posterior depth is new from prior study. A faint calcification is identified within the mass on the exaggerated CC lateral view.Spot compression views were not obtained. No suspicious abnormality identified in the left breast.Ultrasound guided biopsy was performed on 12/16/2015 that showed a suspicious hypoechoic mass measuring 13 x 9 x 11 mm without peripheral blood flow at 9:00 position of the left breast. Ultrasound-guided biopsy was performed, 3 cores were obtained. Targeting appears adequate. There is no demonstration of clip placement on the images. There is no mention of clip placement on the report. No postprocedure mammogram was obtained. Pathology results are not available.", "output": "Screen detected 12 mm focal asymmetry right breast 9:00 position, subsequently biopsied under ultrasound. Clip has not been placed within the mass. Pathology results to be reviewed at University of Chicago.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "54 year old female with bilateral thyroid nodules and anterior superior neck mass. RIGHT LOBE MEASUREMENTS: 6.0 cm x 2.2 cm x 2.1 cm. LEFT LOBE MEASUREMENTS: 6.0 cm x 1.7 cm x 1.5 cm. ISTHMUS MEASUREMENTS: 4 mm in thickness.RIGHT LOBE: A relatively isoechoic nodule is seen along the midpole of the right lobe measuring 0.9 cm x 0.8 cm x 0.8 cm and contains no internal vascularity or definite microcalcifications. There is inferior extension of the right thyroid lobe measuring 1.6 cm x 1.1 cm x 1.1 cm with no increased vascularity or definite microcalcifications. LEFT LOBE: Along the midpole of the left thyroid lobe there is a slightly hypoechoic heterogeneous nodule measuring 1.1 cm x 0.8 cm x 1.2 cm with no internal vascularity or definite microcalcifications. ISTHMUS: No significant abnormality noted. PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small subcentimeter lymph node along the left lateral neck. OTHER: In the neck at level 6 superior to the isthmus there is a heterogeneous nodule measuring 1.4 cm x 0.7 cm x 1.6 cm with no internal vascularity or definite microcalcifications. This may be separate from the thyroid gland.", "output": "1. Multiple thyroid nodules bilaterally that do not meet size criteria for biopsy. There is what apparently represents an inferior extension of the right thyroid lobe, further described above, however attention to this area is recommended on subsequent imaging. 2. Heterogeneous nodule in the neck at level 6 superior to the isthmus which was subsequently biopsied, pathology report pending. "}
{"instruction": "Generate impression based on findings.", "input": "25-year-old female with cirrhosis evaluate blood flow and screening for HCC. LIVER:The transplanted liver measures 20.4 cm in length. The liver appears nodular with coarse echogenicity. No intrahepatic ductal dilation. No new worrisome masses are seen. No ascites.GALLBLADDER, BILIARY TRACT: The gallbladder surgically absent. The common bile duct measures 4.6 mm.PANCREAS: Pancreas is not well-visualized due to bowel gas. No significant abnormality noted.SPLEEN: The spleen measures 13.3 cm in length. No significant abnormalities are noted.RIGHT KIDNEY: Right kidney measures 10.3 cm in length. The right kidney was not well visualized but no significant abnormalities are noted.LEFT KIDNEY: The left kidney measures 10.3 cm in length. No significant abnormalities are noted.PORTAL Vein: the portal vein is patent with hepatopetal flow measuring 47.0 cm/s. The left portal vein is patent with hepatopetal flow measuring 23 cm/s. The right portal vein was not well visualized.HEPATIC VEIN: The common hepatic vein is patent with hepatofugal flow measuring 82.4 cm/s.HEPATIC ARTERY: The common hepatic artery is patent with hepatopetal flow and peak systolic velocity of 54 cm/s, and RI of 0.7. The left hepatic artery is patent with hepatopetal flow and peak systolic velocity of 50 cm/s and RI of 0.5. The right hepatic artery is not well-visualized.SPLENIC VEIN: The splenic vein is patent with hepatopetal flow measuring 21.7 cm/s.SPLENIC ARTERY: The splenic artery is patent with peak systolic velocity of 67 cm/s and RI of 0.5.ABDOMINAL AORTA: Not visualized on this study.INFERIOR VENA CAVA: The IVC is patent with hepatofugal flow measuring 104.2 cm/s.", "output": "The liver appears coarse and nodular which is concerning for developing cirrhotic morphology. No new worrisome masses are seen. Patent vasculature, as above, with normal directional flow. No ascites is seen."}
{"instruction": "Generate impression based on findings.", "input": "72 years old, Female, Reason: evaluation for parathyroid location and any abnormality History: secondary hyperparathyroidism RIGHT LOBE MEASUREMENTS: 4.8 x 1.8 x 1.1 cm.LEFT LOBE MEASUREMENTS: 4.1 x 1.8 x 1.1 cm.ISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Inferior to lower pole of the left thyroid lobe is a hypoechoic nodule with peripheral vascular flow measuring 1.8 x 1.4 x 1.6 cm, appearance consistent with parathyroid adenoma.LYMPH NODES: No significant abnormality noted.", "output": "Parathyroid adenoma adjacent to the left lower pole of the thyroid. Please refer to concomitant scintigraphic imaging from same day for additional findings."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female with gallbladder wall thickening on CT presents for further evaluation. LIVER:No significant abnormality noted.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. No stones or sludge. No pericholecystic fluid. The wall measures 0.3 cm. The common duct measures 0.3 cm.OTHER: No significant abnormality noted.", "output": "1. Normal ultrasound of the gallbladder."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis. Gram-negative bacteremia. Acute kidney injury. Evaluate for renal obstruction or perinephric abscess. LIVER: Cirrhotic liver morphology with coarsened parenchymal echogenicity. The hepatic lesion seen on the prior MRI are not evident, likely due to heterogeneous background parenchymal echogenicity. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Cholelithiasis. Gallbladder distention, without wall thickening or sonographic Murphy's sign elicited.PANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney is 10.0 cm in length. The left kidney is 10.4 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present. No perinephric fluid collection.SPLEEN: 12.1 cm in length, without focal lesions evident.ABDOMINAL AORTA: Patent, without aneurysm.INFERIOR VENA CAVA: Patent.OTHER: Small amount of perihepatic ascites identified. No loculated fluid collection to suggest abscess identified.", "output": "1. Cirrhosis with mild ascites.2. Cholelithiasis without evidence of cholecystitis.3. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "50 year-old male with history of worsening liver failure. Evaluate hepatic vaso-occlusive disease. LIMITED ABDOMENLIVER: Mildly hyperechoic liver parenchyma, unchanged. No biliary dilatation is appreciated.BILIARY TRACT: Not well assessed on this nondedicated study.PANCREAS: Not well assessed on this nondedicated study.RIGHT KIDNEY: Not well assessed on this nondedicated study.", "output": "Patent hepatic vasculature as above. Redemonstration of echogenic liver parenchyma, with ascites and right pleural effusion incompletely imaged."}
{"instruction": "Generate impression based on findings.", "input": "Possible mass on CT chest in the liver, probably in the dome LIVER: Liver measures 15.8 cm without any focal lesion. Especially in the dome of the liver no suspicious cystic or solid mass noted. Increased echogenicity of the liver suggestive of hepatic steatosis. Gallbladder is distended with a gallstone within it. Common bile duct measures up to 5 mm without any stones or sludge within it.BILIARY TRACT: No intrahepatic biliary ductal dilatation. Gallbladder is distended with a gallstone within it.No pericholecystic fluid is notedPANCREAS: Head of the pancreas as visualized appears unremarkable. Body and tail of pancreas is not visualized.OTHER: No significant abnormalities noted.", "output": "No suspicious mass noted in the dome of the liver. Cholelithiasis without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old male with acute kidney injury. Evaluate for hydronephrosis RIGHT KIDNEY: Right kidney is normal in echogenicity and measures 12.3 cm in length without evidence of hydronephrosis. LEFT KIDNEY: Left kidney is normal in echotexture and measures 13.5 cm in length without evidence of hydronephrosis.OTHER: No significant abnormalities noted.", "output": "No evidence of hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Mild hepatomegaly with coarse echogenic parenchyma without mass. Liver length 19.6 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.8 cm in lengthOTHER: Left kidney 10.5 cm in length. Spleen 11.3 cm in length. No ascites.", "output": "Cholelithiasis without acute inflammation or ductal dilatation. Mild hepatomegaly associated with coarse echogenic parenchyma consistent with fatty infiltration/parenchymal dysfunction without mass. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Kidney stones RIGHT KIDNEY: Extensive staghorn calculus occupying the right collecting system. No hydronephrosis. No worrisome mass. Right kidney 11.8 cm in length.LEFT KIDNEY: No significant abnormalities noted. 12.2 cm in length OTHER: Bladder nondistended", "output": "Extensive staghorn calculus occupying the right collecting system. No hydronephrosis. No worrisome mass."}
{"instruction": "Generate impression based on findings.", "input": "Male, 40 years old. Worsening CKD. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 9.0 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.1 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The bladder is incompletely distended. Bilateral ureteral jets are noted.", "output": "1.No hydronephrosis.2.Increased renal cortical echogenicity, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old female with elevated LFTs. LIVER: Increased hepatic echogenicity without discrete focal lesion.BILIARY TRACT: No gallbladder wall thickening, cholelithiasis, or pericholecystic fluid. No ductal dilation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease. No discrete lesions identified."}
{"instruction": "Generate impression based on findings.", "input": "History of gallbladder wall thickening seen on recent chest CT. LIVER: The liver measures 15.5 cm in length. The liver parenchymal echotexture is normal. Multiple small hepatic cystic lesions likely represent biliary hamartomas. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.18 m/s.BILIARY TRACT: The anterior gallbladder wall is thickened, diffusely echogenic, generates dense shadowing, and generates twinkle artifact. The gallbladder lumen and posterior wall are obscured. This appearance is most likely related to cholesterolosis of the gallbladder wall, however, cholelithiasis cannot be excluded. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 10.0 cm in length. RIGHT KIDNEY: Kidney measures 10.2 cm in length. Normal echotexture. No hydronephrosis. Small cyst.LEFT KIDNEY: Kidney measures 11.0 cm in length. Normal echotexture. Mild hydronephrosis, not clearly evident on recent chest CT (although kidney only partially visualized on chest CT). Multiple cysts, the largest of which demonstrates minimal internal complexity.OTHER: No significant abnormalities noted.", "output": "1.Findings suggestive of gallbladder cholesterolosis. Gallbladder lumen and posterior wall obscured, and cholelithiasis not excluded.2.Mild left hydronephrosis, possibly new.Findings discussed with Dr. Schwartz at 3:50 PM on 12/2/2016."}
{"instruction": "Generate impression based on findings.", "input": "Gift of Hope liver workup LIVER: Unremarkable liver echogenicity without mass. Liver length 19.5 cm. Limited Doppler interrogation the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 8.9 cm in lengthOTHER: Trace ascites", "output": "Mild hepatomegaly with unremarkable liver echogenicity without mass or ductal dilatation. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 58 years old Reason: rule out obstruction History: acute kidney injury RIGHT KIDNEY: 10.5 cm in length. Mildly echogenic suggestive medical renal disease. No hydronephrosis or hydroureter.LEFT KIDNEY: 10.7 cm in length. No hydronephrosis or hydroureter.OTHER: Bladder collapsed with Foley catheter in place.", "output": "No evidence of hydronephrosis. Mildly echogenic kidneys. Collapsed urinary bladder."}
{"instruction": "Generate impression based on findings.", "input": "History of multiple thyroid nodules. RIGHT LOBE MEASUREMENTS: 2.1 x 1.7 x 6 cmLEFT LOBE MEASUREMENTS: 1.6 x 1.6 x 6.4 cmISTHMUS MEASUREMENTS: 5 mmRIGHT LOBE: Two solid right thyroid lobe nodules. The larger nodule measures 1.6 x 1.3 x 2.3 cm in the inferior/mid pole. It is predominantly solid without specific suspicious sonographic features. Previously it measured approximately 1.9 x 1.5 x 1.8 cm.LEFT LOBE: Two solid left thyroid nodules are present. The larger nodule measures 1.2 x 1.0 x 1.5 cm in the superior pole. No specific suspicious sonographic features.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No pathologically enlarged or suspicious appearing cervical lymph nodes are identified.OTHER: No significant abnormality noted.", "output": "Bilateral thyroid lobe nodules with the largest being a 2.3 cm solid nodule in the inferior pole of the right thyroid lobe. This is minimally increased in size accounting for differences in measurement technique."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female patient with history of papillary cancer. RIGHT LOBE: Status post thyroidectomy. There is a new hypoechoic focus within the right thyroid bed measuring 0.2 x 0.2 x 0.4 cm.LEFT LOBE: Status post thyroidectomy without recurrent or residual tissue identified.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is a non-descript right level III lymph node measuring 0.8 x 0.4 x 1.5 cm. A benign morphology left level III lymph node measures 0.7 x 0.3 x 1.2 cm. OTHER: No significant abnormality noted.", "output": "1. New hypoechoic focus within the right thyroid bed.2. Non-descript prominent right level III lymph node; this is amenable to biopsy if clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female with right upper quadrant abdominal pain concerning for capsulitis versus issues with gallbladder. LIVER: The liver measures 17.3 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal measures approximately 0.2 m/s.GALLBLADDER, BILIARY TRACT: There are no gallstones, pericholecystic fluid, or gallbladder wall thickening. No intra or extrahepatic biliary ductal dilatation is identified. The common bile duct measures approximately 2 mm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 11.3 cm in length. No evidence of hydronephrosis.OTHER: The left kidney measures 11.9 cm in length. No evidence of hydronephrosis. The spleen measures 9.3 cm in length. An accessory splenule is noted.", "output": "No specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Screening findings in both breasts presents for further follow-up. Three standard views of both breasts left spot magnification and right spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses(BiRads Density Category C), unchanged in pattern and distribution. Multiple enlarged right axillary lymph nodes are again seen. The largest of these measures up to 17 mm, which is slightly enlarged compared to last year's mammograms. High probability benign calcifications in the left upper outer breast appear to layer on the ML view suggesting benign milk of calcium. There are bilateral benign calcifications elsewhere including arterial calcifications. Normal sized left intramammary lymph node in the upper outer quadrant.ULTRASOUND", "output": "Right axillary lymphadenopathy for which ultrasound-guided biopsy of the most suspicious lymph node is recommended. Left breast calcifications are most compatible with benign milk of calcium. If the right axillary lymph node biopsy is benign, then the next breast imaging for this patient could be a six-month follow-up for these calcifications.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Reason: LVAD work up, rule out cirrhosis or kidney disease LIVER: The liver measures 16.0 cm in length. Increased parenchymal echogenicity is suggestive of fatty infiltration/parenchymal dysfunction. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.33 m/s.BILIARY TRACT: Sludge is present within the gallbladder without associated gallbladder wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 12.7 cm in length. RIGHT KIDNEY: Kidney measures 10.2 cm in length. Increased parenchymal echogenicity. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 12.3 cm in length. Increased parenchymal echogenicity. No hydronephrosis, shadowing calculus or mass. Simple cyst. ABDOMINAL AORTA: The abdominal aorta measures 3.1 x 3.1 proximally. The mid and distal aorta are not well visualized.INFERIOR VENA CAVA: Not visualized.OTHER: Foley catheter. Moderate ascites. Right pleural effusion.", "output": "1.Echogenic liver suggestive of fatty infiltration/parenchymal dysfunction without morphologic evidence of cirrhosis. 2.Ascites and right pleural effusion.3.Echogenic kidneys compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules RIGHT LOBE MEASUREMENTS: 4.8 x 2.1 x 2.4 cmLEFT LOBE MEASUREMENTS: 4.8 x 1.9 x 1.6 cmISTHMUS MEASUREMENTS: 1 cmRIGHT LOBE: Stable benign-appearing right thyroid nodules. A representative lower pole spongiform nodule measures 0.7 x 0.6 x 0.5 cm.LEFT LOBE: Stable appearing left thyroid lobe without worrisome nodule.ISTHMUS: Stable isthmic nodules. The right isthmic nodule measures 1.3 x 0.9 x 1.5 cm. The left isthmic nodule measures 1.3 x 0.9 x 1.4 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable thyroid nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old with a history of a multinodular thyroid presents for follow-up. RIGHT LOBE MEASUREMENTS: 4.1 x 1.9 x 2.1 cm.LEFT LOBE MEASUREMENTS: The left lobe is absent.ISTHMUS MEASUREMENTS: The isthmus is absent.RIGHT LOBE: There are several nodules in the right lobe. There is a dominant nodule measuring approximately 1.7 x 1.1 x 1.2 cm. It is mixed cystic-solid, predominantly cystic, well-defined with ring down artifact. This remains stable since the prior examination.LEFT LOBE: The left lobe is absent. There is a round hypoechoic area measuring 0.3 x 0.9 x 0.4 cm. It appears stable since the prior study.ISTHMUS: Isthmus is absent.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Multinodular thyroid as described above. There is has been an interval left thyroidectomy. The right thyroid appears stable."}
{"instruction": "Generate impression based on findings.", "input": "Mass in tail of right carotid and Rathke's cyst or tumor pituitary. New fullness involving the anterior chest wall.IMAGE ACQUISITIONS: Enhanced CT performed of the head. Enhanced CT performed of the neck. See separate report for chest CT. Evaluation of the brain shows no evidence of abnormality of the ventricles or basal cisterns. There is an expansile cystic lesion in the sella turcica that correlates with the lesion noted on MR imaging. Allowing for differences in modality. This does not appear to have changed significantly from the prior study. There is 1 cm nodule within the tail of right parotid gland that is nonspecific, but may represent pleomorphic adenoma. Evaluation of the remainder of the neck soft tissues shows a normal appearance of the nasopharynx and parapharyngeal spaces. No other nodules are seen within the parotid glands. The submandibular glands show bilateral submandibular stones as well as a calcification in the right sublingual space that likely represents a stone as well. There are multiple low-attenuation nodules also seen in the thyroid gland with more pronounced nodularity identified on the left. The largest measures 1.3-cm. Correlation with ultrasound or biopsy may be helpful as warranted clinically. The larynx and hypopharynx are unremarkable. There is no evidence of significant lymphadenopathy identified involving the neck soft tissues.", "output": "Stable cystic mass involving sella turcica and extending into the skull base. Approximately 1 cm nodule right parotid gland. Bilateral submandibular and right sublingual stones. Multiple nodules identified in the thyroid gland, most pronounced involving left lobe. See separate report for chest CT. "}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female with concern for acute hyperthyroidism RIGHT LOBE MEASUREMENTS: The right lobe measures 6.9 cm x 2.7 cm x 2.2 cm.LEFT LOBE MEASUREMENTS: The left lobe measures 5.9 cm x 2.5 cm x 2.0 cm.ISTHMUS MEASUREMENTS: The isthmus measures 0.6 cm.RIGHT LOBE: The right lobe is enlarged and heterogeneous. There is increased vascularity. No dominant nodules are identified.LEFT LOBE: The left lobe is enlarged and diffusely heterogeneous. No dominant nodules are identified.ISTHMUS: The isthmus is enlarged and heterogeneous. No dominant nodules are identified.PARATHYROID GLANDS: None visualized.LYMPH NODES: Several small lymph nodes are seen on the right, the 2 largest were measured. On the right at level 1B this node measures 1.4 cm x 0.8 cm x 0.4 cm. On the right at level 3 this node measures 1.9 cm x 0.5 cm x 0.4 cm. Both of these nodes are slender with a fatty hilum. On the left, there is a level 1B lymph node that measures 1.6 cm x 0.9 cm x 0.4 cm. This node is slender with a fatty hilum. On the left inferior to the thyroid there is a lymph node that measures 1.1 cm x 0.8 cm x 0.8 cm. This is hypoechoic with a fatty hilum.", "output": "1. Multinodular goiter with no dominant nodule seen. The thyroid gland is also hypervascular.2. Several benign-appearing lymph nodes are seen bilaterally, as above."}
{"instruction": "Generate impression based on findings.", "input": "Male; 59 years old. Reason: ? nodules, nodes History: thyroid cancer s/p surgery, i131 RIGHT LOBE MEASUREMENTS: Surgically absent. No suspicious mass within the surgical bed.LEFT LOBE MEASUREMENTS: Surgically absent. No suspicious mass within the surgical bed.ISTHMUS MEASUREMENTS: Surgically absent. No suspicious mass within the surgical bed.RIGHT LOBE: As above.LEFT LOBE: As above.ISTHMUS: As above.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There are prominent bilateral cervical chain lymph nodes, left greater than right. The largest on the right is in level 5 and measures 1.7 x 0.5 x 1.2 cm. The largest on the right is in level 5 and measures 1 x 0.9 x 1.1 cm. No pathologically enlarged lymph nodes by size criteria. No microcalcifications within the lymph nodes.OTHER: No significant abnormality noted.", "output": "Prominent lymph nodes, which are not pathologically enlarged by size criteria. No microcalcifications within the lymph nodes. However, given the prominence of the nodes, close attention at follow-up is recommended."}
{"instruction": "Generate impression based on findings.", "input": "66 years old, Male, Reason: renal failure History: AKI in post renal cell ca. RIGHT KIDNEY: Kidney measures 12.7 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The patient is status post left nephrectomy. No definite abnormality identified in the nephrectomy bed.BLADDER: The bladder is incompletely distended around a Foley catheter precluding complete evaluation. OTHER: No significant abnormalities noted.", "output": "1.Normal echogenicity of the right kidney without evidence of hydronephrosis or shadowing calculus."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old male patient with history of multinodular goiter and history of previous surgeries in 1990s. Evaluate for suspicious nodules. RIGHT LOBE MEASUREMENTS: 6.9 x 2.8 x 2.7 cm.LEFT LOBE MEASUREMENTS: 7.7 x 3.4 x 3.3 cmISTHMUS MEASUREMENTS: 1.3 cmRIGHT LOBE: Multiple predominantly solid nodules. Dominant nodule measures 2.1 x 1.7 x 1.6 cm, is heterogeneous and predominantly solid, not changed substantially but difficult to compare given the multiplicity of nodules.LEFT LOBE: Multiple heterogeneous nodules.Dominant nodule measures 2.1 x 1.8 x 1.7 cm, predominately solid with cystic components and a central, shadowing calcification. Again, not changed substantially but difficult to compare given multiplicity of nodules.ISTHMUS: Multiple predominantly solid nodules.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No suspicious pathologically enlarged lymph nodes.OTHER: No significant abnormality noted.", "output": "Multinodular goiter with no substantial interval change compared to prior."}
{"instruction": "Generate impression based on findings.", "input": "Elevated T3 and T4 with cardiac anomalies RIGHT LOBE MEASUREMENTS: 4.9 x 1.5 x 2 cmLEFT LOBE MEASUREMENTS: 4.2 x 1.6 x 2 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Diffusely heterogeneous gland with increased vascularity. No discrete mass.LEFT LOBE: Diffusely heterogeneous gland with increased vascularity. No discrete mass.ISTHMUS: Diffusely heterogeneous gland with increased vascularity. No discrete mass.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland with increased vascularity. No discrete mass. Findings suggestive for Graves' disease versus acute thyroiditis."}
{"instruction": "Generate impression based on findings.", "input": "7 day old male with encephalocele and meningomyelocele status post repair on 6/11; patient now has seizure like activity in the upper extremities. Patient needs head CT. There is no evidence of intracranial hemorrhage, mass or edema. Panventricular dilatation that is stable when compared to ultrasound obtained 6/13/2008.Wavy contour of the inner table of the calvarium consistent with Luckenschadel skull.Interdigitation of the interhemispheric fissure.Corpus callosum present.The visualized paranasal sinuses are normally pneumatized.", "output": "1. Imaging features associated with Chiari malformation including Luckenschadel skull and interdigitation of the cerebral hemispheres.2. Stable panventricular dilatation compared to ultrasound obtained 6/13/2008."}
{"instruction": "Generate impression based on findings.", "input": "54 years old, Female, Reason: follow-up toxic mng History: increasing thyroid size RIGHT LOBE MEASUREMENTS: 4.6 x 1.6 x 1.3 cmLEFT LOBE MEASUREMENTS: 8.1 x 2.4 x 1.7 cmISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: The gland is diffusely heterogeneous. Subcentimeter hypoechoic focus in the right lower lobe is unchanged measuring 0.4 x 2.2 x 0.4 cm.LEFT LOBE: The gland is diffusely heterogeneous. Subcentimeter hypoechoic focus in the mid left thyroid lobe is unchanged in appearance. There is a dominant solid left lower thyroid lobe nodule is slightly smaller in size measuring 2.8 x 1.2 x 1.6 cm which is amenable to biopsy.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Solid dominant left lower pole thyroid nodule measures slightly smaller in size and is amenable to biopsy. 2.Multiple other subcentimeter hypoechoic foci within the bilateral thyroid lobes appear unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Sarcoid with acute renal insufficiency RIGHT KIDNEY: Right pelvic kidney. Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 10.2 cm in lengthLEFT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 12.1 cm in lengthOTHER: Bladder nondistended", "output": "Mildly echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "History of hepatic adenoma status post excision now with epigastric abdominal pain. LIVER: The liver measures 12.8 cm in length. The liver parenchymal echotexture is normal. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.29 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. Sonographic Murphy's sign was negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 10.8 cm in length. RIGHT KIDNEY: Kidney measures 11.7 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.8 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "No focal hepatic lesions or forthcoming cause of patient's pain identified."}
{"instruction": "Generate impression based on findings.", "input": "65 year old male with abdominal distention, transaminitis, hyperbilirubinemia. Limited exam due to patient body habitus.LIVER: Coarse echotexture of the liver and nodular contour suggestive of underlying cirrhosis. Liver measures 20.9 cm in length. Portal vein is patent with appropriate directional flow. No focal hepatic lesion.  GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No intra or extrahepatic biliary ductal dilatation.PANCREAS: Not well visualized due to overlying bowel gas.RIGHT KIDNEY: Right kidney measures 13.7 cm in length. No hydronephrosis.OTHER: Left kidney measures 13.8 cm in length. No hydronephrosis.Spleen measures 14.2 cm in length.Upper abdominal ascites.", "output": "1. Hepatosplenomegaly. Coarse echotexture and nodular contour of the liver suggestive of underlying cirrhosis.2. Upper abdominal ascites. "}
{"instruction": "Generate impression based on findings.", "input": "Female 77 years old Reason: assess for lymphadenopathy History: L neck pain, swelling All lymph nodes in the neck are of normal size and morphology.Largest nodes are measured for baseline purposes as follows:On the right level 2, measuring 1 x 0.8 x 0.4 cm.On the left level 11.1 measuring x 0.7 x 3.1 cm.In the area of abnormal sensation on the left, the musculature appeared normal and symmetric comparing right and left sides.Formal thyroid ultrasound is not done but numerous bilateral thyroid nodules are identified with varying morphologies including solid, cystic and spongiform. These seem to be described on the ultrasound report of 10/20/2007.", "output": "No pathologic size nodes. No pathologic morphology nodes. Symmetric appearing neck muscles. Thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with history of thyroid cancer post thyroidectomy. Evaluate for recurrent disease. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massesLEFT LOBE: No massesISTHMUS: No massesPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No evidence for recurrent disease. No interval change."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal LFTs; previously on statin LIVER: Mild improvement in degree of liver heterogeneity without mass. Liver length 15.2 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11 cm in lengthOTHER: Left kidney 12 cm in length. Spleen 16 cm in length. No ascites.", "output": "Mild improvement in degree of liver heterogeneity. No hepatic mass or ductal dilatation. No ascites. Stable mild splenomegaly"}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodule seen on CT RIGHT LOBE MEASUREMENTS: 4.7 x 1.9 x 2.5 cmLEFT LOBE MEASUREMENTS: 6.0 x 2.1 x 2.3 cmISTHMUS MEASUREMENTS: 3 mm in AP dimensionRIGHT LOBE: No significant abnormality noted.LEFT LOBE: A 12 mm solid nodule is identified in the left midpole. The nodule is homogeneous and well marginated, without suspicious calcifications or vascularity.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not identified.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "12 mm left thyroid nodule identified, without suspicious features."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with history of bilateral mastectomy in March 2016 and positive surgical margins in the right breast. Evaluate for abnormal right axillary lymph nodes. A targeted right axillary ultrasound was performed. Circumscribed nearly anechoic lesion with posterior through transmission is identified near the patient's site of recent surgery, compatible with an oil cyst. This cyst measures 0.4 x 0.5 x 0.5 cm. No abnormal lymph nodes or suspicious solid or cystic lesions are identified.", "output": "Right axillary oil cyst. No sonographic evidence of malignancy in the right axilla. Recommend surgical follow-up to direct any further management.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "21-year-old male with swelling over the lumbar spine area. Assess fluid collection. There is an approximately 3.2 x 0.4 x 0.9 cm uncomplicated fluid collection. There are some internal echoes. There is posterior acoustic shadowing. The fluid collection is very well-defined. Its depth is about 0.4 cm. It is approximately 0.2 cm from the skin surface.", "output": "1. Nonspecific fluid collection in lower back as described above."}
{"instruction": "Generate impression based on findings.", "input": "16 year old female with recent laparoscopic cholecystectomy with recurrent biliary pain LIVER: The liver measures 14.9 cm. Normal liver echotexture without focal hepatic lesions. Limited interrogation of the main portal vein demonstrates blood flow towards the liver measuring 22.4 cm/sec.GALLBLADDER, BILIARY TRACT: Gallbladder has been removed. No intrahepatic or extrahepatic biliary ductal dilatation. The common bile duct measures up to 7 mm.PANCREAS: Pancreas body and tail are obscured by overlying bowel gas.SPLEEN: The spleen measures 11.3 cm.KIDNEYS: The right kidney measures 10.5 cm. The left kidney measures 10.6 cm. No evidence of hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Status post cholecystectomy with common bile duct measuring up to 7 mm. "}
{"instruction": "Generate impression based on findings.", "input": "Male; 60 years old. Reason: 60 y/o M with PMH of SVT with likely lipoma on upper back, please ultrasound and evaluate On the right upper back at the site of the palpable abnormality is a 6.2 x 1.6 x 4.5 cm intramuscular, ovoid structure which is isoechoic to the adjacent muscle with thin internal striations that are parallel to the long axis of the structure itself. Portions of the border of this lesion are not easily discernible from the adjacent muscle. There is no internal vascularity seen on color Doppler.", "output": "6.2 x 1.6 x 4.5 cm intramuscular structure is most compatible with a lipoma. Other benign etiologies such as normal variant of the musculature are also considered."}
{"instruction": "Generate impression based on findings.", "input": "15-year-old history of right breast mass presents for follow-up. On physical exam, there is a soft mobile palpable mass in the right retroareolar region. A targeted grayscale and color Doppler right breast ultrasound was performed for the palpable area of concern. There is a 2.5 x 1.6 x 2.3 cm well-circumscribed oval hypoechoic mass with internal blood flow, previously measured 2.5 x 1.7 x 2.3 cm, and unchanged in size. Imaging features are highly suggestive of a fibroadenoma.", "output": "No change in size of 2.5 cm right retroareolar mass favoring fibroadenoma. Continual clinical follow-up is recommended as long as the patient's physical exam remains stable. Results and recommendations were discussed with the patient and her mother at the time of exam.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Eval for signs of cirrhosis or portal hypertension History: Chronic HCV LIVER: The liver measures 13.8 cm in length. The liver is smooth in contour and is normal in echotexture. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.21 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 2 mm in diameterPANCREAS: No significant abnormalities noted.SPLEEN: The spleen measures 14 cm in length and is top normal in size. RIGHT KIDNEY: Kidney measures 12.1 cm in length. Normal echotexture No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.6 cm in length. Normal echotexture No hydronephrosis, shadowing calculus or mass.OTHER: No ascites", "output": "No focal liver lesions. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old female patient with multinodular goiter. RIGHT LOBE MEASUREMENTS: 6.9 x 3 x 2.3 cm, previously 6.7 x 2.8 x 3.3 cm. LEFT LOBE MEASUREMENTS: 4.2 x 1.5 x 1.6 cm, previously 4.1 x 1.3 x 1.5 cm.ISTHMUS MEASUREMENTS: The isthmus measures 0.7 cm.RIGHT LOBE: Two solid right lower pole nodules are again identified. The more superior nodule measures 2.7 x 1.7 x 1.6 cm, previously 2.3 x 1.4 x 1.8 cm. The inferior nodule measures 3.7 x 3 x 3.4 cm, previously 2.5 x 2.7 x 3.3 cmLEFT LOBE: No significant abnormality noted.ISTHMUS: A solid isthmic nodule measures 2.9 x 1.3 x 2.7 cm, previously 2.2 x 1.1 x 2.4 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Mild increase in size of the thyroid lesions."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old male undergoing preheart transplant evaluation. LIVER:Measures 14.6 cm. Increased, coarse echogenicity. No focal mass, ascites, or intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: Gallbladder is nondistended with an anechoic lumen. Wall measures 0.3 cm. No pericholecystic fluid, stones, or sludge. Common bile duct measures 0.3 cm.PANCREAS: Evaluation of the pancreas limited due to overlying bowel gas.SPLEEN: Measures 9.8 cm. Multiple echogenic foci within the parenchyma of the spleen likely representing prior granulomatous disease.KIDNEYS: Right kidney measures 11.9 cm. Left kidney measures 11.7 cm. Unremarkable echogenicity. No shadowing calculi, hydronephrosis, or focal mass.ABDOMINAL AORTA: Unable to visualize the aorta due to body habitus and overlying bowel gas.INFERIOR VENA CAVA: Unable to visualize the IVC due to body habitus and overlying bowel gas.OTHER: The bladder is nondistended.", "output": "1. Increased coarse echogenicity of liver consistent with fatty infiltration and chronic liver disease/parenchymal dysfunction. No focal mass or ascites.2. Multiple echogenic foci within the parenchyma of the spleen likely represents calcifications related to prior granulomatous disease.3. Unable to visualize aorta or IVC due to body habitus and overlying bowel gas."}
{"instruction": "Generate impression based on findings.", "input": "75 years old, Female, Reason: pt with cirrhosis, rule out hcc History: rule out hcc LIVER: The liver measures 14.6 cm in length. No significant nodularity or widening of the fissures to suggest cirrhosis. No focal hepatic lesions are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures two mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 9 cm in length. RIGHT KIDNEY: Kidney measures 9.8 cm in length. No hydronephrosis. Subcentimeter right renal simple appearing cyst measuring up to 0.7 cm.LEFT KIDNEY: Kidney measures 10.6 cm in length. No hydronephrosis. Left renal cyst appearing similar to prior exam measuring up to 3.7 cm.OTHER: No significant ascites.", "output": "No sonographic evidence of cirrhosis. No focal hepatic mass."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid thyroid carcinoma status post resection RIGHT LOBE: Status post thyroidectomy without worrisome mass.LEFT LOBE: Status post thyroidectomy without worrisome massISTHMUS: Status post thyroidectomy without worrisome massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: 1.7 x 0.8 x 2.2 cm enlarged lymph node left level 5 supraclavicular region with increased vascularity.OTHER: No significant abnormality noted.", "output": "Enlarged lymph node left level 5 supraclavicular region corresponding to palpable lesion. This lymph node is best considered indeterminate. Would recommend either short interval surveillance follow-up or ultrasound-guided percutaneous biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Female 29 years old Reason: rule out increased size in thyroid nodules History: dysphagia RIGHT LOBE MEASUREMENTS: 8.1 x 3.4 x 3.1 cmLEFT LOBE MEASUREMENTS: 7.9 x 4.0 x 2.9 cmISTHMUS MEASUREMENTS: 1.0 cmRIGHT LOBE: Unchanged heterogeneous large right thyroid nodule measures 5.0 x 3.2 x 3.0 cm, previously 6.1 x 2.9 x 2.5 cm. This nodule has been previously biopsied.LEFT LOBE: Unchanged mid left thyroid nodule, with a heterogeneous appearance, measuring 2.6 x 2.1 x 1.2 cm, previously 2.3 x 2.3 x 1.5 cm. Newly measured nodule, which is unchanged in size, measures 1.3 x 1.3 x 0.9 cm.ISTHMUS: Nodule in the isthmus which was previously present measures 2.2 x 1.5 x 2.3 cm. PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing right level 3 lymph node measures 0.8 x 0.4 x 1.2 cm.OTHER: No significant abnormality noted.", "output": "Multiple bilateral large thyroid nodules, which were previously biopsied, are not significantly changed in size. Newly measured nodules were present on the prior scans."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old female patient with autoimmune hepatitis. Evaluate for cirrhosis and portal hypertension. LIVER: The liver measures 14.4 cm in length and demonstrates mildly increased echogenicity and coarsened hepatic echotexture. There are multiple bilobar hepatic cysts with the largest within the left hepatic lobe measuring 1.2 x 1.0 x 1.5 cm. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 3 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 9.9 cm in length. No evidence of hydronephrosis. There is a 1.7 x 1.7 x 2.1 cm hypoechoic lesion within the inferior pole of right kidney with a septation.OTHER: The left kidney measures 8.5 cm in length. No evidence of hydronephrosis.The spleen measures 9.9 cm in length.", "output": "1. Mildly increased hepatic echogenicity, likely representing chronic liver disease, without suspicious lesion. Bilobar hepatic cysts are identified.2. Minimally complex right lower pole renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female patient with rising bilirubin. Concern for obstruction. LIVER: The liver measures 17.9 cm in length and mildly nodular in contour. Redemonstration of a hyperechoic region within segment IV of the liver which corresponded to fat on prior MRI. A right hepatic dome lesion is not seen on this examination. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There is sludge within the gallbladder. The gallbladder wall is borderline thickened measuring approximately 4 mm in diameter, which is nonspecific in the setting of ascites. An echogenic focus in the gallbladder which likely reasons a polyp measures 0.5 x 0.4 x 0.5 cm. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 4 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 14.0 cm in length and demonstrate increased cortical echogenicity. No evidence of hydronephrosis. OTHER: The left kidney measures 14.1 cm in length and demonstrate increased cortical echogenicity. No evidence of hydronephrosis.The spleen measures 25.2 cm in length.There is mild ascites.", "output": "1. Cirrhotic morphology of the liver with mild ascites and splenomegaly.2. Biliary sludge with non-specific gallbladder wall thickening in the setting of ascites.3. Subcentimeter gallbladder polyp.4. Medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old female with premature hypertension. RIGHT KIDNEY: Right kidney measures 12.3 cm in length. There is no hydronephrosis, shadowing calculus or mass. Echotexture is normal.LEFT KIDNEY: The left kidney measures 12.4 cm in length. There is no hydronephrosis, shadowing calculus or mass. Echotexture is normal.OTHER: Bladder appears unremarkable.", "output": "Normal-appearing kidneys with symmetric size."}
{"instruction": "Generate impression based on findings.", "input": "Chronic renal disease RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 13.5 cm in lengthLEFT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Benign appearing left renal cyst. Left kidney 12.7 cm in lengthOTHER: Bladder nondistended", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or obstruction"}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. She has a personal history of benign left axillary lymph node biopsy in 2013. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. Scattered simple cysts are identified in both breasts. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old male with history of cirrhosis, evaluate for hepatocellular carcinoma. LIVER: Measures 9.2 in length. Cirrhotic morphology and increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: No cholelithiasis. No gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilation. PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Unremarkable in size and echogenicity. KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "Cirrhosis and increased hepatic echogenicity consistent with chronic liver disease. No focal lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "24-year-old male with VP shunt internalized to gallbladder. Right upper quadrant abdominal pain. LIVER: Normal echogenicity of the liver measuring 16.6 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measures is 0.5 m/sec.GALLBLADDER, BILIARY TRACT: Partially visualized VP shunt with tip internalized within the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. Common duct measures 3 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Not well visualized due to overlying bowel gas.RIGHT KIDNEY: Atrophic measuring 9.2 cm in length. Several shadowing stones are present at the inferior pole, largest of which measures 1.3 cm in length. No hydronephrosis is noted.OTHER: Normal echogenicity of the spleen measuring 10.2 cm in length.Left kidney is not visualized. Incompletely visualized right pleural effusion.Trace ascites.", "output": "1. VP shunt internalized into the gallbladder with no surrounding inflammatory changes. 2. Atrophic right kidney with nephrolithiasis. No hydronephrosis. 3. Trace ascites and incompletely visualized right pleural effusion. "}
{"instruction": "Generate impression based on findings.", "input": "51-year-old male with history of thyroid cancer. Evaluate for recurrence. RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Hyperechoic nodular focus in the left thyroid bed unchanged measuring 0.6 x 0.5 x 0.9 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level 3-4 lymph node measuring 1.1 x 1.0 x 0.4 cm without significant interval change. Left level 3 lymph node with benign morphologic features also unchanged.OTHER: No significant abnormality noted.", "output": "No significant interval change since the prior study."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old male with history of alcohol abuse, smoking and cardiovascular risk factors. Patient has abdominal distention. Evaluate for cirrhosis, AAA, mass. LIVER:Hepatic size is upper normal. The liver is diffusely and markedly echogenic which is non--- specific. No focal hepatic abnormality is seen. The hepatic contour is not grossly cirrhotic.GALLBLADDER, BILIARY TRACT: Gallbladder appears normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted.KIDNEYS: The right kidney measures 10.6 cm in length and the left 10.8 cm. Echotexture is normal. No hydronephrosis, shadowing calculus or mass. ABDOMINAL AORTA: Normal in caliber without evidence for aneurysm.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No ascites.", "output": "Echogenic liver, otherwise normal exam."}
{"instruction": "Generate impression based on findings.", "input": "Papillary thyroid carcinoma; assess for regional adenopathy RIGHT LOBE MEASUREMENTS: 4.9 x 1.5 x 1.3 cmLEFT LOBE MEASUREMENTS: 5.8 x 3.5 x 3.7 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: 3.9 x 3.1 x 3.4 cm mixed cystic and solid nodule arising from the left thyroid gland. Solid component demonstrates probable internal microcalcifications and other worrisome complexity.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: 1.2 x 0.9 x 0.5 cm indeterminate left level 2/3 cervical lymph node. Other left level 2 and right level 2 lymph nodes are mildly enlarged but morphologically favor benign reactive lymph nodes.OTHER: No significant abnormality noted.", "output": "Mixed cystic and solid worrisome left thyroid nodule corresponding to known papillary thyroid carcinoma. A mildly enlarged left level 2/3 cervical lymph node is best considered indeterminant. This lymph node should be harvested when the thyroid lesion is resected."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Jacobsen is a 42-year-old female with right breast mastectomy in February 2014 for IDC/DCIS along with a prophylactic left breast mastectomy. She was treated with chemotherapy. She now presents with two palpable areas along the postsurgical scars in the right upper outer breast./right lower axillary region. Upon physical exam at the patient's palpable areas of concern, subtle nodularity is identified at the margin of the implant along the postsurgical scars.A targeted right breast ultrasound was performed for the palpable areas of concern. - in the right lower axillary region, no suspicious cystic or solid mass is identified. The edge of the implant is present at this location.- in the right upper outer breast, no suspicious cystic or solid masses identified. Again, the edge of the implant is present at this location.", "output": "No sonographic evidence for malignancy. Patient is scheduled to see Dr. Jaskowiak after this appointment. BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old male with lymphoma presents for thyroid ultrasound after having incidental thyroid nodules found on PET scan. RIGHT LOBE MEASUREMENTS: 4.6 x 1.2 x 1.8 cm.LEFT LOBE MEASUREMENTS: 4.5 x 1.4 x 1.7 cm.ISTHMUS MEASUREMENTS: 0.07 cm.RIGHT LOBE: There is an approximately 1.7 x 1.3 x 0.8 cm mixed cystic-solid, predominantly solid, lesion in the midpole of the right thyroid. There are internal course calcifications.LEFT LOBE: There is an approximately 1.9 x 0.9 x 1.0 cm round mixed cystic-solid, predominantly solid, lesion in the midpole of the left thyroid. There are internal course calcifications.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Bilateral level 3 lymph nodes the largest of which measures approximately 2.0 x 1.0 x 0.4 cm.OTHER: No significant abnormality noted.", "output": "1. Bilateral thyroid nodules as above both of which are amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Dense breast on mammogram, patient presents for whole breast ultrasound screening examination A bilateral whole breast ultrasound was performed using Sonocine. There is no solid or cystic mass identified. Normal dense glandular tissue identified.Study was double read by Dr. Kulkarni and Dr. Sheth.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 1 year S/P islet cell transplant, please evaluate portal vein flow and doppler portal vein LIVER: The liver measures 16.7 cm in length. Heterogeneous coarse parenchymal echotexture. The portal vein is patent with normal hepatopedal directional blood flow. No focal masses.Peak portal venous velocities: Main portal vein: 29.1 cm/s, right portal vein: 22.47 cm/s, left portal vein: 25 cm/sGALLBLADDER, BILIARY TRACT: Shadowing surgical clips in the hilum. No biliary ductal dilatation. The gallbladder wall measures 0.2 cm and common bile duct measures 0.4 cm.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 10.1 cm in length. No hydronephrosis, masses, or shadowing renal calculi.LEFT KIDNEY: The left kidney measures 9.3 cm in length. No hydronephrosis, masses, or shadowing renal calculi.OTHER: No ascites.", "output": "1. Coarse hepatic echotexture. Patent portal vein with peak velocities as documented above."}
{"instruction": "Generate impression based on findings.", "input": "Left thigh mass Encapsulated hyperechoic soft tissue mass in the subcutaneous tissues nearly isoechoic to surrounding fat measures 5.0 x 2.4 x 3.3 cm. No significant internal vascularity.", "output": "Left thigh soft tissue mass with sonographic findings most consistent with a lipoma."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for thyromegaly RIGHT LOBE MEASUREMENTS: 6. 2 x 2 x 2 cm, heterogenous echotextureLEFT LOBE MEASUREMENTS: 5.1 x 2.7 x 2.7 cm, heterogenousISTHMUS MEASUREMENTS: 1.1 cmRIGHT LOBE: 2 subcentimeter nodules identified in the right lobe mid pole, one which appears completely cystic and measures 6 x 4 x 5 mm and the other nodule that appears hypoechoic/solid that measures 7 x 5 x 3 mm.LEFT LOBE: Large heterogenous lobulated solid mass with microcalcifications involving the mid to inferior pole of the left lobe measures 1.6 x 2 x 1.9 cm. A second solid nodule has been measured in the midpole which appears to be contiguous with the larger inferior pole nodule. A cystic small nodule in the midpole measures 9 x 5 x 6 mm.ISTHMUS: Solid nodule involving the isthmus measures 3.1 x 1.3 x 0.8 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Multiple enlarged level 3 and 4 left neck lymph nodes with effaced hila, largest measuring 5.7 x 1.2 x 2.5 cmLevel 2 and level 3 right neck lymph nodes with normal morphology noted.OTHER: No significant abnormality noted.", "output": "Suspicious left inferior pole nodule with microcalcifications needs further evaluation with ultrasound-guided FNA. Multiple enlarged left level 3 and 4 neck nodes. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: follow-up of multinodular goiter History: neck swelling RIGHT LOBE MEASUREMENTS: 5.1 x 1.8 x 1.7 cmLEFT LOBE MEASUREMENTS: 5.5 x 2.7 x 2.0 cmISTHMUS MEASUREMENTS: 0.36 cmRIGHT LOBE: Reference nodules as noted below:Nodule #1:1.5 x 1.0 x 1.0 cm, predominantly hypoechoic spongiform nodule without significant vascularity or definite microcalcifications.Nodule #3:1.1 x 0.6 x 0.8 cm, part solid hypoechoic nodule without significant vascularity or definite microcalcifications.LEFT LOBE: Reference nodules as noted below:Nodule #1: 1.1 x 0.7 x 0.9 cm, predominantly solid nodule with hypoechoic rim and minimal vascularity without definite microcalcifications.Nodule #3: 0.8 x 0.7 x 0.8 cm, mixed solid and cystic nodule without significant vascularity or definite microcalcifications.ISTHMUS: Reference nodules as noted below:Nodule #1:1.0 x 0.8 x 0.8 cm, predominantly solid nodule with hypoechoic rim without significant vascularity or definite microcalcifications.Nodule #2: 0.9 x 0.6 x 0.7 cm, predominantly solid nodule with hypoechoic rim without significant vascularity or definite microcalcifications.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multinodular goiter as described above. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Towns is a 46-year-old female with a personal history of benign right lateral breast excisional biopsy 20 years previous. She was recalled from screening exam of 08/10/16 for architectural distortion in the right lateral breast. A targeted right ultrasound was performed for the mammographic area of concern. A linear, hypoechoic region is demonstrated on the ultrasound, correlating to the site of a scar from remote prior benign breast biopsy. No solid or cystic mass is identified.", "output": "Postsurgical scarring in the right lateral breast corresponding to the mammographically detected area of architectural distortion. No mammographic or sonographic evidence for malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Liver failure LIMITED ABDOMENLIVER: Markedly echogenic liver echotexture noted without obvious mass. Liver length 18.7 cm.BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 7.4 cm in length RIGHT KIDNEY: No significant abnormalities noted. 11.2 cm in lengthOTHER: Left kidney 10.9 cm in length. Trace ascites.", "output": "Markedly echogenic liver echotexture suggestive for severe fatty infiltration of the liver without mass. Cholelithiasis without acute inflammation or ductal dilatation. Trace ascites.Visualized hepatic vessels patent with normal directional flow. Left and right branches of the hepatic artery could not be visualized due to technical limitations of the exam including severe echogenicity of liver parenchyma."}
{"instruction": "Generate impression based on findings.", "input": "82-year-old male post left thyroidectomy and partial right thyroidectomy for thyroid cancer. Evaluate for recurrent disease. RIGHT LOBE MEASUREMENTS: Right lobe measures 2.5 x 1.2 x 1.9 cmLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No massesISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No interval change. No evidence for recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "75-year-old female with a cholangiocarcinoma presents with gram negative bacteremia and septic shock. Evaluate biliary system. LIVER: Measures 19.3 cm. Coarse heterogenous echotexture of liver noted. Previously noted biliary stent is partially visualized. Area in the left hepatic lobe may have some biliary dilation. No definite ductal dilatation and the common hepatic duct measures approximately 0.5 cm. No mass or ascites. Portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. The common bile duct is not definitely visualized on this study.PANCREAS: Evaluation the pancreas limited due to overlying bowel gas.SPLEEN: The spleen measures 11.7 cm without sonographic abnormalities.KIDNEYS: The right kidney measures 12.1 cm. Left kidney measures 10.5 cm. The kidneys have normal echogenicity. No hydronephrosis, focal mass, or shadowing calculi. OTHER: No fluid collections are seen.", "output": "1. Coarse heterogenous echotexture of liver consistent with chronic liver disease/parenchymal dysfunction2. No definite ductal dilatation however there is a questionable area in the left hepatic lobe that may have some minimal ductal dilatation related to known cholangiocarcinoma."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Hyperparathyroidism History: Tertiary hyperparathyroidism a RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 3.8 x 1.4 x 2.0 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 2.0 cm x 3.8 x 1.4 cm.ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: There is a round, hypoechoic vascular mass at the inferior aspect of the lower pole of left thyroid lobe measuring 2.0 x 1.8 x 1.9 cm which appears extrathyroidal and is consistent with parathyroid adenoma.LYMPH NODES: Multiple benign appearing borderline to mildly enlarged lymph nodes measuring up to 1.34 cm in the long axis.OTHER: No significant abnormalities.", "output": "2.0 x 1.8 x 1.9 cm probable extrathyroidal mass at the inferior aspect of the left thyroid lobe appears consistent with parathyroid adenoma."}
{"instruction": "Generate impression based on findings.", "input": "Low TSH RIGHT LOBE MEASUREMENTS: 5.8 x 1.3 x 1.7 cmLEFT LOBE MEASUREMENTS: 5.0 x 1.5 x 1.5 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Multiple benign-appearing spongiform nodules. A representative lower pole right nodule measures 1.2 x 0.8 x 0.8 cmLEFT LOBE: Multiple benign-appearing spongiform nodules. A representative mid pole nodule measures 0.9 x 0.7 x 0.8 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral spongiform nodules; favor benign etiology. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with possible history of right breast ADH, need whole breast ultrasound ultrasound due to dense breast A bilateral whole breast ultrasound was performed using Sonocine. 2-3 cystic lesions identified in the right upper-outer quadrant consistent with fat necrosis/oil cyst. There is no solid mass identified. Normal dense glandular tissue identified in the rest of the breast.Study was double read by Dr. Kulkarni and Dr. Sheth.", "output": "No sonographic evidence for malignancy.Area of fat necrosis/oil cyst in the right upper-outer quadrant.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter RIGHT LOBE MEASUREMENTS: 6.9 x 4.2 x 4.0 cmLEFT LOBE MEASUREMENTS: 4.5 x 1.6 x 1.8 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Diffusely heterogeneous gland. 5.1 x 3.7 x 3.7 spongiform nodule.LEFT LOBE: Diffusely heterogeneous gland without discrete noduleISTHMUS: Diffusely heterogeneous gland without discrete nodulePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous thyroid gland. Dominant right lobe spongiform nodule; favor benign etiology."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Rush is a 20 year old female presenting with a physician-detected a \"mole\" in the right breast. She has a family history of breast cancer in her mother (diagnosed at age of 29). Upon physical examination, a small mole is seen in the right inferior breast. No discrete mass is appreciated underneath this mole.A targeted right ultrasound was performed for the patient\u2019s area of concern. In the right inferior breast, 6 o'clock position, no suspicious cystic or solid mass is identified. Inferior to the skin lesion, there was a simple cyst measuring 2 mm.", "output": "No sonographic evidence for malignancy. Patient should follow-up with her primary physician as clinically warranted. In addition, given the strong family history, a consideration into initiating surveillance mammography and MRI starting at the age of 25 should be made. All results and recommendations were relayed to the patient.BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female with elevated creatinine and history of hypertension. ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures 10.2 cm in length. There is normal echogenicity of the cortex. No hydronephrosis, stones, or worrisome masses are seen within the right kidney.LEFT KIDNEY: The left kidney measures 10.4 cm in length. The echogenicity is normal within the cortex. There is no hydronephrosis, stones, or worrisome masses seen in the left kidney.OTHER: The bladder is visualized but no significant abnormalities are noted. Additionally, uterine fibroids are visualized.", "output": "1. Negative ultrasound of the kidneys bilaterally. No hydronephrosis, stones, or masses are seen.2. Uterine fibroids are visualized."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female presents as a callback from screening mammography for a retroareolar asymmetry in the left breast. No current breast complaints. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses(BiRads Density Category C), unchanged in pattern and distribution. A circumscribed asymmetry in the left breast 6:00 position persists with spot compression.ULTRASOUND", "output": "Clustered cysts in the left breast correlate with the mammographic asymmetry, and are favored benign. A six-month follow-up ultrasound is recommended to confirm stability.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "Female 54 years old Reason: patient with AKI in setting of dissection, want to eval flow to kidneys History: AKI, hematuria RIGHT KIDNEY: 11.0 cm in length. Normal echogenicity. No hydronephrosis or hydroureter.LEFT KIDNEY: 12.4 cm in length.OTHER: Bladder relatively collapsed.Limited color Doppler with a few spectral waveforms shows blood flow to both kidneys.", "output": "Blood flow is seen to both kidneys. No hydronephrosis. Normal echogenicity."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old female. Evaluate thyroid nodules and parathyroid adenoma. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 2.3 x 2.1 x 5.9 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 2.7 x 2.4 x 6.1 cm.ISTHMUS MEASUREMENTS: The isthmus measures 0.3 cm in thickness.RIGHT LOBE: The right thyroid lobe has a heterogenous echotexture without discrete nodules.LEFT LOBE: The left thyroid lobe has a heterogenous echotexture. In the left lower pole, there is a 1 x 1.4 x 1 cm spongiform nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Posterior to the left upper thyroid pole is a 1.2 x 1 x 1.8 cm hypoechoic nodule concerning for a parathyroid adenoma candidate.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Posterior to the left upper thyroid pole is a 1.2 x 1 x 1.8 cm hypoechoic nodule concerning for a parathyroid adenoma candidate. Correlation with the same day nuclear medicine parathyroid scan is recommended.2. Spongiform nodule in the left lower pole.3. Enlarged thyroid gland with nonspecific heterogenous echotexture. Clinical correlation is needed for possible thyroiditis."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old male with history of acute kidney injury. Evaluate for hydronephrosis. RIGHT KIDNEY: Right kidney measures 10.8 cm. No hydronephrosis or hydroureter. Slightly hyperechoic renal parenchyma, similar to prior.LEFT KIDNEY: Left kidney measures 10.7 cm. No hydronephrosis or hydroureter. Slightly hyperechoic renal parenchyma, similar to prior.URINARY BLADDER: Bladder is distended, within normal limits.OTHER: A small hepatic cyst.", "output": "Hyperechoic renal parenchyma, suggestive of medical renal disease/parenchymal dysfunction, without additional abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Female 69 years old Reason: rule out gallbladder, liver pathology History: right upper shoulder pain with inspiration LIVER: Liver measures 17 cm. No focal lesions. Normal echogenicity.BILIARY TRACT: There are multiple subcentimeter cholesterol polyps within the gallbladder. No evidence of gallstones. No evidence of intra or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: Spleen measures 8.7 cm, normal in size.RIGHT KIDNEY: No evidence of hydronephrosis in both kidneys. There is a 1.5 cm in diameter simple cyst within the right kidney. Normal echogenicity of the right kidney.Within the left kidney there is a large complex cyst measuring 10 x 9 cm. This cyst contains thick septations and mural irregularity and internal echoes. CT or MRI of the kidneys with contrast is recommended to exclude a renal neoplasm. OTHER: No significant abnormalities noted.", "output": "Complex left renal mass. Cystic Renal cell carcinoma cannot be excluded. Contrast-enhanced CT or MRI is recommended for further evaluation.Multiple small cholesterol polyps within the gallbladder.Dr. Blackman was notified and acknowledged about the above findings at the time of the dictation "}
{"instruction": "Generate impression based on findings.", "input": "47-year-old female with end-stage renal disease, secondary hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 4.4 x 2.6 x 2.0 cmLEFT LOBE MEASUREMENTS: 4.0 x 1.9 x 1.7 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Two solid hypoechoic nodules in the right thyroid lobe, the larger more superior nodule measuring 0.7 x 0.5 x 0.8 cm, and the smaller more inferior one measuring 0.5 x 0.4 x 0.4 cm with peripheral calcification.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Hypoechoic peripherally hyperechoic lesion posterior to the inferior right thyroid measures 0.8 x 0.7 x 0.8 cm. Hypoechoic complex lesion posterior to the inferior left thyroid measures 1.7 x 1.5 x 1.3 cm.", "output": "1. Hypoechoic lesions posterior to both inferior thyroid lobes are favored to represent parathyroid hyperplasia given multiplicity and the patient's clinical history. Correlate with results of same day nuclear medicine scan for further characterization. 2. Two small right thyroid nodules as detailed above. "}
{"instruction": "Generate impression based on findings.", "input": "24-year-old with right breast mass. The patient is unable to describe the area of concern. However, a clinic note shows the area of concern to be in the right upper outer quadrant. A targeted right ultrasound was performed for the clinical area of concern. There is no solid or cystic mass identified. Dense parenchymal tissue is seen, and this could account for a clinically palpable area of concern.", "output": "No sonographic evidence for malignancy. Dense parenchymal tissue in the right upper outer quadrant. Clinical correlation with this finding is recommended. The patient will be in touch with Dr. Dade to ensure these benign findings are concordant with her physical exam. If there is any question of discordance, further evaluation could include referral to a breast surgeon.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Rising creatinine RIGHT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 12.3 cm in lengthLEFT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 13.4 cm in lengthOTHER: Bladder nondistended", "output": "Mildly echogenic renal parenchyma raises the possibility of medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Renal ATN RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No change in small perinephric fluid collection.KIDNEY: No significant abnormality noted. 11 cm in lengthCOLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels Patent renal vasculature without evidence for inflow or outflow compromise.OTHER: 1.8 x 2.3 cm focal aneurysmal dilatation involving the right iliac artery in the region of the anastomosis.", "output": "Patent renal vasculature without evidence for inflow or outflow compromise. Unremarkable collecting system without hydronephrosis.Focal aneurysmal dilatation involving the right iliac artery in the region of anastomosis; while this may be an artifact of vessel tortuosity in the region of anastomosis, a true aneurysm cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": "Proteinuria Ultrasound guidance provided for four right renal biopsy passes. A 16 mm collection adjacent to the kidney was noted postprocedure, likely representing a small amount of hemorrhage.", "output": "Ultrasound guidance provided for right renal biopsy."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old female presents with dysphagia. RIGHT LOBE MEASUREMENTS: The right lobe is absent.LEFT LOBE MEASUREMENTS: 4.1 x 2.2 x 2.2 cm.ISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: The right lobe is absent.LEFT LOBE: Heterogeneous nodule in the left lobe measuring approximately 2.3 x 2.1 x 1.7 cm, appears stable when compared to the prior study.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No adenopathy.OTHER: No significant abnormality noted.", "output": "1. Stable multinodular left thyroid. Postsurgical changes of a right-sided thyroid lobectomy. No suspicious adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "The patient submitted outside mammogram dated 7/27/10. Submitted outside study was compared to the current mammogram dated 9/15/15. Two focal asymmetries at upper outer quadrant in the right breast are new, compared to the prior study. Therefore, spot compression views and possible ultrasound study are recommended.", "output": "New two focal asymmetries at upper outer quadrant in the right breast. Spot compression views and possible ultrasound study are recommended. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with a history of stem cell transplant. Now with transaminitis. LIVER: The liver is minimally coarsened. It measures a 18.8 cm in craniocaudal dimension. No focal hepatic lesion or intrahepatic ductal dilatation is evident. There is normal hepatopetal portal venous blood flow at 30 cm/sec.BILIARY TRACT: There is a normally distended gallbladder with a 4-mm non-shadowing nondependent focus which may represent a small adherent gallstone or polyp. No extrahepatic biliary ductal dilatation with the common bile duct measuring 4 mm at the pancreatic head.PANCREAS: The visualized pancreatic head and body are normal.SPLEEN: Marked splenomegaly, measuring 19 cm in length.RIGHT KIDNEY: The right kidney measures 9.5 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 10.2 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident.", "output": "1. Coarse echogenic liver echotexture suggests chronic liver disease/parenchymal dysfunction without a discrete mass or biliary ductal dilatation.2. Small adherent gallstone versus subcentimeter gallbladder polyp.3. Marked splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "34-year-old male with chronic kidney disease. RIGHT KIDNEY: The right kidney measures 11.3 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 11.5 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.OTHER: Patient voided prior to exam.", "output": "Normal renal ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "Reason: pt with autoimmune hepatitis, screen for hepatocellular carcinoma. LIVER: The liver measures 15.2 cm in length and is smooth in contour. The liver parenchymal echotexture is normal. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.27 m/s.BILIARY TRACT: Cholelithiasis including large gallstone measuring up to 2.4 cm in diameter. No associated gallbladder wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 10.6 cm in length. RIGHT KIDNEY: Kidney measures 11.3 cm in length. Normal cortical echotexture. No hydronephrosis. Prominent extrarenal pelvis appearing similar to the 12/11/2012 examination.LEFT KIDNEY: Kidney measures 11.7 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.No focal hepatic lesions.2.Cholelithiasis without evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Right upper abdominal quadrant pain LIVER: Non-cirrhotic liver morphology. Minimally coarsened parenchymal echogenicity. Benign-appearing cysts noted. No suspicious hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Normal appearance of the gallbladderPANCREAS: The pancreas is obscured by bowel gas.KIDNEYS: The right kidney is 11.6 cm in length, with a simple appearing upper pole cyst. The left kidney is 10.8 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 9.0 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites is noted.", "output": "No acute abnormality evident."}
{"instruction": "Generate impression based on findings.", "input": "42 year-old female with new onset right upper quadrant pain with history of acute hepatic failure secondary to Tylenol overdose. LIVER: The liver parenchyma is coarse. There is a focal hyperechogenic geographic region measuring 5.7 cm without mass effect, compatible with focal fatty infiltration. The remainder of the liver is coarse. The liver is normal in size, measuring 16.8 cm in the craniocaudal dimension. The liver capsule is smooth. There is normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: No extrahepatic biliary ductal dilatation with common bile duct measuring 4 mm at the level of the pancreatic head. A normally distended gallbladder is present with sludge. There is mild diffuse wall thickening up to 5 mm markedly improved from the prior study. There may be a small amount of pericholecystic fluid, but no focal tenderness.PANCREAS: The visualized pancreatic head and body are normal.SPLEEN: The spleen measures 10.8 cm without a focal abnormality evident.RIGHT KIDNEY: The right kidney measures 14-cm in length with no hydronephrosis, shadowing calculus or discrete lesion evident. Echogenic cortex. OTHER: The left kidney measures 12.7 cm in length without hydronephrosis, shadowing calculus or discrete lesion. Echogenic cortex.There is a trace amount of ascites. Small left pleural effusion.", "output": "1. Gallbladder sludge, moderate yet improved diffuse gallbladder wall thickening without focal tenderness; overall, these findings are not specific for acute cholecystitis. 2. Coarse hepatic parenchyma with suspected focus of focal fatty infiltration is compatible with diffuse parenchymal dysfunction. 3. Trace ascites. Small left pleural effusion. 4. Echogenic renal cortices compatible with medical renal disease. "}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain. Elevated LFTs. History of renal transplant. LIVER: Non-cirrhotic liver morphology. Minimally echogenic parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Distention of the gallbladder with tumefactive sludge. No gallbladder wall thickening or pericholecystic fluid to suggest cholecystitis.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 9.9 cm in length. The left kidney is 11.1 cm in length. Multiple renal cysts are noted bilaterally. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 16.2 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites identified.", "output": "1. Distended gallbladder with biliary sludge, without evidence of cholecystitis.2. Minimally echogenic liver, compatible with parenchymal dysfunction.3. Splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old female who is recalled from screening for right superior, posterior breast lobulated mass. RIGHT BREAST DIGITAL MAMMOGRAPHY: Medial to lateral, exaggerated CC lateral, and 2 spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Again noted is the lobulated asymmetry located within the superior posterior right breast which persists with spot compression.TARGETED RIGHT BREAST ULTRASOUND:Right breast ultrasound demonstrated a lobulated anechoic focus at the 10:00 position measuring approximately 1.1 x 0.4 x 1.1 cm without vascular flow.", "output": "Findings consistent with right 10 o'clock position cyst. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "History of renal transplant now with elevated creatinine Ultrasound guidance was provided for biopsy of a transplant kidney in the right iliac fossa by the nephrology service. Two biopsy passes were performed.", "output": "Ultrasound guidance provided for transplant renal biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Volume overload, rule out cirrhosis or evidence of HCC, elevated alkaline phosphatase LIVER: Liver measures 16.9 cm, diffuse coarse heterogenous echotexture. No definite focal lesion noted. Portal vein is patent with normal flow directionality.Calcified granuloma noted in the right lobe of liver. Mild perihepatic fluid noted.BILIARY TRACT: Gallbladder is well-distended without any gallstones. No evidence of gallbladder wall thickening. Pericholecystic fluid is noted.Sonographic Murphy sign is negative.CBD measures 3 mm within normal limits.PANCREAS: Pancreas as visualized appears unremarkable. Tail of pancreas is not visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 11.1 cm.RIGHT KIDNEY: Right kidney measures 11.4 cm left kidney measures 10.7 cm. Normal echotexture of the kidneys. No hydronephrosis or focal lesionsOTHER: No ascites", "output": "Diffuse coarse echotexture of the liver consistent with chronic liver disease.Mild ascites."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for right neck mass History: swelling, tenderness to right neck with associated anterior and posterior cervical lymphadenopathy Multiple enlarged anterior and posterior right cervical lymph nodes.Right level 2 lymph node: 4.0 x 1.4 x 2.0 cmRight level 3 lymph node: 2.2 x 1.2 x 1.4 cm and 3.0 x 1.3 x 1.7 cmRight level 4 lymph node: 1.9 x 0.6 x 1.3 cmRight level 5 lymph node: 1.8 x 0.9 x 1.2 cm.", "output": "Multiple nonspecific enlarged right anterior and posterior cervical lymph nodes, which would be amenable to biopsy; continued follow up suggested."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with right thyroid nodule. Assess for change in size. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.3 x 1.7 x 1.4 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.3 x 1.7 x 1.4 cm.ISTHMUS MEASUREMENTS: The isthmus measures 3.3 mm in thickness.RIGHT LOBE: The hypoechoic/spongiform nodule of the right lower thyroid pole measuring 0.6 x 0.4 x 0.6 cm is stable in size and appearance (prior 0.5 x 0.4 x 0.5 cm).LEFT LOBE: Normal homogeneous echotexture of the left thyroid lobe.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Similar-appearing left level 4 lymph node measuring 1.3 x 0.4 x 0.5 cm. A right level 3 lymph node containing a fatty hilum measures 2.5 x 0.7 x 1.3 cm.OTHER: No significant abnormality noted.", "output": "1. Unchanged subcentimeter right thyroid nodule.2. Stable nondescript left level 4 lymph node."}
{"instruction": "Generate impression based on findings.", "input": "Reason: ruq pain with nausea and vomiting for 3 weeks History: as above LIVER: The liver measures 14.4 cm in length. Unremarkable hepatic parenchymal echogenicity and echotexture. The portal vein is patent with normal directional hepatopedal flow, peak velocity is 34.3 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: The gallbladder is decompressed without evidence of shadowing stones or pericholecystic inflammation. The gallbladder wall measures 0.2 cm. The common bile duct measures 0.3 cm. No significant intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.1 cm in length. The left kidney measures 9.4 cm in length. Unremarkable renal parenchymal echogenicity and echotexture. No hydronephrosis. There is a small nonobstructive hyperechoic left mid pole renal calculus measuring up to 5 mm.OTHER: The spleen measures 9.0 cm in length.", "output": "1. Small nonobstructive left renal stone. No hydronephrosis.2. No acute hepatobiliary abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Cope is a 66-year-old female who presents for six-month follow-up for focal asymmetry in the right upper inner breast. Three standard views of the right breast and additional right spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density (BiRads Density Category B), unchanged in pattern and distribution. The focal asymmetry in the right upper inner breast at posterior depth is again seen, questionably increased on ML spot view. Targeted right breast ultrasound was subsequently performed.ULTRASOUND", "output": "Focal asymmetry in the right breast at the 2:00 position with a low suspicion correlate hypoechoic lesion on ultrasound, for which ultrasound-guided biopsy is recommended. If a clear ultrasound correlate is not readily identified at the time of biopsy (or if clip placement does not correlate with the mammographic finding), stereotactic biopsy could be undertaken. Results and recommendations were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female with known right breast malignancy and bilateral axillary lymphadenopathy currently undergoing neoadjuvant chemotherapy. Evaluate treatment response. Family history of ovarian carcinoma in her sister at age 45 and cervical cancer in her daughter and maternal niece. A targeted right ultrasound was performed for the areas of concern. At the 11 o'clock position of the right breast, 3 cm from the nipple there is an irregular hypoechoic mass measuring 2.1 x 1.2 x 3.2 cm (previously 4.0 x 3.6 x 3.4 cm). Mild peripheral vascularity is appreciated.At the 7 o'clock position of the right breast, 2 cm from the nipple, there is a 2.1 x 1.0 x 2.9 cm irregular hypoechoic mass with mild peripheral vascularity (previously 3.7 x 2.5 x 3.6 cm).Targeted ultrasound of the right axilla was performed, without evidence for adenopathy. The previously identified abnormal lymph nodes are not visualized on today's examination.A targeted left axillary ultrasound was performed for the area of concern. Two prominent lymph nodes are present in the left axilla, both demonstrating a hyperechoic appearance, and decreased in size from prior examination suggesting treatment response. The largest lymph node measures 1.9 x 1.0 x 1.7 cm. The second lymph node measures 1.9 x 0.9 x 0.8 cm. No submitted vascularity is associated with either lymph node.", "output": "1. Decrease in size of two right breast masses, as above. 2. Nonvisualization of previously identified right axillary lymph nodes, suggesting response to therapy.3. Decrease in size of left axillary lymph nodes with treatment response. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Salem is a 15 year old female status post left breast lumpectomy in February 2014 for a borderline Phyllodes tumor. She presents today for a short-term ultrasound follow-up to exclude recurrent disease. Upon physical exam of the left breast, a surgical scar is identified. No palpable masses are appreciated.Targeted left breast ultrasound was performed. Scar tissue and fibrosis is identified without discrete mass. No suspicious sonographic findings seen to suggest residual/recurrent tumor.", "output": "No sonographic evidence for residual or recurrent tumor. The patient is scheduled for a follow-up appointment with Dr. Chhablani on 6/11/2015. All results were discussed with the patient and her mother. BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Male 47 years old Reason: hx of kidney cancer, evaluate 2 other renal masses on right RIGHT KIDNEY: Multiple masses are again seen in the right kidney. Solid appearing inferior pole right renal nodule with what appears to be a hypoechoic capsule measures 2.2 x 2.3 x 2.5 cm, increased in size compared to the prior exam when it measured 1.8 x 1.4 x 1.7 cm. This inferior pole lesion was previously documented as enhancing on triple phase abdominal CT, and is concerning for malignancy. Slightly hypoechoic round superior pole nodule measures 2.9 x 2.1 x 3.0 cm. This nodule is likely not significantly changed. Anechoic renal cyst in the right superior pole measures 2.1 x 1.8 x 1.8 cm. Renal cortical echogenicity is within normal limits. No hydronephrosis or shadowing calculus.LEFT KIDNEY: The left kidney is not well visualized on today's exam. Renal cortical echogenicity is within normal limits. No hydronephrosis or shadowing calculus.OTHER: Bladder is distended and unremarkable.", "output": "Increase in size of solid appearing inferior pole right renal nodule, which has been previously documented as enhancing on CT. Findings are concerning for malignancy. Recommend dedicated renal CT to further evaluate."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old male with hepatitis C Evaluate for hepatocellular carcinoma. LIVER: Liver is normal in size and mildly and coarsely echogenic. No focal hepatic mass is identified. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Patient has had a cholecystectomy. Biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.SPLEEN: Poorly visualized but small.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "No evidence for hepatic mass."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old male with multiple myeloma, renal disease, rising creatinine. RIGHT KIDNEY: Measures 11.7 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 13.6 cm in length. Left renal cysts measuring up to 2.3 cm without discrete septation or solid component. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.", "output": "1. Increased renal echogenicity consistent with medical renal disease. 2. No nephrolithiasis, hydronephrosis, or suspicious mass lesion identified. "}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C. Evaluate for hepatocellular carcinoma. LIVER: Non-cirrhotic liver morphology. 18.3 cm in length. Unremarkable parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Status post cholecystectomy.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney is 10.0 cm in length. The left kidney is 10.9 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 12.1 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.", "output": "No suspicious hepatic lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "Reason: rule out infection of right arm fistula History: bacteremia, fever, vomiting In the region of the right biceps, there is a tubular structure compatible with patient's known brachial artery to axillary vein dialysis access graft (as seen on 2/9/2016 vascular ultrasound). No flow is seen within the graft. No drainable fluid collections are identified adjacent to the graft.", "output": "Thrombosed graft without evidence of adjacent drainable collection."}
{"instruction": "Generate impression based on findings.", "input": "Reason: RUQ pain, evaluate for cholecystitis LIVER: The liver measures 17.0 cm in length. Normal hepatic parenchymal echogenicity and echotexture. The portal vein is patent with normal directional hepatopedal flow, peak velocity 19.4 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is distended, however there are no shadowing stones or intraluminal sludge. No pericholecystic inflammation or fluid. No biliary ductal dilatation. Gallbladder wall measures 0.2 cm and the common bile duct measures 0.2 cm. Negative sonographic Murphy's sign.PANCREAS: No significant abnormalities noted. The pancreatic duct measures 0.13 cm.KIDNEYS: The right kidney measures 8.7 cm in length. The left kidney measures 9.7 cm in length. Echogenic renal parenchyma. No shadowing stones or hydronephrosis.OTHER: No ascites.", "output": "1. Distended gallbladder without evidence of cholelithiasis, sludge, or acute inflammation.2. Echogenic kidneys, consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Hypothyroidism RIGHT LOBE MEASUREMENTS: 5 x 2.3 x 2.4 cmLEFT LOBE MEASUREMENTS: 5.2 x 2.3 x 1.9 cmISTHMUS MEASUREMENTS: 0.9 cmRIGHT LOBE: Heterogeneous gland. 0.6 x 0.6 x 0.6 cm calcified mid pole nodule.LEFT LOBE: Heterogeneous gland. 0.9 x 0.8 x 1.3 cm mostly cystic nodule lower pole left thyroidISTHMUS: Heterogeneous glandPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Heterogeneous thyroid gland. Subcentimeter calcified right thyroid nodule. Mostly cystic left thyroid nodule as described. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "22-year-old female with fever, elevated AST/ALT, alkaline phosphatase. Evaluate causes of abnormal LFT. LIVER: The liver is enlarged measuring 20.1 cm in length and is normal in echogenicity with no focal hepatic lesions. No intrahepatic biliary ductal dilatation.GALLBLADDER, BILIARY TRACT: Focal echogenic focus along the gallbladder wall with comet tail artifact compatible with focal adenomyoma. No sludge or gallstones. No pericholecystic fluid. Sonographic Murphy's sign is negative. No extrahepatic biliary ductal dilatation. The common duct measures 2 mm in caliber.PANCREAS: The distal body and tail of pancreas are obscured by overlying bowel gas. The remaining visualized pancreas is normal in echogenicity. No pancreatic ductal dilatation.RIGHT KIDNEY: The right kidney measures 11.5 cm in length with no hydronephrosis or nephrolithiasis. OTHER: The left kidney measures 11.9 cm in length with no hydronephrosis or nephrolithiasis. The spleen measures 12.4 cm in length, upper limits of normal.", "output": "1. Hepatomegaly and borderline splenomegaly.2. Focal adenomyoma along the gallbladder wall."}
{"instruction": "Generate impression based on findings.", "input": "42 year old female who was recalled from screening mammogram for new left breast masses. No family history of breast cancer. LEFT DIAGNOSTIC MAMMMOGRAM: An ML view and three spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. There is redemonstration of a new 1.0 cm mass within the posterior upper inner left breast, which persists on spot compression imaging. Additionally, there is redemonstration of a 1.0 cm mass within the outer slightly inferior left breast, which persists on spot compression imaging.LEFT ULTRASOUND: On physical examination, no palpable lesions are identified.At the 10 o'clock position of the left breast, 4 cm from the nipple, there is a well-circumscribed anechoic cyst with posterior acoustic enhancement measuring 0.7 x 0.6 x 0.7 cm. A second simple appearing cyst is noted deep to this measuring 0.9 x 0.7 x 1.1 cm. This lesion likely corresponds to the new mammographic abnormality seen within the upper inner left breast. No significant vascularity associated with these lesions on Doppler imaging.At the 4 o'clock position of the left breast, 6 cm from the nipple, there is a circumscribed nearly anechoic cyst with posterior acoustic enhancement within the deep breast measuring 1.0 x 1.0 x 1.0 cm. This lesion is felt to correspond to the new mammographic mass seen within the outer slightly inferior breast. No significant vascularity is associated with this lesion on Doppler imaging.", "output": "Simple left breast cysts, corresponding to the new masses visualized on mammogram.No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Female 37 years old; Reason: New nodules? History: Thyroid cancer s/p surgery The patient is status post total thyroidectomy. No suspicious thyroid bed lesions are identified.LYMPH NODES: No suspicious adenopathy noted. There is a right level 2 lymph node that is slender with a fatty hilum and measures 1.7 cm x 0.5 cm x 1.0 cm. There is left level 2 lymph node with a fatty hilum that measures 1.6 cm x 0.6 cm x 0.9 cm.", "output": "Stable exam status-post thyroidectomy without evidence of residual or recurrent disease. No suspicious adenopathy is visualized."}