{"instruction": "Generate impression based on findings.", "input": "Cirrhosis LIVER: Stable cirrhotic morphology without mass. Liver length 11.7 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent portal vein with normal directional flow but diminished velocity of approximately 11 cm/s.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.7 cm in lengthOTHER: Left kidney 12.4 cm in length. Spleen 12.7 cm in length. Mild ascites.", "output": "Stable cirrhotic morphology without mass or ductal dilatation. Limited Doppler interrogation of the main portal vein demonstrates a patent portal vein with normal directional flow but diminished velocity. Mild ascites."}
{"instruction": "Generate impression based on findings.", "input": "Known right breast cancer. Right axillary fullness on clinical exam. Also, left breast focal asymmetry for which ultrasound is requested. A targeted bilateral ultrasound was performed. The known malignancy at the right breast 4:00 position measures 3.6 x 2.9 x 2.8 cm. In the right axilla, several small lymph nodes with retained fatty hila and predominantly hilar blood flow are seen. In the left breast 3:00 position no suspicious cystic or solid mass was seen. Additional scanning above and below the 3:00 position also did not reveal any abnormality.", "output": "1. Known right breast malignancy with current measurements as above, which are similar to outside hospital measurements.2. No sonographically suspicious right axillary lymph nodes.3. No correlate for the focal asymmetry in the left breast. Six-month follow-up is recommended.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Reason: elevated liver enzymes LIVER: Normal liver echogenicity and echotexture. The portal vein is patent. Normal hepatopedal portal venous blood flow, 34.7 cm/s. The liver measures 17.6 cm in length.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. Negative sonographic Murphy sign. The gallbladder wall measures 0.3 cm. The common hepatic duct measures 0.2 cm. No intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.1 cm in length. 5.5 x 4.8 x 4.5 anechoic right renal cyst. Additional complex 2.2 x 1.9 x 2.7 cyst with multiple septations. Echogenic renal cortex. No hydronephrosis.LEFT KIDNEY: The left kidney measures 13.9 cm in length. Echogenic renal cortex. No hydronephrosis.SPLEEN: The spleen is prominent, measuring 14.0 cm in length.OTHER: No significant abnormalities noted.", "output": "Echogenic kidneys may reflect medical renal disease/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "27-year-old male presents with a history of pain in the left axillary region for approximately two months. No known trauma history. Family history of breast cancer. Targeted ultrasound of the left axillary region was performed in the area of the patient's pain. No abnormal findings were identified to account for his symptoms.", "output": "Normal examination. No sonographic abnormalities to account for the patient's pain.BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female with thyroid nodules. Evaluate for calcification. RIGHT LOBE MEASUREMENTS: 1.9 x 1.8 x 5.5 cmLEFT LOBE MEASUREMENTS: 1.9 x 1.6 x 5.5 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: There again noted multiple nodules which are predominantly cystic, many with evidence for colloid comet tail artifact which are unchanged from prior exam. Large, reference cystic nodule in the upper pole measures 1 x 1.3 x 1.6 cm.LEFT LOBE: There again noted multiple nodules which are predominantly cystic, many with evidence for colloid, tail artifact which are unchanged from the prior exam. Reference spongiform nodule in the mid inferior left lobe measures 0.4 x 0.6 x 0.7 cm, slightly smaller than on the prior exam. This also demonstrates comet tail artifact.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 of the thyroid with multiple nodules, most characteristic of colloid nodules. Comet tail artifact may be seen with calcification, but in this patient findings are consistent with colloid."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess for liver dysfunction. Examination somewhat limited by ventilator status and limitations positioning patient.LIVER: The liver measures 23.3 cm in length. Mildly increased parenchymal echogenicity is suggestive of fatty infiltration/parenchymal dysfunction. No focal hepatic lesions or masses are identified. Blood flow within the main portal vein is apparently diminished measuring 15.6 cm/s and with possible intraluminal filling defects.BILIARY TRACT: Cholelithiasis as well as diffuse gallbladder wall thickening measuring up to 7 mm. The sonographic Murphy's sign was not elicited. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3.5 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted.The spleen measures 8.8 cm in length. RIGHT KIDNEY: Kidney measures 11.4 cm in length. Increased parenchymal echogenicity is suggestive of medical renal disease/parenchymal dysfunction. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 11.8 cm in length. Increased parenchymal echogenicity is suggestive of medical renal disease/parenchymal dysfunction. No hydronephrosis, shadowing calculus or mass.OTHER: Moderate abdominal pelvic ascites.", "output": "1.Hepatomegaly and coarse hepatic echotexture suggestive of parenchymal dysfunction. 2.Moderate abdominopelvic ascites.3.Cholelithiasis. Gallbladder wall thickening which is nonspecific in the setting of liver disease and ascites, though cholecystitis not entirely excluded.4.Diminished flow and possible filling defects within the main portal vein which could be artifactual or due to thrombus. Correlation with cross-sectional imaging may be considered as clinically warranted.5.Echogenic kidneys suggestive of parenchymal dysfunction.Discussed with LIGTENBERG, KATHERINE "}
{"instruction": "Generate impression based on findings.", "input": "1 year status post islet cell transplant; evaluate portal venous flow LIVER: Normal parenchymal echogenicity. Well-circumscribed subcentimeter echogenic foci within the right lobe of the liver; favor benign etiology. Liver length 15.3 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Main portal vein velocity 20 cm/s.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Subcentimeter nonobstructing right renal stone. Right kidney 10.5 cm in lengthOTHER: Left kidney 9.4 cm in length. Spleen 9.6 cm in length. No ascites.", "output": "Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Well-circumscribed subcentimeter echogenic foci within the right lobe of the liver; favor benign etiology. No ascites.Subcentimeter nonobstructing right renal stone."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with alcoholism. Evaluate for cirrhosis. LIVER: Liver parenchyma is homogeneous without focal abnormality. There is no gross morphologic change to suggest cirrhosis.BILIARY TRACT: Multiple shadowing gallstones within the gallbladder without wall thickening or pericholecystic fluid. The visualized biliary tract is normal in caliber.PANCREAS: Limited by bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Echogenic consistent with parenchymal disease. OTHER: Limited spleen due to high position. Right pleural effusion", "output": "Normal-appearing liver.Gallstones.Echogenic kidneysRight pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "The patient submitted outside mammogram dated 8/7/12. Submitted outside study was compared to the current mammogram dated 12/18/15. Focal asymmetry in the right upper outer breast appears new and additional spot compression views and possibly ultrasound are recommended.", "output": "New focal asymmetry in the right upper outer breast, for which additional spot compression views and possibly ultrasound are recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "Female 37 years old; Reason: enlarged nontender thyroid gland RIGHT LOBE MEASUREMENTS: 4.8 x 2.0 x 1.2 cmLEFT LOBE MEASUREMENTS: 5.1 x 1.8 x 0.1 cmISTHMUS MEASUREMENT: 0.4 cmRIGHT LOBE: Slight heterogeneity of the gland with no dominant nodule.LEFT LOBE: Slight heterogeneity of the gland no dominant nodule.ISTHMUS: No significant abnormality noted.LYMPH NODES: 1.1 centimeter right level 2 and 2.0 cm left level 2 lymph nodes have fatty hila and benign appearance.", "output": "1.Slight heterogeneity of the thyroid gland which is nonspecific but can be seen as a sequela of thyroiditis.2.No dominant nodule."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old female with renal transplant and acute kidney failure. RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: Transplant kidney measures 12.9 cm in length. Echotexture is normal. No evidence for mass.COLLECTING SYSTEM/URETER: No hydronephrosis.URINARY BLADDER: Not visualized, likely due to decompression.OTHER: No significant abnormality noted", "output": "No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old male patient with right upper quadrant abdominal pain, positive Murphy. Evaluate for fatty liver disease. LIVER: The liver measures 19.3 cm in length and has increased echogenicity. No focal hepatic lesion is identified. The main portal vein flow is hepatopetal and measures 0.4 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. There is no intra- or extrahepatic biliary ductal dilatation. The common hepatic duct measures 1 mm in diameter. Sonographic Murphy's sign is negative.PANCREAS: The head of the pancreas is normal in echogenicity. The tail is obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 11.4 cm in length. No evidence of hydronephrosis.OTHER: The left kidney measures 12.2 cm in length. No evidence of hydronephrosis. There is a 2.3 x 2.3 cm left lower pole simple renal cyst.The spleen measures 10.6 cm in length.", "output": "1. Hepatic steatosis.2. No cholelithiasis or sonographic evidence of acute cholecystitis.3. Left renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "Reason: elevated LFTs in mixed picture, r/o biliary obstruction History: nausea, vomiting LIVER: The liver measures 18.1 cm in length, upper limits of normal. 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 0.32 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 2 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 11.0 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.6 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "No evidence of acute cholecystitis or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "History of poorly differentiated invasive ductal carcinoma of the left breast. Patient received neoadjuvant chemotherapy. Palpable mass in the left breast has recently increased in size. Please evaluate. Note is made that the patient is on Lovenox with marked bruising of the abdomen. History of breast cancer in 3 maternal aunts and two maternal cousins. LEFT UNILATERAL DIGITAL DIAGNOSTIC MAMMOGRAM: Three standard views, an additional MLO view and 2 spot magnification 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. A triangular marker was placed on the skin at the site of palpable mass. Near the 6 o'clock position of the left breast, a 4.5 x 3.2 x 5.5 cm lobulated mass is present containing a percutaneous clip and malignant calcifications. On the most recent mammogram, the mass measured 2.4 x 2.1 x 2.9 cm. On the mammogram of 8/6/2014, the mass measured 4.3 x 4.0 x 4.7 cm. Arterial calcifications are present. The left axilla is obscured by a cardiac generator device.LEFT BREAST ULTRASOUND: On physical examination, the patient has a 4 cm palpable mass at the 6 o'clock position of the left breast. The skin overlying the mass is ecchymotic. A focused left breast ultrasound was performed. At the 6 o'clock position of the left breast, 4 cm from the nipple, a 3.2 x 2.2 x 3.8 cm lobulated hypoechoic mass is present containing in Hydromark clip. Previous measurements on 10/28/2014 were 2.4 x 1.9 x 2.6 cm. On 8/6/2014 the measurements were 4.2 x 3.7 x 2.9 cm.", "output": "Interval increase in the size of biopsy proven carcinoma at the 6 o'clock position of the left breast. Given the history of Lovenox and overlying bruising, a portion of the size increase may be due to internal hematoma. Results were discussed with the patient and her daughter.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "79-year-old male with chronic kidney disease RIGHT KIDNEY: Measures 11.9 cm in length. Three right renal cysts measuring up to 5 cm in diameter without septation or nodular component. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 12.3 cm in length. Two left renal cysts measuring up to 3.7 cm in diameter without septation or nodular 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 and bilateral simple cysts as detailed above. 2. No nephrolithiasis, hydronephrosis, or suspicious mass lesion. "}
{"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": "78-year-old female with goiter. RIGHT LOBE MEASUREMENTS: Incompletely measured due to substernal component. 7.7 x 3.2 x 5.4 cmLEFT LOBE MEASUREMENTS: Incompletely measured due to substernal component. 7.1 x 2.6 x 3.6 cmISTHMUS MEASUREMENTS: 1.6 cmRIGHT LOBE: Diffusely heterogeneous. Small cystic colloid nodule measuring 0.5 x 1.1 x 0.5 cm. Solid, isoechoic nodule arising from the lower pole likely incompletely visualized, measuring 2.3 x 2.5 x 1.9 cm. Other less well-defined solid nodules are present. LEFT LOBE: Diffusely heterogeneous. Complex cystic nodule in the upper pole measuring 0.7 x 1 x 1.3 cm. Rounded, probably cystic nodule with small wall nodule in the midportion measuring 1.1 x 1.2 x 1.1 cm. Incompletely marginated, isoechoic but heterogeneous solid lower pole nodule measuring 3.5 x 4 by at least 3.5 cm. There are discrete, coarse calcifications in the left thyroid.ISTHMUS: Confluent heterogeneous and solid nodules with coarse calcification the most measurable approximating 1.6 x 1.6 x 1.6 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Large goiter with substernal thyroid. Multiple solid and cystic nodules. Coarse calcification in the left lobe and isthmus."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with acute kidney injury, decreased oral intake. RIGHT KIDNEY: Measures 10.3 cm in length. Small bilateral echogenic foci in the kidneys without twinkling or posterior acoustic shadowing most likely represent renal sinus fat or small angiomyolipomas. No hydronephrosis.LEFT KIDNEY: Measures 10.3 cm in length. Small bilateral echogenic foci in the kidneys without twinkling or posterior acoustic shadowing most likely represent renal sinus fat or small angiomyolipomas. No hydronephrosis.URINARY BLADDER: Incompletely distended. OTHER: No significant abnormalities noted.", "output": "1. Small echogenic renal foci bilaterally may represent renal sinus fat or small angiomyolipomas, and do not have typical sonographic features of calculi. 2. No hydronephrosis. "}
{"instruction": "Generate impression based on findings.", "input": "67 year old female with physician palpated left breast area. Recent, unremarkable screening mammogram. On physical examination, a ridge of dense breast tissue is noted at the approximate 12 to one o'clock position of the left breast. No further palpable abnormality is identified.A targeted left ultrasound of the upper outer quadrant was performed for the palpable area of concern. There is no solid or cystic mass identified. A band of dense parenchymal tissue is noted at the approximate one o'clock position, 2 cm from the nipple. No abnormal vascularity is associated with this area.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Reason: mixed cardiogenic/septic shock with rising LFTs and WBC, eval gall bladder for e/o cholecystitis, eval hepatic and portal vein for clot History: worsening shock Very limited examination due to patient positioning/body habitus.LIVER: The liver appears demonstrates increased echogenicity and coarse echotexture. No focal hepatic lesions. Hepatic length measures 14.5 cm. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 18.7 cm/s. GALLBLADDER/BILIARY TRACT: Gallbladder sludge noted, with the wall measuring 3 mm. No pericholecystic fluid collection. The common bile duct measures 2 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: Not visualized.KIDNEYS: The right kidney measures 13.7 cm and without evidence of hydronephrosis. The left kidney is not visualized.OTHER: Ascites is noted in the upper abdomen.", "output": "1.Very limited examination as above, with patient's left portal vein, hepatic arteries, right hepatic vein, splenic vein and artery, left kidney, and spleen not visualized.2.Increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation identified.3.Gallbladder sludge without evidence of cholecystitis or cholelithiasis.4.Patent main portal vein."}
{"instruction": "Generate impression based on findings.", "input": "75-year-old female with right upper quadrant pain. Evaluate for biliary pathology. Of note, the exam is limited by patient's inability to hold breath during the exam and due to bowel gas.LIVER:The liver measures approximate 14.7 cm. There is coarse, increased, and heterogeneous echotexture of the parenchyma. No mass or ascites noted. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended and the wall measures 0.1cm. There is a negative Murphy's. No stones or sludge seen. No pericholecystic fluid. The common bile duct measures 3.3 mm.PANCREAS: Evaluation of the pancreas is limited due to overlying bowel gas.SPLEEN: The spleen measures 7.7 cm. No significant abnormality noted.KIDNEYS: The right kidney measures 10.4 cm. There is a round anechoic area with posterior acoustic enhancement measuring approximately 2.2 x 2.3 x 3.1 cm that is consistent with a simple cyst. No concerning mass or shadowing calculi. No hydronephrosis. The left kidney measures 9.4 cm. There is a round anechoic area with posterior acoustic enhancement measuring approximately 2.3 x 2.1 x 1.9 cm and is consistent with a simple cyst. No concerning mass or shadowing calculi. No hydronephrosis. The kidneys appear atrophic bilaterally. OTHER: No significant abnormality noted.", "output": "1. Coarse and echogenic liver consistent with chronic liver disease/parenchymal dysfunction. No ductal dilatation, mass, or ascites.2. Atrophic kidneys consistent with chronic medical renal disease/parenchymal dysfunction.3. No evidence of cholelithiasis or gallbladder disease."}
{"instruction": "Generate impression based on findings.", "input": "Callback from screening for left breast calcifications and a right breast mass. Bilateral ML views, right spot compression views and left magnification 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 cluster of calcifications in the left upper outer breast has a typically benign coarse morphology on spot magnification. Additionally, a smaller but similar cluster of calcifications can be seen on the right, further suggesting a benign etiology. The round circumscribed mass in the right lower outer quadrant persists on spot compression. There is the suggestion of fat density within mass. Elsewhere, a few scattered benign calcifications are seen on the right. 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: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female with right upper quadrant pain. Evaluate gallbladder. LIVER: Increased echogenicity of the liver measuring 20.4 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 the gallbladder. No gallbladder wall thickening. No pericholecystic 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 12.5 cm in length. There is a shadowing stone at the mid to upper pole measuring 1.8 cm x 1.2 cm x 1.7 cm which likely corresponds to the stone seen on CT dated 4/22/2014. No hydronephrosis is noted.OTHER: Left kidney measures 12.1 cm in length. No hydronephrosis or shadowing calculi are noted. Normal echogenicity of the spleen measuring 12.0 cm in length.", "output": "1. Hepatomegaly with increased echogenicity suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesions. 2. Non obstructing right nephrolithiasis appears similar to CT dated 4/22/2014. 3. No evidence of cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "Septic shock. LIVER: Non-cirrhotic liver morphology. 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. Biliary sludge and subcentimeter gallstones noted, without evidence of 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 11.9 cm in length. The left kidney is 11.2 cm in length. The renal parenchyma is echogenic bilaterally. No suspicious renal lesions are evident. No hydronephrosis is seen.BLADDER: Not well visualized, likely secondary to underdistention from Foley catheter drainage.SPLEEN: Not well visualized, secondary to inability to reposition the patient.ABDOMINAL AORTA: Patent, without significant abnormality noted. Normal arterial waveforms. No aortic aneurysm identified.INFERIOR VENA CAVA: Patent, without significant abnormality noted. IVC filter noted.OTHER: Small right pleural effusion. Small amount of ascites identified.", "output": "1. Biliary sludge and subcentimeter gallstones, without cholecystitis.2. Echogenic liver, compatible with parenchymal dysfunction.3. Echogenic renal parenchyma, compatible with medical renal disease.4. Small amount of ascites and small right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "Angiomyolipoma RIGHT KIDNEY: 11.2 cm in length. The hyperechoic mass in the superior pole measures 5.3 x 3.7 x 5.3 cm. This mass was previously measured as 5.1 x 3.7 x 6.5 cm, however is likely unchanged when measured similarly and accounting for differences in technique. No hydronephrosis is present.LEFT KIDNEY: 11.5 cm in length. A 2 cm benign-appearing cyst is noted in the lower pole. No suspicious lesion is seen. No hydronephrosis is present.OTHER: No significant abnormalities noted.", "output": "Right renal angiomyolipoma, without significant interval change. This lesion meets size criteria for interventional radiology consultation and possible embolization."}
{"instruction": "Generate impression based on findings.", "input": "30 year old female patient with palpable left breast mass and prior ultrasound demonstrating a fibroadenoma. A targeted left ultrasound was performed in the area of palpable abnormality at the 2:00 position 3 cm from the nipple. Dense glandular tissue was seen without solid or cystic mass identified.Separate from the palpable lesion in the 2:00 position 1 cm from the nipple a circumscribed oval hypoechoic mass was seen that measures 8 x 4 x 8 mm, compatible with a fibroadenoma. No other solid or cystic mass was identified in the remaining left breast or on ultrasound of the whole right breast.", "output": "1.Dense glandular tissue in the area of palpable abnormality without cyst or mass at this location.2.Findings compatible with a fibroadenoma in the left breast at the 2:00 position 1 cm from the nipple, separate from the site of palpable abnormality.3.No cyst or mass in the right breast.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "BPH RIGHT KIDNEY: Atrophic echogenic parenchyma without mass or stone. Associated with moderate to severe hydronephrosis and proximal hydroureter. Right kidney 11.9 cm in lengthLEFT KIDNEY: No significant abnormalities noted. Left kidney 12.4 cm in length. OTHER: Enlarged prostate. Distended bladder. The patient could not void; accordingly post void images and evaluation of right hydronephrosis post void could not be obtained.", "output": "Atrophic echogenic right renal parenchyma associated with moderate to severe hydronephrosis and proximal hydroureter. Enlarged prostate with a distended bladder. The patient could not void; accordingly post void images and evaluation of right hydronephrosis post void could not be obtained."}
{"instruction": "Generate impression based on findings.", "input": "Reason: rule out thyroid nodules, history of XRT for Hodgkin's lymphoma, ? lymph node on right RIGHT LOBE MEASUREMENTS: 1.7 x 0.9 x 0.9 cm.LEFT LOBE MEASUREMENTS: 1.4 x 0.6 x 0.9 cm.ISTHMUS MEASUREMENTS: 0.1 cm.RIGHT LOBE: 0.7 x 0.5 x 0.6 cm solid hyperechoic right mid pole nodule demonstrates internal vascularity however there are no internal calcifications. No other suspicious nodules or masses. Otherwise atrophic gland.LEFT LOBE: Atrophic left thyroid without suspicious nodules or masses.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Several subcentimeter benign-appearing lymph nodes. Right cervical level 2 lymph node measures 0.7 x 0.8 x 0.3 cm and demonstrates a fatty hilum.OTHER: No significant abnormality noted.", "output": "Solid right thyroid nodule as described above is indeterminate, although echogenic nodules are highly likely benign. However, if biopsy is desired in this high risk patient, the nodule is amenable. "}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis with history of TIPS LIVER: Cirrhotic morphology again noted. No mass. Liver length 12.1 cm. Limited Doppler interrogation of the TIPS demonstrates a patent TIPS. Patent main portal vein with normal directional flow. Main portal vein velocity 48 cm/s. GALLBLADDER, BILIARY TRACT: Cholelithiasis again noted. Moderate bilobar and extrahepatic ductal dilatation again noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.8 cm in lengthOTHER: Left kidney 11.2 cm in length. Spleen 8.8 cm in length. No ascites.", "output": "Technically limited study. Patent main portal vein with normal directional flow. Patent TIPS. Cirrhotic morphology without obvious mass. Moderate bilobar and hepatic ductal dilatation again noted. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "31 year old female with rising liver function tests, evaluate for mass. LIVER: Enlarged measuring 22.1 cm in length. Increased echogenicity consistent with diffuse fatty infiltration. Focal fatty sparing noted adjacent to the gallbladder fossa. No discrete hepatic lesions identified. 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": "Hepatomegaly and increased echogenicity consistent with hepatic steatosis. No discrete liver masses or biliary ductal dilation. "}
{"instruction": "Generate impression based on findings.", "input": "37-year-old female, 13 weeks pregnant presents to the diagnostic clinic to evaluate left breast palpable mass. Family history of breast cancer in 2 maternal aunts. Recent mammogram in February 2015 was within normal limits. A targeted left axillary ultrasound was performed for the patient\u2019s area of pain. Patient indicates area of pain in the left lower axillary region. No discrete mass was palpated on physical examination. There is no solid or cystic mass identified. Normal axillary lymph node is identified in this entity.", "output": "Area of pain in the left lower axillary region corresponds to normal glandular tissue. A Normal axillary lymph node is identified in the vicinity.Patient is due in April 2016. Annual screening mammogram is recommended after April 2016.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old female with weight loss, Nash LIVER: Measures 18.3 in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Cholelithiasis without 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": "1. Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease, without discrete focal lesion. 2. Cholelithiasis. "}
{"instruction": "Generate impression based on findings.", "input": "38-year-old male post thyroidectomy for cancer. Follow-up for recurrent disease. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: There is again noted in the inferior right bed extending to midline a hypoechoic ovoid mass measuring 0.4 x 0.6 x 0.8 cm without significant change. Previously noted second mass more superiorly in the bed is no longer visualized.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 hypoechoic mass in the inferior right bed extending to midline.Second right bed abnormality no longer visualized."}
{"instruction": "Generate impression based on findings.", "input": "70 year-old female. Her quadrant tenderness, liver distention, low platelets. Ultrasound for hepatomegaly, biliary disease, cirrhosis? LIVER: Normal echogenicity and echotexture of the liver. No focal hepatic mass. The liver is 15.9 cm in length. Hepatopetal portal venous flow with undulation of the waveform and dilated hepatic veins, likely related to congestion from right heart failure.GALLBLADDER, BILIARY TRACT: No biliary ductal dilatation. Common duct is 4 mm in diameter, within normal limits. Cholelithiasis without evidence of acute cholecystitis.PANCREAS: Visualized pancreatic head is normal in echogenicity. The rest of the pancreas is obscured by bowel gas.OTHER: Small amount of right upper quadrant ascites.", "output": "1. Cholelithiasis without evidence of acute cholecystitis. No biliary ductal dilatation. Liver length is at the upper limits of normal. Small amount of perihepatic ascites.2. Findings consistent with right heart failure. "}
{"instruction": "Generate impression based on findings.", "input": "66 year old male, evaluation for heart transplant. Baseline exam LIVER: Coarse echogenicity of the liver measuring 17.2 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. Common duct measures 4 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Not well-visualized overlying bowel gas.SPLEEN: Normal echogenicity of the spleen measuring 11.6 cm in length.KIDNEYS: Right kidney measures 11.1 cm in length. Non obstructing nephrolithiasis is noted. Left kidney measures 11.3 cm in length. No hydronephrosis or shadowing calculi are noted.ABDOMINAL AORTA: Atherosclerotic abdominal aorta with measurements as follows: proximal aorta measures 2.8 cm x 2.4 cm, the mid abdominal aorta measures 2.0 cm x 2.3 cm and the distal abdominal aorta measures 1.9 cm x 2.1 cm.INFERIOR VENA CAVA: The visualized IVC is patent with appropriate directional flow.OTHER: Small amount of ascites.Incompletely imaged bilateral pleural effusions.", "output": "1. Hepatomegaly with coarse echotexture suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesions. 2. Non obstructing right nephrolithiasis.3. Small amount of ascites and incompletely imaged bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old female patient with fullness in neck, increased unilateral blood vessel appearance on neck exam. Evaluate for thyromegaly. RIGHT LOBE MEASUREMENTS: 1.8 x 1.3 x 4.5 cm.LEFT LOBE MEASUREMENTS: 1.8 x 1.7 x 4.8 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: The right thyroid lobe is homogeneous in echogenicity without focal thyroid lesion.LEFT LOBE: The left thyroid lobe is homogeneous echogenicity and contains a 0.6 x 0.4 x 0.3 cm ovoid, spongiform nodule within the midpole.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: There is a 0.6 x 0.5 x 0.5 cm hypoechoic nodule inferior to the right thyroid lobe which may represent a parathyroid adenoma.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. No dominant thyroid lesion identified.2. Possible parathyroid adenoma inferior to the right thyroid lobe; correlate with serum calcium levels."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal sufficiency RIGHT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. 13 cm in length.LEFT KIDNEY: Left kidney absent.OTHER: Bladder nondistended", "output": "Echogenic right renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis. Left kidney absent."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Assess for Kidney stones. Patient with Primary HPT. RIGHT KIDNEY: The right kidney measures 9.3 cm in length. 0.6 x 0.4 x 0.5 cm hyperechoic parenchymal stone in the mid right kidney. No evidence of obstruction or hydronephrosis.LEFT KIDNEY: Left kidney measures 9.2 cm in length. No shadowing stones or hydronephrosis. 1.6 x 1.6 x 1.8 cm anechoic cyst.OTHER: The urinary bladder is poorly distended, limiting evaluation.", "output": "Focal right parenchymal calcification without evidence of obstruction or nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old male with abnormal liver function. LIVER: The liver is normal in size but is moderately echogenic, progressive when compared to prior exams. Presumably this is related to fatty infiltration although other causes of parenchymal dysfunction cannot be excluded. No focal hepatic abnormality. Portal vein is patent with appropriate flow direction.BILIARY TRACT: No significant abnormalities noted.PANCREAS: Limited due to bowel gas. No gross abnormality.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Progressively echogenic liver."}
{"instruction": "Generate impression based on findings.", "input": "History of thyroid cancer and ovarian cancer, rule out adenopathy or recurrence. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Status post thyroidectomy. No abnormal soft tissue nodules identified within the thyroidectomy bed.LEFT LOBE: Status post thyroidectomy. No abnormal soft tissue nodules identified within the thyroidectomy bed.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.OTHER: No significant abnormality noted.", "output": "No evidence of local recurrence or suspicious lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine RIGHT KIDNEY: Unremarkable echogenicity without mass, stone, or hydronephrosis. 12 cm in lengthLEFT KIDNEY: Unremarkable echogenicity without mass, stone, or hydronephrosis. 11.9 cm in lengthOTHER: Bladder nondistended", "output": "Negative renal ultrasound without evidence for mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal failure RIGHT KIDNEY: Normal appearing parenchyma without worrisome mass, stone, or hydronephrosis. Benign-appearing cyst. Right kidney 10.7 cm in lengthLEFT KIDNEY: Normal appearing parenchyma without worrisome mass, stone, or hydronephrosis. Benign-appearing cyst. Left kidney 10.7 cm in length.OTHER: Bladder nondistended. Left pleural effusion", "output": "Normal parenchymal echogenicity without worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old female undergoing renal biopsy. Ultrasound guidance was provided for a renal biopsy performed by nephrology service.", "output": "Ultrasound guidance was provided for renal biopsy performed by nephrology service. 3 passes were attempted."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 45 yo with PSC please evaluate gallbladder LIVER: The liver measures 15.9 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 0.19 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, though this was better assessed on prior MRCP. The common bile duct measures 2.2 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 9.6 cm in length. RIGHT KIDNEY: Kidney measures 10.5 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 12.1 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Increased hepatic echogenicity raising the possibility of chronic liver disease. Normal sonographic appearance of the gallbladder. No sonographic evidence of biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Gee is an 18 year old female who reports a right breast lump. No family history of breast cancer. Focused right breast ultrasound showed normal breast tissue in the area of palpable concern in the right breast 4:00 position 3 cm from the nipple. There is no solid or cystic mass identified.", "output": "Normal breast tissue corresponding to the area of palpable concern in the right breast. No sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually starting at age 40. Results and recommendations were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Rich is a 20-year-old female with palpable masses in the left upper outer breast presenting for follow-up ultrasound evaluation. History of right breast fibroadenoma status post excision. Family history of breast cancer in maternal grandmother diagnosed at 62 years of age. On physical examination, two palpable firm mobile masses were identified in the left upper outer breast.A targeted left ultrasound was performed for the palpable area of concern. In the left breast 2:00 position 5 cm on the nipple there are 2 hypoechoic masses as seen on the prior study with measurements provided below:The larger mass is lobular in shape with circumscribed margins measuring 2.1 cm x 1.2 cm x 2.0 cm, previously 2.0 cm x 1.0 cm x 1.6 cm. There is internal flow on Doppler imaging.The smaller mass is lobular in shape with circumscribed margins measuring 0.9 cm x 0.5 cm x 1.0 cm, previously 0.9 cm x 0.5 cm x 1.0 cm. There is internal flow Doppler imaging.", "output": "Stable to minimal increase in size of two presumed fibroadenomas of the left breast. Recommend follow-up with breast surgery as clinically warranted. All results and recommendations were discussed with the patient. BIRADS: 3 - Probably benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Papillary thyroid carcinoma status post resection with palpable lymph nodes 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: Stable benign-appearing cervical lymph nodes bilaterally. 0.6 x 0.4 x 1.2 cm hypoechoic lymph node within the subcutaneous tissues left level 5 periarticular region corresponding to the palpable lesion.OTHER: No significant abnormality noted.", "output": "Hypoechoic normal sized lymph node within the subcutaneous tissues left level 5 periarticular region corresponding to the clinically palpable focus. Its appearance favors a benign reactive etiology over metastatic focus. Would recommend special attention to this lymph node on future surveillance scans. Otherwise stable examination without evidence for metastatic focus. Benign-appearing regional lymph nodes again noted and unchanged."}
{"instruction": "Generate impression based on findings.", "input": "No retroperitoneal neuroendocrine tumor with chronic renal disease RIGHT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 10.2 cm in lengthLEFT KIDNEY: Mildly echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Stable left renal cyst. Left kidney 8.7 cm in lengthOTHER: Bladder nondistended. Retroperitoneal mixed cystic and solid mass again noted", "output": "Mildly echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis. Retroperitoneal mixed cystic and solid mass again noted."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old female presents for short-term follow-up of right breast fibroadenoma. A targeted right ultrasound was performed for the patient\u2019s area of concern. At the 11 o'clock position of the right breast, 9 cm from the nipple, there is redemonstration of an oval, circumscribed, parallel oriented hypoechoic mass measuring 1.7 x 0.9 x 1.8 cm (previously 1.6 x 0.7 x 1.8 cm). Given differences in technique, this is unchanged from prior examination.", "output": "Stable benign morphology mass at 11 o'clock position of the right breast, compatible with benign fibroadenoma. The lungs the patient's physical examination remains normal, bilateral diagnostic mammogram and right unilateral ultrasound is recommended in 6 months to confirm stability of the fibroadenoma. Result 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": "History of microhematuria. RIGHT KIDNEY: The right kidney is normal in size measuring 11.5 cm in length. No hydronephrosis. Normal echogenicity. No shadowing nephrolithiasis. No suspicious lesion.LEFT KIDNEY: The left kidney is normal in size measuring 11.3 cm in length without hydronephrosis, shadowing nephrolithiasis or suspicious lesion. Normal echogenicity.URINARY BLADDER: Normally distended urinary bladder. Bilateral ureteral jets are visualized.OTHER: No significant abnormalities noted.", "output": "No hydronephrosis, shadowing nephrolithiasis or suspicious lesion."}
{"instruction": "Generate impression based on findings.", "input": "Male 65 years old Reason: baseline exam as part of heart transplant evaluation LIVER:Liver measures 15.7 cm. Mildly echogenic liver appearance which is nonspecific. No focal mass. Main portal vein is patent with normal directional flow and velocity 15 cm/s.GALLBLADDER, BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. The 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 difficult to visualize but likely measures 6.2 cm.KIDNEYS: Right kidney measures 9.0 cm. Left kidney measures 11.1 cm. Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. ABDOMINAL AORTA: Proximal aorta is obscured by overlying bowel gas. The mid aorta measures 1.8 cm in diameter. The distal aorta is also obscured by overlying bowel gas.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Bladder is nondistended.", "output": "Appearance of the abdominal viscera is within normal limits."}
{"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": "Enlarged thyroid RIGHT LOBE MEASUREMENTS: 6.5 x 2.5 x 2.6 cmLEFT LOBE MEASUREMENTS: 6.6 x 2.5 x 2.5 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: 0.5 x 0.8 x 0.6 cm spongiform nodule lower poleLEFT LOBE: 0.5 x 0.3 x 0.5 cm spongiform nodule lower poleISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral subcentimeter benign-appearing spongiform nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female with spinal cord compression/neurogenic bladder and AKI. RIGHT KIDNEY: Increased echogenicity, consistent with prior examination.LEFT KIDNEY: Increased echogenicity, consistent with prior examination.OTHER: Foley catheter in place.", "output": "Increased renal echogenicity consistent with medical renal disease. Foley catheter in place."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old female with right renal biopsy earlier in the day, now with dizziness and hematuria. RIGHT KIDNEY: The right kidney measures 8.1 cm in length. Cortex is echogenic. No hydronephrosis, shadowing calculus or mass. There is a trace of perinephric fluid. No significant hematoma identified.LEFT KIDNEY: The left kidney measures 10.4 cm in length and the cortex is mildly echogenic. No hydronephrosis, shadowing calculus or mass.OTHER: Urinary bladder appears unremarkable without significant internal debris. No free fluid.", "output": "Trace perirenal fluid on the right. No significant hematoma identified.Mildly echogenic kidneys with asymmetric size."}
{"instruction": "Generate impression based on findings.", "input": "55 year-old female with Hashimoto's, left lobe slightly more prominent. RIGHT LOBE MEASUREMENTS: 3.7 cm x 1.2 cm x 1.2 cm.LEFT LOBE MEASUREMENTS: 3.7 cm x 1.3 cm x 0.7 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: Minimally heterogeneous echotexture with no discrete nodule identified.LEFT LOBE: Minimally heterogeneous echotexture with no discrete nodule identified.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.", "output": "Unremarkable examination. "}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female with multiple known gallstones, now with persistent right upper quadrant pain for past week. Evaluate for cholecystitis LIVER: Multiple hepatic hypoechoic lesions are identified. The largest of these measures 1.8 x 1.9 x 2.1 cm with posterior acoustic enhancement and no internal vascularity. Additional hypoechoic hepatic lesions with questionable peripheral vascularity. Main portal vein is patent with peak systolic velocity of 0.3 m/s. GALLBLADDER, BILIARY TRACT: Cholelithiasis with gallbladder wall measuring 0.3 cm without evidence of pericholecystic fluid. Common hepatic duct measures 0.5 cm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The kidneys are normal in echotexture with the right kidney measuring 11.1 cm and left kidney measuring 11.4 cm in length.OTHER: No significant abnormalities noted.", "output": "1.Cholelithiasis without specific findings to suggest cholecystitis.2.Multiple indeterminate hepatic hypoechoic lesions. Further evaluation with dedicated liver protocol CT or MR examination is recommended."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old female with history of acute cholecystitis treated with antibiotics, now with recurrent abdominal pain. LIVER: No significant abnormalities noted. Limited spectral and color Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder contains multiple dependent and shadowing calculi as well as a non--- mobile calculus in the region of the neck. There is layered sludge within the gallbladder. Gallbladder wall thickness is increased. There is no discrete pericholecystic fluid. The biliary tract appears normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Findings consistent with acute cholecystitis given history."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis; HCC screen LIVER: Stable cirrhotic morphology without mass. Liver length 13.1 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: Gallbladder absent. No ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: 15 cm in lengthRIGHT KIDNEY: AbsentOTHER: Left kidney 12.2 cm in length. Left renal cyst. No ascites.", "output": "Stable cirrhotic morphology without mass or ductal dilatation. No ascites. Mild splenomegaly again noted."}
{"instruction": "Generate impression based on findings.", "input": "Male 84 years old Reason: Liver pathology History: new transaminitis, history of non-hodgkin's lymphoma, rheumatoid arthritis LIVER: Coarse echotexture of the liver. No focal liver lesions. Liver measures 17.7 cm, slightly increased in size.GALLBLADDER, BILIARY TRACT: No evidence of cholelithiasis. No evidence of intra or extrahepatic biliary dilatation.PANCREAS: The visualized pancreatic head and body are unremarkable.RIGHT KIDNEY: Right kidney measures 12.2 cm. Left kidney measures 11.5 cm. No evidence of hydronephrosis or focal lesions.OTHER: No significant abnormalities noted.", "output": "Coarse echotexture of the liver. Mild hepatomegaly."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old male with right scrotal mass. RIGHT TESTIS: Normal in size, contour and echogenicity. Normal vascularity by color and spectral DopplerLEFT TESTIS: Left testicle is smaller than the right, and slightly hypoechoic and heterogeneous. There is a 2 mm focus of increased echogenicity in the left testicle without definite shadowing to suggest calcification. This could also represent an area of focal fibrosis. There is no associated mass identified.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: 5 mm cyst.OTHER: Superior to the right testicle in the region of palpable abnormality as described by the patientThere is a 1.5 cm ovoid, simple cyst consistent with spermatic cord cyst. Also is a small supratesticular varicocele.", "output": "Small and mildly hypoechoic left testicle. Patient provides history of nondistended testis. Focal internal echogenicity without appreciable mass effect could be related to calcification or scar.Cyst of the right spermatic cord with small varicocele."}
{"instruction": "Generate impression based on findings.", "input": "45 years old, Male, Reason: elevated liver enzymes LIVER: The liver is mildly enlarged measuring 17.5 cm in length. Increased echogenicity of the hepatic parenchyma is consistent with fatty infiltration. Questionable minimal contour irregularity raises the possibility of early cirrhosis. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.1 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 11.5 cm in length. RIGHT KIDNEY: Kidney measures 12.5 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 12.1 cm in length. Normal echotexture. No evidence of hydronephrosis. Nonobstructing nephrolithiasis with a stone measuring up to .7 cm.OTHER: No significant abnormalities noted.", "output": "1.Questionable minimal contour irregularity raises the possibility of early cirrhosis.2.Diffusely increased echogenicity of the liver is consistent with fatty infiltration.3.Nonobstructing left nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Hyperparathyroidism RIGHT LOBE MEASUREMENTS: 5.1 x 1.7 x 1.7 cmLEFT LOBE MEASUREMENTS: 5.4 x 1.2 x 1.6 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: No significant change in multiple subcentimeter predominantly cystic nodules. The largest nodule is within the superior pole measuring 0.8 x 0.5 x 0.6 cm.LEFT LOBE: Relatively stable upper pole isoechoic nodule measuring 1 x 0.9 x 1 cm.ISTHMUS: Stable subcentimeter hypoechoic nodules.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable bilateral thyroid nodules. No convincing extrathyroidal focus identifiable as a parathyroid lesion."}
{"instruction": "Generate impression based on findings.", "input": "Renal stones RIGHT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 9.8 cm in lengthLEFT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 9.7 cm in lengthOTHER: Bladder nondistended", "output": "Negative renal ultrasound. No evidence for mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female patient with epigastric pain, lipase greater than 3000. 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 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 demonstrates decreased echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 11.9 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 12.1 cm in length. No evidence of hydronephrosis.The spleen measures 8.2 cm in length.", "output": "1. Hypoechoic pancreas which can be seen with inflammation/pancreatitis. 2. No evidence of cholelithiasis."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with uptrending AST/ALT. Evaluate for hepatic abnormalities. LIVER: Coarse echogenicity of the liver measuring 25.6 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: Sludge within the gallbladder. Small amount of pericholecystic fluid. No gallbladder wall thickening. Sonographic Murphy's sign is negative. Common duct measures 2 mm in thickness. No intra-or extra hepatic biliary ductal dilatation.PANCREAS: Distal body and tail of the pancreas is obscured by overlying bowel gas. The visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: Measures 12.0 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Spleen measures 10.6 cm in length and is normal in echogenicity.Left kidney is not well assessed measuring 10.9 cm in length. No definite hydronephrosis or shadowing calculi are noted.", "output": "1. Sludge within the gallbladder with small amount of pericholecystic fluid however no definite evidence of cholecystitis.2. Hepatomegaly with coarse echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old female with history of pancreatitis, gallstones. Concern for ductal obstruction. Limited examination due to patient body habitus and presence of bowel gas.LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: Cholelithiasis with gallbladder wall measuring upper limits of normal. No pericholecystic fluid or sonographic Murphy sign. No biliary ductal dilation or evidence of choledocholithiasis.PANCREAS: The majority of the pancreas is not clearly visualized due to bowel gas.RIGHT KIDNEY: Increased renal echogenicity. Small left renal calculi and mild prominence of the left collecting system.OTHER: No significant abnormalities noted.", "output": "1.Cholelithiasis without specific evidence of acute cholecystitis.2.Increased hepatic echogenicity consistent with diffuse parenchymal disease or hepatic steatosis.3.Limited evaluation of the pancreas secondary to patient's bowel gas. Please see recent prior CT from 8/23/2015.4.Increased renal echogenicity consistent with medical renal disease. Nephrolithiasis and mild prominence of the left renal collecting system, but no frank hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Female 32 years old; Reason: 32 y/o 7 weeks pregant with right breast Ca, need ultrasound of thyroid for further eval History: 32 y/o 7 weeks pregnant with right breast Ca, need ultrasound of thyroid for further eval RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.6 x 2.0 x 1.7 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.7 x 2.6 x 1.8 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.13 cm.RIGHT LOBE: There are 2 nodules in the right lobe of the thyroid.Nodule #1: There is a round hypoechoic nodule without microcalcifications or internal vascularity in the mid right thyroid that measures approximately 0.6cm in diameter.Nodule #2: There is a mixed solid and cystic but predominately cystic appearing hypoechoic round lesion measuring approximately 9mm in diameter.LEFT LOBE: There is one nodule in the left thyroid.Nodule #1: There is a heterogenous nodule with scattered cystic spaces, no significant internal vascularity or definite microcalcifications measuring approximately 1.7 cm x 1.5 cm.ISTHMUS: There is one nodule in the isthmus of the thyroid.Nodule #1: There is echogenic lesion with peripheral vascularity and no definite microcalcifications measuring approximately 8mm in diameterLYMPH NODES: No suspicious adenopathy noted. OTHER: The thyroid has a diffusely heterogeneous echotexture.", "output": "1.Multinodular thyroid as above. Background heterogenicity could be due to thyroiditis. Please correlate with laboratory values. "}
{"instruction": "Generate impression based on findings.", "input": "Male 58 years old Reason: Evaluate for patency of previous TIPS procedure History: GI bleeding, bright red blood per rectum LIVER: Cirrhotic liver morphology. Unchanged simple appearing cyst measuring 1 x 0.9 x 0.8 cm. TIPS stent is patent. Main portal vein is patent with peak velocity of 52 cm/s. It is somewhat tortuous near the area of the TIPS. Hepatic arteries patent with normal flow. Intrahepatic portal vein is not well-visualized. Right portal vein is not well-visualized. The left portal vein has normal flow.BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. Common bile duct measures 4 mm.PANCREAS: Pancreas is not well seen.SPLEEN: Spleen is enlarged measuring 18.5 cm. Splenic vein is patent with a peak velocity of 24.6 cm/s.KIDNEYS: Right kidney is not well visualized. There is a right superior pole renal cyst measuring 6 x 5.3 x 6.6 cm. Right kidney measures 11.6 cm in length. Left kidney demonstrates normal cortical echogenicity. No hydronephrosis or shadowing calculus bilaterally. Left renal cyst measures 3 x 2.8 x 2.6 cm.OTHER: Trace perihepatic ascites", "output": "1.Patent TIPS stent and a patent main portal vein. 2.Cirrhotic morphology of the liver and trace perihepatic ascites.3.Splenomegaly"}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with fever, abdominal pain. Evaluate for up quadrant from gallbladder pathology. Limited exam as patient unable to lie in the decubitus position or check for Murphy's sign. Midline bandage partially obscures the left liver and pancreas.LIVER: Increased echogenicity of the liver measuring 21.4 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: Multiple shadowing stones within the gallbladder. Trace pericholecystic fluid. Gallbladder wall measures up to 3 mm in thickness. Unable to check for sonographic Murphy sign. Common bile duct measures 3 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Normal echogenicity of the visualized pancreas.RIGHT KIDNEY: Increased echogenicity of the right kidney measuring 11.0 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the spleen measuring 14.4 cm in length.Left kidney measures 12.0 cm in length and is increased in echogenicity. No hydronephrosis or shadowing calculi are noted.", "output": "1. Cholelithiasis with trace pericholecystic fluid. Findings may represent early cholecystitis.2. Hepatomegaly with increased echogenicity of the liver compatible with fatty infiltration.3. Increased echogenicity of the kidneys suggestive of parenchymal dysfunction. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "History oncocytoma and right renal lesion RIGHT KIDNEY: 3.1 x 2.3 x 3.3 cm solid mass arising from the lower pole the right kidney again noted and relatively unchanged from the recent CT. No stone or hydronephrosis. Right kidney 10.1 cm in lengthLEFT KIDNEY: 7.5 x 7.5 x 7.2 cm solid mass arising from the upper pole the left kidney again noted unchanged from the recent CT. No hydronephrosis. No stone. Left kidney 12.2 cm in length.OTHER: Bladder nondistended", "output": "No change in bilateral solid renal masses. No hydronephrosis or stone."}
{"instruction": "Generate impression based on findings.", "input": "Male; 33 years old. Reason: eval for obstruction, reason for AKI History: AKI RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: Continued decrease in size of the complex fluid collection along the posterior portion of the transplanted kidney. This currently measures 1.8 x 1.9 x 0.8 cm (previously 2.3 x 1.4 x 1.3 cm).KIDNEY: The transplanted kidney measures 12.7 cm in length. The cortex is echogenic. There is no shadowing renal stone.COLLECTING SYSTEM/URETER: Persistent mild dilatation of the transplant collecting system appearing similar to the prior study.URINARY BLADDER: The bladder wall appears thickened however the bladder is not fully distended.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels.The iliac artery and anastomoses are patent. The renal arteries are patent with velocities of 0.4-0.9 m/sec (resistive indices 0.63-0.80). The segmental arteries are patent with velocities of 0.3-0.5 m/sec (resistive indices 0.61-0.66).The arcuate arteries are patent with velocities of 0.2-0.4 m/sec (resistive index 0.62-0.68).The iliac vein and renal vein are patent. OTHER: No significant abnormality noted", "output": "1.Mild hydronephrosis not significantly changed compared to the prior ultrasound.2.Patent transplant renal vasculature.3.Continued decrease in size of perinephric hematoma."}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine Ultrasound guidance was provided for biopsy of a transplant kidney in the right iliac fossa by the nephrology service.", "output": "Ultrasound guidance provided for transplant renal biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Nodular goiter RIGHT LOBE MEASUREMENTS: 7.1 x 4.4 x 9.3 cm. Large in size with heterogeneous background echotexture. Unremarkable vascularity.LEFT LOBE MEASUREMENTS: 4.7 x 3.8 x 8.8 cm. Large in size with heterogeneous background echotexture. Unremarkable vascularity.RIGHT LOBE: Diffusely heterogeneous background gland, without discrete measurable nodules.LEFT LOBE: Diffusely heterogeneous background gland, with a spongiform 4.0 cm nodule again seen.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "Heterogeneous goiter with benign-appearing nodules."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodule seen on CT scan. RIGHT LOBE MEASUREMENTS: 5.1 x 2.0 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.3 x 1.4 x 1.4 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: The parenchyma is normal in echogenicity. In the inferior pole there is a 2.1 x 1.6 x 1.9 cm well-defined isoechoic solid nodule.LEFT LOBE: The parenchyma is normal in echogenicity. In the mid region there is a 9 x 8 x 8 predominately cystic nodule. More superiorly there is a 8 x 5 x 7 mm predominantly solid isoechoic nodule with small cystic components with possible comet tail artifact suggesting a colloid nodule.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 nodules with the largest being a solid 2.1 cm on the right. No specific suspicious sonographic features, however it is amenable to FNA sampling as clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old female with Papillary thyroid cancer. Assess lateral lymph nodes. RIGHT LOBE MEASUREMENTS: 5.5 cm x 1.6 cm x 2.2 cmLEFT LOBE MEASUREMENTS: 4.8 cm x 1.7 cm x 1.5 cmISTHMUS MEASUREMENTS: 7 mm in thicknessRIGHT LOBE: No discrete nodules identifiedLEFT LOBE: No discrete nodules identifiedISTHMUS: Conglomerate mass along the Isthmus is noted measuring 1.2 cm x 2.4 cm with lobular margins and internal echogenic foci likely microcalcifications as well as internal vascularity on Doppler exam.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small bilateral benign appearing lymph nodes in the neck.OTHER: No significant abnormality noted.", "output": "Dominant Isthmus mass as described above. No sonographic evidence of nodal metastases."}
{"instruction": "Generate impression based on findings.", "input": "Patient with ischemic cardiomyopathy and acute kidney injury. Evaluate for obstruction. RIGHT KIDNEY: Right kidney measures 12.1 cm in length. A 3.7 cm septated cyst is redemonstrated and unchanged compared to prior. There is no evidence of hydronephrosis. Kidneys mildly echogenic.LEFT KIDNEY: Left kidney measures 11.2 cm in length. No hydronephrosis. Left kidney is mildly echogenic.URINARY BLADDER: Poorly distended and difficult to evaluateOTHER: No significant abnormalities noted.", "output": "No hydronephrosis of either kidney. Stable septated cyst in the right kidney. Medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "History of cirrhosis. Evaluate for HCC. LIVER: The liver is shrunken and nodular compatible with cirrhosis. The parenchyma is coarse and moderately echogenic. No focal lesion is evident. It measures 13.7 cm in craniocaudal dimension.Normal hepatopedal portal venous blood flow at 0.2 m/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation with the common duct measuring 5 mm. PANCREAS: Limited evaluation of the pancreatic head/body is unremarkable.SPLEEN: The spleen measures 9.8 cm in length.RIGHT KIDNEY: The right kidney measures 8.1 cm in length without hydronephrosis or shadowing nephrolithiasis. It is mildly echogenic with cortical thinning.OTHER: The left kidney measures 8.3 cm in length without hydronephrosis or nephrolithiasis. It is mildly echogenic with cortical thinning.Moderate volume ascites.", "output": "Cirrhotic morphology without a suspicious focal lesion. Moderate volume ascites."}
{"instruction": "Generate impression based on findings.", "input": "58 year-old female with ascites and elevated lipase, evaluate for cholelithiasis or infection. LIVER: The liver measures 15.5 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 0.3 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 2 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 10.4 cm in length. RIGHT KIDNEY: Kidney measures 12.8 cm in length. Normal echotexture. Mild hydronephrosis. LEFT KIDNEY: Kidney measures 13.1 cm in length. Normal echotexture. Mild hydronephrosis. OTHER: Ascites.", "output": "1.No evidence of cholelithiasis or cholecystitis.2.Abdominal ascites and bilateral pleural effusions. 3.Mild righter greater than left hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female patient with elevated liver enzymes. LIVER: The liver measures 19.9 cm in length and demonstrates increased parenchymal echogenicity with focal hypoechogenicity near the gallbladder. 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 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 10.9 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.2 cm in length. No evidence of hydronephrosis.The spleen measures 7.8 cm in length.", "output": "1. Increased hepatic echogenicity consistent with hepatic steatosis with focal areas of sparing.2. Cholelithiasis without sonographic evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old male with acute on chronic pancreatitis and abdominal pain. Evaluate for gallstones. LIVER: Mildly echogenic without focal abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder contains deep tendon sludge, but no shadowing gallstones or wall thickening. There is no pericholecystic fluid.PANCREAS: Pancreatic substance is poorly visualized. Multiple large complex cystic masses are identified in the abdomen consistent with pseudocystsRIGHT KIDNEY: No significant abnormalities noted.OTHER: Trace ascites", "output": "Gallbladder sludge without stones.Pseudocysts.Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for pathology, renal disease, advanced heart failure workup LIVER:Liver measures 16.9 cm with mildly increased echotexture. No intrahepatic biliary ductal dilatation. No focal lesion noted. Portal vein demonstrates normal flow directionality and patency.GALLBLADDER, BILIARY TRACT: Mildly distended gallbladder with shadowing gallstones within it consistent with cholelithiasis. Gallbladder wall thickness is within normal limits. Trace ascites noted.PANCREAS: Not well visualized due to overlying bowel gasSPLEEN: Spleen measures 7.6 cm appears unremarkable.KIDNEYS: Right kidney is not visualized. Please correlate with history of nephrectomy or agenesis?Left kidney measures 11.5 cm with normal echo texture. Prominence of the left renal pelvis resolved on postvoid sonography.ABDOMINAL AORTA: Abdominal aorta appears unremarkable. No evidence of aneurysmal dilatation or atherosclerotic changes. Proximal aorta measures 2.5 x 2.4 cm, mid aorta measures 1.8 x 1.5 cm and distal aorta measures 1.5 x 1.5 cm.INFERIOR VENA CAVA: PatentOTHER: No significant abnormality noted.", "output": "No findings suggestive of acute cholecystitis.Trace ascites in the abdomenRight kidney could not be visualized in the abdomen, correlate with history of nephrectomy or concerned for agenesis."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old male with acute kidney failure. Evaluate for hydronephrosis. Abnormal liver function. LIVER:There is hepatomegaly with the liver measuring at least 20 cm in length. The hepatic parenchyma is echogenic which is nonspecific. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: The head is normal. The body and tail are less well seen due to bowel gas.SPLEEN: Splenomegaly with the spleen measuring at least 15 cm in length.KIDNEYS: Right kidney measures 15.7 cm in length and is likely mildly echogenic consistent with parenchymal disease. No hydronephrosis, shadowing calculus or mass. Left kidney measures approximately 15.2 cm in length and is likely mildly echogenic consistent with parenchymal disease. No hydronephrosis, shadowing calculus or mass.ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No ascites.", "output": "Hepatosplenomegaly with echogenic liver.No evidence for hydronephrosis. Kidneys may be mildly echogenic."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Mukhopadhyay is a 24 year old female presenting with a palpable abnormality in the left breast for the past 6 months. She denies any tenderness or history of trauma. Upon physical exam at the patient's area of concern, no discrete mass is appreciated.A targeted left breast ultrasound was performed for the palpable area of concern. Dense fibroglandular tissue is identified at the area of concern along with a 6 mm cyst. No suspicious cystic or solid masses are identified.", "output": "Dense fibroglandular tissue without sonographic evidence for malignancy. Patient should follow-up with her primary care physician as clinically warranted. All results and recommendations were relayed to the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis with nausea and vomiting LIMITED ABDOMENLIVER: Cirrhotic morphology without mass. Liver length 17.5 cmBILIARY TRACT: Gallbladder absent. No ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: 14.4 cm in length. RIGHT KIDNEY: No significant abnormalities noted. 10.2 cm in length.OTHER: Left kidney 11.7 cm in length. No ascites", "output": "Cirrhotic liver without mass or ductal dilatation. Patent hepatic vessels with normal directional flow. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B LIVER: Coarse echogenic liver echotexture without mass. Liver length 16.8 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.7 cm in lengthOTHER: Left kidney 11.6 cm in length. Spleen 11.4 cm in length. No ascites.", "output": "Coarse echogenic liver suggestive for parenchymal dysfunction/fatty infiltration without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Male 65 years old with left inguinal area mass Well-circumscribed heterogeneously echogenic nodule measuring 5.6 x 4.9 x 2.0 cm. No abnormal vascularity.", "output": "Correlating the ultrasound findings with CT, this most likely represents a lipoma."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old male with thyroid nodule on MR exam. RIGHT LOBE MEASUREMENTS: 4.9 x 1.8 x 2.3 cmLEFT LOBE MEASUREMENTS: 4.2 by 2 x 1.9 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Homogeneous in echotexture. LEFT LOBE: Homogeneous in echotexture. In the mid portion of the left lobe there is a rounded, solid nodule measuring approximately 1 x 1 x 1 cm which is uniform and slightly hypoechoic compared to thyroid tissue.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Solitary 1 cm solid left thyroid nodule the appearance is nondescript by ultrasound and in this age range could be followed."}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine RIGHT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Lower pole cyst. Right kidney 9.8 cm in lengthLEFT KIDNEY: Echogenic parenchyma without worrisome mass or hydronephrosis. Possible subcentimeter nonobstructing renal stone. Left kidney 9.9 cm in lengthOTHER: Bladder nondistended", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass or obstruction. Possible nonobstructing left subcentimeter renal stone"}
{"instruction": "Generate impression based on findings.", "input": "Reduced urine output acute renal insufficiency RIGHT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. 11.7 cm in length.LEFT KIDNEY: Echogenic renal parenchyma without worrisome mass, stone, or hydronephrosis. Left hepatic cyst. 10.4 cm in length.OTHER: Bladder nondistended.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "49 year-old asymptomatic female presents for whole breast ultrasound for dense breast screening. Patient has history of right breast invasive ductal carcinoma and DCIS status post mastectomy with reconstruction and implant in August 2013. 3-D whole breast ultrasound was performed for the left breast 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 in the left breast.BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Male 77 years old; Reason: history of thyroid nodule, please evaluate for interval change History: left thyroid nodule Multiple nodules identified within the right and left lobes of the thyroid as noted previously without substantial change.RIGHT LOBE MEASUREMENTS: 5.3 x 2.5 x 2.3 cm, not substantially changedLEFT LOBE MEASUREMENTS: 4.6 x 2.2 x 2.1 cm, not substantially changedISTHMUS MEASUREMENT: 0.4 cm, not substantially changedRIGHT LOBE:The largest nodule on the right measures 0.6 x 0.6 x 0 .3 cm, stable in size, with the cystic component, as noted previously. This nodule is located within the superior pole and contains central calcifications. Small nodule also noted posterior to the right lobe of the thyroid which could represent a parathyroid gland.LEFT LOBE: The largest nodule on the left is predominantly solid. It is centrally iso/hyperechoic and peripherally hypoechoic and measures 1.2 x 1.2 x 1.0 cm, slightly smaller (this nodule was previously sampled). This is located within the inferior pole.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Atherosclerosis of the carotid arteries noted.", "output": "Multiple nodules are redemonstrated throughout the thyroid gland, not substantially changed compared to prior. "}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter. RIGHT LOBE MEASUREMENTS: 4.8 x 2.1 x 2.5 cm, similar to prior. Normal background vascularity.LEFT LOBE MEASUREMENTS: 4.2 x 2.4 x 2.1 cm, similar to prior. Normal background vascularity.ISTHMUS MEASUREMENTS: 3 mm in AP dimension.RIGHT LOBE: Multiple predominantly solid nodules with minimal cystic elements are again noted. The largest of these measures 1.8 x 1.7 x 1.4 cm in the superior pole and is unchanged accounting for differences in measurement technique. Unchanged vascularity. No new suspicious features.LEFT LOBE: Mildly heterogeneous lobulated solid nodule is again noted, measuring 2.6 x 2.4 x 2.0 cm and is unchanged accounting for differences in measurement technique. Unchanged vascularity. No new suspicious features.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "Multinodular goiter, without significant interval change."}
{"instruction": "Generate impression based on findings.", "input": "Call back from screening mammogram for multiple focal asymmetric density in the right breast. DIAGNOSTIC MAMMOGRAM OF THE RIGHT BREAST: Three standard views with spot compression of right breast 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.The previously described 3 focal asymmetries seen in the upper outer right breast persist on the spot compression. In addition, another small asymmetry in the right middle breast is also confirmed on the CC view with spot compression. Incidental note is made of the low-lying right axillary lymph node.TARGETED ULTRASOUND OF THE RIGHT BREAST:On physical examination, no mass is appreciated in the upper-outer right breast and medial right breast. At the 9:00 location of the right breast, approximately 5 cm from the nipple, 2 adjacent oval, well-circumscribed hypoechoic masses are identified measuring up to 4 mm in maximum diameter. These two masses demonstrate fatty hila and central vascular flow, most compatible with intramammary lymph nodes and corresponding to the 2 adjacent well defined masses in the mid right breast upper outer quadrant on the diagnostic mammogram.There is no sonographic finding to correlate mammographic area of concern in the upper outer right breast, slightly posterior to the above intramammary lymph nodes.At 4:00 location of right breast, approximately 3 cm from the nipple, a 5 x 2 x 5 mm well-circumscribed hypoechoic mass is noted, which is parallel to the skin, most compatible with a small fibroadenoma.Incidental note is made of the 7 x 8 mm right axillary lymph node, corresponding to the mammographically incidental finding.", "output": "A small focal asymmetry in the upper outer posterior right breast without sonographic correlate or abnormal finding on physical exam, probably a benign process. Other benign findings as described above. As long as the patient's physical examination remains unremarkable, right unilateral diagnostic mammogram is recommended in 6 months. 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": "46-year-old male with cirrhosis and on autoimmune hepatitis. Evaluate for hepatocellular carcinoma. LIVER: Mildly and coarsely echogenic without focal abnormality. Overall size within normal limits. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Biliary tract is normal in caliber. Gallbladder appears unremarkable.PANCREAS: Head and body are normal. The tail was not well seen.SPLEEN: Upper normal in size.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Stable examination without hepatic mass."}
{"instruction": "Generate impression based on findings.", "input": "19-year-old female patient with history of right lumpectomy for fibroadenoma. Patient complains of new/increasing right breast mass immediately inferior to the nipple. A targeted right ultrasound was performed for the palpable area of concern. Physical examination demonstrated a small palpable lump in the inferior right breast just below the nipple. Targeted ultrasound of this area at the 6:00 position 1 cm from the nipple showed a 1.7 x 1.1 x 1.4 cm (previously 1.8 x 0.9 x 1.3) parallel circumscribed oval hypoechoic mass with internal vascularity.", "output": "No significant interval change in inferior right breast benign morphology mass, likely representing a fibroadenoma. Recommend continued surgical consultation follow-up.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate right renal mass History: 25lb weight loss, stage IV Chronic renal disease, renal mass seen on non contrast CT RIGHT KIDNEY: Exophytic predominantly anechoic mass arising from the right kidney measuring 4.2 cm x 4.2 cm x 3.6 cm with internal septation and questionable solitary mural nodule seen dorsal to the area of septation on a few of the images. Increased echogenicity of the renal parenchyma suggestive of medical renal disease. No hydronephrosis.LEFT KIDNEY: Increased echogenicity of the renal parenchyma suggestive of medical renal disease. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Exophytic predominantly cystic mass with internal septation and questionable mural nodule. Continued follow-up in 4 months is recommended to ensure no increase in size of the mural nodule."}
{"instruction": "Generate impression based on findings.", "input": "48 year old female with history of right upper quadrant pain. Evaluate for gallbladder pathology. LIVER: Hepatic steatosis, without focal abnormality.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Hepatic steatosis, without additional abnormality."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old female patient with pain, tingling on right side. RIGHT LOBE MEASUREMENTS: 4.6 x 1.4 x 1.7 cm.LEFT LOBE MEASUREMENTS: 4.8 x 1.5 x 1.7 cm.ISTHMUS MEASUREMENTS: 4 mm in thickness.RIGHT LOBE: The right thyroid lobe is homogeneous in echogenicity without dominant thyroid lesion.LEFT LOBE: The left thyroid lobe is homogeneous in echogenicity. There is a subcentimeter cystic nodule containing colloid.ISTHMUS: The isthmus is homogeneous in echogenicity. There is a subcentimeter echogenic nodule within the inferior aspect of the right isthmus. PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. No specific findings to account for the patient's symptoms.2. No dominant thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "Female; 47 years old. Reason: r/o adenopathy, recurrence History: h/o thyroid cancer, 1 year follow up study RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: No residual thyroid tissue. No suspicious lesion.LEFT LOBE: No residual thyroid tissue. No suspicious lesion.ISTHMUS: No residual thyroid tissue. No suspicious lesion.LYMPH NODES: Two prominent level 4 lymph nodes on the left are seen. The largest measures 1.2 x 0.6 x 0.5 cm and has a fatty hilum. A left level 6 lymph node near the clavicle measures 0.7 x 0.3 x 1.1 cm and has a fatty hilum.", "output": "1.No evidence of recurrence in the thyroid bed. 2.A few prominent bilateral lymph nodes have a normal appearing fatty hila and are likely benign reactive nodes."}
{"instruction": "Generate impression based on findings.", "input": "66 year old female with history of altered mental status and possible biliary obstruction. Evaluate for portal thrombosis in the setting of hyperkalemia. LIVER: The liver measures 17.3 cm, and has no biliary dilatation. Small amount of abdominal ascites. Portal vein is patent, with velocity measured at 14 cm/sec.BILIARY TRACT: Cholelithiasis, without evidence of cholecystitis. No biliary dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Hyperechoic renal parenchyma, which may be seen in medical renal disease. No hydronephrosis or hydroureter. Small right renal cyst, measuring approximately 2.4 cm.OTHER: Pleural effusions and abdominal ascites.", "output": "1.Ascites and pleural effusions as above.2.Cholelithiasis, without findings of cholecystitis.3.No biliary dilatation or portal vein thrombosis."}
{"instruction": "Generate impression based on findings.", "input": "History of renal stones. RIGHT KIDNEY: 10.2 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. Two subcentimeter renal stones are identified. No hydronephrosis.LEFT KIDNEY: 11.3 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. Two subcentimeter renal stones are identified. No hydronephrosis.BLADDER: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral subcentimeter non-obstructing renal stones. "}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with creatinine elevation. Assess for obstruction/hydronephrosis. RIGHT KIDNEY: The right kidney is atrophic measuring 5 cm in length, and marked parenchymal atrophy is evident. No hydronephrosis.LEFT KIDNEY: The left kidney measures 13.5 cm in length. Normal echogenicity. No hydronephrosis.URINARY BLADDER: The urinary bladder is partially distended and shows no acute abnormality.OTHER: No significant abnormalities noted.", "output": "1. No hydronephrosis.2. Atrophic right kidney with compensatory hypertrophy of the left kidney. Left kidney shows normal echogenicity of the renal parenchyma."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs and sepsis LIVER: Mildly heterogeneous liver echotexture without mass. Liver length 19.5 cm.GALLBLADDER, BILIARY TRACT: Cholelithiasis with mild diffuse wall thickening and mild pericholecystic fluid. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10 cm in lengthOTHER: Left kidney 10.2 cm in length. Spleen 9.8 cm in length. No ascites.", "output": "Mildly heterogeneous liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites.Cholelithiasis with gallbladder wall thickening and pericholecystic fluid raises the possibility of acute cholecystitis. A Murphy's sign could not be assessed due to the patient's inability to cooperate."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: Coarse echogenic liver echotexture without mass. Liver length 16.8 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.7 cm in lengthOTHER: Left kidney 11.7 cm in length. Spleen 6.2 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": "66 year old female with a right lobe nodule. Previously biopsied and showed a follicular lesion of uncertain significance. RIGHT LOBE MEASUREMENTS: 2.3 x 2.7 x 4.9 cmLEFT LOBE MEASUREMENTS: 1.1 x 1.4 x 3.5 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: The right lobe is nearly completely replaced by a 3.5 x 2.3 x 2.7 cm isoechoic solid nodule with increased vascularity and well-defined margins. No associated calcifications.LEFT LOBE: The left thyroid lobe is normal in morphology, echogenicity, and size and contains a 5 x 4 x 2 mm superior pole hypoechoic nodule with no specific suspicious sonographic features.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "3.5-cm solid right thyroid lobe nodule. 5-mm left superior pole hypoechoic nodule with no specific suspicious sonographic features."}
{"instruction": "Generate impression based on findings.", "input": "History of right lumpectomy and reconstruction. New palpable area of concern in the medial inferior right breast marked by the clinical service. A targeted right ultrasound was performed for the area marked by the clinical service. There is a mixed echogenicity lesion, predominantly cystic in appearance, with hyperechoic components as well. This measures 1.0 x 1.1 cm. The finding is likely related to fat necrosis/oil cyst formation.", "output": "Findings are most compatible with fat necrosis/oil cyst formation. The patient will be following up with Dr. Jaskowiak today for further management which will include palpably guided FNA.BIRADS: 3 - Probably benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with history of hemachromatosis. Evaluate liver. No current symptoms. LIVER: The liver measures 14.2 cm in diameter. Note is made of a diffusely heterogenous echotexture affecting the liver. No focal mass lesion identified. No intra- or extra-hepatic biliary ductal dilation. GALLBLADDER, BILIARY TRACT: No gallstones are identified. The common duct measures 5 mm in diameter. PANCREAS: The pancreas is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 11.6 cm in length.OTHER: The spleen measures 11.7 cm in diameter.", "output": "Diffusely heterogeneous echotexture of the liver is nonspecific but may be seen in setting of hepatic steatosis/parenchymal dysfunction. No evidence of focal masslesion."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old male with acute kidney injury. Evaluate for hydronephrosis, obstruction. RIGHT KIDNEY: Measures 9.1 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. 0.9 cm right renal cyst without septation or nodular component.LEFT KIDNEY: Measures 11.0 cm in length. Increased echogenicity and mild hydronephrosis. 0.9 cm left renal cyst without septation or nodular component.URINARY BLADDER: Collapsed and incompletely visualized.OTHER: Moderate ascites.", "output": "1. Mild left hydronephrosis.2. Increased renal echogenicity consistent with medical renal disease.3. Moderate ascites."}
{"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. 2 cm gallstone noted in the gallbladder fundus. Otherwise unremarkable 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 11.7 cm in length. The left kidney is poorly visualized. The renal parenchyma is echogenic bilaterally. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 10.9 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.", "output": "1. Cholelithiasis without evidence of cholecystitis.2. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female with history of microscopic hematuria, negative CT in 2011. RIGHT KIDNEY: The right kidney measures 9.4 cm in length and is normal echogenicity with no focal lesions, nephrolithiasis or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.4 cm in length and is normal in density with no focal lesions, nephrolithiasis or hydronephrosis.OTHER: The bladder is nondistended limiting evaluation. No pelvic free fluid.", "output": "No focal renal lesions, hydronephrosis or nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "56 years old, Female, Reason: thyroid nodules History: thyroid nodules, pls assess for changes RIGHT LOBE MEASUREMENTS: 6.2 by 3.0 x 2.4 cmLEFT LOBE MEASUREMENTS: 2.9 x 2.3 by 5.9ISTHMUS MEASUREMENTS: 0.3RIGHT LOBE: There is a solid nodule within the right thyroid lobe which is slightly hypoechoic to background tissue measuring 1.7 x 1.4 x 1.4 cm.LEFT LOBE: There is a left predominantly solid nodule with mostly heterogeneously hypoechoic density in the periphery with a 6-mm hypoechoic central area. There is no vascular flow within this nodule. No definite calcifications within this nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is a right level 2 lymph node measuring 2.4 x 1.7 x 0.7 cm with a fatty hilum which is not significantly changed from the prior exam.OTHER: No significant abnormality noted.", "output": "Bilateral lower pole nodules which are not significantly changed in size and appearance."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male with history of thyroid cancer and squamous cell cancer. Evaluate for recurrence, with special attention to node that had changed in echotexture previously. RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Lymph nodes in the right neck level III station are without suspicious features. No new lymphadenopathy is identified. Specifically, the left neck level IV lymph node seen previously is not identified.OTHER: No significant abnormality noted.", "output": "No evidence of recurrent or metastatic disease. No lymphadenopathy. The previously discussed left level IV lymph node is not identified."}
{"instruction": "Generate impression based on findings.", "input": "Neobladder with acute renal insufficiency RIGHT KIDNEY: Echogenic renal parenchyma without mass or stone. No significant hydronephrosis. Right kidney 13.6 cm in lengthLEFT KIDNEY: Echogenic renal parenchyma without mass or stone. No significant change in mild left hydronephrosis. Left kidney 12.7 cm in length.OTHER: Unremarkable neobladder.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass or stone. No significant change in mild left hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "71 year-old female with weight loss, enlarged thyroid. RIGHT LOBE MEASUREMENTS: 6.3 cm x 2.1 cm x 1.8 cmLEFT LOBE MEASUREMENTS: 6.4 cm x 2.7 cm x 2.5 cmISTHMUS MEASUREMENTS: 5 mm in thickness.RIGHT LOBE: Predominately solid nodule with small cystic components at the lower pole measures 1.6 cm x 1.5 cm x 1.8 cm. No evidence of internal vascularity or definite microcalcifications.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Left neck level 2 benign-appearing lymph node measures 1.1 cm x 0.7 cm x 0.4 cm.OTHER: No significant abnormality noted.", "output": "Predominantly solid nodule with small cystic components at the lower pole of the right thyroid lobe measuring 1.8 cm in longest dimension. Benign appearing left neck lymph node. "}
{"instruction": "Generate impression based on findings.", "input": "Female; 73 years old. Reason: RUQ ultrasound to evaluate for gallstones in pt with elevated lipase and epigastric pain History: epigastric pain LIVER: The liver measures 17.2 cm in length. The liver contour is smooth, the parenchyma demonstrates coarse echotexture. No worrisome masses identified.The portal vein is patent and demonstrates a normal direction of flow with a peak velocity of 0.33 m/sec.BILIARY TRACT: The gallbladder is normal in appearance without shadowing stones. There is no gallbladder wall thickening or pericholecystic fluid. There is mild intrahepatic biliary ductal dilatation. The common bile duct measures 3 mm, normal.PANCREAS: The pancreas is unremarkable. The body and tail are obscured by overlying bowel gas. There is no ultrasound evidence of pancreatitis.SPLEEN: The spleen measures 1.7 cm in length.RIGHT KIDNEY: The right kidney measures 10.4 cm in length. The renal cortex is echogenic. There is no renal stone or hydronephrosis. No worrisome renal mass is identified. Within the superior pole of the right kidney and a 1.1 x 1.1 x 1.1 centimeter simple renal cyst.OTHER: The left kidney measures 11.7 cm in length. The renal cortex is echogenic. There is no renal stone or hydronephrosis. No worrisome renal mass is identified.", "output": "1.No ultrasound evidence of pancreatitis. 2.Mild intrahepatic biliary ductal dilatation. No cholelithiasis, evidence of acute cholecystitis, or extrahepatic biliary ductal dilatation.3.Echogenic kidneys consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female patient with right lower quadrant pain and a transplant kidney. Evaluate for vascular patency. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No perinephric fluid collection is identified.KIDNEY: The right kidney measures 10.6 cm in length.COLLECTING SYSTEM/URETER: No evidence hydronephrosis.URINARY BLADDER: No significant abnormality noted.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels The transplant right renal artery is patent. Peak systolic velocity at the anastomosis measures approximately 1.1 m/s with RI of 0.81. Intrarenal resistive indices range from 0.65 to 0.76. The transplant right renal vein is patent.OTHER: No significant abnormality noted", "output": "1. No evidence of hydronephrosis.2. Patent transplant renal vasculature. "}
{"instruction": "Generate impression based on findings.", "input": "48-year-old male with right upper quadrant abdominal pain. LIVER: Normal in size and echotexture. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: The visualized biliary tract is normal in caliber.The gallbladder is collapsed with borderline wall thickening and a trace of fluid. No definite shadowing gallstones are identified.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Highly echogenic consistent with parenchymal disease. Correlate with history of renal disease or renal function testing. No hydronephrosis or shadowing calculus.OTHER: Left kidney poorly visualized. Limited views of the spleen demonstrate no abnormality.", "output": "Collapsed gallbladder with borderline wall thickening and trace of fluid. This appearance is not consistent with acute cholecystitis and no gallstones are identified.Significantly echogenic right kidney. Correlation with history of renal disease or renal function testing."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female patient with elevated AST and ALT. Evaluate for liver disease/lesions. LIVER: The liver measures 18.3 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 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 pancreas is normal in echogenicity.RIGHT KIDNEY: The right kidney measures 11 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.7 cm in length. No evidence of hydronephrosis.The spleen measures 10 cm in length.", "output": "No specific findings to account for the patient's symptoms. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: History of radiation as a child. Please assess for malignancy History: History of radiation as a child. Please assess for malignancy RIGHT LOBE MEASUREMENTS: 4.1 x 1.5 x 1.8 cm.LEFT LOBE MEASUREMENTS: 3.5 x 1.2 x 1.7 cm.ISTHMUS MEASUREMENTS: 0.2 cm.RIGHT LOBE: Normal echogenicity, morphology, and sinus without discrete nodules or masses.LEFT LOBE: Normal echogenicity, morphology, and sinus without discrete nodules or masses.ISTHMUS: Normal echogenicity, morphology, and sinus without discrete nodules or masses.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Normal appearing thyroid without interval change."}
{"instruction": "Generate impression based on findings.", "input": "75 years old, Female, Reason: evaluate for thyroid nodules History: history of thyroid nodules RIGHT LOBE MEASUREMENTS: 5.5 x 1.7 x 4.5 cmLEFT LOBE MEASUREMENTS: 8.3 x 2.8 x 2.6 cm.ISTHMUS MEASUREMENTS: 0.23RIGHT LOBE: Subcentimeter right thyroid nodule with heterogeneous appearance measuring 0.8 x 0.5 x 0.4 cm.LEFT LOBE: Large left thyroid nodule is solid and cystic in appearance with questionable microcalcifications measuring 4.2 x 2.9 x 2.1 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Benign-appearing level 2 lymph node measuring 1.1 x 2.7 x 0.4 cm.", "output": "1.Mixed solid/cystic left thyroid nodule measuring up to 4.2 cm, would be amenable to US-guided FNA/biopsy if not already performed.2.Bilateral subcentimeter thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Mildly echogenic parenchyma without worrisome mass or hydronephrosis. Multiple subcentimeter nonobstructing right renal stones Stable renal sinus cysts. Right kidney 14 cm in length.LEFT KIDNEY: Mildly echogenic parenchyma without worrisome mass, stone, or hydronephrosis. 14.3 cm in length.OTHER: Bladder nondistended", "output": "Mildly echogenic parenchyma suggestive for medical renal disease/parenchymal dysfunction without worrisome mass or hydronephrosis. Multiple subcentimeter nonobstructing right renal stones."}
{"instruction": "Generate impression based on findings.", "input": "50 year-old female with epigastric/right upper quadrant pain. LIVER: Liver is normal in size and echotexture. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder wall is normal to upper normal without pericholecystic fluid. Dependent gallstones are present within the gallbladder. The gallbladder is not distended. The biliary tract is normal in caliber.PANCREAS: Poorly visualized due to bowel gas.RIGHT KIDNEY: Highly echogenic without hydronephrosis.OTHER: Highly echogenic left kidney without hydronephrosis. Small cyst.", "output": "Gallstones with gallbladder wall normal to upper normal. No gross evidence for acute cholecystitis.Highly echogenic kidneys as previously noted."}
{"instruction": "Generate impression based on findings.", "input": "Hyperparathyroidism RIGHT LOBE MEASUREMENTS: 5.4 x 2 x 2.2 cmLEFT LOBE MEASUREMENTS: 5.7 x 2.1 x 1.9 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: 2.3 x 1.9 x 2.0 cm spongiform nodule.LEFT LOBE: No significant abnormality noted.ISTHMUS: 2 subcentimeter hypoechoic nodules. The largest measuring 0.8 x 0.7 x 0.5 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Lower pole right thyroid spongiform nodule. 2 subcentimeter isthmic hypoechoic nodules. No regional adenopathy. No convincing parathyroid adenoma candidate."}
{"instruction": "Generate impression based on findings.", "input": "93-year-old female with right upper quadrant pain and elevated transaminases. LIVER: There is normal in size and echotexture. No focal hepatic abnormality except for small cyst adjacent to the gallbladder fossa. Limited spectral and color Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Patient was unable to turn for this exam. The gallbladder appears unremarkable without cholelithiasis, wall thickening or pericholecystic fluid. The very tract is normal in caliber.PANCREAS: The head and body are adequately visualized. Small cystic area in the head as previously noted.. The tail was not well seen.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: Moderate right pleural effusion.", "output": "Normal gallbladder and supine position.Right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "Ascites. Evaluate inferior vena cava. INFERIOR VENA CAVA: The extrahepatic inferior vena cava is patent.OTHER: The bladder is partially distended. Ascites is noted on the study bilaterally in the lower quadrants", "output": "Patent extra hepatic inferior vena cava."}
{"instruction": "Generate impression based on findings.", "input": "HNF1B mutation associated with renal cysts RIGHT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. No renal cysts appreciated. 9.4 cm in lengthLEFT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. No renal cysts appreciated. 11.3 cm in length.OTHER: Bladder nondistended", "output": "Negative renal ultrasound. Normal parenchymal echogenicity without mass, stone, or hydronephrosis. No renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "82-year-old female with left submandibular nodule. In the region of the palpable abnormality in the left submandibular region there is a normal-appearing lymph node measuring 0.6 x 1 1 x 1 cm. No other abnormalities are identified.", "output": "Normal-appearing lymph node corresponds to palpable abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Multiple thyroid nodules RIGHT LOBE MEASUREMENTS: 6 x 3.1 x 2.4 cmLEFT LOBE MEASUREMENTS: 4.5 x 2.3 x 3 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Multiple thyroid nodules. A 1.1 x 1.1 single hypoechoic focus with coarse internal echogenic foci is present and will be biopsied later today. A dominant predominantly solid nodule within the lower pole of the right thyroid gland measures approximately 4 x 2.3 x 2.1 cm; this thyroid nodule also be biopsied later today.LEFT LOBE: Multiple thyroid nodules. A number of these thyroid nodules are predominantly cystic and favor benign etiology. A dominant predominantly solid nodule within the lower pole measuring 1.2 x 0.8 x 1 cm is present and will be biopsied later today.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 nodules. 3 of these nodules as described will be biopsied later today."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Mildly coarse liver echogenicity without mass. Liver length 16.4 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.9 cm in length.OTHER: Left kidney 12.3 cm in length. Spleen 8.8 cm in length. No ascites", "output": "Mildly coarse liver echogenicity raises the possibility of fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C and elevated lipase LIVER: Coarse echogenic liver echotexture without mass. Liver length 17 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.5 cm in lengthOTHER: Left kidney 10.6 cm in length. Spleen 11.3 cm in length. No ascites.", "output": "Cholelithiasis without acute inflammation or ductal dilatation. Coarse echogenic liver echotexture consistent with fatty infiltration/parenchymal dysfunction without mass. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old male with borderline hypertension, CKD. Evaluate kidneys. ULTRASOUND KIDNEYSRIGHT KIDNEY: Measures 11.6 cm in length. There is diffuse parenchymal loss with secondary caliectasis likely due to volume loss. No hydronephrosis. No shadowing calculi.LEFT KIDNEY: Normal in echogenicity measuring 11.5 cm in length. No hydronephrosis or shadowing calculi.OTHER: No significant abnormalities noted.", "output": "1. Diffuse right renal parenchymal loss with secondary caliectasis. No hydronephrosis bilaterally. 2. No evidence of renal artery stenosis. "}
{"instruction": "Generate impression based on findings.", "input": "Follow-up bilateral hydronephrosis BLADDER  Wall Thickness: Normal  Contents: Distended and normal. Distal Ureter -- SFU Grade**  Right: 0  Left: 0   Ureteral Jets Right: Observed  Left: Not observedKIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 1  Left: 1  Length*** Right: 5 cm Left: 5 cm   Mean for age: 4.2 cm  Range for age: 3.8 - 5.8 cmADDITIONAL OBSERVATIONS: None", "output": "Bilateral grade 1 pelvicaliceal dilation.*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": "48-year-old male with abdominal pain. LIVER: Liver is normal in size and echotexture. Small hepatic cysts identified.GALLBLADDER, BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Small cyst identified.OTHER: No significant abnormality", "output": "Normal gallbladder and biliary tract.Hepatic and renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "Male 69 years old Reason: eval for hepatomegaly and ascites History: swelling Small volume generalized ascites.Mild hepatomegaly noted liver 18.7 cm in length.", "output": "Small volume generalized ascites."}
{"instruction": "Generate impression based on findings.", "input": "Short-term follow-up for probable fat necrosis in the left breast. A targeted left ultrasound was performed for the area of concern. At the 11:30 position, mixed hyperechoic and hypoechoic tissue with a several millimeter sized cyst is present measuring up to 1.4 cm, though significantly decreased in volume compared to the prior study. Incidental note is made of a superficially located 5 mm cyst near the nipple. There is no suspicious solid or cystic mass identified.", "output": "Findings compatible with resolving fat necrosis. As long as physical exam findings are not suspicious, routine mammography would be due in July 2016.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Male 55 years old Reason: to rule out hcc per protocol LIVER: Measures 15.3 in length. Increased hepatic echogenicity with coarse echotexture but no discrete focal lesion. Patent portal vein with antegrade flow with velocity of 24 cm/s. BILIARY TRACT: No cholelithiasis. No gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilation. There are hyperechoic foci in the wall of the gallbladder with ringdown artifact likely representing cholesterolosis. In addition, there is a 3 x 2 x 3 mm gallbladder polyp.PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Status post splenectomy.KIDNEY: The left kidney measures 10.7 cm in length. No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "Coarse, echogenic liver texture consistent with parenchymal dysfunction. No focal liver lesion."}
{"instruction": "Generate impression based on findings.", "input": "Female; 57 years old. Reason: r/o fatty liver disease History: elevated GGT LIVER: The liver measures 22.1 cm in length. This diffuse coarse and echogenic with geographic areas of focal sparing. No suspicious lesions are identified.The main portal vein is patent and demonstrates normal direction of flow with a peak velocity of 20 cm/sec.BILIARY TRACT: The gallbladder is normal in appearance without cholelithiasis. The common bile duct measures 5 mm. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head of the pancreas is unremarkable. The body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: The spleen measures 10.2 cm in length.RIGHT KIDNEY: The right kidney measures 11.1 cm in length. There is no hydronephrosis, shadowing renal stone, or suspicious lesion identified. OTHER: The left kidney measures 10.2 cm in length. There is no hydronephrosis, shadowing renal stone or suspicious lesion identified.", "output": "Hepatomegaly and diffuse hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "History of ulcerative colitis and prior abnormal LFTs. LIVER: The liver is normal in morphology, echogenicity and size, measuring 15 cm in length. No focal lesion or intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 0.3 m/s. BILIARY TRACT: Normally distended gallbladder without gallbladder wall thickening, pericholecystic fluid, gallstones or focal tenderness. The common duct measures 3 mm, within normal limits.PANCREAS: No significant abnormalities noted of the pancreatic head and proximal body. Otherwise the pancreas is obscured by overlying bowel gas.SPLEEN: The spleen measures 9.3 cm without a focal lesion.RIGHT KIDNEY: The right kidney measures 12.1 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. OTHER: The left kidney measures 11.9 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion.", "output": "Unremarkable right upper quadrant ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Afagwu is a 25-year-old female with a personal history of biopsy-proven fibroadenoma of the right breast. She presents today for a new mass in the left breast for the past 2-3 months. Upon physical exam at the patient's area of concern, no discrete mass is appreciated.A targeted left breast ultrasound was performed for the palpable area of concern. In the left breast 7:00 location, approximately 3 cm from the nipple, no suspicious cystic or solid mass is identified.", "output": "No sonographic correlate identified for the patient's palpable area of concern. The patient should follow up with her primary care physician as clinically warranted, presuming these results are concordant with the physical exam findings. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old woman with AKI. RIGHT KIDNEY: Measures 12.8 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 11.8 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Bilateral ureteral jets were visualized. The bladder is well-distended and without abnormality. OTHER: Shadowing cholelithiasis, no gallbladder wall thickening.", "output": "1.Increased renal echogenicity consistent with medical renal disease. No nephrolithiasis or hydronephrosis.2.Cholelithiasis without evidence of cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "Rule out adenopathy or recurrence. Thyroid cancer with 2 year follow-up RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS:Status post thyroidectomy.ISTHMUS MEASUREMENTS:Status post thyroidectomy.RIGHT LOBE:Status post thyroidectomy.LEFT LOBE:In the left thyroidectomy bed there is a hypoechoic focus unchanged measuring 0.3 x 0.2 x 0.8 cm.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level 2 lymph node measures 1.6 x 0.5 x 0.7 cm, unchangedOTHER: No significant abnormality noted.", "output": "Unchanged subcentimeter left thyroid bed nodule and right level 2 lymph node."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old female patient with hyperparathyroidism. Please assess for thyroid nodules. RIGHT LOBE MEASUREMENTS: 3.9 x 1.1 x 1.3 cm.LEFT LOBE MEASUREMENTS: 3.0 x 0.9 x 0.8 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: The right thyroid lobe is homogeneous in echogenicity. No dominant thyroid nodule is identified.LEFT LOBE: The left thyroid lobe is homogeneous in echogenicity. No dominant thyroid nodule is identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: There is a hypoechoic structure measuring 0.9 x 0.6 x 1.4 cm in the midline superior mediastinum/supraclavicular region which may correlate to findings on concomitant nuclear medicine scan.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Hypoechoic structure within the superior mediastinum/supraclavicular region may correlate to a focus of uptake on concomitant nuclear medicine scan and represent a parathyroid adenoma."}
{"instruction": "Generate impression based on findings.", "input": "HCV cirrhosis LIVER: Cirrhotic morphology again noted without mass. Liver length 19.5 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 11.3 cm in lengthRIGHT KIDNEY: Right renal cyst. Right kidney 10 cm in length. OTHER: Nonobstructing subcentimeter left renal stone. Left renal cyst. Left kidney 10 cm in length. No ascites.", "output": "Stable cirrhotic morphology without mass or ductal dilatation. Cholelithiasis without acute inflammation. No ascites. Nonobstructing left renal stone."}
{"instruction": "Generate impression based on findings.", "input": "27 year old female with history of left breast pain, no palpable mass. A targeted left ultrasound was performed for the patient\u2019s area of concern. No palpable mass was felt on physical exam. There is no discrete solid or cystic mass identified on ultrasound in the area of pain in the left upper outer quadrant.", "output": "No sonographic evidence for malignancy in the area of pain in the left upper outer quadrant.BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "History of acute kidney injury on chronic kidney disease. Ultrasound guidance was provided for percutaneous biopsy of right kidney. Three passes were performed.", "output": "Ultrasound guidance for percutaneous biopsy of right kidney."}
{"instruction": "Generate impression based on findings.", "input": "History of CHF and abnormal LFTs. LIVER:The liver measures 22 cm in length. It is mildly echogenic. The hepatic veins are dilated. Normal hepatopedal portal venous blood flow at 30 cm/s. No focal suspicious lesion. No intrahepatic biliary ductal dilatation.GALLBLADDER, BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 4 mm. Status post cholecystectomy.PANCREAS: The visualized portions of pancreatic head and body are unremarkable. The remainder is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 17 cm in length without a focal lesion.KIDNEYS: The right kidney measures 10.8 cm in length without hydronephrosis, shadowing nephrolithiasis or suspicious lesion. Note is made of a 7 mm simple appearing cyst. Probable extrarenal pelvis. Color Doppler demonstrates hilar blood flow.The left kidney measures 11.9 cm in length without hydronephrosis, shadowing nephrolithiasis or suspicious lesion. Two simple appearing cysts are noted. Color Doppler demonstrates hilar blood flow.ABDOMINAL AORTA: The abdominal aorta is normal in caliber and tapers distally. It measures 2.1 cm proximally 1.9 cm at the mid-portion and 1.9 cm distally. INFERIOR VENA CAVA: The visualized portions of the inferior vena cava are unremarkable.OTHER: Partially distended bladder is otherwise unremarkable.", "output": "Hepatosplenomegaly. Dilated hepatic veins and mildly coarse liver parenchyma suggestive of hepatic congestion. Probable steatosis. No hydronephrosis. Bilateral simple appearing cysts."}
{"instruction": "Generate impression based on findings.", "input": "Stage IV melanoma with brain metastasis with right thyroid focus seen on recent PET/CT RIGHT LOBE MEASUREMENTS: 4.4 x 1.4 x 2.1 cmLEFT LOBE MEASUREMENTS: 5.2 x 1.2 x 2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: 0.4 x 0.3 x 0.3 hypoechoic subcentimeter nodule mid right thyroid glandLEFT 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": "Subcentimeter right mid pole thyroid nodule; a benign etiology is favored. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "75 year old female who was recalled from screening mammogram for new left breast mass. No family history of breast cancer. MAMMOGRAM: An ML view 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 almost entirely fatty, unchanged in pattern and distribution. There is redemonstration of a 2.1-cm circumscribed, lobulated mass within the upper inner left breast, which persists on spot compression imaging.ULTRASOUND: A targeted left ultrasound was performed for the area of concern. At the 11 o'clock position of the left breast, 6 cm from the nipple there is a parallel, hypoechoic, lobulated mass with angular margins measuring 2.0 x 1.0 x 1.4 cm. There is minimal vascularity associated with this lesion.", "output": "2.0-cm hypoechoic mass at the 11 o'clock position of the left breast, corresponding to the mammographic finding. Ultrasound guided biopsy of this mass is recommended. Results and recommendation were discussed with the patient, and all of her questions were answered.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Left knee swelling Sonographic evaluation was performed about the left knee in preparation for possible aspiration. The images demonstrate no significant fluid with a minimal amount of subcutaneous edema noted anteriorly.", "output": "No evidence of joint effusion or surrounding fluid. These findings were conveyed to the ordering clinician Dr. T. Balach at the time of the exam."}
{"instruction": "Generate impression based on findings.", "input": "Reason: kidney stone, or other pathology History: left sided abdominal pain, left lumbar area RIGHT KIDNEY: The right kidney measures 10.3 cm in length. Normal renal echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.8 cm in length. Normal renal echogenicity. No shadowing stones or hydronephrosis.OTHER: Ureteral jets not visualized. Unremarkable bladder.", "output": "No acute renal abnormality. No renal calculi or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female patient with history of right breast cancer and benign mass seen on surveillance imaging. A targeted right breast ultrasound was performed. In the 10 o'clock position of the right breast 5 cm from the nipple there is a 0.6 x 0.3 x 1.0 cm parallel circumscribed oval hypoechoic mass is present, previously 0.8 x 0.8 x 0.3 cm. The previously seen lesion in the 11 o'clock position was not seen on the current examination.", "output": "Stable benign lesion in the 10 o'clock position of the right breast. Previously identified lesion in the 11 o'clock position was not visualized on today's examination. Recommend diagnostic bilateral mammogram in 6 months.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury RIGHT KIDNEY: 8.9 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 8.6 cm in length. Increased renal parenchymal echogenicity. 1.1 cm benign-appearing cyst noted in the midpole. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: Collapsed with Foley catheter identified.OTHER: No significant abnormality noted.", "output": "Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "40 year-old male presents with groin pain. RIGHT TESTIS: No significant abnormalities noted. Normal vascularity LEFT TESTIS: No significant abnormalities noted. Normal vascularityRIGHT EPIDIDYMIS: 3 mm cyst right epididymal headLEFT EPIDIDYMIS: 1.8 cm cyst left epididymal headOTHER: Borderline left scrotal varicocele.", "output": "Bilateral epididymal head cysts, larger on the left.Borderline left varicoceleI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Nausea vomiting right upper quadrant pain LIVER: 2.9 x 2.7 x 3 cm mixed echogenicity within segment 7 of the right lobe of the liver; this lesion is unchanged. Background liver again demonstrates heterogeneous echotexture. Liver length 15.5 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.7 cm in length OTHER: Left kidney 10.5 cm in length. Spleen 8.8 cm in length. No ascites.", "output": "Cholelithiasis without acute inflammation or ductal dilatation. Stable right hepatic lobe mass lesion consistent with FNH. Background liver parenchyma consistent with chronic liver disease. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are a bilateral mammogram and ultrasound from 7/23/2015 and performed at the WomanCare P.C. Breast and Bone Density Center, Arlington IL . Two standard views of both breasts and ML and two spot compression views of left breast were obtained. The breast parenchyma is extremely dense. A BB marker in the left breast upper outer quadrant corresponds to a palpable abnormality/thickening. There is extensive bilateral scattered calcifications noted. Most of the calcifications layer on the ML view suggestive of milk of calcium. No obvious mass is noted on spot compression views.Ultrasound: In the right breast are multiple cysts most of which demonstrate calcifications, especially the cyst in the 9:00 position. Clustered cyst is noted in the right breast 12:00 position which measure 1.0 x 0.4 cm. In the left breast are multiple simple, septated cysts containing hyperechoic calcifications in the left upper outer quadrant and the largest septated cyst in the left breast 1:00 position measures 10 x 7 mm.", "output": "1.The area of thickening/palpable in the left breast upper outer quadrant most likely corresponds to fibrocystic changes. 2.Bilateral scattered breast calcifications and multiple, septated and clustered cysts in both breasts. 3.Given the absence of prior mammograms for comparison, a six-month follow-up mammogram is recommended to demonstrate stability of the calcifications. 4.A right breast ultrasound is also recommended in the right breast to demonstrate stability of the clustered cyst.BIRADS: 3 - Probably benign finding.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old male history of alcoholic cirrhosis. Recurrent ascites with recent abdominal drain now with erythema around the site. There is diffuse body wall edema with a focus of more confluent fluid in the palpable region of concern measuring 1.9 x 2.5 cm. The collection is not loculated. Another focus of more confluent fluid measures 2.3 x 1.5 x 2.9 cm with a channel communicating with the peritoneal ascites. There is no significant surrounding soft tissue hyperemia.", "output": "Diffuse body wall edema/anasarca with two regions of confluent non-loculated fluid collections, one of which communicates with the peritoneal ascites and likely reflects a small fluid containing hernia, which may be related to the recent drainage catheter tract. "}
{"instruction": "Generate impression based on findings.", "input": "Mild leukemia. History of stem cell transplant. Increasing liver function tests. LIVER: Non-cirrhotic liver morphology. 18 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. Collapsed gallbladder, without specific evidence of 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 11.4 cm in length. The left kidney is 11.8 cm in length, with an extrarenal pelvis incidentally noted. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 11.6 cm in length at the upper limits of normal, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites identified.", "output": "Mildly increased hepatic echogenicity, compatible with parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Status post cystectomy with ileal conduit with increased creatinine RIGHT KIDNEY: Normal parenchymal echogenicity with minimal hydronephrosis. No mass. Right kidney 7.9 cm in lengthLEFT KIDNEY: Normal parenchymal echogenicity with minimal hydronephrosis. Left kidney 9.8 cm in length. No massOTHER: Status post cystectomy.", "output": "Normal renal parenchymal echogenicity with bilateral minimal hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Male 63 years old; Reason: R/O liver fibrosis History: long standing hx of HCV LIVER: The liver measures 14.0 cm in length. There is 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 20.9 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.1 mm. No stones are seen, there is very minimal sludge. No pericholecystic fluid. 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 measures 8.2 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 13.6 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones are seen. There is a mildly complex cyst revisualized at the mid to upper pole measuring 3.6 cm x 3.9 cm x 3.6 cm. This previously measured 3.5 cm x 3.6 cm x 3.4 cm. Again demonstrated is thin septation within the cyst. A simple renal cyst is redemonstrated at the lower pole measuring 3.8 cm x 4.2 cm x 3.6 cm.LEFT KIDNEY: The left kidney measures 12.7 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. The liver has increased echogenicity compatible with fatty infiltration/hepatocellular dysfunction. No worrisome masses or intrahepatic ductal dilation are seen.2. Mildly complex renal cyst at the right mid to upper pole appears relatively stable in size from prior ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "Male 75 years old; Reason: of liver, screen for hcc History: same LIVER: The liver measures 18.9 cm in length. There is increased echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. A hepatic cyst is redemonstrated in the right lobe measuring 1.3 cm x 1.5 cm x 1.5 cm. The main portal vein is patent with normal hepatopetal flow measured at 10.9 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.6 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 4.7 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.2 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 12.8 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 12.3 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "Mild hepatomegaly. The liver has increased echogenicity compatible with fatty infiltration/hepatocellular dysfunction. No worrisome masses seen."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B. Evaluate for hepatocellular carcinoma LIVER: Non-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. Prominent common bile duct is within normal limits given prior 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 10.5 cm in length, and pelvic in location. The left kidney is 10.9 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.4 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites is identified in the upper abdomen.", "output": "Increased hepatic echogenicity, compatible with parenchymal dysfunction. No evidence of cirrhosis. No suspicious hepatic lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Postma is a 45-year-old woman with biopsy-proven left breast cancer. She presents today for further evaluation of nonspecific lymph node seen on breast MRI and ultrasound at outside hospital and palpated by surgeon. A targeted left axillary ultrasound was performed for the palpable area of concern by Dr. Jaskowiak. -In the lower axilla, there is a 1.1 x 0.4 x 0.7 cm normal morphology lymph node noted with normal uniform cortical thickness and fatty hilum (annotated #1). -Another normal morphology lymph node measuring 1.6 x 1.2 cm with uniform cortical thickness and fatty hilum is seen in the mid axilla (annotated #2). These two lymph nodes correspond to those identified on outside hospital ultrasound examinations. No suspicious lymph nodes are identified.", "output": "Normal left axillary lymph nodes. Findings were communicated to the patient and Dr. Jaskowiak's office at the time of the exam.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Dopplers to assess portal flow History: pulmonary hypertension LIVER: The liver measures 16.7 cm in length. Normal hepatic parenchymal echogenicity and echotexture. The portal vein is patent with normal directional hepatopedal flow, peak velocity 18.9 cm/s. No focal masses.GALLBLADDER, BILIARY TRACT: Decompressed gallbladder without shadowing stones or sludge. The gallbladder wall measures 0.3 cm. The common bile duct measures 0.3 cm. No biliary ductal dilatation.PANCREAS: Limited evaluation due to overlying bowel gas. The pancreatic duct measures 0.2 cm.RIGHT KIDNEY: The right kidney measures 9.5 cm in length. Small midpole anechoic cyst measures 0.8 x 0.9 x 1.0 cm. Additional exophytic lower pole anechoic cyst measures 0.9 cm in the transverse plane. The renal parenchyma is unremarkable. No definite shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 7.9 cm in length. Multiple tiny hyperechoic foci with posterior acoustic shadowing likely represent tiny nonobstructive intrarenal calculi. No hydronephrosis.OTHER: The spleen measures 16.3 cm in length, enlarged. No ascites.", "output": "1. No acute hepatobiliary abnormality. Specifically, normal portal venous directional flow, velocity, and waveforms.2. Multiple subcentimeter non-obstructive left renal stones.3. Splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Sickle cell disease in crisis Moderate splenomegaly with spleen length 18 cm. Homogeneous parenchyma without evidence for perisplenic fluid collection or infarction. Incidental note made of subcentimeter nonobstructing left renal stone. Liver length 18 cm in length.", "output": "Moderate splenomegaly without evidence for perisplenic fluid collection or infarction. Nonobstructing left renal stone."}
{"instruction": "Generate impression based on findings.", "input": "62 years old, Male, Reason: cirrhosis History: HCV LIVER: The liver measures 17.8 cm in length. Echogenicity of the liver parenchyma is within normal limits. 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. No nodularity to the liver capsule or widening of the fissures to suggest cirrhosis.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: The spleen is enlarged measuring 16.8 cm in length. RIGHT KIDNEY: Kidney measures 10.2 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.OTHER: No significant abnormalities noted.", "output": "1.No definite evidence of cirrhosis. No nodularity or of the liver capsule or widening of the fissures to suggest cirrhosis.2.Splenomegaly is present.3.Liver size is at the upper limits of normal."}
{"instruction": "Generate impression based on findings.", "input": "Reason: kidney stone History: stone RIGHT KIDNEY: The right kidney measures 11.0 cm in length. Multiple small stones measuring up to 0.6 cm in length. Anechoic cyst measures 2.3 x 1.8 x 1.8 cm. No hydronephrosis.LEFT KIDNEY: The left kidney measures 10.3 cm in length. Multiple small stones in the left inferior pole measure up to 0.8 cm in length. Anechoic cyst in the mid left kidney measures 2.2 x 2.3 x 2.4 cm. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Multiple small bilateral renal calculi without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female with history of cirrhosis who presents for hepatocellular carcinoma screening. LIVER: Hepatic parenchyma is coarse in echogenicity with nodular contour; findings consistent with cirrhosis. No focal hepatic lesions to suggest hepatocellular carcinoma. The liver measures 18.5 cm in length.Main portal vein flow is hepatopetal with velocities measuring 22 cm/s.BILIARY TRACT: No biliary ductal dilatation. Gallbladder is absent.PANCREAS: No significant abnormalities noted.SPLEEN: Spleen measures 10.8 cm in length.RIGHT KIDNEY: The right kidney measures 11.0 cm and left kidney measures 10.2 cm in length without evidence of hydronephrosis. OTHER: Atherosclerotic calcifications affect the abdominal aorta. No ascites.", "output": "1.Cirrhotic morphology without hepatic mass or ductal dilatation. 2.No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Palpable goiter RIGHT LOBE MEASUREMENTS: 6 x 1.9 x 2.8 cmLEFT LOBE MEASUREMENTS: 6.2 x 1.4 x 2.2 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Dominant predominantly solid lower pole nodule measuring 2.8 x 2.3 x 3.1 cm.LEFT LOBE: Dominant predominantly solid lower pole module measuring 2.5 x 1.5 x 2.7 cmISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Dominant bilateral lower pole thyroid nodules. These lesions are amenable to ultrasound guided percutaneous biopsy."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old female presents with swelling of her right wrist. There is a clinical concern for fluid collection. There is edema of the soft tissue of the right wrist without a loculated fluid collection or mass.", "output": "1. Edema of the soft tissue of the right wrist without discrete fluid collection or mass."}
{"instruction": "Generate impression based on findings.", "input": "Left upper quadrant pain. LIVER: The liver is mildly echogenic. No focal lesion or biliary ductal dilatation. It is normal in size measuring 16.4 cm in craniocaudal dimension. Normal hepatopedal portal blood flow at 0.3 m/s. BILIARY TRACT: No extrahepatically biliary ductal dilatation with the common duct measuring 4 mm. Normally distended gallbladder without gallstones, wall thickening or pericholecystic fluid. No focal tenderness.PANCREAS: Limited evaluation of the pancreatic head shows no significant abnormality. The remainder the pancreas is not visualized.SPLEEN: The spleen is normal in size measuring 11.5 cm.RIGHT KIDNEY: The right kidney measures 12.8 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. OTHER: The left kidney measures 13.2 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion.", "output": "No specific findings to account for the patient's intermittent left upper quadrant pain."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodule. Assess interval change. RIGHT LOBE MEASUREMENTS: 5.1 X 1.7 x 1.5 cm, unchanged.LEFT LOBE MEASUREMENTS: 4.5 x 1.6 x 1.2 cm, unchanged.ISTHMUS MEASUREMENTS: 0.2 cm, unchangedRIGHT LOBE: Normal echotexture and size. A predominantly solid isoechoic nodule with a hypoechoic halo is again seen in the inferior pole and is unchanged in appearance and size, measuring 0.6 x 0.5 x 0.4 cm. LEFT LOBE: Normal echotexture and size. No significant abnormality noted.ISTHMUS: Normal echotexture and size. No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing lymph nodes are present bilaterally. Right level 4 lymph node measures 0.6 x 0.4 x 0.4 cm. OTHER: No significant abnormality noted.", "output": "1.Normal thyroid size2.Right inferior pole isoechoic thyroid nodule measuring 0.6 cm, unchanged."}
{"instruction": "Generate impression based on findings.", "input": "41 y.o. male presents with RUQ. Evaluate hepatobiliary system. LIVER:The liver measures approximately 20.1 cm. There is coarse and increased echogenicity of the parenchyma. No mass, ascites, or intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder length measures approximately 13.9 cm. Echogenic dependent material within the gallbladder likely represents sludge. No stones. The gallbladder wall thickness is 0.2 cm. No pericholecystic fluid. The common bile duct measures 7.5 mm. Negative sonographic Murphy's sign.PANCREAS: Evaluation limited by overlying bowel gas.SPLEEN: The spleen measures 11.8 cm. No sonographic abnormalities.KIDNEYS: The right kidney measures 12.1 cm. The cortex has normal echogenicity. No shadowing calculi, hydronephrosis, or worrisome mass. The left kidney measures approximately 10.8 cm. The cortex has normal echogenicity. No shadowing calculi, hydronephrosis, or worrisome mass. OTHER: No significant abnormality noted.", "output": "1. Coarse and increased echogenicity of the parenchyma in the liver consistent with chronic liver disease/parenchymal dysfunction. No mass or ascites.2. Hepatomegaly.3. Gallbladder sludge without signs of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Kiawana Lagrone is a 23 year old female who presents for evaluation of intermittent left superior breast shooting pain for months. She denies associated skin change, nipple discharge or palpable lump. ULTRASOUND:On physical examination, no discrete mass is palpated.A targeted left ultrasound was performed for the patient\u2019s area of pain in the superior left breast. There is no solid or cystic mass identified.", "output": "No sonographic evidence of malignancy in the left breast at site of pain. The patient should follow up with her primary care physician as clinically warranted, presuming these results are concordant with the physical exam findings. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually at age of 40 years. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"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": "Male 22 years old; Reason: h/o rosai dorfman and thyroid nodules History: nodule comparison RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 5.0 x 1.4 x 1.3 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.2 x 1.2 x 1.7 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.3 cm.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: There is round circular hypoechoic lesion in the anterior isthmus measuring 0.5 cm in diameter; stable in size when compared to the prior study.LYMPH NODES: No lymphadenopathy noted.OTHER: No significant abnormality noted.", "output": "1.Lesion at anterior isthmus of thyroid stable in size."}
{"instruction": "Generate impression based on findings.", "input": "Male 65 years old Reason: Is there abscess or pocket of fluid in L elbow? History: L elbow cellulitis.Additional history from ultrasound technologist indicates patient has pain and swelling for one month. There are ill-defined hypoechoic areas within the muscle of the posterior elbow without a discrete loculated drainable fluid collection. This is along the posterior aspect of the elbow. This is consistent with induration or possible cellulitis without discrete drainable abscess. There are some comparison images to the right side. Subjectively I think the abnormal left side is slightly hyperemic.", "output": "No drainable abscess. Small ill-defined hypoechoic areas suggestive of cellulitis."}
{"instruction": "Generate impression based on findings.", "input": "Female 44 years old Reason: Single subcentimeter left thyroid nodule with a calcification, follow-up ultrasound History: none RIGHT LOBE MEASUREMENTS: 5.3 x 1.5 x 1.2 cmLEFT LOBE MEASUREMENTS: 5 x 1.2 x 1.3 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Previously noted 5 x 5 mm hypoechoic nodule with central linear hyperechoic focus is unchanged.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small benign-appearing lymph nodes are unchanged.OTHER: No significant abnormality noted.", "output": "No significant change in the left lower lobe solitary subcentimeter nodule."}
{"instruction": "Generate impression based on findings.", "input": "57 year-old female with provided history of acute pancreatitis. Evaluate for gallstones. LIVER: The liver is normal in morphology without a discrete focal lesion or intra-hepatic biliary ductal dilatation. The parenchyma is slightly coarse in echotexture. There is normal hepatopetal portal venous blood flow. The velocity is slightly elevated at 54 cm/sec.GALLBLADDER, BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common bile duct measuring 5 mm. Normally distended gallbladder with a 5 mm shadowing gallstone. There is no gallbladder wall thickening or pericholecystic fluid.PANCREAS: Partially visualized pancreatic parenchyma is enlarged and decreased in echogenicity compatible with edema and acute pancreatitis. No parapancreatic fluid collection is visualized.RIGHT KIDNEY: The right kidney is normal in size, measuring 10.2 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident.OTHER: The spleen is normal in size, measuring 11.5 cm. The left kidney is normal in size, measuring 7.8 cm without hydronephrosis or shadowing calculus. There is a 9-mm hypoechoic lesion within the superior aspect of the kidney, incompletely characterized.", "output": "1. Cholelithiasis without evidence of acute cholecystitis.2. Coarsened hepatic echotexture may reflect parenchymal dysfunction.3. Edematous and enlarged partially visualized pancreas, compatible with acute pancreatitis.4. Incompletely characterized 9-mm left superior pole lesion."}
{"instruction": "Generate impression based on findings.", "input": "Mass in back of neck. Suspected lipoma. Prominent fat lobules are noted in the palpable area of concern, which may represent a lipoma or prominent atypical subcutaneous fat. No suspicious vascularity or mass is identified.", "output": "Prominent subcutaneous fat versus lipoma, without suspicious features."}
{"instruction": "Generate impression based on findings.", "input": "Enlarged thyroid seen on cervical MRI RIGHT LOBE MEASUREMENTS: 2.4 x 1.8 x 4.8 cmLEFT LOBE MEASUREMENTS: 2.6 x 1.5 x 5 cmISTHMUS MEASUREMENTS: 0.1 cmRIGHT LOBE: Subcentimeter benign-appearing colloid cyst.LEFT LOBE: 2 spongiform nodules. Lower pole nodule measures 1.8 x 1.3 x 2.3 cm. Mid pole nodule measures 0.8 x 0.5 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": "Two left thyroid spongiform nodules; favor benign etiology. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male with hepatitis B, HIV positive. Evaluate for hepatocellular carcinoma. LIVER: Normal in size and coarsely echogenic. No focal hepatic abnormality. GALLBLADDER, BILIARY TRACT: Gallbladder appears normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: Inadequately visualized due to bowel gas.RIGHT KIDNEY: Small cystOTHER: Small left renal cyst. Spleen normal in size.", "output": "No interval change. No evidence for hepatic mass."}
{"instruction": "Generate impression based on findings.", "input": "27-year-old female with palpable lump in the left breast found by her doctor. A targeted left ultrasound was performed for the palpable area of concern in the upper outer quadrant of the left breast. There is no solid or cystic mass identified. There is dense fibroglandular tissue in this area.", "output": "No sonographic evidence for malignancy in the left breast. Palpable abnormality in the upper outer quadrant of the left breast likely corresponds to dense fibroglandular tissue. Further evaluation of a clinically suspicious abnormality should not delayed by negative imaging. Rather, negative imaging may serve to reinforce a negative clinical impression. Therefore, continued clinical management is recommended.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Transaminitis LIVER: Numerous bilobar confluent mass lesions consistent with metastatic disease. Limited Doppler interrogation the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 19.7 cmBILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 13.8 cm in lengthRIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 12.1 cm in length OTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. Left kidney 13.6 cm in length. Mild ascites.", "output": "Numerous bilobar confluent hepatic mass lesions consistent with metastatic disease. Mild ascites.Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 44 y/o MDS, with increase ALK ,eval biliary tree, any cirrhosis? LIVER: The liver measures 18.5 cm in length, enlarged. Normal hepatic parenchymal echogenicity and echotexture. The portal vein is patent with normal directional hepatopedal flow, peak velocity 35.4 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. The gallbladder wall measures 1.9 mm. The common bile duct measures 3.2 mm. No intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: No significant abnormalities noted.KIDNEYS: The right kidney measures 12.0 cm in length. The left kidney measures 11.6 cm in length. Unremarkable renal parenchyma. No shadowing stones or hydronephrosis.OTHER: The spleen measures 15.0 cm in length, enlarged. No ascites.", "output": "1. Hepatosplenomegaly. No specific evidence of cirrhosis or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: Mildly echogenic liver without worrisome mass. Benign-appearing hepatic cysts. Liver length 16.1 cm.BILIARY TRACT: Gallbladder absent. No ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 10.7 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 12.1 cm in lengthOTHER: Left kidney 9.8cm in length. No ascites", "output": "Mildly echogenic liver suggestive for parenchymal dysfunction/chronic liver disease without worrisome mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs with abdominal pain LIVER: Normal parenchymal echogenicity without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 16.1 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 11.5 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 11.3 cm in lengthOTHER: Left kidney 10.4 cm in length. No ascites", "output": "Negative right upper quadrant abdominal ultrasound. No evidence for acute hepatobiliary abnormality. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old alcoholic cirrhosis of liver without ascites screen for HCC LIVER: Liver measures 17 cm, mild heterogenous echotexture with mild nodularity suggestive of cirrhotic morphology without any focal lesions. No intrahepatic delivery ductal dilatation.GALLBLADDER, BILIARY TRACT: Common bile duct measures up to 3 mm. The gallbladder is well distended without gallbladder wall thickening. No evidence of gallstones.PANCREAS: No significant abnormalities noted.KIDNEY: Right kidney measures 9 cm the left kidney measures 10 cm. No hydronephrosis or focal lesions. Previously described left renal stone is not seen on today's imagingOTHER: Spleen measures 11 cm without any focal lesions.", "output": "Cirrhotic morphology of the liver without any focal lesion. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "72 year old female with acute kidney injury. RIGHT KIDNEY: The right kidney measures 10.6 cm in length without hydronephrosis or shadowing calculus. There is a 3.2 x 8.3 x 3.3 cm inferior pole septated cyst. There is mild cortical thinning. LEFT KIDNEY: The left kidney measures 10.1 cm in length without hydronephrosis or shadowing cavus. There is a 7 mm inferior pole simple appearing cyst. There is mild cortical thinning. URINARY BLADDER: The urinary bladder is nearly completely contracted.", "output": "No hydronephrosis. Simple and minimally complex cysts as above."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant abdominal 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 8-10 mm gallstones noted, with a small amount of biliary sludge. No evidence of cholecystitis. 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 9.9 cm in length. The left kidney is 9 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9.2 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid is identified.", "output": "Cholelithiasis without cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Female; 51 years old. Reason: R/o mass v/s hernia History: Patient with gum ball size supraumbilical mass painful Superior to the umbilicus in the area of the patient's palpated abnormality is a fascial defect measuring approximately 0.9 x 0.7 cm transverse by AP. The hernia measures 3.4 x 1.0 x 2.1 cm and contains bowel and a small amount of free fluid. Peristalsis of the bowel is seen. There is no evidence of bowel wall thickening or dilation of the bowel loops.", "output": "Ventral wall hernia containing bowel without evidence of other complication."}
{"instruction": "Generate impression based on findings.", "input": "61 year old female with right upper quadrant pain. The patient was mildly tender to palpation during exam.LIVER: Findings of cholecystectomy. No biliary dilatation or other acute abnormality. Liver demonstrates subtle coarse echogenicity.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": "Findings of cholecystectomy, without acute abnormality. Mild epigastric tenderness during exam."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with history of bridging fibrosis. Evaluate for HCC. LIVER: Coarse echotexture of the liver measuring 18.5 cm in length. No focal hepatic lesions. The main portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. 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: Measures 9.7 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 11.5 cm in length. No hydronephrosis or shadowing calculi are noted.Normal echogenicity of the spleen measuring 9.7 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": "Male 58 years old Reason: aki History: aki. RIGHT KIDNEY: The right kidney measures 11.7 cm. There is no hydronephrosis or shadowing renal stones. The renal cortex is mildly hyperechoic.LEFT KIDNEY: The left kidney measures 11.9 cm. There is no hydronephrosis or shadowing renal stones. The cortex is mildly hyperechoic.OTHER: Bladder is incompletely distended. Diffuse sludge is incidentally noted within the gallbladder. Dedicated gallbladder imaging was not performed.", "output": "The renal cortex is mildly hyperechoic bilaterally consistent with medical renal disease. No hydronephrosis or shadowing stones."}
{"instruction": "Generate impression based on findings.", "input": "Jaundice with history of breast carcinoma LIVER: Extensive bilobar hepatic mass lesions consist with metastatic disease noted. A representative segment 8 lesion measures 3.2 x 3.4 cm. Liver length 16.8 cmGALLBLADDER, BILIARY TRACT: Minimal bilobar and hepatic ductal dilatation. Mildly prominent extrahepatic ductal dilatation with maximal CBD diameter of 0.7 cm. Gallbladder absent.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9 cm in lengthOTHER: Left kidney 11 cm in length. Spleen 10.4 cm in length. Trace ascites.", "output": "Extensive bilobar hepatic metastatic lesions. Minimal bilobar and extrahepatic ductal dilatation. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate cause of elevated LFTs History: elevated LFTs, acute myelogenous leukemia. LIVER: The liver measures 23.1 cm in length. The liver parenchymal echotexture is normal. There is a round, predominantly hyperechoic circumscribed lesion within the left lobe of the liver measuring 1.2 x 1.4 x 1.2 cm. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.26 m/s.BILIARY TRACT: The gallbladder appears contracted without evidence of cholelithiasis. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3.5 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 12.9 cm in length. RIGHT KIDNEY: Kidney measures 12.9 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 12.8 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: Bilateral pleural effusions.", "output": "1.Hepatomegaly.2.1.4 cm hyperechoic lesion within the left hepatic lobe which is nonspecific, but favor benign etiology such as a hemangioma.3.Pleural effusions. "}
{"instruction": "Generate impression based on findings.", "input": "FDG avid right thyroid nodule RIGHT LOBE MEASUREMENTS: 4.5 x 2.2 x 2.2 cmLEFT LOBE MEASUREMENTS: 4.5 x 1.9 x 1.7 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Multiple right thyroid nodules. The dominant midpole nodule in is solid and measures 1.9 x 1.4 x 1.9 cm. Spongiform upper pole nodule measures 0.8 x 0.5 x 0.8 cm. A hypoechoic spongiform nodule within the lower pole measures 1.2 x 2.8 x 0.7 cm.LEFT LOBE: Multiple subcentimeter nodules. Representative upper pole nodule measures 0.5 x 0.4 by 0.4 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple thyroid nodules bilaterally. The dominant solid nodule within the right thyroid gland corresponds to the FDG avid lesion on PET/CT. This nodule will be biopsied today."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female patient with thyroid cancer status post surgery. RIGHT LOBE: Status post thyroidectomy without recurrent tissue identified.LEFT LOBE: A hypoechoic nodule in the region of the left thyroid bed measures approximately 0.6 x 0.6 x 0.8 cm, previously 0.6 x 0.5 x 0.8 cm.ISTHMUS: An anteriorly located well-circumscribed isoechoic nodule within the left aspect of the isthmus measures approximately 1.2 x 0.7 x 1.5 cm, previously 1.1 x 0.7 x 1.4 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is an enlarged right level four lymph node measuring 1.5 x 1.2 x 2.4 cm, which has a fatty hilum.OTHER: No significant abnormality noted.", "output": "1. Status post thyroidectomy with stable postoperative changes.2. Stable isthmus nodule.3. Enlarged right level IV lymph node has a fatty hilum, however is new compared to the prior study; this is amenable to biopsy if clinically indicated. Findings communicated via e-mail to Dr Sarne."}
{"instruction": "Generate impression based on findings.", "input": "Female; 36 years old. Reason: cholecystitis? History: RUQ pain, tenderness, vomiting LIVER: Liver measures 18.7 cm in length. The liver contour is smooth, the parenchyma is normal in echogenicity. No worrisome masses identified.The main portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.3 m/sec.BILIARY TRACT: The gallbladder is normal in appearance. There is no cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The common duct measures 0.6 cm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas are normal in appearance. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 9.4 cm in length.RIGHT KIDNEY: The right kidney measures 10.7 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone. LEFT KIDNEY: The left kidney measures 10.7 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone.", "output": "Mild hepatomegaly but otherwise normal ultrasound right upper quadrant. Specifically there is no cholelithiasis, biliary ductal dilatation, or evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "47 years old, Male, Reason: r/o cause for renal failure History: renal failure RIGHT KIDNEY: Kidney measures 11.5 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. No hydronephrosis or shadowing calculus. Hypoechoic right lower pole renal cyst measures 1.7 x 1.7 x 1.5 cm. LEFT KIDNEY: The left kidney is very difficult to visualize due to patient's body habitus. Kidney measures 9.0 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. No hydronephrosis, shadowing calculus or mass. Left lower pole renal cyst measures 3.8 x 3.1 x 4 cm.Bladder: The bladder is nondistended.", "output": "1.Bilateral diffusely increased echogenicity of the kidneys consistent with medical renal disease.2.No evidence of hydronephrosis or shadowing calculus.3.Bilateral renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "Female 40 years old Reason: Patient with left sided fluid collection - please evaluate as she had the fluid collection drained this week History: fluid collection Diffuse subcutaneous edema is present within the superficial soft tissues. Within the abdomen there is a simple appearing 10.0 x 1.2 x 5.2 cm. Superficial to this simple appearing fluid collection there is a much smaller round anechoic fluid collection measuring 0.9 x 0.9 x 0.6 cm. Adjacent to the midline in the left lower quadrant there is a heterogeneous appearing fluid collection measuring 4.2 x 4.6 x 2.7 cm with complex internal echogenicity. This collection is nonspecific.", "output": "1.2 simple appearing fluid collections as above.2.Complex appearing fluid in the left lower quadrant is nonspecific. Interval follow-up imaging may be obtained if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "72 year old female with history of thyroid nodule. RIGHT LOBE MEASUREMENTS: 4.7 x 1.7 x 1.3 cmLEFT LOBE MEASUREMENTS: 5 x 1.9 x 1.7 cm ISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: There are several well-defined cystic and spongiform subcentimeter nodules. The largest measures 9 mm and is predominantly cystic. No specific suspicious sonographic features.LEFT LOBE: There are several well-defined cystic and spongiform nodules. The largest is a spongiform nodule with comet tail artifact reflecting colloid, measuring 1.3 cm.ISTHMUS: There is a 2.3 x 2.0 x 1.8 cm solid nodule extending from the inferior aspect of the isthmus without hypervascularity or microcalcifications. It is well defined and heterogeneous.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. 2.3 cm indeterminate solid inferior isthmus nodule. Given its size and hypermetabolism on PET an FNA should be considered.2. Multiple additional bilateral cystic and spongiform nodules."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Hendrix is a 76 year old female with known left breast cancer undergoing neoadjuvant chemotherapy. She presents for ultrasound evaluation to assess response. On physical examination, no discrete mass is palpated in the left upper inner quadrant.A targeted left ultrasound was performed at the site of the biopsy-proven cancer. The biopsy-proven cancer in the left breast 11:00 position, approximately 7 cm nipple, now measures 1.3 x 0.9 x 1.3 cm , previously measuring 2.0 x 1.8 x 2.2 cm). Biopsy clip is noted centrally within this mass.", "output": "Interval decrease in size of known cancer in the left breast. Patient should follow-up with her breast surgeon for further management. Results and recommendations were discussed with the patient.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old female with transaminitis. LIVER: Coarsely echogenic as previously noted but normal in size. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Gallbladder is collapsed without significant wall thickening. No cholelithiasis or pericholecystic fluid. Visualized biliary tract is normal in caliber.PANCREAS: Limited due to bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Both kidneys are within the pelvis. OTHER: No significant abnormalities noted.", "output": "No significant change. Echogenic liver. No biliary tract dilatation."}
{"instruction": "Generate impression based on findings.", "input": "45 year-old male with persistently mildly elevated LFTs. LIVER: The liver is coarse, echogenic with decreased through transmission, limiting evaluation for a focal lesion. Given this limitation, there is no focal lesion or intrahepatic biliary ductal dilatation. Liver measures 21.4 cm in craniocaudal dimension. Normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid, or focal tenderness. No extrahepatic biliary ductal dilatation with the common bile duct measuring 2 mm.PANCREAS: The suboptimally visualized pancreatic body and head are grossly unremarkable.SPLEEN: The spleen is mildly enlarged, measuring 14.1 cm in length.RIGHT KIDNEY: The right kidney measures 13.7 cm in length without hydronephrosis. OTHER: The left kidney measures 13.3 cm in length without hydronephrosis.", "output": "1. Hepatomegaly and findings compatible with severe diffuse fatty infiltration of the liver. 2. Mild splenomegaly. "}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. Personal history of benign right breast biopsy with pathology of fibroadenoma. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. In the right upper outer breast, approximately 9:30 location, there is an oval hypoechoic lesion identified measuring 1.8 x 0.9 cm. This corresponds in size and location to the biopsy-proven fibroadenoma identified on the mammogram from 2013. No solid or cystic mass is identified.", "output": "Right breast fibroadenoma. No sonographic evidence for malignancy. Of note, the patient's last screening mammogram was performed in 2013. She is now due for a bilateral screening mammogram. BIRADS: 2 - Benign.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Female; 52 years old. Reason: evaluate for cirrhosis History: chronic HCV LIVER: The liver measures 14.5 cm in length. The liver surface is smooth and the liver parenchyma demonstrates a normal echotexture. No suspicious mass is identified. There is no ascites.The main portal vein is patent and demonstrates normal direction of flow with a peak velocity of 20 cm/sec.BILIARY TRACT: The gallbladder is normal in appearance without cholelithiasis. The common duct measures 4 mm. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas appear normal. The pancreatic tail is obscured by overlying bowel gas.SPLEEN: 8.3 cm in length.RIGHT KIDNEY: Right kidney measures 10.8 cm in length. The renal parenchyma demonstrates normal echogenicity. There is no suspicious mass, hydronephrosis or shadowing stone. OTHER: The left kidney measures 9.8 cm in length. The renal parenchyma demonstrates normal echogenicity. There is no suspicious mass, hydronephrosis or shadowing stone.", "output": "No evidence of cirrhosis. No suspicious liver mass is identified."}
{"instruction": "Generate impression based on findings.", "input": "23-year-old with self palpated mass right breast 5 to 6 o'clock position for evaluation A targeted right ultrasound was performed for the palpable area of concern. On physical examination, normal dense glandular tissue noted. No discrete mass was palpated . Ultrasound demonstrated dense glandular tissue. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy, corresponding to patient's palpable area of concern right breast.Clinical correlation is recommended.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Female 76 years old; Reason: follow up US history of thyroid nodule History: follow up US history of thyroid nodule RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.6 x 2.0 x 1.7 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.7 x 2.6 x 1.8 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.13 cm.RIGHT LOBE: Multiple benign-appearing spongiform nodules all stable in size with the exception of one. There has been an interval increase in size of a mixed solid and cystic, predominantly cystic, lesion. It previously measured 5 cm x 5 cm and now measures 9 cm x 9 cm. There is peripheral vascularity but no definite microcalcifications.LEFT LOBE: Multiple benign-appearing nodules all stable in size in comparison to the prior study.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted. OTHER: No significant abnormality noted.", "output": "1.Multiple lesions throughout the thyroid all stable in size except slight increase of one right sided nodule as above.2.Overall increase of vascularity suggestive of possible underlying thyroiditis. Please correlate with laboratory values."}
{"instruction": "Generate impression based on findings.", "input": "Nontoxic goiter RIGHT LOBE MEASUREMENTS: 5.6 x 3.3 x 2 cmLEFT LOBE MEASUREMENTS: 5.2 x 2.1 x 2.1 cmISTHMUS MEASUREMENTS: 1.2 cmRIGHT LOBE: Benign-appearing predominantly cystic subcentimeter nodule measuring 0.8 x 0.5 x 0.6 cm.LEFT LOBE: Hypoechoic subcentimeter nodule inferior pole left thyroid gland measuring 0.6 x 0.7 x 0.6 cm associated with old colloid and coarse calcification.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral subcentimeter nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Epigastric pain LIVER: Normal parenchymal echogenicity without mass. Liver length 16.1 cm. Limited Doppler interrogation the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. Spleen 7.7 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. Right renal cyst. 9.3 cm in lengthOTHER: Left kidney 9.3 cm in length. No ascites. Bilateral pleural effusions.", "output": "Cholelithiasis without acute inflammation or ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Cysts RIGHT LOBE MEASUREMENTS: 5.5 x 2.2 x 2.0 cmLEFT LOBE MEASUREMENTS: 5.2 x 2.2 x 1.6 cmISTHMUS MEASUREMENTS: 5 mm in AP dimension.RIGHT LOBE: Few subcentimeter cystic and solid nodules identified. The largest cyst measures 11 mm. No suspicious features are identified. A spongiform soft tissue nodule measures 7 mm. LEFT LOBE: The left lobe is mildly heterogeneous with subcentimeter cysts, the largest of which measures 6 mm. No suspicious features are identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not identified.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "Multiple cystic and spongiform thyroid nodules, without suspicious features. "}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female with multiple palpable nodules over the lower extremities. Right lower extremity:Note is made of multiple compressible superficial vessels, corresponding to the patient's palpable area of concern. No focal mass lesions are identified.Left lower extremity:Note is made of multiple compressible superficial vessels, corresponding to the patient's palpable area of concern. No focal mass lesions are identified.", "output": "No focal mass lesions to correspond to the patient's palpable areas of concern. There are multiple compressible superficial vessels in the adjacent area. If clinical concern for superficial thrombophlebitis or deep venous thrombosis, further evaluation with dedicated venographic sonography is recommended."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old male patient evaluation for preheart transplant workup. Evaluate for intra-abdominal process. LIVER:The liver measures 17.0 cm in length and demonstrates increased, coarsened hepatic echotexture with prominent periportal echos. Scattered subcentimeter anechoic lesions with posterior acoustic enhancement within both hepatic lobes are consistent with cysts. GALLBLADDER, BILIARY TRACT: The gallbladder is not visualized on this examination. No intra or extrahepatic ductal dilatation is identified. The common duct measures 2 mm in diameter.PANCREAS: The pancreas is not visualized secondary to overlying bowel gas.SPLEEN: The spleen measures 9.9 cm in length.KIDNEYS: The right kidney measures 10.2 cm and the left kidney measures 11.7 cm in length. No evidence of hydronephrosis. ABDOMINAL AORTA: The abdominal aorta is normal in caliber. A catheter is noted within the aorta.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: The bladder is partially decompressed by a Foley catheter.", "output": "Coarsened hepatic echotexture with prominent periportal echoes; this appearance is nonspecific but has been described with hepatitis. Alternatively, prior CT demonstrates multiple cystic hepatic lesions likely representing biliary hematomas which might produce this appearance"}
{"instruction": "Generate impression based on findings.", "input": "73 year old female with ascites and AKI. Evaluate liver, vasculature and kidneys. LIVER: Large portion of the liver is occupied by a heterogeneous predominantly solid lesion measuring 9.4 cm x 7.1 cm x 9.1 cm. The main portal vein is patent with appropriate directional flow. Peak velocity measures 0.4 m/sec.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. Mild gallbladder wall thickening which is nonspecific in the setting of ascites. No pericholecystic fluid. Common duct measures 9 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Obscured by overlying bowel gas.SPLEEN: Normal echogenicity of the spleen measuring 11.2 cm in length.KIDNEYS: Right kidney measures 10.2 cm in length and is increased in echogenicity. Left kidney measures 10 .is an increase in length and is increased in echogenicity. No hydronephrosis or shadowing calculi are noted bilaterally.ABDOMINAL AORTA: Proximal aorta measures 2.4 cm x 2.4 cm. The mid aorta measures 1.8-cm x 1.4-cm.INFERIOR VENA CAVA: The visualized IVC is patent. OTHER: Moderate ascites.", "output": "1. Hepatomegaly with increased echogenicity suggestive of parenchymal dysfunction/fatty infiltration. Large heterogeneous mass corresponds to the lesion noted on CT and does not appear significantly changed. Main portal vein is patent.2. Increased echogenicity of the kidneys suggestive of nonspecific medical renal disease. No obstruction. 3. Moderate ascites.4. Mild gallbladder wall thickening which is nonspecific in the setting of ascites. No sonographic evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for change in thyroid nodules RIGHT LOBE MEASUREMENTS: 6.1 x 2.5 x 2.0 cm.LEFT LOBE MEASUREMENTS: 6.3 x 2.2 x 1.7 cm.ISTHMUS MEASUREMENTS: 0.9 cm.RIGHT LOBE: Heterogeneous nodules measuring up to 0.7 to 0.7 x 0.6 cm in the midpole, grossly stable.LEFT LOBE: Heterogeneous nodules measuring up to 0.9 x 0.6 x 0.6 cm in the lower pole, grossly stable.ISTHMUS: Nodules measuring up to 1.5 x 1.0 x 1.2 cm, grossly stable.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable appearance of multinodular goiter."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old male. Bilateral maxillofacial swelling, eyelid swelling. Evaluate for lymph node calcification or swelling? Neck masses? Edematous thickening of the subcutaneous tissues of the chin without a focal mass. Benign appearing normal-sized lymph node in the right upper neck. No lymphadenopathy.", "output": "Targeted area of site of swelling in the chin demonstrated subcutaneous edema without evidence of a focal mass or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "56 years old, Female, Reason: HBV evalaute for HCC History: HBV LIVER: The liver measures 12.0 cm in length. Mildly coarse echogenicity of the liver. Unchanged small right liver cyst measuring 5 mm. No evidence of nodularity to the liver. 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. Patient's known 4-mm polyp is unchanged in size and appearance. 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 8.4 cm in length. RIGHT KIDNEY: Kidney measures 10.0 cm in length. Normal echotexture. Nohydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 9.6 cm in length. Normal echotexture. Nohydronephrosis or shadowing calculus.OTHER: No significant abnormalities noted.", "output": "1.No evidence of cirrhosis or hepatic mass. 2.Unchanged right hepatic 5-mm cyst.3.Subcentimeter gallbladder polyp is unchanged in size and appearance."}
{"instruction": "Generate impression based on findings.", "input": "Male 65 years old Reason: assess for liver lesions History: HCV; advanced fibrosis LIVER: Coarse echotexture of the liver suggestive of chronic liver disease. No focal liver lesions.BILIARY TRACT: Cholelithiasis without sonographic evidence of cholecystitis or biliary dilatation.PANCREAS: Pancreas is not well seen 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": "Coarse echotexture of the liver. Cholelithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Bruce submitted outside mammograms dated 1/8/2015 and 3/8/2016, from Mercy Hospital. Submitted outside studies were compared to the current mammogram/ultrasound dated 11/4/2016. The breast parenchyma is composed of scattered fibroglandular density (BiRads Density Category B), unchanged in pattern and distribution. Previously identified mass in the right lateral breast (2:30 location) and left upper outer breast (1:00 location) are stable when compared to prior mammograms dating back to 2015.There is no significant change between these studies.", "output": "Bilateral stable benign morphology masses. 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: NSB - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old male. Abnormal LFTs. Evaluate for obstruction. LIVER: Normal echogenicity and echotexture the liver. The liver is 12 cm in length. No focal hepatic mass. Hepatoportal venous flow.GALLBLADDER, BILIARY TRACT: No biliary ductal dilatation. Common duct is 3 mm, within normal limits. Gallbladder sludge. Trace pericholecystic fluid, nonspecific in presence of ascites. Patient is not tender over the gallbladder.PANCREAS: Visualized pancreatic head is normal in echogenicity. Remainder of the pancreas is obscured by bowel gas.RIGHT KIDNEY: Right kidney is than 20 cm in length and has a cyst. No hydronephrosis.OTHER: Large bilateral pleural effusions. Trace perisplenic fluid.", "output": "No biliary ductal dilatation. Gallbladder sludge with trace pericholecystic fluid, nonspecific in presence of ascites. Large bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old female with history of cholecystectomy, outside ultrasound showing biliary dilation. LIVER: Mild intrahepatic biliary ductal dilation. No focal hepatic lesions identified.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. Marked dilation of the common bile duct measuring up to 1.4 cm. No choledocholithiasis or discrete mass lesions are identified in the field of view of the examination. PANCREAS: The pancreatic body and tail are obscured by bowel gas. The visualized portions of the pancreas appear within normal limits. KIDNEY: No significant abnormalities noted.OTHER: 1.3 x 0.7 cm nonspecific peripancreatic lymph node.", "output": "Dilated common bile duct up to 1.4 cm and mild intrahepatic ductal dilation are somewhat greater than expected following cholecystectomy. Consider MRCP for further evaluation as warranted clinically. "}
{"instruction": "Generate impression based on findings.", "input": "Septic shock. Elevated alkaline phosphatase. LIVER: Non-cirrhotic liver morphology. Innumerable metastatic lesions are again noted. 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: Status post right nephrectomy. The left kidney is 12.8 cm in length with simple appearing cysts, measuring up to 3.3 cm.. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 11 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. Bilateral pleural effusions. Small amount of ascites identified.", "output": "1. No specific findings to account for the patient's septic shock. 2. Small amount of ascites and bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Reason: RUQ pain, rule out GB stone, pancreatitis LIVER: Coarse, heterogeneous liver echotexture, consistent with parenchymal dysfunction/hepatic steatosis. The liver measures 16.6 cm in length. The portal vein is patent with normal portal venous hepatopedal blood flow, maximum flow 31.6 cm/s. No nodules or masses.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. The proximal common bile duct measures 0.2 cm. The gallbladder wall measures 0.2 cm. No biliary ductal dilatation. No stones within the gallbladder or evidence of cholecystitis.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.8 cm in length. No hydronephrosis.LEFT KIDNEY: The left kidney measures 10.7 cm in length. No hydronephrosis.SPLEEN: The spleen measures 12.0 centers in length.OTHER: No significant abnormalities noted. No ascites.", "output": "Findings consistent with hepatic parenchymal dysfunction or hepatic steatosis. No findings to support cholelithiasis or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: splenomegaly-evaluate liver, spleen and portal flow. LIVER: The liver measures 19.3 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 0.19 m/s.BILIARY TRACT: Gallbladder surgically absent. Mild prominence of the common bile duct measuring up to 10 mm, not unexpected status post cholecystectomy. No intrahepatic biliary ductal dilatation.PANCREAS: Obscured by bowel gas.SPLEEN: The spleen is enlarged measuring 16.3 cm in length.RIGHT KIDNEY: Kidney measures 12.2 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 13.2 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No ascites.", "output": "1.Mild hepatomegaly. Increased hepatic echogenicity suggestive of parenchymal dysfunction/fatty infiltration. No ascites.2.Mild prominence of the common bile duct which is not unexpected status post cholecystectomy. "}
{"instruction": "Generate impression based on findings.", "input": "Status post liver transplant for hepatitis B with recurrent hepatitis B virus LIMITED ABDOMENLIVER: Status post liver transplant; no hepatic lesion. Liver length 15.5 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 13.1 cm in lengthRIGHT KIDNEY: Right renal cyst. Right kidney 10.2 cm in lengthOTHER: Left kidney 10.6 cm in length. No ascites.", "output": "Status post renal transplant without mass or ductal dilatation. No ascites. Patent hepatic vasculature with normal directional flow."}
{"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 mass or suspicious finding identified.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Male; 61 years old. Reason: History of hepatitis C. Please evaluate for hepatocellular CA. History: As above LIVER: The liver measures 16.5 cm in length. The liver contour is smooth. The parenchyma is diffusely increased in echogenicity with a coarsened echotexture. No worrisome mass is identified. There is no ascites.The main portal vein is patent with hepatopetal flow and a peak velocity of 0.23 m/sec.BILIARY TRACT: The gallbladder is nondistended. Multiple shadowing stones are seen within the gallbladder. There is no gallbladder wall thickening or pericholecystic fluid. The common duct measures 3 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreas is not well visualized due to overlying bowel gas.SPLEEN: The spleen measures 12.2 cm in length.RIGHT KIDNEY: The right kidney measures 11.7 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis, shadowing renal stone, or worrisome mass identified. OTHER: The left kidney measures 10.8 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis, shadowing renal stone, or worrisome mass identified.", "output": "1.Coarse and echogenic liver compatible with parenchymal dysfunction. No worrisome hepatic lesion.2.Cholelithiasis without ultrasound evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Recurrent UTIs RIGHT KIDNEY: Echogenic renal parenchyma. No worrisome mass. Benign renal cyst. Multiple subcentimeter nonobstructing stones. Right kidney 9.1 cm in lengthLEFT KIDNEY: Echogenic renal parenchyma without worrisome mass. Benign renal cyst. Multiple subcentimeter nonobstructing stones. Left kidney 8.7 cm in length.OTHER: Bladder nondistended", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass or hydronephrosis. Multiple bilateral subcentimeter nonobstructing renal calculi."}
{"instruction": "Generate impression based on findings.", "input": "Male 57 years old Reason: 57 y/o M with pancreatitis eval for biliary stone History: belly pain LIVER: Liver is normal in appearance measuring 15.8 cm. No focal hepatic masses. No perihepatic fluid. Main portal vein is patent with normal directional flow and a peak velocity 23.5 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. No evidence of acute inflammation of the gallbladder. Gallbladder wall measures 1 mm. No gallstones. There is a small gallbladder polyp which measures 0.3 x 0.2 x 0.4 cm. Common bile duct is nondilated measuring 4 mm. No evidence of choledocholithiasis.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 7.9 cmKIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 10.3 cm. Left kidney measures 10.4 cm. OTHER: No significant abnormalities noted.", "output": "1.No evidence of choledocholithiasis as clinically questioned.2.Small, subcentimeter gallbladder polyp."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female with metastatic medullary thyroid carcinoma RIGHT LOBE MEASUREMENTS: 5.4 x 2.0 x 1.8 cmLEFT LOBE MEASUREMENTS: 6.0 x 2.8 x 2.6 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Heterogeneous hypoechoic mass with calcifications and ill-defined margins in the left thyroid lobe measures approximately 4.1 x 3.3 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Unilateral left cervical lymphadenopathy in stations II-IV. The largest lymph node in the level III station measures 2.5 x 2.8 x 1.8 cm and contains calcifications.OTHER: No significant abnormality noted.", "output": "Left thyroid mass and bulky left lymphadenopathy as described above is consistent with the patient's known malignancy. "}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female patient with multiple thyroid nodules. Assess thyroid nodules. RIGHT LOBE MEASUREMENTS: 5.1 x 1.7 x 1.8 cm.LEFT LOBE MEASUREMENTS: 4.4 x 1.4 x 1.4 cm.ISTHMUS MEASUREMENTS: 4 mm in thickness.RIGHT LOBE: There is a solid hypoechoic nodule measuring 0.9 x 0.5 x 0.7 cm within the inferior pole of the right thyroid lobe.LEFT LOBE: There is a well-circumscribed, hypoechoic solid nodule measuring 1.3 x 0.9 x 1.6 cm inferior to the left thyroid lobe which may be exophytic in nature or external to the gland.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: See above.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Subcentimeter right thyroid nodule.2. Hypoechoic solid nodule inferior to the left thyroid lobe which could represent an exophytic nodule or possibly a parathyroid adenoma; correlate with calciums levels/nuclear medicine scan if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Mass on the back with back pain Ultrasound shows an ill-defined hypoechoic area that measures 1.9 x 2.1 x 1.2 cm in the subcutaneous tissue involving the dermis without peripheral blood flow which could represent an infected sebaceous cyst or epidermal inclusion cyst.", "output": "Superficial hypoechoic subcutaneous lesion involving the dermis which could represent an infected sebaceous cyst or epidermal inclusion cyst. Clinical correlation is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Status post resection hepatic hemangioma with high drain output LIMITED ABDOMENLIVER: Status post resection right lobe hemangioma. Extensive overlying gas obscures much of remains of the right lobe of the liver. No focal parenchymal mass BILIARY TRACT: Status post cholecystectomy. No ductal dilatation RIGHT KIDNEY: No significant abnormalities noted.OTHER: No perihepatic fluid collection or hematoma. Trace ascites", "output": "Status post resection of hemangioma. No worrisome hepatic mass or perinephric fluid collection or hematoma. Trace ascites. Patent hepatic vessels with normal directional flow."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old male with recurrent hyperparathyroidism after two prior parathyroid operations. Status post partial thyroidectomy. Please evaluate for adenoma. RIGHT LOBE MEASUREMENTS: Again seen are changes consistent with the patient's history of right lobe thyroidectomy. There is interval development of a focus of hypoechoic tissue in the right thyroid bed, measuring 1.5 x 0.9 x 1.1 cm. LEFT LOBE MEASUREMENTS: 2.9 x 1.4 x 1.6 cmISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: Again seen are changes consistent with the patient's history of right lobe thyroidectomy. There is interval development of a focus of heterogenous but predominately hypoechoic tissue with internal vascularity in the right thyroid bed, measuring 1.5 x 0.9 x 1.1 cm. Additionally, note is made of an round, hypoechoic focus along the inferior margin of the right thyroid bed, measuring 6 x 4 x 4 mm without internal vascularity.LEFT LOBE: The left lobe is again noted to be diffusely heterogeneous and lobulated, appearing slightly decreased in size when compared to the prior study.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Note is made of an round, hypoechoic focus along the inferior margin of the right thyroid bed, measuring 6 x 4 x 4 mm without internal vascularity.LYMPH NODES: Normal appearing right level IV cervical lymph nodes are identified.OTHER: No significant abnormality noted.", "output": "Heterogenous left lobe of the thyroid with interval development of a 6 mm hypoechoic focus along the inferior margin of the surgical bed of the right lobe of the thyroid gland which may represent a parathyroid adenoma candidate. Further evaluation with a parathyroid nuclear medicine scintigraphic examination could be considered if clinically indicated. "}
{"instruction": "Generate impression based on findings.", "input": "History of right upper quadrant pain. No reported history of chronic liver disease. LIVER: The liver is normal in morphology, size and echogenicity, measuring 15 cm in length. The liver capsule is smooth. No intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 39 cm/s.Note is made of a 1.0 x 0.9 x 0.8 cm echogenic lesion without a surrounding halo, statistically likely a benign hemangioma in the absence of chronic liver disease.BILIARY TRACT: Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid, or focal tenderness. No extrahepatic biliary ductal dilatation with the common duct measuring 3 mm.PANCREAS: The visualized pancreatic head and body is unremarkable. The remainder the pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 8.5 cm in length without a focal lesion.RIGHT KIDNEY: The right kidney measures 10.4 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow. The renal cortex is mildly echogenic. OTHER: The left kidney measures 10.8 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Note is made of prominent renal sinus fat and mild cortical echogenicity. Color Doppler demonstrates hilar blood flow.", "output": "No specific findings to account for the patient's right upper quadrant pain.1 cm right hepatic lobe echogenic lesion statistically likely represents a benign hemangioma in the absence of chronic liver disease.Findings suggestive of medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female presents with localized swelling of her neck. There is a clinical concern for goiter. RIGHT LOBE MEASUREMENTS: 2.3 x 1.8 x 4.0 cm.LEFT LOBE MEASUREMENTS: 1.8 x 1.3 x 4.5 cm.ISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: There is an approximately 1.9 x 1.7 x 2.1 cm spongiform nodule; favor benign etiology. Otherwise, the parenchyma appears normal and homogenous.LEFT LOBE: There is approximately 0.9 x 0.8 x 1.1 cm spongiform nodule that appears similar to the nodule in the right lobe. Favor benign etiology. Otherwise, the parenchyma appears normal homogenous.ISTHMUS: Normal and homogenous appearing parenchyma.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing lymph nodes are noted bilaterally.OTHER: No significant abnormality noted.", "output": "1. Bilateral spongiform nodules as above; favor benign etiology."}
{"instruction": "Generate impression based on findings.", "input": "78-year-old male presents with abdominal pain. There is clinical concern for mesenteric ischemia. LIVER:Measures 15.0 cm. Coarse echotexture of liver. No 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. The wall measures 2.0 mm. No pericholecystic fluid, stones, or sludge. Common bile duct measures 2.9 mm.PANCREAS: Evaluation the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 9.6 cm without sonographic abnormalities.KIDNEYS: Right kidney is 11.7 cm. Left kidney is 12.1 cm. Kidneys are mildly echogenic bilaterally. No hydronephrosis, shadowing calculi, or focal mass. TECHNIQUE: Doppler flow images were obtained on abdominal vasculature.ABDOMINAL AORTA: Patent without aneurysm.OTHER: The celiac artery is patent with peak systolic velocity at 223.1 cm/s. The resistive index is 0.71.The superior mesenteric artery is patent with peak systolic value 172.0 cm/s. The resistive index is 0.83.The inferior mesenteric artery is shadowed out by bowel gas and not evaluated on this study.", "output": "1. Coarse echotexture of liver consistent with chronic liver disease/parenchyma dysfunction. No mass or ascites.2. Echogenic kidneys consistent with medical renal disease/parenchymal dysfunction. No hydronephrosis.3. Aorta without evidence of aneurysm. Celiac artery and SMA are patent as above. IMA inadequately evaluated on this study."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Palmer is a 41-year-old female with history of high probability benign morphology mass in the right breast was originally recalled from screening of 01/20/16, presenting for her follow-up exam. Three standard views of the right breast and two additional 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. Again seen is a circumscribed subcentimeter mass in the right retroareolar region, without associated calcifications. In addition, a triangular marker is placed at the site of palpable abnormality in the right lower outer breast. Underlying this marker are several partially obscured circumscribed masses, which appear similar to prior examinationsUltrasound was subsequently performed.ULTRASOUND", "output": "Benign cysts in the palpable area of concern in the right breast and a cluster of microcysts in the right breast in the mammographic area of concern. No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 6 months in order to ensure stability of these findings. Results and recommendation 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": "44-year-old female with history of asymptomatic angiomyolipoma. RIGHT KIDNEY: Measures 12.4 cm in length. Increased renal echogenicity. Hyperechoic lesion in the superior pole of the right kidney measures 5.1 x 3.7 x 6.5 cm, previously 4.0 x 3.4 x 4.3 cm.LEFT KIDNEY: Measures 12.4 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.", "output": "1.Interval increase in size of right renal angiomyolipoma. The lesion meets size criteria for interventional radiology consultation and possible embolization.2.Increased renal echogenicity consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male presents with transaminitis. LIVER:The liver measures 20.2 cm. There is increased and coarse echogenicity of the liver. No masses or ascites. No intrahepatic biliary dilation. The portal vein is patent with hepatopedal flow measured with peak velocity at 16.6 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended. An echogenic foci within the gallbladder is thought to represent a gallstone. Gallbladder wall measures 0.2 cm. Common bile duct measures 0.7 cm. No pericholecystic fluid. Negative sonographic Murphy's sign.PANCREAS: Evaluation of pancreas is limited due to overlying bowel gas.SPLEEN: The spleen measures 8.5 cm. No abnormalities are noted.KIDNEYS: The right kidney measures 11.5 cm. The cortex has normal echogenicity. No shadowing calculi or hydronephrosis. Left kidney measures approximately 11.1 cm. The cortex has normal echogenicity. No no shadowing calculi or hydronephrosis. OTHER: No significant abnormality noted.", "output": "1. Coarse and echogenic liver consistent with chronic liver disease/parenchymal dysfunction.2. Hepatomegaly without masses or ascites.3. Cholelithiasis without signs of acute inflammation."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old male presents for HCC surveillance with history of HBV. LIVER: The liver morphology is normal and the capsule is smooth. The liver parenchyma is echogenic. It is normal in size, measuring 16 cm in craniocaudal dimension. There is no focal hepatic lesion or biliary ductal dilatation. Normal hepatopetal portal venous blood flow is present at 40 cm/sec.GALLBLADDER, BILIARY TRACT: Normally distended gallbladder without evidence of inflammation. The common duct is normal in caliber, measuring 5 mm.PANCREAS: The visualized portions of the pancreas are normal in appearance.RIGHT KIDNEY: The right kidney is normal in size, measuring 10.5 cm without hydronephrosis. The left kidney is normal in size, measuring 12.1 cm without hydronephrosis.OTHER: The spleen is normal in size, measuring 10.4 cm.", "output": "Echogenic hepatic parenchyma, compatible with diffuse fatty infiltration. No focal hepatic lesion or stigmata of cirrhosis."}
{"instruction": "Generate impression based on findings.", "input": "Nonspecific elevation of levels of transaminases and lactic acid dehydrogenase, screen for fatty liver LIVER: Liver measures 15.9 cm with mild to moderate hepatic steatosis. No focal liver lesions noted. No intrahepatic ductal dilatation. Portal vein demonstrates normal flow directionality and patency.GALLBLADDER, BILIARY TRACT: Gallbladder is well distended with normal gallbladder wall thickness. No evidence of gallstones.PANCREAS: No visualization of pancreas due to overlying bowel gas.RIGHT KIDNEY: Right kidney measures 11.8 cm and left kidney measures 12.3 cm. No hydronephrosis or hydroureter. Normal echotexture noted.OTHER: No ascitesSpleen measures 13.4 cm with normal echotexture.", "output": "Mild to moderate hepatic steatosis without any focal lesions.No ascitesLimited visualization of the pancreas due to overlying bowel gas."}
{"instruction": "Generate impression based on findings.", "input": "86-year-old female with abdominal pain after eating. Evaluate for gallstones. LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: Mild gallbladder sludge but no cholelithiasis or evidence of cholecystitis. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.KIDNEY: Atrophic echogenic kidneys consistent with chronic medical renal disease. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.No evidence of cholelithiasis or cholecystitis.2.Atrophic echogenic kidneys consistent with chronic medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Right middle and lower abdominal pain, assess for ventral hernia. Intact abdominal wall at the region of the sonographic evaluation in right mid/lower abdomen, with no evidence of fascial defect.", "output": "No fascial defect to suggest abdominal wall hernia."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female patient with right breast asymmetry on screening mammogram. History of two benign left breast biopsies in 2002 and 2003. Family history of breast cancer in paternal aunt diagnosed at unknown age. RIGHT DIAGNOSTIC MAMMOGRAM: An ML 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, unchanged in pattern and distribution. A 6-mm oval mass in the right lower inner breast persists on spot compression views.RIGHT BREAST ULTRASOUND: Targeted right breast ultrasound was performed. In the 5 o'clock position of the right breast 1 cm with from the nipple there is a septated cyst that measures 5 x 2 x 5 mm.", "output": "5 mm benign morphology mass in the right breast possibly corresponding to a benign septated cyst on ultrasound. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with bladder cancer and impaired renal function. RIGHT KIDNEY: The right kidney measures 11.5 cm in length without hydronephrosis or discrete lesion evident. There is an echogenic shadowing focus in the interpolar region without a recent CT correlate which may be a nonobstructing stone but is nonspecific. LEFT KIDNEY: The left kidney measures 11.2 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident.URINARY BLADDER: The urinary bladder is contracted around a Foley catheter.", "output": "No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "1-year-old female with thyromegaly and subclinical hyperthyroidism. RIGHT LOBE MEASUREMENTS: 5.5 x 1.8 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.7 x 2.1 x 1.6 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Diffusely heterogeneous in echotexture with small hypoechoic area in the upper pole measuring 0.4 x 0.5 x 0.6 cm which is not specific in appearance.LEFT LOBE: Diffusely heterogeneous in echotexture with ill-defined focal region in the mid left lobe which has a spongiform type appearance..ISTHMUS: Heterogeneous in echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There are prominent but morphologically normal lymph nodes in the neck bilaterally. Patient complains of upper respiratory infection.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous thyroid with small right nodule and ill-defined , spongiform appearing left nodule."}
{"instruction": "Generate impression based on findings.", "input": "Palpable painful left breast mass. History of prior left breast benign biopsy. Physical examination in the patient's area of concern revealed a subcentimeter nodule in the left breast at the 11:00 position 3 cm in the nipple, with tenderness to palpation. No associated skin changes were noted.A targeted left ultrasound was performed in this area, demonstrating a round 4 x 3 x 4 mm hypoechoic lesion with well-defined margins and foci of internal vascularity.", "output": "Indeterminate 4 mm lesion with internal vascularity in the left breast. Ultrasound-guided biopsy is recommended. Findings and recommendation were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess for liver disease History: elevated AST and ALT LIVER: Mildly increased hepatic echogenicity. 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: Layering gallbladder sludge without shadowing gallstones. 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 12.9 cm in length. RIGHT KIDNEY: Kidney measures 10.3 cm in length. Normal echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.9 cm in length. Normal echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Mildly increased hepatic echogenicity suggestive of fatty infiltration/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury. RIGHT KIDNEY: The right kidney measures 9.4 cm in length without hydronephrosis, shadowing nephrolithiasis or suspicious lesion. The renal cortex is echogenic. Perihepatic and perirenal ascites.LEFT KIDNEY: The left kidney measures 10.0 cm in length without hydronephrosis, shadowing nephrolithiasis or suspicious lesion. Note is made of a 5 cm simple appearing inferior pole cyst. The renal cortex is echogenic. Perirenal ascites.URINARY BLADDER: The urinary bladder is partially distended with diffuse smooth wall thickening.OTHER: At least moderate volume ascites. Heterogeneous/coarsened liver echotexture and splenomegaly suggested, partially imaged.", "output": "No hydronephrosis. Partially distended urinary bladder may account for the mild diffuse wall thickening.Echogenic kidneys compatible with medical renal disease.Moderate volume ascites.Heterogeneous/coarsened liver echotexture and splenomegaly suggested, partially imaged.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Elevated lipase and abdominal pain. Slightly limited by body habitus.LIVER: The liver is coarse and increased in echogenicity. It measures 11.9 cm in craniocaudal dimension. No focal lesion is evident. No intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 22 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation with the common duct measuring 4 mm.Partially contracted gallbladder containing sludge and small shadowing gallstones. No gallbladder wall thickening, pericholecystic fluid or focal tenderness.PANCREAS: The pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 5 cm and is poorly visualized otherwise.RIGHT KIDNEY: The right kidney measures 11.6 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. OTHER: The left kidney measures 10.8 cm without hydronephrosis, shadowing nephrolithiasis or discrete lesion.", "output": "1. Cholelithiasis without evidence of acute cholecystitis.2. Coarse and increased liver echogenicity suggestive of diffuse fatty infiltration.3. No biliary ductal dilatation. The pancreas is obscured by overlying bowel gas."}
{"instruction": "Generate impression based on findings.", "input": "24-year-old female with personal history of right breast carcinoma with axillary lymph node involvement, status post right lumpectomy and sentinel lymph node biopsy in October 2014 for invasive ductal carcinoma, presents for right axillary ultrasound for physician palpated right axillary lymph node. Patient complains of right axillary tenderness. A targeted right axillary ultrasound was performed for the palpable area of concern. A single normal morphology right axillary lymph node is appreciated with normal hilar flow, measuring 0.6 x 0.4 x 0.5 cm. No abnormal solid or cystic mass is identified.", "output": "Single normal morphology right axillary lymph node. No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female with chronic kidney disease. Ultrasound guidance was provided for biopsy of the right kidney.", "output": "Ultrasound guidance."}
{"instruction": "Generate impression based on findings.", "input": "Reason: further assessment of liver heterogeneity seen on CT imaging History: CT imaging findings LIVER: The liver measures 15.9 cm in length. The background liver parenchymal echotexture is normal. Corresponding to the area of hypoattenuation in hepatic segment 6 on the recent CT, there is a somewhat geographic area of increased echogenicity measuring 2.2 x 1.6 x 2.6 cm. No additional focal hepatic lesions are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 21.9 m/s.BILIARY TRACT: There is no evidence of cholelithiasis or pericholecystic fluid. Mild focal gallbladder wall thickening may reflect adenomyomatosis. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 6 mm in diameter.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.The spleen measures 10.8 cm in length. RIGHT KIDNEY: Kidney measures 11.4 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 11.3 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "Nonspecific hyperechoic area within hepatic segment 6 corresponding to area of hypoattenuation on recent CT. Top differential considerations include focal fat deposition or hemangioma in the absence of known underlying malignancy. If further characterization is desired, MRI could be considered as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "15-year-old male complains of swelling in the left pectoral region. Left nipple areolar complex is asymmetric in comparison to the right. No abnormal fluid collections. No mass.", "output": "Left nipple areolar complex asymmetry without mass or abnormal fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male with prior thyroidectomy. Evaluate for recurrent neoplasm. 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: At the 1B level bilaterally there are prominent lymph nodes with fatty hila. Although one of the left nodes is somewhat lobulated, the appearance is suggestive of reactive/inflammatory adenopathy. Previously noted right level 2 node is not identified.] The right level 1B node appears similar. Other nodes were not demonstrated on prior exam.OTHER: No significant abnormality noted.", "output": "No evidence for local recurrence in the bed.Prominent 1B nodes bilaterally likely reactive."}
{"instruction": "Generate impression based on findings.", "input": "Alcohol dependence with withdrawal; history fatty liver LIVER: Coarse echogenic liver echotexture without mass. Liver length 17.5 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right renal cyst. 12.6 cm in lengthOTHER: Left kidney 13.3 cm in length. Spleen 11 cm in length. No ascites.", "output": "Coarse echogenic liver consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "29 year old female with right upper quadrant pain. LIVER: Normal echogenicity of the liver measuring 16.1 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate directional flow.BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are normal echogenicity.SPLEEN: Normal echogenicity of the spleen measuring 11.9 cm in length.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 12.1 cm in length. No hydronephrosis or shadowing calculi are noted. OTHER: Normal echogenicity of the left kidney measuring 11.6 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "Unremarkable examination."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Known bilobar metastasis not well appreciated on the ultrasound. Liver length 13.1 cmGALLBLADDER, BILIARY TRACT: Diffuse abnormal gallbladder wall thickening and trace pericholecystic fluid associated with gallstones and positive Murphy sign. Mild bilobar intrahepatic ductal dilatation associated with extrahepatic ductal dilatation. Common bile duct diameter 1.1 cm.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right kidney 10.9 cm in lengthOTHER: Left kidney 10.6 cm in length. No ascites.", "output": "Diffuse abnormal gallbladder wall thickening and trace pericholecystic fluid associated with gallstones and positive Murphy sign. Findings consistent with acute cholecystitis. Associated with mild bilobar intrahepatic ductal dilatation and moderate extrahepatic ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old female patient with bilateral thyroid nodules. RIGHT LOBE MEASUREMENTS: 8.6 x 4.2 x 3.5 cm.LEFT LOBE MEASUREMENTS: 10.2 x 3.5 x 3.4 cm.ISTHMUS MEASUREMENTS: 8 mm in thickness.RIGHT LOBE: The right thyroid lobe is enlarged and heterogeneous in echogenicity. There is a 3.0 x 2.6 x 3.1 cm complex, heterogeneous, mostly solid nodule with the right mid lobe.LEFT LOBE: The left thyroid lobe is enlarged and heterogeneous in echogenicity, predominantly within the lower pole. No discrete measurable nodule is identified within this large area of heterogeneity.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. "}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female presents for follow-up evaluation for neoadjuvant chemotherapy of the biopsy-proven cancer in the left breast. A left breast ultrasound was performed at the area of proven cancer at the 11:00 position, 3 cm from the nipple. The known cancer measures 11 x 7 x 12 mm (previously 14 x 10 x 12 mm). Increased blood flow within the mass is present.", "output": "Decrease in size of the proven left breast cancerBIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Gallbladder activity on PET done for lymphoma staging-evaluate for inflammation vs solid mass. Asymptomatic. LIVER: The liver measures 15.7 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 0.2 m/s.BILIARY TRACT: No cholelithiasis. Gallbladder mildly contracted which somewhat limits evaluation, but no abnormal gallbladder wall thickening identified; visualized lumen unremarkable. 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 7.1 cm in length. RIGHT KIDNEY: Limited visualization. Kidney measures 8.5 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.1 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "No evidence of acute cholecystitis or abnormal gallbladder wall thickening."}
{"instruction": "Generate impression based on findings.", "input": "40 year-old male with renal failure and proteinuria. Ultrasound guidance was provided for biopsy of native right kidney.", "output": "Ultrasound guidance."}
{"instruction": "Generate impression based on findings.", "input": "49 year old female with history of right upper quadrant pain after meals. Please evaluate gallbladder. LIVER: No significant abnormalities noted. The liver measures 19 cm in length.BILIARY TRACT: Cholelithiasis, without gallbladder wall thickening or pericholecystic fluid to suggest cholecystitis. No biliary dilatation.PANCREAS: No significant abnormalities noted. There is an approximately 3 x 2 x 1 cm hypoechoic focus near the head of the pancreas, nonspecific and likely representing a lymph node.SPLEEN: No significant abnormalities noted. The spleen measures 8 cm in length.RIGHT KIDNEY: No significant abnormalities noted. The right kidney measures 11.7 cm.OTHER: No significant abnormalities noted. The left kidney measures 10 cm.", "output": "Cholelithiasis, without findings of cholecystitis. Small lymph node near the head of the pancreas, nonspecific."}
{"instruction": "Generate impression based on findings.", "input": "Male, 72 years old. S/p cystectomy+ileal conduit now with acute renal failure. RIGHT KIDNEY: The right kidney measures 12.2 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.2 cm in length, with increased cortical echogenicity. Slight left renal pelvic fullness. No hydronephrosis or shadowing stones.OTHER: The urinary bladder is surgically absent.", "output": "Increased renal cortical echogenicity, compatible with medical renal disease or parenchymal dysfunction. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old female with thrombocytopenia. History of alcohol abuse LIVER: Liver is again noted to be coarsely echogenic, little change from prior exams. Liver is normal in size. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein. GALLBLADDER, BILIARY TRACT: Previously identified small gallstone not visualized on today's exam. No wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: Limited by bowel gasRIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Coarsely echogenic liver without change.Gallstone not identified on today's study."}
{"instruction": "Generate impression based on findings.", "input": "Female; 23 years old. Reason: 23yoF T1DM with Cr 3.0, unclear if AKI on CKD or baseline CKD, p/w flank pain History: as above RIGHT KIDNEY: The right kidney measures 9.1 cm. The renal cortex is echogenic. There is no hydronephrosis, shadowing renal stone, or worrisome mass.LEFT KIDNEY: The left kidney measures 9.1 cm. The renal cortex is echogenic. There is a hydronephrosis, shadowing renal stone, or worrisome mass.URINARY BLADDER: The bladder is nondistended.OTHER: No significant abnormalities noted.", "output": "Echogenic kidneys compatible with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Assess for stability in size of nodules, unable to biopsy, as on Plavix History: see above RIGHT LOBE MEASUREMENTS: 4.7 x 1.5 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.9 x 1.9 x 1.7 cmISTHMUS MEASUREMENTS: 0.2 cm in the AP dimensionRIGHT LOBE: Hypoechoic spongiform nodule in the right mid pole measures 0.7 x 0.6 x 0.6 cm, previously 0.7 x 0.6 x 0.7 cm, stable in size and appearance.Mixed cystic and solid in the inferior pole measures 1.6 x 0.6 x 0.9 cm, previously 1.9 x 0.9 x 1 cm, stable in size and appearance.No new nodules or masses.LEFT LOBE: Previously described as two separate nodules, the mixed cystic and solid lesions with small calcified focus in the mid pole have not changed in size or appearance and measure as a whole 3.5 x 2.5 x 1.7 cm, previously measured at 2.0 x 0.6 x 1.5 cm and 2.1 x 2.1 1.9 cm.No new nodules or masses.ISTHMUS: No new nodules or masses.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Several benign appearing nonenlarged cervical lymph nodes.OTHER: No significant abnormality noted.", "output": "No significant interval change in size and morphology of bilateral thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "86-year-old male with urinary retention presents for suprapubic bladder catheter placement. Ultrasound was provided during and for confirmation of suprapubic catheter placement. Preprocedural images demonstrate predominantly anechoic urine with small, echogenic foci representing debris in a normally distended bladder. After placement of the catheter the retention balloon is visualized within the lumen of the bladder.", "output": "Imaging was provided for successful suprapubic urinary bladder catheter placement."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female with a history of a renal neoplasm presents for follow-up. Evaluate for recurrence. RIGHT KIDNEY: The right kidney is absent. No evident mass in the renal fossa.LEFT KIDNEY: The left kidney measures 11.47 m. The cortex has normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass.OTHER: The bladder appears nondistended.", "output": "1. Left kidney without mass.2. Surgical changes of right-sided nephrectomy without evidence of recurrence."}
{"instruction": "Generate impression based on findings.", "input": "46 year old female who was recalled from screening mammogram for bilateral breast masses. No family history of breast cancer. MAMMOGRAM: An ML view and 3 spot compression views of the right breast, and An ML view 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 almost entirely fatty, unchanged in pattern and distribution. There is redemonstration of a subcentimeter mass within the upper central right breast, which persists on spot compression imaging. Additionally, there is redemonstration of a subcentimeter mass in the upper outer left breast, which partially disperses on spot compression imaging. ULTRASOUND: Targeted right ultrasound was performed for the mammographic area of concern. At the 12 o'clock position of the right breast, 14 cm from the nipple there is a circumscribed hypoechoic mass with parallel orientation measuring 0.6 x 0.1 x 0.1 cm. A second 0.1 x 0.2 x 0.4 cm is noted adjacent to this. These likely represent simple cysts and account for findings on mammogram.Targeted left ultrasound was performed of the mammographic area of concern. Within the upper outer quadrant of the left breast, no solid or cystic mass is identified. Findings on mammogram likely represent superimposed glandular tissue.", "output": "1. High-probability benign right breast lesions most likely cysts, accounting for findings on mammogram. Six month follow-up right unilateral mammogram and possible ultrasound are recommended to assess stability.2. Partial dispersement of the left breast findings, with no sonographic correlate. The mammographic finding likely represents superimposition of normal glandular tissue. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old male with history of equivocal left renal lesion on CT. Hematuria. RIGHT KIDNEY: The right kidney is within normal limits.LEFT KIDNEY: Although the left kidney is normal in size, there are several small tiny cysts. Additionally, there is an approximately 1 cm hypoechoic focus with internal echoes in the upper pole that may represent a hemorrhagic/complex cyst. No definite internal vascularity.OTHER: No hydronephrosis, no hydroureter. Bilateral renal jets are seen. Prostate enlargement.", "output": "1.Left renal upper pole complex cystic focus may represent a hemorrhagic/complex cyst, although this is nonspecific and should be followed up in 6 months with ultrasound.2.Prostate enlargement."}
{"instruction": "Generate impression based on findings.", "input": "Papillary thyroid carcinoma status post thyroidectomy RIGHT LOBE: Status post thyroidectomy. Stable 0.5 x 0.3 x 0.5 cm hypoechoic focus within the right thyroid bed. The second more inferior right thyroid bed focus is not identified on the current examinationLEFT LOBE: Status post thyroidectomy. No worrisome mass or noduleISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy. Stable hypoechoic focus within the right thyroid bed. No worrisome mass or regional adenopathy appreciated."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old female with history of papillary thyroid cancer. RIGHT LOBE MEASUREMENTS: 4.9 x 1.8 x 1.0 cmLEFT LOBE MEASUREMENTS: 4.2 x 1.6 x 1.2 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Two small primarily cystic nodules with peripheral echogenic foci measure 0.3 cm, most likely benign.LEFT LOBE: Solid heterogeneous hypoechoic mass in the left thyroid measures 2.2 x 1.6 x 1.5 cm with taller than wide ill-defined margins and microcalcifications, consistent with the patient's known malignancy. Cystic left inferior pole nodule with peripheral echogenic focus measures 0.6 cm, most likely benign.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A subcentimeter lymph node in the left level three station is indeterminate morphologically. Other scattered bilateral cervical lymph nodes have overall benign morphologic features.OTHER: No significant abnormality noted.", "output": "1.Left thyroid lesion as described above consistent with the patient's known papillary neoplasm.2.Indeterminate left level three lymph node is amenable to either biopsy or intraoperative localization.3.Other cervical lymph nodes and subcentimeter thyroid nodules are without specific suspicious features. "}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female with history of multinodular goiter.Three dominant nodules. Please evaluate for interval changes. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 5.7 x 1.8 x 2.3 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 6.4 x 3.7 x 4.8 cm.ISTHMUS MEASUREMENTS: The thyroid isthmus measures 0.4 cm in thickness.RIGHT LOBE: The right thyroid lobe has heterogenous echotexture. The dominant nodule of the right lower lobe measures 1.9 x 1 x 0.9 cm (prior 1.6 x 1 x 0.8).LEFT LOBE: Enlarged left thyroid lobe containing multiple solid/cystic nodules. The known dominant nodule of the left upper pole measures 4.9 x 2.7 x 3.8 cm (prior 4.6 x 3.5 x 2.4 cm).ISTHMUS: The heterogenous solid/cystic nodule of the isthmus measures 2.4 x 2.6 x 1.4 cm (prior 2.1 x 2 x 1.4 cm).PARATHYROID GLANDS: A hypoechoic focus posterior-inferior to the right thyroid lobe measures 1.3 x 0.8 x 0.7 cm.LYMPH NODES: No suspicious cervical lymphadenopathy.OTHER: No significant abnormality noted.", "output": "1. Thyromegaly with multiple solid/cystic nodules. These nodules are similar in appearance and stable to slightly increased in size.2. A hypoechoic focus posterior-inferior to the right thyroid lobe is a candidate for parathyroid tissue. Correlation with nuclear medicine imaging is suggested."}
{"instruction": "Generate impression based on findings.", "input": "Male; 29 years old. Reason: mild LFT abnormalities, evaluate for hepatic abnormalities History: LFT abnormalities LIVER: The liver measures 12.5 cm in length. Liver surface is smooth. The liver parenchyma is increased in echogenicity with a coarsened echotexture. No worrisome mass is identified. There is no ascites.The 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 without cholelithiasis. The common duct measures 4 mm. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 9.3 cm in length.RIGHT KIDNEY: The right kidney measures 10.2 cm in length. The renal cortex is normal in echogenicity. There is no shadowing renal stone or hydronephrosis. No worrisome mass is identified. OTHER: The left kidney measures 9.2 cm in length. The renal cortex is normal in echogenicity. There is no shadowing renal stone or hydronephrosis. No worrisome mass is identified", "output": "Coarse, echogenic liver compatible with hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "Antiphospholipid syndrome. Recurrent GI bleed. Evaluate for mesenteric thrombosis. Evaluation of portal vein only requested. LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. No focal hepatic lesions. Patent portal vein with normal flow velocity 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 7.6 cm in length. The left kidney is 8.2 cm in length. The renal parenchyma is echogenic bilaterally. 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. No ascites.", "output": "1. Patent portal vein.2. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old male with pancreatitis, mild transaminitis, abdominal pain. LIVER: Measures 21.7 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: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "Hepatomegaly and increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease, without discrete focal lesion. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: thyroid cancer s/p total thyroidectomy History: thyroid cancer RIGHT LOBE: Status post thyroidectomy. No focal lesion in the thyroid bed.LEFT LOBE: Status post thyroidectomy. No focal lesion in the thyroid bed.ISTHMUS: Status post thyroidectomy. No focal lesion in the thyroid bed.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There are a few bilateral benign morphology cervical lymph nodes.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy. No evidence of recurrent or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Enlarged thyroid RIGHT LOBE MEASUREMENTS: 5.9 x 1.8 x 1.7 cmLEFT LOBE MEASUREMENTS: 5 x 1.7 x 1.3 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Diffusely heterogeneous without discrete nodule. Normal vascularityLEFT LOBE: Diffusely heterogeneous without discrete nodule. Normal vascularityISTHMUS: Diffusely heterogeneous without discrete nodule. Normal vascularityPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland without increased vascularity raises the possibility of chronic thyroiditis. No discrete nodule. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodule RIGHT LOBE MEASUREMENTS: 5.4 x 1.4 x 1.3 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.4 x 0.9 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: 0.4 x 0.3 x 0.3 hypoechoic nodule lower pole.LEFT LOBE: 1 x 0.8 x 0.5 spongiform nodule midportion left lobe.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Spongiform nodule midportion left lobe thyroid gland. Subcentimeter hypoechoic right thyroid nodule. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with right upper quadrant pain and history of liver cysts. LIVER: Liver is normal in size and echotexture. There is a large, simple-appearing right lobe cyst measuring 5.4 x 7.2 x 6.3 cm. Compared to measurements obtained on prior study this has enlarged although is little changed from a CT from 2012. Smaller cyst is also identified measuring 1.3 x 1.6 x 1.7 cm in the inferior right lobe. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Interval increase in size of larger hepatic cyst compared with most recent ultrasound although not significant change from remote CT. This remains simple in appearance without wall thickening or mass. Occasionally, a large biliary cystadenoma may have this unilocular appearance."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old male with proteinuria and hematuria. Membranous glomerulo nephritis. Elevated creatinine. Ultrasound guidance, right kidney.", "output": "Ultrasound guidance as noted above."}
{"instruction": "Generate impression based on findings.", "input": "Patient presents for evaluation of focal asymmetry in the left central posterior breast. DIGITAL LEFT BREAST DIAGNOSTIC MAMMOGRAM: One ML, CC 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. Focal asymmetry in the left central posterior breast as noted on the CC view partially persists on the spot compression views. This could not be reproduced on the repeat full field CC view and is most likely due to positioning. No suspicious microcalcifications are present. TARGETED LEFT BREAST ULTRASOUND: No evidence of a cystic or solid mass in the central left breast.", "output": "High probability benign left central breast focal asymmetry without a sonographic correlate. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with acute kidney injury. RIGHT KIDNEY: Measures 12.7 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 12.7 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Collapsed with a Foley catheter in place.OTHER: No significant abnormalities noted.", "output": "1. Increased renal echogenicity consistent with medical renal disease. 2. No nephrolithiasis, hydronephrosis, or suspicious mass. "}
{"instruction": "Generate impression based on findings.", "input": "Any evidence of a fluid collection or abnormality in transplant History: recent increase in creatinine and now odd pressure sensation over kidney KIDNEY: Transplanted kidney in the right iliac fossa measures 10.4 cm in length. There is a hypoechoic, heterogenous fluid collection along the posterior aspect of the kidney, with mild adjacent mass effect on the renal parenchyma. Mild pelvocaliectasis. Color doppler reveals patent vasculature. No shadowing stones are identified.OTHER: Nephroureteral stent is visualized in the bladder. Ureteral jets are not visualized. Additional small anechoic fluid collection in the pelvis lateral to the bladder measures approximately 5.3 x 2.5 x 3.2 cm and may represent the right ovary.", "output": "Perinephric hematoma posterior to the left iliac fossa transplanted kidney with mild pelvocaliectasis but no significant hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old female with history of thyroid carcinoma 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: Normal appearing lymph nodes bilaterallyOTHER: No significant abnormality noted.", "output": "No evidence recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "Primary hyperparathyroidism RIGHT LOBE MEASUREMENTS: 5.4 x 1.7 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.8 x 1.8 x 1.7 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Multiple subcentimeter spongiform nodules. A representative mid pole nodule measures 0.9 x 0.4 x 0.8 cm.LEFT LOBE: Multiple spongiform and solid thyroid nodules. The solid nodules demonstrate foci of comet tail artifact. A representative mid pole nodule measures 1.4 x 0.8 x 1.2 cm.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; a benign etiology for these nodules is favored. No regional adenopathy. No convincing parathyroid adenoma candidate could be visualized."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter RIGHT LOBE MEASUREMENTS: 4.9 x 1.2 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.3 x 1.4 x 2.1 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: No change in multiple benign-appearing mixed cystic and solid nodules. A representative lower pole nodule measures 0.5 x 0.5 x 0.3 cm.LEFT LOBE: No change in multiple benign-appearing mixed cystic and solid nodules. Representative upper pole nodule again measures 2.1 x 0.8 x 1 cm.ISTHMUS: Stable heterogeneous nodule within the isthmus measuring 0.8 x 0.4 x 0.8 cmPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable bilateral benign-appearing thyroid nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Hepatocellular carcinoma status post RFA LIVER: No significant change in size or appearance of right lobe ablation defect measuring 2.9 x 2.2 x 2.7 cm.GALLBLADDER, BILIARY TRACT: Stable cholelithiasis without acute inflammation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma again noted.. 7.9 cm in length.OTHER: Echogenic left renal parenchyma again noted. Left kidney 9.3 cm in length. Spleen 9.5 cm in length. No ascites.", "output": "No significant change in right lobe hepatic ablation defect lesion. No new hepatic lesions appreciated. No ascites. Echogenic renal parenchyma again suggestive for medical renal disease/parenchymal dysfunction without obstruction."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female with history of open cholecystectomy, gated by tissue infection with either edema, tenderness, warmth at the surgical site. Evaluate for abscess. Grayscale and color ultrasound of the anterior abdominal wall soft tissues demonstrate a small loculated subcutaneous collection at the right upper quadrant incision site associated with a surgical clip. Its largest component along the lateral margin measures 0.6 x 0.4 cm. There is associated overlying skin thickening.", "output": "Small loculated surgical site subcutaneous collection as described above is not drainable at this time. "}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are digital mammographic images (9/24/15), ultrasound images of both breasts (9/24/15), images from ultrasound guided biopsy of left breast with specimen radiograph and postprocedural left mammographic images, and images from ultrasound guided right breast aspiration (9/24/15) performed at Rush University Medical Center. For comparison, digital mammographic images (9/11/14, 9/11/13, 3/1/10), ultrasound images (9/11/14, 1/27/14, 9/11/13) are available. DIGITAL MAMMOGRAPHIC IMAGES (9/24/15):The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Multiple circumscribed masses are present in both breasts. Many of those masses are stable and benign. An oval mass at lower outer quadrant in the left breast shows interval increase in size. Multiple calcifications in both breast are unchanged. There are no suspicious findings in either breast on mammogram.ULTRASOUND IMAGES OF BOTH BREASTS (9/24/15):There are multiple simple cysts in the right breast. In the left breast, there is an irregularly shaped hypoechoic mass with angular margins at 6:30 position measuring 6 x 6 mm. A complicated cyst measuring 6 mm is seen at 4:00 position. In addition, there are multiple simple cysts in the left breast. A simple cyst at left 4:30 position likely corresponds to the developing circumscribed mass on left mammogram.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF LEFT BREAST WITH SPECIMEN RADIOGRAPH AND POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES, AND IMAGES FROM ULTRASOUND GUIDED RIGHT BREAST ASPIRATION (9/24/15):An aspiration for the complicated cyst at 4:00 position in the right breast was performed. Complete resolution of the cyst was achieved. Core needle biopsy for the hypoechoic mass at 6:30 in the left breast was performed with appropriate needle placement. Radiograph of the specimen shows several pieces of solid tissue without calcifications. Postprocedural mammographic images show a marker clip located at lower inner quadrant in the left breast.Per outside pathology report, the result of the core biopsy of left breast was DCIS grade 3.", "output": "Biopsy proven DCIS in the left breast. The lesion was occult on mammogram and was detected on ultrasound. Given complicated appearance of mammogram and dense breast tissue, breast MRI would be helpful to rule out any other occult disease.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old male with metastatic lung cancer, on Alectinib. CT showed mild diffuse gallbladder wall thickening suggestive of acute inflammation. LIVER: Measures 14.3 cm in length with multiple bilobar hepatic metastatic lesions similar to recent CT study. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/s.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. Gallbladder wall thickening is noted measuring 8 mm in thickness. No pericholecystic fluid. Sonographic Murphy sign is negative. Common duct measures 3 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 9.4 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 10.2 cm in length. No hydronephrosis or shadowing calculi are noted.Spleen measures 11.3 cm in length and is normal in echogenicity.", "output": "1. Gallbladder wall thickening may represent chronic cholecystitis. No evidence of acute cholecystitis. 2. Multiple bilobar hepatic metastatic lesions similar to recent CT. "}
{"instruction": "Generate impression based on findings.", "input": "27-year-old with personal history of biopsy-proven right breast papilloma and high probability benign fibroadenoma presents for follow-up. Targeted grayscale and color Doppler ultrasound was performed for the previously identified right breast masses.In the 9:00 position 4 cm from the nipple, the well-circumscribed mildly vascular hypoechoic mass likely representing a fibroadenoma is not significantly changed in size measuring 1.3 x 0.7 x 1.1 cm (previously measured 1.1 x 0.8 x 1.0 cm).In the 3:00 position 1 cm from the nipple, the isoechoic mass and marker clip representing the biopsy-proven papilloma is faintly visualized, measuring approximately 0.4 x 0.4 x 0.4 cm, unchanged in size.", "output": "No change in size of benign right breast masses. No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B. Evaluate for HCC. LIVER: Non-cirrhotic liver morphology. Increased parenchymal echogenicity. A 1.8 cm hypoechoic lesion is identified in the left hepatic lobe, not seen on the prior ultrasound or CT. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Several 1-2 cm gallstones noted. Otherwise unremarkable 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 12.0 cm in length, with a 1.7 cm exophytic cyst. The left kidney is 11.1 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 13.5 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites identified.", "output": "1. Hypoechoic lesion measuring 1.8 cm in the left hepatic lobe, not seen on prior imaging. This lesion is indeterminate by sonographic appearance and further characterization with contrast-enhanced CT or MRI with liver protocol is recommended. 2. Cholelithiasis without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant and epigastric pain LIVER: Coarse echogenic liver echotexture without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 13.4 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 6.5 cm in lengthRIGHT KIDNEY: Right renal cyst. Right kidney 10.2 cm in length.OTHER: Multiple left renal cysts. Left kidney 9.1 cm in length. No ascites", "output": "Coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or duct dilatation. Unremarkable gallbladder without acute inflammation or gallstones. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "30 yo female with loosely clustered calcifications in the right breast 3:00 position. Family history of breast cancer diagnosed in sister at age 27. A targeted right ultrasound was performed for the mammographic area of concern. There is no solid or cystic mass identified. Fibrocystic change with multiple calcifications are identified in the mammographic area of concern, which will be targeted for biopsy under ultrasound guidance. BIOPSY", "output": "Successful ultrasound-guided core biopsy of the right breast calcifications and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain and elevated LFTs LIMITED ABDOMENLIVER: Coarse echogenic liver echotexture without mass. Liver length 15 cm.BILIARY TRACT: Gallbladder absent. No ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 7.6 cm in length RIGHT KIDNEY: Mildly echogenic renal parenchyma again noted without mass, stone, or hydronephrosis. 8.7 cm in lengthOTHER: Mildly echogenic left renal parenchyma again noted without mass, stone, or hydronephrosis. 8.4 cm in length. No ascites.", "output": "Coarse echogenic liver consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites. Patent hepatic vessels with normal directional flow.Mildly echogenic renal parenchyma again noted suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant and right flank pain LIVER: Unremarkable echogenicity without mass. Liver length 14.8 cmGALLBLADDER, BILIARY TRACT: Probable gallbladder polyp measuring 0.3 x 0.3 x 0.3 cm. No acute inflammation. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.2 cm in lengthOTHER: Left kidney 11.1 cm in length. Spleen 9.9 cm in length. No ascites.", "output": "Probable subcentimeter gallbladder polyp. Otherwise unremarkable examination."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Kelly is a 24 year old female presenting with a physician detected area of \"breast thickening\" in the right breast. She denies any discrete mass, trauma, or fever/chills. Family history of breast cancer in mother, diagnosed at the age of 56. Upon physical exam at the palpable area of concern, no discrete mass is appreciated.A targeted right breast ultrasound was performed for the palpable area of concern. In the right breast 12 o'clock location, approximately 2 cm from the nipple, no suspicious cystic or solid mass is identified.", "output": "No sonographic evidence for malignancy. Patient should follow-up with her primary care physician as clinically warranted.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Female 22 years old Reason: include liver and pancreas, ER visit 4/20/16, r/o pancreatitis, c/o abdominal pain, hx small bowel obstruction History: include liver and pancreas, ER visit 4/20/16, r/o pancreatitis, c/o abdominal pain, hx small bowel obstruction LIVER: Liver is normal in size and echogenicity. No focal liver lesions.GALLBLADDER, BILIARY TRACT: Gallbladder is mildly contracted but otherwise unremarkable. No evidence of biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.RIGHT KIDNEY: No significant abnormalities noted. Right kidney measures 9 cm. Left kidney measures 9.2 cm.OTHER: No significant abnormalities noted. Spleen measures 8.3 cm.", "output": "Unremarkable ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old female with abdominal pain. Evaluate for cholelithiasis. LIVER: The liver measures 14.4 cm in length. Mild increased hepatic echogenicity without discrete focal lesion.GALLBLADDER, BILIARY TRACT: No cholelithiasis. No gallbladder wall thickening, pericholecystic fluid, or sonographic Murphy sign. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "1. No cholelithiasis or evidence of cholecystitis.2. Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease."}
{"instruction": "Generate impression based on findings.", "input": "Worsening urine output and renal function RIGHT KIDNEY: Echogenic renal parenchyma without worrisome mass, stone, or hydronephrosis. Benign-appearing renal cyst. Right kidney 8.9 cm in length.LEFT KIDNEY: Echogenic renal parenchyma without worrisome mass, stone, or hydronephrosis. Benign appearing renal cyst. Left kidney 11.8 cm in length.OTHER: Bladder collapsed. Mild ascites.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or obstruction. Mild ascites."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules RIGHT LOBE MEASUREMENTS: 5.8 x 2.2 x 2.2 cmLEFT LOBE MEASUREMENTS: 5.9 x 1.6 x 1.6 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Stable predominant solid right thyroid nodule measuring 3.4 x 2.3 x 1.3 cmLEFT LOBE: Stable spongiform nodules. Mid pole nodule measures 0.5 x 0.5 x 0.3 cm. Inferior nodule measures 1 x 1 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": "Stable bilateral thyroid nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Male 67 years old Reason: r/o acalculous cholecystitis History: sepsis, abdominal discomfort, c/f gallbladder dilation on CT abdomen LIVER: Increased echogenicity of the liver compatible with fatty infiltration. Liver is enlarged. Liver measures 18.6 cm.BILIARY TRACT: Gallbladder is significantly distended. There is gallbladder wall thickening. Sludge is present within the gallbladder. 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: No significant abnormalities noted.RIGHT KIDNEY: 2 x 2.4 cm hypoechoic lesion within the left kidney. This study is limited for optimal evaluation of this lesion. Right kidney is unremarkable measuring 11.9 cm. Left kidney measures 12.3 cm. OTHER: No significant abnormalities noted.", "output": "Sonographic findings compatible with acute cholecystitis. Diffuse fatty infiltration of the liver. Hepatomegaly. Left renal cyst.Dr. Wali was notified and acknowledged about the above findings at the time of dictation."}
{"instruction": "Generate impression based on findings.", "input": "Hyperthyroidism RIGHT LOBE MEASUREMENTS: 1.4 x 4.6 x 1.7 cmLEFT LOBE MEASUREMENTS: 1 x 3.3 x 1.4 cmISTHMUS MEASUREMENTS: 0.2 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": "Mildly atrophic thyroid gland without nodule or increased vascularity. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Right-sided testicular pain RIGHT TESTIS: 4.0 x 2.1 x 3.0 cm. No significant abnormalities noted. Normal testicular vascularity.LEFT TESTIS: 4.2 x 2.3 x 2.7 cm. No significant abnormalities noted. Normal testicular vascularity.RIGHT EPIDIDYMIS: 9 x 11 x 9 mm. No significant abnormalities noted. Normal epididymal vascularity.LEFT EPIDIDYMIS: 10 x 10 x 10 mm. No significant abnormalities noted. Normal epididymal vascularity.OTHER: Small bilateral hydroceles.", "output": "No specific evidence of testicular torsion, orchitis, or epididymitis. Small non-specific bilateral hydroceles."}
{"instruction": "Generate impression based on findings.", "input": "51 year old with known multiple cysts in both breasts presents for annual mammogram. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Multiple masses in both breasts are again seen; some of them have increased in size. Diffuse benign calcifications are again noted in both breasts.Ultrasound study for both breasts is performed. There are multiple cysts in both breasts, right greater than left. No suspicious findings or solid masses are seen in either breast.", "output": "No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency; chronic renal disease RIGHT KIDNEY: Echogenic parenchyma without worrisome mass or hydronephrosis. Nonobstructing subcentimeter right renal stone. Right kidney 9.8 cm in lengthLEFT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Left kidney 10.2 cm in length.OTHER: Bladder nondistended", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass or obstruction. Nonobstructing subcentimeter right renal stone."}
{"instruction": "Generate impression based on findings.", "input": "Male 53 years old; Reason: elevated PTH, hypercalcemia, assess for parathyroid adenoma History: as above RIGHT LOBE MEASUREMENTS: 5.5 x 2.3 x 2.1 cm.LEFT LOBE MEASUREMENTS: 5.6 x 2.1 x 1.8 cm.ISTHMUS MEASUREMENT: 0.4 cm.RIGHT LOBE: Normal and homogenous echogenicity of the right thyroid parenchyma. There is an approximately 1.3 x 1.3 x 1.0 cm round spongiform nodule on the right.LEFT LOBE: Normal and homogenous echogenicity of the left thyroid parenchyma without mass or nodule.ISTHMUS: Normal and homogenous echogenicity of the isthmus parenchyma without mass or nodule.LYMPH NODES: No suspicious adenopathy noted. OTHER: Posterior and inferior to the right thyroid, there is an approximately 1.3 x 0.8 x 0.9 cm mixed echogenicity lesion that may represent a parathyroid adenoma.", "output": "1.Possible parathyroid adenoma of the right inferior gland. No adenopathy.2.Spongiform nodule in right thyroid as above; favor benign etiology."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old female with a palpable lump/mass along the right lateral sternum/chest presents for ultrasound. Patient does not palpate the lump anymore. She felt it was a soft nodule that went away in 2 weeks. Family history of breast cancer in maternal aunt. A targeted right superior/infraclavicular ultrasound was performed for the patient\u2019s area of concern. There is no solid or cystic mass identified. Normal glandular tissue noted. Ultrasound was performed in both supine and sitting position as patient thought the lesion was previously well appreciated in the sitting position.", "output": "No sonographic evidence for malignancy corresponding to patient's area of concern in the right infraclavicular/superior breastBIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Reason: R/o tendonitis History: 23-year-old female chronic (4-6 week) anterior knee pain in active adult The patellar tendon was visualized in its entirety and appears intact. The patellar tendon is of normal size and echogenicity. There is no increased vascularity on Doppler interrogation. There is no evidence of a prepatellar or deep infrapatellar bursitis. There are no sonographic findings to account for the patient's pain.", "output": "Normal appearing patellar tendon without findings to account for the patient's pain. If further imaging evaluation is clinically warranted, MRI may be considered."}
{"instruction": "Generate impression based on findings.", "input": "Elevated liver enzymes. Lower extremity edema. LIVER: Non-cirrhotic liver morphology. Increased parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction. Calcifications likely represent granulomata of prior infection.GALLBLADDER, BILIARY TRACT: No intrahepatic biliary ductal dilation. Prominent common bile duct within normal limits given 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 8.3 cm in length. The left kidney is 10.2 cm in length. No suspicious renal lesion evident. No hydronephrosis is present.SPLEEN: 12.2 cm in length, without focal lesion evident.OTHER: No significant abnormalities noted.", "output": "Increased hepatic echogenicity, compatible with parenchymal dysfunction/steatosis."}
{"instruction": "Generate impression based on findings.", "input": "HCV LIVER: Mildly heterogeneous and echogenic liver echotexture without mass. Liver length 14.7 cm.GALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation. Probable adenomyomatosisPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.4 cm in lengthOTHER: Left kidney 9 cm in length. Spleen 8.4 cm in length. No ascites.", "output": "Mildly heterogeneous and echogenic liver parenchyma suggestive for chronic liver disease without mass or ductal dilatation. No ascites. Cholelithiasis without acute inflammation or ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Non-cirrhotic liver morphology. 15.0 cm in length. 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 10.9 cm in length. The left kidney is 11.8 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9.2 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid identified.", "output": "No specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old male with history of thyroid cancer, status post surgery. 1.4 cm hypoechoic nodule seen on outside study, with biopsy-proven recurrence. RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not identified.LYMPH NODES: The 1.4 cm lymph node seen on the outside study is again identified at level 3 between the left carotid artery and left internal jugular vein. This node again measures 1.4 cm, however appears of normal morphology. An additional level 3 lobulated lymph node with internal hyperechoic area measures 9 x 5 x 5 mm. Multiple additional subcentimeter lymph nodes are noted throughout the left neck with suspicious internal echogenicity.OTHER: No significant abnormality noted.", "output": "1. Multiple suspicious-appearing lymph nodes in the left neck, particularly at left level 3 . This level 3 lesion underwent fine-needle aspiration. Please see separate biopsy report for any additional details.2. Previously seen 1.4 cm lymph node identified in the left neck at level 3 between the carotid artery and internal jugular vein."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with history of left breast mass status post trauma. Annual follow-up. Family history of breast cancer in maternal cousin. Mammogram: Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. An 10:00 position of the left breast, the previously mentioned dense mass has significantly decreased in size now measuring 20 x 8 mm. There are stable subcentimeter benign type masses, likely benign intramammary lymph nodes, in the left upper outer quadrant.The right breast is unremarkable.Ultrasound: A targeted left breast ultrasound was performed in the area of mammographic abnormality at the 10:00 position. Approximately 8- 10 cm from the nipple at the 10:00 position, there is a mixed echogenicity oval lesion with a hyperechoic rim which has significantly decreased in size now measuring 16 x 7 x 5 mm (compared to 13 x 12 x 12 mm on prior). There was no internal vascularity.", "output": "Findings compatible with a resolving hematoma in the 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."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are digital mammographic images (9/24/15), ultrasound images of both breasts (9/24/15), images from ultrasound guided biopsy of left breast with specimen radiograph and postprocedural left mammographic images, and images from ultrasound guided right breast aspiration (9/24/15) performed at Rush University Medical Center. For comparison, digital mammographic images (9/11/14, 9/11/13, 3/1/10), ultrasound images (9/11/14, 1/27/14, 9/11/13) are available. DIGITAL MAMMOGRAPHIC IMAGES (9/24/15):The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Multiple circumscribed masses are present in both breasts. Many of those masses are stable and benign. An oval mass at lower outer quadrant in the left breast shows interval increase in size. Multiple calcifications in both breast are unchanged. There are no suspicious findings in either breast on mammogram.ULTRASOUND IMAGES OF BOTH BREASTS (9/24/15):There are multiple simple cysts in the right breast. In the left breast, there is an irregularly shaped hypoechoic mass with angular margins at 6:30 position measuring 6 x 6 mm. A complicated cyst measuring 6 mm is seen at 4:00 position. In addition, there are multiple simple cysts in the left breast. A simple cyst at left 4:30 position likely corresponds to the developing circumscribed mass on left mammogram.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF LEFT BREAST WITH SPECIMEN RADIOGRAPH AND POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES, AND IMAGES FROM ULTRASOUND GUIDED RIGHT BREAST ASPIRATION (9/24/15):An aspiration for the complicated cyst at 4:00 position in the right breast was performed. Complete resolution of the cyst was achieved. Core needle biopsy for the hypoechoic mass at 6:30 in the left breast was performed with appropriate needle placement. Radiograph of the specimen shows several pieces of solid tissue without calcifications. Postprocedural mammographic images show a marker clip located at lower inner quadrant in the left breast.Per outside pathology report, the result of the core biopsy of left breast was DCIS grade 3.", "output": "Biopsy proven DCIS in the left breast. The lesion was occult on mammogram and was detected on ultrasound. Given complicated appearance of mammogram and dense breast tissue, breast MRI would be helpful to rule out any other occult disease.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Female 51 years old Reason: assess right upper quadrant for abnormality History: elevated alk phos LIVER: Liver measures 17.5 cm. The liver is coarse and nodular, concerning for cirrhosis. Main portal vein is patent with normal directional flow and a peak velocity of 26 cm/s.BILIARY TRACT: Patient is postcholecystectomy. Common bile duct measures 4 mm. No intra or extra hepatic biliary ductal dilatation.PANCREAS: Pancreas is not well-visualized. Spleen is normal in appearance measuring 11.8 cm.SPLEEN: No significant abnormalities noted.KIDNEYS: Right kidney is echogenic measuring 7.9 cm in length. Left kidney measures 7.5 cm. No hydronephrosis.OTHER: Large volume ascites.", "output": "1.Coarse nodular liver, compatible with cirrhosis. No focal hepatic lesion or biliary abnormality.2.Large volume ascites. "}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female with flank pain, hematuria Limited examination due to body habitus. RIGHT KIDNEY: Measures 10.5 cm in length. No hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 12.0 cm in length. No hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.", "output": "No nephrolithiasis, hydronephrosis, or suspicious lesion. "}
{"instruction": "Generate impression based on findings.", "input": "Known history of myeloid circumflex, with palpable area of concern marked by the clinical service in the right axilla. A targeted ultrasound was performed for the right axillary palpable area of concern marked by the service. At this site, there is a superficially located predominantly hyperechoic area measuring 9 x 8 mm which is highly suggestive of a benign process like fat necrosis. There is no solid or cystic mass identified.", "output": "Hyperechoic area in the right axilla is highly suggestive of fat necrosis. Further management for this finding will be directed by Dr. Jaskowiak. If clinically desired, ultrasound-guided biopsy can be performed.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain and elevated lipase LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: Gallbladder collapsed. Diffuse gallbladder wall thickening with trace pericholecystic fluid. Negative Murphy's. No ductal dilatation.OTHER: No significant abnormalities noted.", "output": "Gallbladder collapsed. Diffuse gallbladder wall thickening with trace pericholecystic fluid with negative Murphy's. Favor benign etiology such as low-protein and right heart failure. No compelling evidence to suggest acute inflammation. No ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "88-year-old male with history of cholecystitis. Evaluate for cholecystitis LIVER: The liver is normal in echotexture and measures 16.1 cm in length.GALLBLADDER, BILIARY TRACT: Layering gallbladder debris consistent with sludge. Gallbladder wall measures 0.3 cm without evidence of pericholecystic fluid. Negative sonographic Murphy's sign.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Kidneys are normal in echotexture with the right kidney measuring 10.6 and the left kidney measuring 9.1 cm in length.OTHER: No significant abnormalities noted.", "output": "Gallbladder sludge without sonographic evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and tomosynthesis were performed 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 a focal asymmetry in the right upper outer quadrant for which further evaluation with spot compression and possibly ultrasound is recommended. No suspicious microcalcifications are present.", "output": "Focal asymmetry in the right upper outer quadrant for which further evaluation with spot compression 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 mammograms and ultrasound dated 6/17/14 and priors back to 10/9/12. Submitted outside study was compared to the current mammogram dated 8/26/15. The focal asymmetry in the right upper outer breast is stable compared to prior mammograms. At a similar location on the submitted ultrasound images, several adjacent cysts are seen. The left breast masses are not clearly visualized on prior studies (though the more posterior of the left breast masses is seen variably on some prior images--suggesting a waxing and wanning cyst).", "output": "Left breast masses should be further evaluated with spot compression and ultrasound. Right breast finding is stable and does not require additional work up at this time.  BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old female with right upper quadrant and epigastric pain. LIVER: The liver is normal in morphology, echogenicity and size, measuring 16.6 cm in craniocaudal dimension. Note is made of a 1 x 1 x 0.7 cm right hepatic lobe echogenic lesion without posterior shadowing or enhanced through transmission. No additional hepatic lesions are identified and the liver capsule is smooth. No intrahepatic biliary ductal dilatation. There is normal hepatopetal portal venous blood flow at 20 cm/sec. The hepatic duct measures 3 mm at the porta hepatis, normal.BILIARY TRACT: There is a normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid, or focal tenderness. The common bile duct at the level of the pancreatic head is normal in caliber measuring 3 mm.PANCREAS: The visualized portions of the pancreatic body and head are normal.SPLEEN: The poorly visualized spleen measures 5 cm in length.RIGHT KIDNEY: The right kidney measures 8.6 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow. OTHER: Limited evaluation of the left kidney, which measures 8.8 cm in length, shows no hydronephrosis, shadowing calculus or discrete lesion. Color Doppler demonstrates hilar blood flow.", "output": "1. No specific findings to account for the patient's right upper quadrant and epigastric pain, accounting for the incomplete visualization of the pancreas. 2. Incidental 1 cm right hepatic lobe lesion likely represents a benign hemangioma in the absence of chronic liver disease. If there is a history of chronic liver disease further evaluation with a dedicated liver CT and/or MRI is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Right breast focal asymmetry seen on outside mammograms. A targeted right ultrasound was performed for the mammographic area of concern. An ill-defined 1.1 x 0.8 x 1.1 cm heterogeneously hypoechoic mass is seen in the 12:30 position of the right breast 6 cm from the nipple with posterior acoustic shadowing. Mild peripheral vascularity is noted.", "output": "Suspicious right breast lesion. Ultrasound guided biopsy is recommended for further evaluation. Findings were discussed with the patient. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old male with right upper quadrant pain LIVER: Echotexture likely mildly increased which is non--- specific. No gross mass on limited exam.GALLBLADDER, BILIARY TRACT: Gallbladder is poorly distended without wall thickening, definite stones or pericholecystic fluid. However, the exam is limited due to under distention and bowel gas.PANCREAS: Limited due to bowel gas.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Limited exam without gallbladder abnormality.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 49 years old; Reason: assess for cirrhosis, h/o ETOH use and congestive heart failure History: weight loss, elevated LFTS LIVER: The liver measures 15.3 cm in length. There is coarse 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 wall measures 3.1 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 4.3 mm in diameter. There are prominent vessels around the gallbladder which could be collaterals. This most likely does not represent cavernous transformation given the portal vein is patent.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 5.6 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.5 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.OTHER: No significant abnormality noted.", "output": "1. Increased and coarse echotexture of liver consistent with chronic liver disease/parenchymal dysfunction. No masses."}
{"instruction": "Generate impression based on findings.", "input": "60 years old, Female, Reason: abdominal abscess pocket History: cellulitis, pain, erythema In the right lower quadrant there is a complex area of subcutaneous heterogeneous echogenicity measuring approximately 3.4 x 2.6 x 3.3 cm. Curvilinear hypoechoic component of this complex likely represents fluid measuring up to 5 mm in greatest dimension (image time stamped 2:13:18). Skin thickening is present. Wound draining pus during ultrasound examination.", "output": "Complex subcutaneous area of heterogeneous echogenicity with scattered small loculated fluid may represent a severe focal cellulitis or developing abscess, only small amount of internal fluid seen. "}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules RIGHT LOBE MEASUREMENTS: 5.8 x 1.6 x 1.9 cmLEFT LOBE MEASUREMENTS: 6.2 x 1.6 x 1.9 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: No significant change in multiple right thyroid nodules. Upper lobe nodule measures 1.1 x 0.8 x 1.1 cm. Mid pole nodule measures 1 x 10.6 x 0.9 cm. Lower pole nodule measures 0.6 x 0.3 x 0.6 cmLEFT LOBE: Stable left thyroid nodules. The largest again measures 1 x 0.6 x 1 cm.ISTHMUS: Stable solid isthmic nodule measuring 0.7 x 0.4 x 0.6 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable bilateral thyroid nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Hematuria RIGHT KIDNEY: Atrophic echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Renal cyst. Right kidney 7.4 cm in length.LEFT KIDNEY: Atrophic echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Renal cyst. Left kidney 8 cm in lengthOTHER: Bladder nondistended", "output": "Atrophic echogenic parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male with history of HCV, cirrhosis. Evaluate for HCC. LIVER: The liver measures 15.3 cm in length. No focal hepatic lesion is identified. There is coarsened echotexture of the liver with increased echogenicity consistent with chronic liver disease. The liver is mildly nodular in contour. Main portal vein flow is hepatopetal and measures 0.2 m/s.GALLBLADDER, BILIARY TRACT: There is no intra or extrahepatic biliary ductal dilatation. There is no pericholecystic fluid, gallbladder wall thickening, or gallstones. The common bile duct measures 4 mm in diameter. PANCREAS: The pancreas is largely obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 11 cm in diameter. The left kidney measures 11.7 cm in length. No evidence of hydronephrosis. OTHER: The spleen measures 10.3 cm in length.", "output": "Coarsened echotexture and increased echogenicity of the hepatic parenchyma consistent with chronic liver disease. No focal hepatic lesion is identified."}
{"instruction": "Generate impression based on findings.", "input": "Renal stone RIGHT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. 11.7 cm in length.LEFT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. 10.8 cm in length.OTHER: Bladder collapsed", "output": "Normal renal ultrasound with normal parenchymal echogenicity without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old male patient with history of invasive greater than 3 cm papillary thyroid cancer. Evaluate for recurrence. RIGHT LOBE: Status post thyroidectomy without visible parenchymal tissue or recurrent mass.LEFT LOBE: Status post thyroidectomy without visible parenchymal tissue or recurrent mass.ISTHMUS: Status post thyroidectomy without visible parenchymal tissue or recurrent mass.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Bilateral mildly enlarged submandibular lymph nodes are noted.OTHER: No significant abnormality noted.", "output": "1. No visible parenchymal tissue or recurrent mass in the thyroid bed.2. Mildly enlarged submandibular lymph nodes, which are possibly reactive in etiology."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male with hepatitis C. Evaluate for cirrhosis. LIVER: Course echotexture of the liver measuring 13.5 cm in length. No focal hepatic lesions. Portal vein is patient with appropriate directional flow; peak velocity measures 0.2 m/s. GALLBLADDER, BILIARY TRACT: 1.2 cm shadowing stone within the gallbladder. No pericholecystic fluid. No gallbladder wall thickening. Sonographic Murphy's sign is negative. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Not well-visualized due to overlying bowel gas.RIGHT KIDNEY: Normal echogenicity measuring 9.4 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the left kidney measuring 11.7 cm in length. No hydronephrosis or shadowing calculi are noted.Normal echogenicity of the spleen measuring 12.1 cm in length.", "output": "1. Coarse echotexture of the liver suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesions.2. Cholelithiasis without evidence of cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female with right lower abdominal/groin enlarging mass, possible hernia versus lipoma. In the region of right groin bulge/mass noted by the patient there is a hernial sac containing loops of bowel which increases with Valsalva maneuver and is reducible.", "output": "Right inguinal bowel containing reducible hernia."}
{"instruction": "Generate impression based on findings.", "input": "26 day old female neonate with apnea. History of ventriculomegaly. Please evaluate for ventriculomegaly/any mass effect. There is mild asymmetric enlargement of the left lateral ventricle on comparison to the right; however this finding is within normal limits and was seen on prior head ultrasound. There is no evidence of intracranial hemorrhage, mass or edema. No evidence of ventriculomegaly; the basal cisterns are normal in appearance.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses are normally pneumatized; the mastoid air cells are partially opacified.", "output": "No evidence of ventriculomegaly or other acute abnormality. "}
{"instruction": "Generate impression based on findings.", "input": "Call back from screening mammogram for a mass in the left breast. An ML view and two spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. A lobulated mass is reidentified at lower inner quadrant in the left breast. The mass is circumscribed, isodensity mass.Focused ultrasound for the left breast is performed. There is an elongated anechoic lesion measuring 11 x 3 mm at 7:00 position, consistent with a cyst, corresponding to the mass on the mammogram.", "output": "No mammographic or sonographic evidence of malignancy. A cyst in the left breast. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "57 year-old female with goiter on Synthroid for suppression RIGHT LOBE MEASUREMENTS: 3.3 cm x 1.5 cm x 2.3 cmLEFT LOBE MEASUREMENTS: 4.3 cm x 1.5 cm x 1.5 cmISTHMUS MEASUREMENTS: 5 mm in thickness.RIGHT LOBE: Heterogeneous echotexture. Solid nodule again seen at the inferior pole measuring 1.7 cm x 1.3 cm x 1.1 cm, previously 0.9 cm x 1.1 cm x 1.2 cm.LEFT LOBE: Heterogeneous in echotexture with no discrete nodules identified.ISTHMUS: Nodule along the right side of the isthmus is again seen measuring 2.2 cm x 2.0 cm x 0.9 cm, previously measured 2.2 cm x 2.2 cm x 1.5 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: In the right submandibular region corresponding to the patient's palpable lump is a lymph node with normal fatty hilum measuring 2.0 cm x 0.8 cm x 1.4-cm.OTHER: No significant abnormality noted.", "output": "Heterogeneous thyroid gland with solid nodules as described above unchanged. Benign appearing lymph node in the right mandibular region corresponding to the patient's palpable lump."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female with epigastric abdominal pain. Also, screening for pancreatic cancer due to strong family history. LIVER: NLiver is normal in size and normal in echogenicity in face study. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Gallbladder is well-visualized. There may be a small amount of gallbladder sludge. Otherwise, the gallbladder appears normal without cholelithiasis, wall thickening or pericholecystic fluid. Visualized biliary tract is normal in caliber.PANCREAS: Normal in size, contour and echogenicity.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Minimal gallbladder sludge. Otherwise normal exam. Normal appearance of the pancreas."}
{"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 subcentimeter gallstones identified. Very mild gallbladder wall thickening. Positive sonographic Murphy's sign elicited.PANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney is 10.8 cm in length. The left kidney is 10.5 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.4 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites.", "output": "Cholelithiasis with mild gallbladder wall thickening and positive sonographic Murphy's sign, likely representing mild cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female with fever of unknown origin. Evaluate for intra-abdominal fluid. Limited images demonstrate no evidence for intra-abdominal fluid.", "output": "No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter. Gland appears to be enlarging, per patient. Prior biopsies demonstrated benign nodules at Loyola, per patient. RIGHT LOBE MEASUREMENTS: 4.7 x 1.9 x 2.0 cmLEFT LOBE MEASUREMENTS: 5.3 x 1.3 x 1.3 cmISTHMUS MEASUREMENTS: 2 mm in AP dimensionRIGHT LOBE: The right thyroid lobe is diffusely heterogeneous without discrete nodules. LEFT LOBE: The left thyroid lobe is multinodular. The largest of these measures 12 mm, with homogeneous echotexture, defined margins, and without suspicious features. Additional colloid nodules identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not identified.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multinodular goiter, without suspicious features identified."}
{"instruction": "Generate impression based on findings.", "input": "History of hepatitis B, screening for hepatocellular carcinoma. LIVER: The liver measures 12.2 cm in length. The liver parenchymal echotexture is mildly coarse. Redemonstration of focal lesion within segment 2 measuring 1.2 x 1.3 x 1.7 cm, unchanged in size, with imaging features on prior CT compatible with hemangioma. Stable right lobe hepatic cyst. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.26 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 3 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 7.4 cm in length. RIGHT KIDNEY: Kidney measures 10.7 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": "Stable left lobe hemangioma and right lobe hepatic cyst. No worrisome focal hepatic lesions identified. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter RIGHT LOBE MEASUREMENTS: 6.4 x 1.6 x 2.2 cmLEFT LOBE MEASUREMENTS: 5.9 x 1.6 x 1.5 cmISTHMUS MEASUREMENTS: 1 mm in AP dimension.RIGHT LOBE: Unchanged solid heterogeneous 1.9 cm nodule in the inferior pole.LEFT LOBE: Multiple subcentimeter cystic and heterogeneously solid nodules are unchanged. The largest of these measures 10 x 7 x 5 mm, previously 9 x 8 x 5 mm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing lymph nodes identified.OTHER: No significant abnormality noted.", "output": "Unchanged multinodular goiter."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Battie is a 40 year old presenting with an enlarging palpable lesion in the right breast, previously found to be a cyst on prior diagnostic mammogram on 08/19/2016. A targeted right ultrasound was performed for the patient\u2019s palpable area of concern. Multiple enlarging simple cysts are identified, the largest of which measures 3.9 x 2.5 x 3.3 cm. No suspicious solid masses identified.", "output": "Multiple benign simple cysts of the right 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. The patient can certainly get an ultrasound-guided cyst aspiration as a possible option for her enlarging cysts. Bilateral screening mammogram is recommended annually, due next in August 2017. All results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Female 58 years old Reason: Liver dysfunction History: ascites, hx of pancreatic and breast cancer LIVER: There are calcifications within the liver. Hepatic veins and IVC are dilated. Right-sided pleural effusion. Enlarged liver secondary to heart failure.BILIARY TRACT: Gallbladder is not visualized. No evidence of intra or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Atrophic right kidney without evidence of hydronephrosis. Echogenic right kidney. Right kidney measures 8.6 cm. OTHER: No significant abnormalities noted.", "output": "Echogenic right kidney. Moderate amount ascites. Small right-sided pleural effusion. Enlarged liver secondary to heart failure."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old male post thyroidectomy for papillary thyroid carcinoma with nodal metastases. 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: Morphologically normal lymph nodes bilaterally. A level 2 node on the right which is mildly abnormal in shape with poor visualization of fatty hilum is completely unchanged from prior exam, measuring 0.4 x 1 x 1.1 cm.OTHER: No significant abnormality noted.", "output": "No evidence for local recurrence or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male with history of thyroid cancer post thyroidectomy. Follow-up nodules. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: There again noted to rounded, slightly hypoechoic nodules in the thyroidectomy bed. These are less well-visualized than on the prior exam. Nodule in the mid bed measures 0.4 x 0.4 x 0.5 cm without change and nodule in the inferior bed measures 0.5 x 0.5 x 0.5 cm without significant change.LEFT LOBE: No masses byISTHMUS: No massesPARATHYROID GLANDS: No massesLYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable nodules in the right thyroidectomy bed."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury and hyperkalemia. RIGHT KIDNEY: Right kidney measures 11.4 cm. The cortex is increased in echogenicity. No renal calculus, hydronephrosis or suspicious mass identified.LEFT KIDNEY: Left kidney measures 9.1 cm. The cortex is increased in echogenicity. No renal calculus, hydronephrosis or suspicious mass identified.URINARY BLADDER: No significant abnormalities noted.OTHER: The liver appears nodular and increased in echogenicity. There is heterogeneity within the hepatic dome, probable mass. Large volume ascites present.", "output": "1.Echogenic kidneys, probable medical renal disease. No renal calculus, hydronephrosis or suspicious mass.2.Nodular heterogeneous liver, compatible with cirrhosis. Hepatic mass present, but incompletely evaluated on this dedicated renal ultrasound.3.Large volume ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 20 years old Reason: Needs US guided biopsy of transplant kidney History: Worsening of renal function Ultrasound guidance and technical assistance was provided for a renal allograft in the right iliac fossa. Dr. Chon attending. 2 passes made (one18-gauge 1.5 g and one 25 g).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": "79-year-old female patient with gallbladder wall thickening on CT. LIVER: The liver measures 15.4 cm in length. No focal hepatic lesion is identified Hepatic parenchyma echogenicity is mildly heterogeneous. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder contains numerous shadowing gallstones. There is no pericholecystic fluid or gallbladder wall thickening. Sonographic Murphy's sign is negative. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 6 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. Renal cortical echogenicity is slightly increased.OTHER: The left kidney measures 9.9 cm in length. No evidence of hydronephrosis. Renal cortical echogenicity is slightly increased. There is a 4.1 x 4.3 x 4.3 cm left upper pole simple renal cyst.The spleen measures 8.5 cm in length.", "output": "1. Cholelithiasis without sonographic evidence of acute cholecystitis.2. Medical renal disease and simple left upper pole renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant ultrasound, evaluate for cholecystitis LIVER: Liver measures 19.5 cm with diffuse coarse echotexture. Portal vein demonstrates normal flow directionality and patency. No focal lesions noted. Minimal fluid fluid noted in the abdomen. No intrahepatic biliary ductal dilatation.BILIARY TRACT: Gallbladder is distended with normal gallbladder wall thickness measuring up to 2.5 mm. No evidence of gallstones. Minimal sludge noted in the gallbladder. Cannot assess Murphy's sign on this patient as per the technologist. Common bile duct measures up to 4 mm within normal limits.PANCREAS: Head of the pancreas partially visualized appears unremarkable. Body and tail of pancreas could not be visualized due to overlying bowel gas.SPLEEN: Spleen measures 14.6 cm, mildly increased in size. Echogenic area in the spleen is not completely evaluated but could represent a small hemangioma.RIGHT KIDNEY: Right kidney measures 11.9 cm and left kidney measures 9 cm. Limited evaluation of the left kidney due to patient positioning. Mild increased echogenicity of the kidneys noted bilaterally. No hydronephrosis. OTHER: Minimal fluid in the abdomen", "output": "Coarse diffuse echotexture of the liver without any focal lesions. Distended gallbladder with minimal sludge within it without evidence of acute cholecystitis.Mild splenomegaly however spleen and left kidney could not be completely evaluated due to patient positioning.Bilateral echogenic kidneys consistent with chronic medical renal disease.Mild ascites"}
{"instruction": "Generate impression based on findings.", "input": "21-year-old male with abnormal liver function. Short gut syndrome. LIVER: Liver is enlarged, measuring at least 20 cm in length. Echotexture is within normal limits. No focal hepatic abnormality.GALLBLADDER, BILIARY TRACT: Gallbladder contains dependent sludge without gallstones, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: Not visualized due to access.RIGHT KIDNEY: Likely highly echogenic.OTHER: Left upper quadrant could not be evaluated.", "output": "Hepatomegaly.Gallbladder sludge."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female patient with biopsy-proven left breast IDC on chemotherapy. UNILATERAL LEFT DIAGNOSTIC MAMMOGRAM:Three standard views of the left 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. Again seen is in irregular mass with spiculated margins in the left lower outer breast that measures 1.4 x 1.7 cm on CC view, previously 1.8 x 2.1 cm when measured similarly. A percutaneous clip is noted along the posterior margin of the mass. Few benign calcifications are noted distant from the mass.In the left axilla there is a percutaneous clip immediately posterior to a lymph node that measures 0.7 x 1.0 cm, previously measuring 1.4 x 1.9 cm.LEFT BREAST AND AXILLARY ULTRASOUND:In the 4:00 position 5 cm from the nipple there is an irregular hypoechoic mass that measures 1.5 x 1.4 x 1.8 cm, previously 2.2 x 2.2 cm on ultrasound dated 09/18/2015.In the left axilla there are two abnormal appearing lymph nodes. One lymph node measures 0.8 x 0.7 x 0.8 cm. The previously biopsied lymph node with posterior clip measures 1.6 x 0.5 x 0.6 cm, previously measuring up to 1.6 cm on 10/08/2015. However, this lymph node node is decreased in volume compared to prior.", "output": "Interval decrease in size of known left breast cancer as well as interval decrease in size of left axillary lymph nodes. Findings were discussed with the patient.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old female with a nontender palpable lump in the right breast for 2 weeks. A targeted right ultrasound was performed in the 2:00 position of the medial upper right breast approximately 3 cm from the nipple. On physical exam in this area, a non-tender mass was palpable. By ultrasound of this region, a oval circumscribed hypoechoic mass measuring 1.1 x 2.3 cm with internal vascular flow was identified.", "output": "2.3 cm right breast mass could be a fibroadenoma. However, surgical consultation for consideration of palpably guided sampling is recommended to exclude malignancy. Results and recommendations were discussed with the patient who agreed with the plan.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Single thyroid nodule. Palpable. History of Hashimoto's thyroiditis, per patient. RIGHT LOBE MEASUREMENTS: 4.0 x 1.4 x 1.5 cm. Normal in size with normal background echotexture and vascularity.LEFT LOBE MEASUREMENTS: 3.9 and 1.1 x 1.2 cm. Normal in size with normal background echotexture and vascularity.ISTHMUS MEASUREMENTS: 1 mm in AP dimension.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: 6 mm solid isoechoic nodule in the right aspect of the isthmus.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "6 mm solid nodule in the right aspect of the isthmus. This may be amenable to percutaneous biopsy."}
{"instruction": "Generate impression based on findings.", "input": "History of fatty liver LIVER: Echogenic heterogeneous echotexture without mass. Liver length 19.4 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.6 cm in lengthOTHER: Left kidney 12 cm in length. Spleen 11.7 cm in length. No ascites", "output": "Echogenic heterogeneous liver echotexture consistent with fatty infiltration without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 51 years old Reason: eval left labia/groin for fluid collection History: cellulitis and induration s/p bee sting The left labia is markedly edematous and swollen with hypo and anechoic indurated areas. No evidence of any loculated collection to suggest abscess. The largest focal measurable areas 0.7 x 0.7 cm. Labia are vascular on color Doppler imaging.", "output": "Swollen and indurated left labia with largest loculated collection measuring only 0.7 cm. No collections that would be amenable to percutaneous drainage."}
{"instruction": "Generate impression based on findings.", "input": "Chronic indwelling Foley with retention of urine RIGHT KIDNEY: Echogenic renal parenchyma. Multiple minimally complex cysts. No stone or hydronephrosis. 11.5 cm in lengthLEFT KIDNEY: Echogenic renal parenchyma without worrisome mass, stone, or hydronephrosis. 1.2 cm hypoechoic focus in the region of the mid; favor normal renal parenchyma.OTHER: Diffuse bladder wall thickening. Indwelling Foley catheter noted. Trace ascites. Large right pleural effusion.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis. Diffuse bladder wall thickening suggestive for chronic inflammation; indwelling Foley catheter noted. Trace ascites. Large right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis. Evaluate for hepatocellular carcinoma. LIVER: Non-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 9.8 cm in length. The left kidney is 9.4 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 9.8 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites identified.", "output": "Mildly coarsened hepatic echogenicity compatible with parenchymal dysfunction, without suspicious hepatic lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "Cholelithiasis with history of cirrhosis LIVER: Cirrhotic morphology without mass. Liver length 13 cmGALLBLADDER, BILIARY TRACT: Stable cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: Stable subcentimeter pancreatic cyst.RIGHT KIDNEY: No significant abnormalities noted. Stable renal cysts. Right kidney 11.2 cm in lengthOTHER: Stable left renal cyst. Left kidney 11.1 cm in length. Spleen 10.2 cm in length. No ascites.", "output": "Stable cirrhotic morphology without mass or ductal dilatation. No ascites. Stable subcentimeter pancreas cyst. Stable cholelithiasis without acute inflammation or ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal failure RIGHT KIDNEY: Echogenic renal parenchyma without worrisome mass or stone. Minimal hydronephrosis. Right kidney 12.4 cm in lengthLEFT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. Left kidney 12.7 cm in lengthOTHER: Bladder nondistended. Abdominal ascites.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass or stone. Minimal right hydronephrosis. Abdominal ascites."}
{"instruction": "Generate impression based on findings.", "input": "Right renal mass. RIGHT KIDNEY: 10.5 cm in length. The 2.9 x 2.2 x 2.8 cm solid mass at the superior pole is again noted, previously 2.8 x 2.2 x 2.7 cm. Additional multiple minimally complex cysts are identified. No hydronephrosis.LEFT KIDNEY: 10.5 cm in length. Multiple minimally complex cysts are identified. No suspicious lesions are evident. No hydronephrosis.BLADDER: Diffusely thickened bladder wall, similar to prior. OTHER: Prostatomegaly, measuring 6.4 x 6.2 x 5.1 cm and similar to prior.", "output": "Unchanged appearance of the right upper pole renal mass, which remains suspicious for renal cell carcinoma."}
{"instruction": "Generate impression based on findings.", "input": "Liver failure. Known spontaneous left renal hemorrhage at outside hospital. LIVER: Cirrhotic liver morphology. Coarsened parenchymal echogenicity. No focal hepatic lesions. GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. The gallbladder is not well-visualized.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 13.3 cm in length. The renal parenchyma is markedly echogenic. No suspicious renal lesions or hydronephrosis.The left kidney is 13.1 cm in length. No suspicious renal lesions. Mild hydronephrosis. A 12.5 x 8.3 x 5.4 cm hypoechoic collection extends from the inferior pole of the left kidney and is incompletely visualized.BLADDER: Collapsed with Foley catheter in place.SPLEEN: 12.6 cm in length, without focal lesions evident.ABDOMINAL AORTA: Patent. 2.2 cm in maximal diameter, without aneurysm. The distal most aorta is obscured by overlying bowel gas.INFERIOR VENA CAVA: Patent.OTHER: Moderate amount of ascites noted. Complex appearing right pleural effusion is partially imaged.DOPPLER", "output": "1. Cirrhosis with minimal detectable portal venous flow.2. 12 cm retroperitoneal collection at the inferior pole of the left kidney, compatible with hemorrhage given the clinical history. This is incompletely visualized by ultrasound and CT is recommended if more complete evaluation is warranted.3. Echogenic kidneys compatible with medical renal disease. Mild left-sided hydronephrosis.4. Moderate amount of ascites. Right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old male patient with UTI, sepsis. Evaluate for hydronephrosis. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No perinephric fluid collection is identified.KIDNEY: The transplant kidney measures 12.1 cm in length. Renal cortical echogenicity is within normal limits. A subcentimeter cyst is noted within the lower pole.COLLECTING SYSTEM/URETER: There is mild pelvicalyceal prominence, which decreases post-void. A catheter is noted within the renal pelvis.URINARY BLADDER: The bladder is distended with fluid with retention post-void. The distal end of a ureteral stent is visualized.OTHER: No significant abnormality noted", "output": "1. Mild prominence of the collecting system which decreases post-void.2. Post-void urinary retention. "}
{"instruction": "Generate impression based on findings.", "input": "57 years old, Female, Reason: 57 yo F with intermittent RLQ abdominal pain x weeks with CT showing concerns for cholecystitis. Pls aid in eval of acute vs. chronic cholecystitis. History: intermittent RLQ pain LIVER: The liver measures 14.1 cm in length. Mildly increased hepatic parenchymal echogenicity is consistent with fatty infiltration. 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: Multiple gallstones are present within the gallbladder. Gallbladder wall is hypovascular is mildly thickened measuring 5 mm. The sonographic Murphy's sign is negative. No intrahepatic biliary ductal dilatation is present. The common bile duct measures 8 mm in diameter. No evidence of pericholecystic fluid.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 9.7 cm in length. RIGHT KIDNEY: Kidney measures 10.3 cm in length. Normal echotexture of the right kidney. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 9.7 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "Cholelithiasis without definite evidence of acute cholecystitis. However findings may represent chronic cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Patient with newly elevated LFTs and lactic acidosis, recent hyperthermia, assess for parenchymal disease, also do Doppler to look for thrombosis LIVER: Liver measures 12.3 cm with mild coarse echotexture without any focal lesions. No intrahepatic biliary ductal dilatation.Main portal vein demonstrates normal flow directionality and patency. The portal vein peak velocity measures 24.11 cm/s.BILIARY TRACT: Gallbladder appears unremarkable. No evidence of gallstones.PANCREAS: Head and body of pancreas visualized, tail of pancreas is not visualized due to overlying bowel gas. Pancreatic duct is mildly prominent measuring up to 3 mm.SPLEEN: No significant abnormalities noted. Spleen measures 5.2 cm, incompletely imaged spleen.RIGHT KIDNEY: Right kidney measures 8.9 cm and left kidney measures 8.4 cm. Mild increased echogenicity of both kidneys consistent with chronic medical renal disease. No hydronephrosisOTHER: Bilateral pleural effusions noted.", "output": "Bilateral pleural effusions.Main portal vein is patent.Mild coarse echotexture of the liver consistent with chronic liver disease/liver dysfunction.Incompletely imaged spleen due to patient positioning and overlying bowel gas."}
{"instruction": "Generate impression based on findings.", "input": "24-year-old female, pregnancy with right upper quadrant pain. Evaluate for subcapsular hematoma the liver. LIVER: Normal in size and echotexture. No associated fluid collections. Main portal vein is patent with appropriate flow direction.GALLBLADDER, BILIARY TRACT: No cholelithiasis, wall thickening or pericholecystic fluid. Visualized intra and extra hepatic biliary tract are normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Probable horseshoe kidney crossing the midline.OTHER: No significant abnormalities noted.", "output": "No evidence for subcapsular hematoma. No cause for patient's right upper quadrant pain identified."}
{"instruction": "Generate impression based on findings.", "input": "79-year-old male with history of CHF, VT ablation with rising LFTs, AMS. Evaluate patency of portal and hepatic vasculature. LIMITED ABDOMENLIVER: Increased echogenicity the liver measuring 15.4 cm in length. No focal hepatic lesions.BILIARY TRACT: The gallbladder is not visualized. No intra-or extrahepatic noted ductal dilatation.PANCREAS: Visualized portions of the pancreas are unremarkable.SPLEEN: Normal echogenicity of the spleen measuring 11.0 cm in length. RIGHT KIDNEY: Mildly echogenic right kidney measuring 10.0 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Mildly echogenic left kidney measuring 9.3 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "1. Increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. No hepatic mass. Patent inflow and outflow hepatic vasculature.2. Mildly echogenic kidneys suggestive of parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal failure RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. Right kidney 9 cm in lengthLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. Left kidney 10.4 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": "Right breast fibroadenoma, assess stability. Patient indicates palpable mass right breast 10:00 minimally increases in size during periods, mostly stable. A targeted right ultrasound was performed for the palpable area of concern. On physical examination, 2 cm mobile mass noted in the right breast 10 to 12:00 position. Ultrasound demonstrates a possible bilobed or 2 adjacent small masses at 10:00 position. The hypoechoic encapsulated mass measures 2.5 x 1.2 x 2.4 cm, previously measured 2.5 x 0.9 x 2 cm, mostly unchanged from prior study. Peripheral blood flow noted. There are no new masses noted.", "output": "Palpable abnormality right breast 10:00 position corresponds to stable benign fibroadenoma based on imaging. Findings conveyed to the patient and her mother.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Screening for hepatocellular carcinoma History: cirrhosis; hx of HCV LIVER: The liver measures 19.35 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 0.19 m/s.BILIARY TRACT: Nonmobile, non-shadowing focus along the gallbladder wall likely representing a polyp measuring up to 4 mm, unchanged. No gallbladder wall thickening or pericholecystic fluid. 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 12.3 cm in length. RIGHT KIDNEY: Kidney measures 13.4 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 14.9 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No ascites.", "output": "1.Hepatomegaly and cirrhotic liver morphology without focal hepatic lesions. No ascites.2.4 mm gallbladder polyp is stable."}
{"instruction": "Generate impression based on findings.", "input": "Reason: nodule on CT History: none RIGHT LOBE MEASUREMENTS: 5.9 x 1.7 x 1.7 cm.LEFT LOBE MEASUREMENTS: 4.9 x 1.9 x 1.5 cm.ISTHMUS MEASUREMENTS: 0.6 cm.RIGHT LOBE: In the inferior pole, there is a predominantly solid well-defined ovoid nodule measuring 0.9 x 0.5 x 0.9 cm, likely benign.LEFT LOBE: In the left lobe, there is a spongiform ovoid nodule measuring 1.2 x 0.8 x 1.0 cm.ISTHMUS: In the isthmus, there is a spongiform ovoid nodule measuring 1.2 x 0.8 x 1.0 cm, likely benign.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Three likely benign thyroid nodules. "}
{"instruction": "Generate impression based on findings.", "input": "Inflammatory bowel disease with abdominal pain and fatigue LIVER: No significant abnormalities noted. 15.4 cm in length BILIARY TRACT: Probable adenomyomatosis of gallbladder. No evidence for acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 10.9 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10 cm in lengthOTHER: Left kidney 11.2 cm in length. No ascites.", "output": "Probable adenomyomatosis of gallbladder without evidence for acute inflammation or ductal dilatation. No acute hepatobiliary abnormality. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "22 years old, Male, Reason: Evaluate liver and biliary tract History: 22 yo M with hx of MCTD, tricuspid regurgitation, R knee infection, new transaminitis LIVER: The liver measures 16.6 cm in length. The parenchymal echogenicity of the liver is normal. No focal hepatic lesion identified. IVC and hepatic veins are distended, may be seen in the setting of rightsided heart failure. The portal vein is patent with pulsatile hepatopetal flow and 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 5.5 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 11.6 cm in length. No evidence of hydronephrosis.LEFT KIDNEY: Kidney measures 9.2 cm in length. No evidence of hydronephrosis.", "output": "1.Normal gallbladder and biliary tract with no evidence of cholelithiasis or acute cholecystitis.2.The parenchymal echogenicity of the liver is normal. No focal hepatic lesion identified. 3.IVC and hepatic veins are distended, suggesting rightsided heart failure. "}
{"instruction": "Generate impression based on findings.", "input": "51-year-old male with hepatitis C. Evaluate for HCC. LIVER: The liver parenchyma is mildly increased and coarsened in echogenicity. No discrete lesion is identified. It measures 17.8 cm in craniocaudal dimension. No intrahepatic biliary ductal dilatation. Normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: The common duct measures 5 mm in caliber, within normal limits. The patient is status post cholecystectomy.PANCREAS: The visualized portions of the pancreatic body and head are normal.SPLEEN: The spleen is normal morphology, echogenicity and size, measuring 11.8 cm in length.RIGHT KIDNEY: The right kidney measures 10.7 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 10.7 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow.", "output": "Mild hepatic parenchymal hyper-echogenicity suggesting underlying hepatic steatosis and/or parenchymal dysfunction. No discrete liver lesion."}
{"instruction": "Generate impression based on findings.", "input": " There are 5 lumbar-appearing vertebrae. For the purposes of this exam, the last fully formed disc is at L5-S1 with the last rib-bearing vertebra designated as T12.The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the low normal L2-L3 level. On prone imaging, there is clear ventral motion of the distal cord and conus within the thecal sac. No abnormal fat signal intensity is seen along the distal thecal sac to suggest a fatty filum.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine.", "output": "Essentially unremarkable noncontrast MRI of the lumbar spine, without MR imaging findings of tethered cord. Conus termination is at the lower limits of normal at L2-L3."}
{"instruction": "Generate impression based on findings.", "input": "Male 60 years old Reason: evaluate for hydronephrosis, medical renal disease in transplanted kidney History: patient with progressive creatinine worsening post transplant, course complicated by BK viremia and acute rejection RIGHT ILIAC FOSSA KIDNEY: No hydronephrosis or shadowing calculus. Renal cortex has increased echogenicity consistent with medical renal disease. Perinephric fluid collection is decreased in size compared to the prior exam measuring 2.8 x 1.2 x 2.0 cm.OTHER: No significant abnormalities noted.", "output": "1.No hydronephrosis or shadowing calculus. Increased renal cortical echogenicity is nonspecific but can be seen in the setting of medical renal disease. 2.Perinephric fluid collection is decreased in size compared to the prior exam."}
{"instruction": "Generate impression based on findings.", "input": "History of HCV, cirrhosis LIVER: Nodular contour of the liver with coarse echotexture compatible with cirrhotic morphology. No focal lesions noted.GALLBLADDER, BILIARY TRACT: Large stone noted within the distended gallbladder. The wall thickness within normal limits without evidence of pericholecystic fluid. No extra or intrahepatic ductal dilatation noted. Common bile duct measures up to 3 mm.PANCREAS: Partially visualized due to overlying bowel gas, unremarkableRIGHT KIDNEY: Right kidney measures 7.8 cm and left kidney measures 10.4 cm. Areas of cortical thinning noted in both kidneys. Normal echotexture without hydronephrosis. OTHER: The spleen measures 6.3 cm with normal echo texture.", "output": "Cirrhotic morphology of liver without any focal discrete lesion. No ascites. Cholelithiasis without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for acute cholecystitis. Evaluate right iliac fossa renal allograft. LIVER: The liver is normal in morphology, echogenicity and size measuring 15.3 cm in craniocaudal dimension. No focal lesion or intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 36 cm/s. Normally distended gallbladder without significant wall thickening pericholecystic fluid or focal tenderness (although non-specific in the setting of pain medication administration)2 4 mm non-dependent adherent non-shadowing gallstones and/or polyps.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation with the common duct measuring 2 mm.PANCREAS: The visualized portions of the pancreatic head are unremarkable. The body and tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 10.9 cm in length.RIGHT ILIAC FOSSA TRANSPLANT: The right iliac fossa transplanted kidney measures 13.7 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. It demonstrates normal corticomedullary differentiation. No peritransplant fluid collection. Color Doppler demonstrates hilar blood flow.OTHER: No significant abnormalities noted.", "output": "1. Two 4 mm adherent non-shadowing gallstones versus gallbladder polyps. No evidence of acute cholecystitis.2. Unremarkable right iliac fossa renal allograft. Please note that detailed evaluation of the vasculature was not performed."}
{"instruction": "Generate impression based on findings.", "input": "Unknown baseline creatinine, renal disease RIGHT KIDNEY: Measures 10.3 cm. Echogenic renal parenchyma. No hydronephrosis or mass.LEFT KIDNEY: Measures 9.1 cm. Echogenic renal parenchyma. No hydronephrosis or mass. Nonobstructive stone in the renal pelvis measures up to 0.9 cm.OTHER: Bladder is incompletely distended.", "output": "Medical renal disease and nonobstructive left renal pelvis stone."}
{"instruction": "Generate impression based on findings.", "input": "15-year-old female with history of right breast mass, presenting for short-term sonographic follow-up. No family history of breast cancer. On the physical exam there is a mobile oval mass at the right 11:00 position.Targeted ultrasound of the right upper outer breast, 11:00 position 3 cm from the nipple reveals an oval circumscribed parallel hypoechoic mass measuring 2.2 x 1.1 x 1.9 cm (largely stable in size using similar measuring techniques), with internal vascularity and posterior acoustic enhancement.", "output": "No enlargement of the high probability benign right 11:00 mass, with imaging characteristics suggestive of a fibroadenoma. As long as the mass remains clinically stable and will be followed, sonographic follow-up in 6-12 months is suggested. BIRADS: 3 - Probably benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "57 year old female post thyroidectomy for thyroid cancer. Follow-up small focus left thyroid bed. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massesLEFT LOBE: No masses. There is identified small hypoechoic area no longer seen.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No evidence for mass or abnormal lymph nodes."}
{"instruction": "Generate impression based on findings.", "input": "Female 32 years old Reason: r/o goiter. r/o nodules. r/o adenopathy History: Goiter. Had nodes on outside study RIGHT LOBE MEASUREMENTS: 4.7 x 1.6 x 1.5 cmLEFT LOBE MEASUREMENTS: 4.3 x 1.3 x 1.5 cmISTHMUS MEASUREMENTS: 6 mmRIGHT LOBE: Coarse echotexture of the thyroid suggestive of thyroiditis.LEFT LOBE: Coarse echotexture of the thyroid suggestive of thyroiditis.ISTHMUS: Thyroiditis.PARATHYROID GLANDS: There are multiple, well-defined, hypoechoic, bilateral lobar and round lesions inferior to the inferior aspect of the right lobe of the thyroid, suspicious for parathyroid adenomas/hyperplasia. Largest one is bilateral lobar and measures 1.4 x 0.6 cm.Similarly there are also well-defined, hypoechoic lesions inferior to the inferior aspect of the left thyroid lobe measuring 1.3 x 0.5 cm. These are also suspicious for parathyroid adenoma/hyperplasia.LYMPH NODES: Benign-appearing lymph nodes in the supraclavicular region on the left and in the neck bilaterally.OTHER: No significant abnormality noted.", "output": "Coarse echotexture of the thyroid suggestive of thyroiditis.Well-defined, round hypoechoic lesions inferior to the inferior aspect of the thyroid lobes. Etiology of these is uncertain but given the location and appearance-suspicious for parathyroid adenoma/hyperplasia. Clinical correlation and if necessary further evaluation with nuclear medicine scan is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Female 52 years old Reason: thyroid nodules History: thyroid nodules RIGHT LOBE MEASUREMENTS: 5.4 x 1.6 x 1.3 cmLEFT LOBE MEASUREMENTS: 5.2 x 1.5 x 1.1 cmISTHMUS MEASUREMENTS: 2 mm RIGHT LOBE: Again noted are multiple nodules in the right thyroid lobe. Index complex cystic solid and upper pole nodule is slightly smaller measuring 1.6 x 0.6 x 1 cm. Other nodules are also unchanged.LEFT LOBE: Again noted are multiple nodules in the left thyroid lobe. Index lower pole nodule is unchanged measuring 1.6 x 0.8 x 1 cm. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No significant change in the size and number of the nodules."}
{"instruction": "Generate impression based on findings.", "input": "81 years Female with pain over left renal fossa following trauma. RIGHT KIDNEY: Kidney measures 9.4 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.0 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: The bladder appears grossly unremarkable.", "output": "Unremarkable examination without evidence of perinephric fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "Multiple lymph nodules. There is no evidence of significant cervical lymphadenopathy base on size criteria, including subcentimeter right level 5A lymph nodes. The major salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.", "output": "No discernible thyroid nodules or significant lymphadenopathy in the neck."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old with known breast cancer and palpable left supraclavicular nodes. A targeted left ultrasound was performed for the area marked by the clinical service in the supraclavicular region. There are multiple adjacent small masses. Several of these are highly compatible with abnormal morphology lymph nodes. These measure up to 9 mm. The largest mass is a mixed echogenicity mass with increased vascularity measuring 2.0 x 1.9 cm. This could represent an additional lymph node replaced by tumor.", "output": "Multiple masses at the site of palpable concern most compatible with abnormal lymph nodes. The patient is followed by Dr. Jaskowiak.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Hematuria RIGHT KIDNEY: 9.4 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis. No perinephric fluid collections.LEFT KIDNEY: 9.2 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis. No perinephric fluid collections.BLADDER: Collapsed.OTHER: No significant abnormality noted.", "output": "No specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Successful hypodense lesion seen on prior chest CT. Weight loss. Normal TSH. RIGHT LOBE MEASUREMENTS: 5.1 x 2.6 x 2.3 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.2 x 0.9 cmISTHMUS MEASUREMENTS: 0.2 cm in AP dimensionRIGHT LOBE: The heterogeneous predominantly-solid nodule in the midpole measures 3.2 x 1.8 x 2.8 cm, with some features suggestive of early spongiform changes. LEFT LOBE: Predominately cystic 0.4 x 0.3 x 0.4 cm nodule in the lower pole.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: 1.5 x 0.7 x 0.3 cm left level 3 lymph node, without suspicious features.", "output": "Thyroid nodules, with the dominant right lobe nodule demonstrating early spongiform changes."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old female with a multinodular thyroid. Evaluate nodules. RIGHT LOBE MEASUREMENTS: 5.3 x 1.6 x 1.8 cm.LEFT LOBE MEASUREMENTS: 4.5 x 1.8 x 1.8 cm.ISTHMUS MEASUREMENTS: 0.2 cm.RIGHT LOBE: The right parenchyma is heterogeneous and nodular. There are multiple hypoechoic areas throughout the thyroid. There are associated somewhat linear areas of increased echogenicity which may be seen in thyroiditis. No focal mass. The right thyroid appears less vascular in comparison to the prior study.LEFT LOBE: Left parenchyma is heterogenous and nodular. There are multiple hypoechoic areas throughout the thyroid. There are associated somewhat linear areas of increased echogenicity which may be seen in thyroiditis. No focal mass. The left thyroid appears less vascular in comparison to the prior study.ISTHMUS: The parenchyma of the isthmus is heterogenous and nodular. There are multiple hypoechoic areas throughout the isthmus. No focal mass. The isthmus appears less vascular comparison to prior study.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Parenchyma heterogenous and nodular without focal mass. The appearance is suggestive of thyroiditis. Interval decrease in vascularity in comparison to the prior study dated May 2016.Due to the lack of focal mass, biopsy was not performed. This was discussed with Dr. Peter Angelos."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old female complains of right upper quadrant pain. LIVER:The liver measures 15.5 cm. There is normal echogenicity of the parenchyma. No masses, ascites, or intrahepatic ductal dilatation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: There is an approximately 1.7 x 0.6 cm hyperechoic, dependent, shadowing foci in the gallbladder that is consistent with a gallbladder stone. No sludge or debris is seen. The gallbladder wall measures approximately 0.1 cm. There is a negative sonographic Murphy's sign. No pericholecystic fluid. The common bile duct measures approximately 0.2 cm.PANCREAS: Evaluation appears limited due to overlying bowel gas, however the visualized portions appear normal.SPLEEN: The spleen measures approximately 10.5 cm. No abnormalities noted.KIDNEYS: The right kidney measures approximately 11.9 cm. The cortex has normal echogenicity. No shadowing calculi, concerning mass, or hydronephrosis. The left kidney measures approximately 10.4 cm. The cortex has normal echogenicity. No shadowing calculi, concerning mass, or hydronephrosis.OTHER: No significant abnormality noted.", "output": "1. Cholelithiasis as described above without signs of acute inflammation or ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Female; 31 years old. Reason: eval left neck salivary gland History: left neck tenderness 4 x 4 mm colloid cyst in the right thyroid gland.The patient indicated the area of tenderness on the left neck posterior to the ear. Images obtained in this location reveal no abnormal lymph nodes or fluid collection. The imaged portions of the left submandibular gland are unremarkable.", "output": "No ultrasound finding to explain the patient's left neck tenderness."}
{"instruction": "Generate impression based on findings.", "input": "Oliguria, AKI RIGHT KIDNEY: Measures 9.7 cm. No hydronephrosis. No shadowing intrarenal echogenic focus seen to suggest underlying nephrolithiasis. No perinephric free fluid.LEFT KIDNEY: Measures approximately 9.7 cm, when large lower pole exophytic cyst included, measures up to 15 cm in longitudinal dimension. The cyst appears simple and measures 7.1 x 5.3 x 4.6 cm. No hydronephrosis. No shadowing intrarenal echogenic focus seen to suggest underlying nephrolithiasis. No perinephric free fluid.OTHER: Mild to moderate degree urinary bladder distention containing Foley catheter.", "output": "1. No hydronephrosis.2. Distended during bladder despite presence of Foley catheter, suspicious for nonfunctioning or poorly functioning Foley catheter and correlation with patient's clinical history recommended and repositioning should be considered."}
{"instruction": "Generate impression based on findings.", "input": "Term cell tumor status post right colectomy now with left testicular lesion RIGHT TESTIS: Status post orchiectomyLEFT TESTIS: 0.6 x 0.5 x 0.6 cm hypoechoic discrete mass within the left testicle. This lesion does not appear to be associated with the mediastinum.RIGHT EPIDIDYMIS: Status post orchiectomyLEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Moderate left hydrocele", "output": "Subcentimeter hypoechoic discrete mass within the left testicle not associated with the mediastinum. This finding is worrisome for a neoplastic focus, including malignancy."}
{"instruction": "Generate impression based on findings.", "input": "Female 29 years old Reason: biopsy of transplanted kidney History: elevated SCR Ultrasound guidance provided for a kidney biopsy performed by the nephrology service.", "output": "Ultrasound guidance provided for a kidney biopsy performed by the nephrology service."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Rule out obstruction, AKI on potential CKD RIGHT KIDNEY: The right kidney measures 10.57 m in length. There is increased renal parenchymal echogenicity. There is no hydronephrosis, focal mass, or stone.LEFT KIDNEY: The left kidney measures 10.47 m in length. There is increased renal parenchymal echogenicity. There is no hydronephrosis, focal mass, or stone.URINARY BLADDER: No significant abnormalities noted.OTHER: Mildly increased hepatic echogenicity and echotexture.", "output": "Increased renal parenchymal echogenicity, which can be seen in the setting of chronic medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Male; 54 years old. Reason: R lateral shoulder dermal thickening, evaluate for deep mass History: above In the area of the palpable abnormality overlying the right deltoid muscle is a 2.9 x 0.9 x 2.4 cm area of subcutaneous edema. No underlying mass is identified. There is no drainable collection.", "output": "Subcutaneous edema but no discrete mass or drainable collection in the area of the patient's reported abnormality. Correlate clinically for signs/symptoms of cellulitis."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old female with focal pain and swelling left groin. In the left pudenda there is a hypoechoic region in the deep subcutaneous fat which appears mildly complex. During Valsalva,, this region elongates and there is an apparent, focal defect in the musculature of the pelvic wall deep to this location. Findings are consistent with a small hernia, likely containing fat. There is no evidence for bowel herniation.", "output": "Findings consistent with small pelvic wall hernia, likely containing fat."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain. LIVER: The liver measures 17.4 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 0.21 m/s.BILIARY TRACT: Cholelithiasis without associated gallbladder wall thickening or pericholecystic fluid. Technologist reported positive Murphy's sign. There is a shadowing stone measuring up to 1.1 cm in the intrapancreatic portion of the common bile duct with associated upstream dilation of the common bile duct up to 8 mm. No significant intrahepatic biliary ductal dilatation.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 11.4 cm in length. RIGHT KIDNEY: Kidney measures 11.8 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": "1.Choledocholithiasis including 1.1 cm common bile duct stone with associated extrahepatic biliary ductal dilatation.2.Cholelithiasis without associated gallbladder wall thickening or pericholecystic fluid.Preliminary findings of choledocholithiasis were discussed by radiology resident on call resident with Dr. Bokarius 4:07 a.m. on 12/13/2016."}
{"instruction": "Generate impression based on findings.", "input": "Short-term follow-up for probably benign mass in the right breast. A targeted right ultrasound was performed . An oval hypoechoic lesion does not appear significantly changed in size, today measuring 5 x 4 mm. No vascularity is seen within the finding. This is favored to represent a complicated cyst or another benign etiology. A normal morphology lymph node is also seen posterior and superior to this mass. There is no suspicious solid or cystic mass identified.", "output": "No significant change in right breast mass. At this point, bilateral diagnostic mammogram with possible ultrasound is recommended in February 2016.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "68 year old female with abnormal alkaline phosphatase and lipase. History of cholecystectomy and lupus on steroids. The study was limited due to the patient's body habitus and bowel gas shadowing.LIVER: The liver parenchyma is coarse and mildly hyperechoic. The liver measures 13.9 cm in craniocaudal dimension. No intrahepatic biliary ductal dilatation or focal hepatic lesion is identified. There is also hepatopetal portal venous blood flow at 30 cm/sec.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common bile duct measuring 3 mm. The patient is status post cholecystectomy.PANCREAS: The pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen is mostly obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 11.4 cm in length without hydronephrosis or shadowing calculus. OTHER: There is mild generalized body wall edema. Small amount of ascites and pleural effusions.", "output": "1. Limited study as described above without biliary ductal dilatation.2. Heterogeneous and coarse liver parenchyma likely related to steatosis/diffuse parenchymal dysfunction.3. Trace ascites and bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Warren is a 64-year-old woman with known biopsy proven left breast cancer on hormonal therapy presents for follow-up. On physical exam, there is a palpable hard mass in the left breast centered at the 12:00 position, compatible with known cancer.A targeted left breast ultrasound was performed for the palpable area of concern. In the 12:00 position, 1 cm from nipple, there is a 4.3 x 1.6 x 3.6 cm hypoechoic to isoechoic mass consistent with the known malignancy, previously measuring 3.4 x 1.5 x 3.1 cm. There does not seem to be any significant change in size of this mass, accounting for differences in image acquisition (panoramic views) and technique.", "output": "No significant change in size of biopsy-proven cancer in the left breast. Continued surgical management is recommended. The 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": "Patient is a 55-year-old female who presents for for the evaluation of the focal asymmetry seen in bilateral breasts seen on the prior screening mammogram dated 8/26/2015. Bilateral MLO and spot compression of both breasts Were performed digitally and reviewed with the aid of R2 CAD, 8.3. The breast parenchyma composed of scattered fibroglandular elements, unchanged in pattern and distribution.A 7 mm focal asymmetry identified on the screening mammogram in the left breast upper-outer quadrant persist on the diagnostic spot compression. Asymmetry in the medial right breast disperses into normal breast tissue.With physical exam, no discrete mass was palpated. Focused ultrasound demonstrates a 8 x 4 x 7 mm heterogeneous oval mass with calcifications and a few cystic components in the left breast at 2:00 location, 1 cm from the nipple. This likely represents a clustered cyst.", "output": "No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended in 6 months to evaluate stability of a clustered cyst. 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": "Male 60 years old Reason: RUQ pain History: RUQ pain LIVER: Gallbladder is significantly distended with layering debris. Gallbladder wall is thickened. The fifth cholecystitis cannot be excluded. Small amount of ascites is noted. Bilateral small pleural effusion.No evidence of intra or extrahepatic biliary dilatation.", "output": "Distended gallbladder with layering sludge. Cholecystitis cannot be entirely excluded."}
{"instruction": "Generate impression based on findings.", "input": "Female 41 years old Reason: 41 yo AAF - with proteinuria and CKD - getting a biopsy History: 41 yo AAF - with proteinuria and CKD - getting a biopsy Ultrasound provided for the nephrology service for a ultrasound-guided biopsy of the right kidney.", "output": "Ultrasound provided for the nephrology service for a ultrasound-guided biopsy of the right kidney."}
{"instruction": "Generate impression based on findings.", "input": "Left renal mass noted on outside hospital CT. A cortically based exophytic mass is partially visualized arising from the superior pole of the left kidney. Due to limited visualization, after discussion with the patient, the decision was made to proceed with a CT-guided biopsy. No biopsy was performed as part of the ultrasound examination.", "output": "Limited images obtained of the left kidney as part of an aborted biopsy procedure. CT-guided biopsy will now be performed."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B LIVER: Coarse echogenic liver parenchyma again noted. 1.2 x 1 x 1.5 cm hypoechoic focus within the right lobe again noted and unchanged. Liver length 13.8 cmGALLBLADDER, BILIARY TRACT: Stable subcentimeter gallbladder polyp measuring 0.5 cm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.2 cm in length.OTHER: Left kidney 12.5 cm in length. Spleen 12 cm in length. No ascites", "output": "Stable coarse echogenic liver parenchyma noted consistent with chronic liver disease. Stable right lobe hypoechoic focus; correlation with prior studies and MR suggests a benign etiology. Stable gallbladder polyp. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis of liver LIVER: Coarse echogenic liver echotexture again noted without mass. Liver length 17.4 cm. Limited Doppler interrogation of 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. 9.6 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.4 cm in lengthOTHER: Left kidney 10.1 cm in length. No ascites", "output": "Coarse echogenic liver echotexture again noted consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "52 year old female who was recalled from screening mammogram for new right breast mass. No family history of breast cancer. 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, unchanged in pattern and distribution. Within the anterior, upper outer right breast, there is redemonstration of a new, circumscribed mass which persists on spot compression imaging, measuring approximately 0.7 cm. Approximately 2 cm posterior to this new mass, there is an intramammary lymph node.RIGHT BREAST ULTRASOUND: On physical examination, no palpable lesion is identified.At the 11 o'clock position of the right breast, 3 cm from the nipple, there is a 0.5 x 0.2 x 0.6 cm cluster of cysts. No significant vascularity is associated with this lesion.At the 11 o'clock position of the right breast, 5 cm from the nipple, there is a 0.7 cm benign intramammary lymph node.", "output": "Clustered cysts at the 11 o'clock position of the right breast, corresponding to the finding on prior mammogram.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."}
{"instruction": "Generate impression based on findings.", "input": "Male, 50 years old. S/p renal txp, ureteral stenosis, eval degree of hydronephrosis. LEFT ILIAC FOSSA TRANSPLANT KIDNEY: The transplant kidney in the left iliac fossa measures 12.5 cm in length, with normal cortical echotexture. Moderate to severe hydronephrosis. No shadowing stone is identified. No perinephric fluid collections.OTHER: The native kidneys are atrophic. The bladder is incompletely distended.", "output": "Moderate to severe hydronephrosis of the left iliac fossa transplant kidney. No perinephric fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old male with history of abdominal pain, fevers. Assess for pyelonephritis. Very limited examination due to patient cooperation and positioning.RIGHT KIDNEY: Measures 8.4 cm in length. Mildly increased renal echogenicity without hydronephrosis.LEFT KIDNEY: Not clearly visualized due to the limitations of the study.BLADDER: Collapsed with a Foley catheter in place.OTHER: No significant abnormalities noted.", "output": "1. Very limited examination as detailed above with nondiagnostic examination of the left kidney. 2. Increased right renal echogenicity consistent with medical renal disease, without hydronephrosis. "}
{"instruction": "Generate impression based on findings.", "input": "Enlarged thyroid on exam RIGHT LOBE MEASUREMENTS: 3.6 x 1.8 x 1.7 cmLEFT LOBE MEASUREMENTS: 5.3 x 2.2 x 2.5 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Diffusely heterogeneous gland. Predominantly solid lower pole nodule measuring 0.6 x 0.6 x 0.6 cm. Predominantly cystic subcentimeter nodule mid pole measuring 0.4 x 0.3 x 0.4 cm.LEFT LOBE: Diffusely heterogeneous gland. Predominantly solid lower pole nodule measuring 2.2 x 1.7 x 1.8 cm. Subcentimeter cystic focus also noted within the mid pole.ISTHMUS: Diffusely heterogeneous glandPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland. Predominantly solid left lower pole nodule; this lesion is amenable to ultrasound-guided biopsy. Additional subcentimeter nodules as described. No thyromegaly. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "History of Hashimoto's thyroiditis with nodules. RIGHT LOBE MEASUREMENTS: 4.6 x 1.5 x 1.8 cm.LEFT LOBE MEASUREMENTS: 4.5 x 1.8 x 1.9 cm.ISTHMUS MEASUREMENTS: 0.4 cm.RIGHT LOBE: Diffusely heterogeneous parenchymal echotexture, appearance consistent with sequelae of Hashimoto's thyroiditis. Hyperechoic midpole nodule measuring 0.7 x 0.6 x 0.9 cm.LEFT LOBE: Diffusely heterogeneous parenchymal echotexture, appearance consistent with sequelae of Hashimoto's thyroiditis. Hyperechoic midpole nodule measuring 0.9 x 0.7 x 0.5 cm.ISTHMUS: Heterogeneous echotexture without discrete nodules.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Left level 2 cervical lymph node measuring 1.8 x 0.5 x 1.1 cm with indeterminate appearance in terms of shape and echogenicity.OTHER: No significant abnormality noted.", "output": "1.Thyroid appearance compatible with Hashimoto's thyroiditis including hyperechoic nodules.2.Left level 2 cervical lymph node which may be reactive but has indeterminate imaging features. Continued follow-up is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury, not improving Examination is limited by inability to reposition the patient.RIGHT KIDNEY: Poorly visualized due to inability to reposition the patient. No gross hydronephrosis.LEFT KIDNEY: 9.9 cm in length. Increased renal parenchymal echogenicity. An 8 mm nonobstructing stone is noted in the inferior pole. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: Poorly visualized due to inability to position the patient.OTHER: No significant abnormality noted.", "output": "Left nephrolithiasis, without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Female 36 years old Reason: enlarged thyroid on exam with fatigue, please evaluate RIGHT LOBE MEASUREMENTS: 5.7 x 1.7 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.5 x 1.6 cm.ISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: No nodules are present in the right thyroid lobe. Right thyroid lobe is mildly heterogeneous, with possible mild hypovascularity.LEFT LOBE: No nodules are present in the left thyroid lobe. Left thyroid lobes also mildly heterogeneous, with possible mild hypovascularity.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Mild heterogeneity and possible mild hypovascularity can be seen in mild thyroiditis. Recommend correlation with lab values."}
{"instruction": "Generate impression based on findings.", "input": "87-year-old male with acute on chronic kidney disease. RIGHT KIDNEY: The right kidney measures 10.4 cm in length without hydronephrosis, shadowing calculus or discrete lesion. Color Doppler demonstrates hilar blood flow. The renal cortex is thinned and echogenic.LEFT KIDNEY: The left kidney measures 9.9 cm in length without hydronephrosis or shadowing calculus. There is a 2.9 x 2.8 x 2.7 cm nearly anechoic, partially septated cystic lesion, likely a septated cyst. Color Doppler demonstrates hilar blood flow. The renal cortex is thinned and echogenic.URINARY BLADDER: The urinary bladder is normally distended with anechoic fluid. There may be mild wall thickening.OTHER: No significant abnormalities noted.", "output": "No hydronephrosis. Medical renal disease. Probable septated left renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "Pulmonary hypertension with abdominal distention LIVER: Mildly coarse echotexture without mass. Liver length 18 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Multiple renal cysts. Right kidney 11.3 cm in length.OTHER: Left kidney not well visualized due to overlying dressings. Spleen 14.9 cm in length. Trace ascites. Left pleural effusion.", "output": "Mildly coarse liver echotexture associated with mild hepatomegaly without mass or ductal dilatation. Trace ascites. Echogenic right kidney parenchyma raises the possibility of medical renal disease/parenchymal dysfunction without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Palpable soft tissue mass in the right lower axillary region, increased in size in the last 6 months. This is a known mass for the past 6 years. Patient will undergo egg retrieval process seen. A targeted right lower axillary ultrasound was performed for the patient\u2019s area of concern. A 2 cm oval nontender soft mass is palpated in the right lower axillary region along the anterior clavicular line, best in the sitting position. Ultrasound demonstrates an oval parallel rounded hypoechoic mixed echogenic mass measuring 4.6 x 1.3 x 1.7 cm with peripheral blood flow. The mass appears encapsulated with an adjacent small 6 x 4 mm normal morphology lymph node in the vicinity. The mass could arise within the muscle fibers and the skin. No definite glandular tissue is identified in the vicinity.", "output": "Palpable abnormality in the right lower axillary region although has benign characteristics with an adjacent normal morphology lymph node, could represent an atypical lipoma or fibroadenolipoma if this appears to be an extension of the breast tissue. Further evaluation with an FNA/core biopsy or MRI is recommended. The findings were discussed with the patient in detail.BIRADS: 3 - Probably benign finding.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old female with renal transplant, rule out hydronephrosis stones or masses. LOCATION: Right iliac fossa.RENAL TRANSPLANT: The transplanted kidney measures 12.2 cm. The cortex has normal echogenicity. There is no evidence of hydronephrosis or stones. In the upper pole, there is a round exophytic hyperechoic area that appears solid. This appears stable in size from prior CT. There is also a hypoechoic round cyst located in the lower pole measuring 1.7 cm x 1.2 cm x 1.8 cm. There is a corresponding hypodense lesion seen on prior CT.PERITRANSPLANT TISSUES: No significant abnormality notedURINARY BLADDER: No significant abnormality noted", "output": "1. There is a hyperechoic lesion in the upper pole of the transplanted kidney corresponding to the intermediately attenuating lesion seen on prior CT. This appears stable in size. The lesion appears solid on ultrasound and malignancy must be considered. Recommend contrast enhanced cross-sectional imaging for further characterization of this upper pole lesion.2. Renal cyst noted in the lower pole of the transplanted kidney, corresponding to the inferior pole lesion seen on CT.3. No perinephric collection or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old female with history of hepatitis B. Evaluate for cirrhosis. LIVER:Measures 13.5 cm. Increased, coarse echotexture of the liver. No focal mass, ascites, or intrahepatic dilation. Portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The lumen of the gallbladder is anechoic. The gallbladder wall measures 0.4 cm. No stones or sludge. No pericholecystic fluid. The common hepatic duct measures 0.4 cm.PANCREAS: Evaluation the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 8.3 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 11.0 cm. Left kidney measures 11.0 cm. The cortices have normal echogenicity. No shadowing calculus, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "1. Increased, coarse echotexture of the liver consistent with chronic liver disease/parenchymal dysfunction. No focal mass. Liver does not have cirrhotic morphology."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old female for follow-up thyroid nodules. RIGHT LOBE MEASUREMENTS: 6 x 2.2 x 2.8 cmLEFT LOBE MEASUREMENTS: 6.7 x 2.1 x 3 cmISTHMUS MEASUREMENTS: 1.1 cmRIGHT LOBE: In the right lobe, there is again noted and almost isoechoic mass with at least a partial hypoechoic rim measuring 0.7 x 0.6 x 0.7 cm without significant change.LEFT LOBE: Complex cystic nodule in the midportion of the left lobe anteriorly measures 1.5 x 1.7 x 1.8 cm, increased in size when compared to prior and also increase in complexity. Posterior hypoechoic and likely spongiform nodule measures 0.6 x 0.7 x 0.9 cm without change.ISTHMUS: Previously noted spongiform-appearing isthmus nodule has changed in appearance, now without obvious cystic component and with poorly defined borders measuring 0.8 x 1.4 x 1 cm, significantly decreased in size when compared to prior exam.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Increase in size of complex cystic left thyroid nodule.2. Stable right and posterior left thyroid nodules.3. Significant decrease in size of prior spongiform nodule, now with ill-defined margins and no obvious cystic component. Presumably, this is related to involution of a colloid nodule."}
{"instruction": "Generate impression based on findings.", "input": "HIV; fevers LIVER: Heterogeneous and echogenic liver echotexture noted without mass. Liver length 19 cmGALLBLADDER, 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 10.7 cm in length. Spleen 16.3 cm in length. No ascites.", "output": "Heterogeneous and echogenic liver echotexture suggestive for parenchymal dysfunction/fatty infiltration without mass or ductal dilatation. Mild hepatomegaly.Mild splenomegaly without mass or associated loculated fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 10 cm in lengthLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 11.2 cm in length.OTHER: 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": "49-year-old female patient with pancreatitis. Evaluate for gallstones. LIVER: The liver measures 17.3 cm in length. 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 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 6.3 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. There is a 1.4 x 1.0 cm right midpole renal cyst. OTHER: The left kidney measures 7.2 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. There is a 0.9 x 0.8 x 1.0 cm renal sinus cyst.The spleen measures 10.4 cm in length.", "output": "1. No cholelithiasis. 2. Medical renal disease with atrophic kidneys and bilateral renal cysts. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 43 years old. Status post right nephrectomy for oncocytoma. RIGHT KIDNEY: The right kidney is surgically absent. A soft tissue focus in the right retroperitoneum measures approximately 1.5 x 2.2 x 2.7 cm, without internal vascularity.LEFT KIDNEY: The left kidney measures 11.7 cm with normal cortical echotexture. No focal lesion or hydronephrosis.OTHER: The bladder is incompletely distended.", "output": "1.Status post right nephrectomy. No focal lesion in the left kidney.2.Nonspecific 2 cm soft tissue focus in the retroperitoneal soft tissues."}
{"instruction": "Generate impression based on findings.", "input": "Evaluation for hydronephrosis RIGHT KIDNEY: 11.3 cm in length. No focal lesions or hydronephrosis. The renal parenchyma is mildly echogenic.LEFT KIDNEY: 10.9 cm in length. No focal lesions or hydronephrosis. The renal parenchyma is mildly echogenic.BLADDER: No significant abnormalities noted. Bilateral ureteral jets identified.OTHER: No significant abnormalities noted.", "output": "Findings compatible with medical renal disease, without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "The patient submitted outside mammogram dated 5/11/11, 4/13/10, from 2525 S. Michigan Ave, Chicago 60616. Submitted outside study was compared to the current mammogram dated 3/18/15. Multiple masses in both breasts appear new from prior studies and ultrasound is recommended for further evaluation. Small cluster of calcifications in left upper outer quadrant is progressing in a benign fashion. The right axillary lymph node appears prominent but stable from prior exams.", "output": "Multiple masses in both breasts appear new from prior studies and ultrasound is recommended for further evaluation. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with a history of alcoholism. Evaluate for liver lesions, vessel patency, cirrhosis. LIMITED ABDOMENLIVER: Measures 12.3 cm. Nodular contour. Increased, course, heterogenous echogenicity. No focal mass, ascites, or intrahepatic biliary dilation.BILIARY TRACT: Gallbladder is nondistended with an anechoic lumen. Gallbladder wall measures approximately 2.4 mm. No stones, sludge, or pericholecystic fluid. Common bile duct measures approximately 0.4 cm.PANCREAS: Evaluation of the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 14.8 cm. KIDNEYS: Right kidney measures 10.8 cm. Left kidney measures 11.6 cm. Normal echogenicity. No focal mass, hydronephrosis, or shadowing calculi.OTHER: No significant abnormalities noted.", "output": "1. Portal vein thrombosis is suspected.2. No ascites which could be due to previously seen splenorenal shunt on a prior CT.3. Nodular contour of liver consistent with cirrhotic morphology. No focal mass."}
{"instruction": "Generate impression based on findings.", "input": "Male, 74 years old. Hydronephrosis, follow-up. RIGHT KIDNEY: The right kidney measures 11.8 cm in length, with mildly increased cortical echogenicity. No focal lesions or hydronephrosis. LEFT KIDNEY: The left kidney measures 11.2 centimeters in length, with mildly increased cortical echogenicity. Mild hydronephrosis, unchanged. No focal lesions.OTHER: The bladder is distended, with bilateral ureteral jets noted.", "output": "1.Mild left-sided hydronephrosis, unchanged.2.Mildly increased renal cortical echogenicity suggests medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Epigastric pain hepatitis C carrier LIVER: Coarse heterogeneous echotexture without mass. Liver length 16.5 cm.GALLBLADDER, BILIARY TRACT: Gallbladder absent. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Stable right renal cysts. Right kidney 10.4 cm in lengthOTHER: Left kidney 10.7 cm in length. Spleen 9.9 cm in length. No ascites.", "output": "Coarse heterogeneous liver echotexture suggestive for chronic liver disease without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Reason: chronic itching in patient with chronically elevated Alk Phos LIVER: The liver measures 13.6 cm in length. Normal hepatic parenchymal echogenicity and echotexture. The portal vein is patent with normal hepatopedal portal flow, peak velocity 28 cm/s.GALLBLADDER, BILIARY TRACT: Equivocal to mildly dilated intrahepatic biliary ducts. No extrahepatic biliary ductal dilatation. The common bile duct measures 0.2 cm. Status post cholecystectomy.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.4 cm in length. No hydronephrosis or shadowing stones.LEFT KIDNEY: The left kidney measures 12.0 cm in length. No hydronephrosis or shadowing stones.OTHER: The spleen measures 10.2 cm in length.", "output": "Mild intrahepatic biliary ductal prominence, please correlate with bilirubin level. No extrahepatic biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Axillary painful soft tissue growth Hypoechoic focus in the subcutaneous soft tissues with surrounding ill-defined hyperechogenicity measures 0.3 x 0.2 x 0.3 cm. No significant vascularity within the hypoechoic focus.", "output": "Hypoechoic focus in the subcutaneous soft tissues of the right axilla with surrounding ill-defined hyperechogenicity as described above does not meet the criteria for a specific benign etiology. MRI or biopsy may be considered for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Renal failure. Ultrasound guidance provided for 3 right renal biopsy passes. No postprocedure hematoma is evident.", "output": "Ultrasound guidance provided for right renal biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Heart transplant workup LIVER:Coarse echogenic liver parenchyma without mass. Liver length 18 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. 10.7 cm in length KIDNEYS: Right renal minimally complex cyst. No hydronephrosis. Subcentimeter nonobstructing renal stone. Right kidney 12.1 cm in length; left kidney 12.2 cm in length ABDOMINAL AORTA: Distal aorta obscured by gasINFERIOR VENA CAVA: No significant abnormality noted.OTHER: No ascites", "output": "Mild hepatomegaly with coarse echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Cholelithiasis without acute inflammation. No ascites. Distal aorta are obscured by gas. Nonobstructing right nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Male 62 years old Reason: history of cirrhosis, HCC screening History: cirrhosis LIVER: The liver is enlarged measuring 19.4 cm. Nodular contour of liver is consistent with cirrhosis. No focal hepatic mass. Main portal vein is patent with normal directional flow and a peak velocity of 14.5 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. The gallbladder has been removed. Common bile duct measures 3 mm.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 15.0 cm.RIGHT KIDNEY: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 11.2 cm. Left kidney measures 11.6 cm. Left renal cyst measures 5.0 x 3.9 x 4.6 cm.OTHER: No ascites.", "output": "Cirrhotic liver morphology without focal mass."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis LIVER: Cirrhotic morphology again noted without mass. Liver length 14.5 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: No change in gallbladder wall thickening and trace pericholecystic fluid. Cholelithiasis unchanged. No ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9 cm in lengthRIGHT KIDNEY: Right kidney not visualized OTHER: Left kidney 13.5 cm in length. No ascites.", "output": "Stable cirrhotic morphology without worrisome mass or ductal dilatation. Stable cholelithiasis with chronic gallbladder wall thickening and trace pericholecystic fluid again noted and unchanged. No ascites"}
{"instruction": "Generate impression based on findings.", "input": "Female 64 years old; Reason: change in thyroid bed History: thyroid cancer s/p I131 sg RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENT: Status post thyroidectomy.RIGHT LOBE: No residual thyroid tissue identified.LEFT LOBE: No residual thyroid tissue identified.ISTHMUS: No residual thyroid tissue identified.LYMPH NODES: Single right level 2 lymph node with a normal smooth cortex and echogenic hilum measuring 1.1 x0.7 x 0.3 cm.OTHER: No significant abnormality noted.", "output": "No evidence of residual or recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old male patient with history of thyroid cancer and large high-grade adenoma. Surgically resected. RIGHT LOBE: Status post thyroidectomy without evidence of disease recurrence. An echogenic focus within the right thyroid bed is unchanged.LEFT LOBE: Status post thyroidectomy without evidence of disease recurrence.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A lymph node in the left thyroid surgical bed is not significantly changed in size measuring 1.3 x 0.4 x 0.4 cm. A benign morphology right level three lymph node measures 1.4 x 0.4 x 0.9 cm, previously 1.5 x 0.4 x 0.9 cm. There is a benign morphology left level two lymph node measuring 1.5 x 0.8 x 0.3 cm.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy without evidence of disease recurrence."}
{"instruction": "Generate impression based on findings.", "input": "Rule out recurrent thyroid cancer RIGHT LOBE: Status post thyroidectomy. 0.8 x 0.3 x 0.5 cm hypoechoic focus within the right thyroid bed not clearly identified on the prior study. This lesion demonstrates a possible echogenic fatty hilum.LEFT LOBE: Status post thyroidectomy. Stable left thyroid bed hypoechoic focus measuring 0.6 x 0.3 x 0.4 cm.ISTHMUS: Status post thyroidectomyPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable subcentimeter left thyroid bed hypoechoic focus.Subcentimeter right thyroid bed hypoechoic focus with possible internal fatty hilum not clearly identified on prior studies. While this finding may represent a benign lymph node, would pay special attention to this lesion on future surveillance scans.No regional adenopathy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Bilateral call back for left breast mass and right breast calcifications. An ML view and two spot 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. Left upper outer quadrant mass persists with spot compression. Calcifications in the right lower outer breast appear to layer on the ML magnification view and appear smudgy on the CC magnification view, suggesting milk of calcium. Adjacent blood vessels are noted. ULTRASOUND", "output": "1. Mass in the left upper outer quadrant for which ultrasound-guided biopsy is requested. Benign etiologies are favored, though malignancy is not entirely excluded.2. Probably benign calcifications in the right breast, suggestive of milk of calcium on mammography and clustered microcysts on ultrasound. Six-month follow-up right mammogram is recommended to ensure stability.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required."}
{"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. In the right upper outer breast, 9:30 location, there is a superficially located round hypoechoic lesion identified measuring approximately 0.4 cm.In the left breast, no suspicious cystic or solid mass is identified.", "output": "Incompletely characterized hypoechoic lesion in the right upper outer breast. Additional imaging, including repeat diagnostic ultrasound with possible mammogram, is recommended for further evaluation. BIRADS: 0 - IncompleteRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "Male 66 years old Reason: CKD History: Nausea, dizziness RIGHT KIDNEY: Echogenic kidney. Right kidney measures 9.3 cm. No focal lesions or hydronephrosis.LEFT KIDNEY: Echogenic kidney. Left kidney measures 9.3 cm. No focal lesions or hydronephrosis. 1 states stone in the lower pole of the left kidney.OTHER: No significant abnormalities noted.", "output": "Echogenic bilateral kidneys. Left nephrolithiasis without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "75 year-old male with fever, abdominal pain, sepsis. Evaluate for cholecystitis. LIVER: Normal echogenicity of the liver measuring 18.6 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate direction of flow; the velocity measures 0.4 m/sec.GALLBLADDER, BILIARY TRACT: Gallbladder unremarkable. No gallbladder wall thickening. No pericholecystic fluid. Sonographic Murphy's sign is negative. Common hepatic duct measures 4 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Tail of the pancreas obscured by overlying bowel gas. The visualized portions are unremarkable.RIGHT KIDNEY: The right kidney measures 12.2 cm in length and is mildly increased in echogenicity. No hydronephrosis or shadowing calculi are noted. Cyst at the midpole measures 1.2 cm x 1.2 cm. OTHER: Left kidney measures 10.3 cm in length and is mildly increased in echogenicity. Hypoechoic focus not well assessed measuring approximately 2.3 cm x 1.9 cm x 1.5 cm.Spleen measures 12.7 cm in length.", "output": "1. Mildly increased echogenicity of the kidneys suggestive of medical renal disease.2. Bilateral cystic renal lesions as described above. 3. No sonographic evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: cause of abdominal pain, suspect for choledocholithiasis History: episode of abdominal pain with elevated transaminases. LIVER: The liver measures 15.9 cm in length. Coarse echogenic hepatic parenchyma. The portal vein is patent with normal directional hepatopedal portal venous blood flow, peak velocity 22.1 cm/s. No focal masses.GALLBLADDER, BILIARY TRACT: Several mobile echogenic stones in the gallbladder lumen without evidence of pericholecystic inflammation. The gallbladder wall measures 0.2 cm, common hepatic duct 0.2 cm, common bile duct 0.3 cm. No biliary ductal dilatation. Negative sonographic Murphy's sign.PANCREAS: The pancreatic duct measures 0.3 cm.RIGHT KIDNEY: The right kidney measures 10.5 cm in length. No hydronephrosis, masses, or shadowing stones.LEFT KIDNEY: The left kidney measures 10.1 cm in length. No hydronephrosis, masses, or shadowing stones.OTHER: No ascites.", "output": "1. Cholelithiasis without evidence of acute inflammation.2. Coarse echogenic hepatic parenchyma, consistent with hepatic steatosis or parenchymal dysfunction. "}
{"instruction": "Generate impression based on findings.", "input": "Female 58 years old; Reason: r/o adenopathy, recurrence History: thyroid cancer. 1 year follow up study RIGHT LOBE MEASUREMENTS: Status post thyroidectomy. LEFT LOBE MEASUREMENTS: Status post thyroidectomy. ISTHMUS MEASUREMENT: Status post thyroidectomy. RIGHT LOBE: Status post thyroidectomy. Subcentimeter hypoechoic focus in the right thyroidectomy bed is unchanged from the prior examination, now measuring 0.4 x 0.3 x 0.2 cm.LEFT LOBE: Status post thyroidectomy.ISTHMUS: Status post thyroidectomy.LYMPH NODES: No suspicious cervical lymphadenopathy is identified.OTHER: No significant abnormality noted.", "output": "Stable examination, no evidence of locoregional disease recurrence."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal liver function tests. LIVER: Non-cirrhotic liver morphology. Mildly heterogeneous parenchymal echogenicity. 15 cm in length. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Contracted gallbladder, which limits visualization and evaluation. 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 10.4 cm in length. The left kidney is 10.3 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.9 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites.", "output": "Heterogeneous hepatic echogenicity, compatible with parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male presents with transaminitis. Evaluate for focal hepatic lesions. LIVER:The liver measures approximately 20.8 cm. There is increased, coarse, heterogeneous echotexture of the liver parenchyma. No masses or ascites. No intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended, the wall measures 0.17 cm. There is echogenic and dependent material within the gallbladder, likely representing sludge. No stones. Negative sonographic Murphy's sign. The common bile duct measures 0.14 cm.PANCREAS: Evaluation. There is limited due to overlying bowel gas.SPLEEN: The spleen measures 7.8 cm. No abnormalities noted.KIDNEYS: The right kidney measures 11.2 cm. The cortex has normal echogenicity. No shadowing calculi or hydronephrosis. The left kidney measures 12.0 cm. The cortex has normal echogenicity. No shadowing calculi or hydronephrosis. OTHER: No significant abnormality noted.", "output": "1. Coarse echogenic liver consistent with chronic liver disease/parenchymal dysfunction. No mass or ascites.2. Hepatomegaly."}
{"instruction": "Generate impression based on findings.", "input": "52 year old female with history of decompensated Nash cirrhosis and one of overload. LIMITED ABDOMENLIVER: Coarse hepatic echogenicity consistent with history of cirrhosis. No discrete masses are identified.BILIARY TRACT: No biliary dilatation. There is gallbladder wall thickening which is likely related to the patient's ascites.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. The spleen measures 13.3 cm. RIGHT KIDNEY: No significant abnormalities noted. The right kidney measures 9 cm.OTHER: Moderate amount of ascites. The left kidney measures 10.9 cm.", "output": "1.Hepatic cirrhosis with moderate ascites.2. Probable cavernous transformation of main portal vein."}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine Interval decrease in size of perinephric hematoma, now measuring 5.1 x 2.9 cm. No stone or significant hydronephrosis. OTHER: Bladder nondistended.", "output": "Interval decrease in size of perinephric hematoma. No significant hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Male, 84 years old. Palpable mass left upper quadrant. No discrete fluid collection or solid mass lesion is identified. No ascites. The region of reported palpable abnormality corresponds with bowel loops which appear normal.Limited images of the liver show increased hepatic echogenicity.The kidneys are only partially imaged.", "output": "1.No mass, fluid collection, or other acute sonographic abnormality to account for the patient's symptoms.2.Increased liver echogenicity, compatible with hepatic steatosis or parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Decompensated cirrhosis LIVER: Diffuse coarse echotexture of the liver which measures 18.6 cm with nodular surface suggestive of cirrhotic morphology. Portal vein demonstrates reversal of flow (hepatofugal) within it. If clinically indicated, liver Doppler examination can be performed to evaluate the hepatic artery and portosystemic shunts.Minimal ascites noted.BILIARY TRACT: No intrahepatic biliary ductal dilatation. Gallbladder is distended with mild gallbladder wall thickening measuring up to 4 mm which could be due to adjacent ascites. Gallbladder sludge noted. No definite evidence of gallstones. Sonographic Murphy sign is negative.PANCREAS: Not visualized due to overlying bowel gas.SPLEEN: Spleen measures 21 cm, increased in size without any focal lesions.RIGHT KIDNEY: Right kidney measures 13.2 cm and left kidney measures 12 cm with normal echotexture. No evidence of hydronephrosis. No renal stones. OTHER: Ascites noted. Right pleural effusion noted.", "output": "1. Diffuse cirrhotic morphology of the liver without any focal lesions. Hepatofugal/reversal of flow in the portal vein noted. Distended gallbladder with sludge and gallbladder wall thickening most likely due to adjacent ascites rather than cholecystitis.2. Moderate splenomegaly with ascites.3. Right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old female with history thyroid cancer status post total thyroidectomy. 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: Single left level 2 benign-appearing lymph node measuring 1.8 x 0.3 x 0.7 cm. OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy without mass in surgical bed. "}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain. Status post cholecystectomy and splenectomy in 1987. LIVER: Non-cirrhotic liver morphology. Mildly coarse parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: Mildly prominent common bile duct, which may reflect prior cholecystectomy. Otherwise no biliary ductal dilation. PANCREAS: Limited evaluation of the pancreas due to partial obscuration by bowel gas. The visualized pancreatic head and neck appear prominent.KIDNEYS: The right kidney is 12.7 cm in length. The left kidney is 12.4 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: Status post splenectomy.OTHER: No significant abnormalities noted. No abdominal free fluid identified.", "output": "1. Limited evaluation of the pancreas. However, the visualized pancreatic head and neck appear prominent. If there is clinical and laboratory suspicion for pancreatitis, CT may be considered for further evaluation.2. Mildly coarse hepatic echogenicity, compatible with steatosis. "}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Stable complex benign cyst. Right kidney 11.3 cm in length.LEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 11.4 cm in lengthOTHER: Bladder not visualized due to overlying bandages", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male with a history of cirrhosis presents for HCC screening. LIVER: The liver is nodular in contour and coarse in echogenicity. The liver measures 14 cm in craniocaudal dimension. There is a new 2 cm hypoechoic well-defined mass in the left hepatic lobe. GALLBLADDER, BILIARY TRACT: Partially contracted gallbladder without wall thickening, pericholecystic fluid, gallstones or focal tenderness. No intrahepatic biliary ductal dilatation. No extra-hepatic biliary ductal dilatation with the common duct measuring 2 mm.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.5 cm without hydronephrosis, shadowing nephrolithiasis or discrete lesion evident.OTHER: Splenomegaly, measuring 15.8 cm. The left kidney measures 11.3 cm without hydronephrosis, shadowing nephrolithiasis or suspicious lesion. 1.3-cm simple appearing cyst.", "output": "New 2 cm hypoechoic mass is suspicious for HCC. Further characterization with a dedicated liver MRI is recommended. These findings were discussed with the ordering physician Dr. Shah at 1530 on 05/01/2015. "}
{"instruction": "Generate impression based on findings.", "input": "Bilateral axillary pain. A targeted bilateral ultrasound was performed for the patient's areas of pain. Slightly prominent lymph nodes that retain their normal fatty hila are seen in each axilla, none uniquely suspicious in appearance. No suspicious cystic or solid mass was apparent.", "output": "Symmetric mildly prominent axillary lymph nodes are probably reactive. This correlates to the findings from recent MRI.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "23-year-old male with acute kidney injury. Evaluate for hydronephrosis. History of sickle cell disease. RIGHT KIDNEY: The right kidney measures 10.1 cm in length. No hydronephrosis, shadowing stones, or suspicious masses. Increased echogenicity of the renal parenchyma.LEFT KIDNEY: The left kidney measures 10.3 cm in length. No hydronephrosis, shadowing calculi, or suspicious lesions. Increased echogenicity of the renal parenchyma.URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormalities noted.", "output": "1. No hydronephrosis.2. Increased echogenicity of the renal parenchyma is nonspecific and suggestive of chronic medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "73 years old, Male, Reason: pt with +HepC Ab but negative RNA viral load. Looking for features of cirrhosis or splenomegaly History: none, just +Hepc Ab LIVER: The liver measures 17.3 cm cm in length. A coarse echogenic liver is consistent with fatty infiltration. No nodularity of the capsule to suggest cirrhosis. 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 4 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 8.9 cm in length. RIGHT KIDNEY: Kidney measures 10.1 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 11.2 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Coarse echogenic liver is consistent with fatty infiltration.2.No nodularity or widening of the fissures to suggest cirrhosis."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Mildly coarse liver echotexture noted without mass. Liver length 15.1 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.8 cm in lengthOTHER: Left kidney 11 cm in length. No ascites", "output": "Mildly coarse liver echotexture consistent with chronic liver disease without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "18-year-old female with waxing and waning palpable lump in the right axilla. The patient is able to identify the lump at this time, but indicates that it is much less conspicuous than it was last night or in the past. Family history of premenopausal breast cancer in the patient's mother. A targeted right axillary ultrasound was performed for the palpable area of concern. On physical examination, a focal area of thickening can be appreciated at the site indicated by the patient. There is no solid or cystic mass identified. There is some tissue in this area that has a questionable sonographic appearance of accessory breast tissue. The finding is not definite. No lymph nodes are identified in the area (normal, abnormal, or otherwise).", "output": "No sonographic evidence for malignancy. No definite finding to explain the patient's area of palpable concern. Continued clinical management is recommended for the patient's area of palpable concern. Further evaluation, including biopsy, should not be delayed by negative imaging. Rather, negative imaging may serve to reinforce a negative clinical impression. The results and recommendations were discussed with the patient at the completion of the exam.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old with multiple cysts in both breasts complains of tenderness in both breasts. Ultrasound for both breasts are performed. The patient has a tender spot in the right 12 - 1 o'clock position. There is a simple cyst at one o'clock position in the right breast measuring 15 x 15 mm. Additionally, there are small simple cysts at one o'clock, 12 o'clock, 10 o'clock position and retroareolar region in the right breast. In the left breast, there is a simple cyst measuring 16 x 11 mm at 12 o'clock position, where the patient feels tenderness. There are more simple cysts in the left breast at upper outer quadrant.", "output": "Multiple simple cysts in both breasts. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "History of multinodular goiter. Previous bilateral fine-needle aspiration demonstrated benign thyroid nodules. RIGHT LOBE MEASUREMENTS: 5.3 x 2.2 x 1.5 cmLEFT LOBE MEASUREMENTS: 4.8 x 1.4 x 1.2 cmISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: 2 dominant right thyroid lobe nodules with the superior nodule measuring 2.7 x 1.5 x 1.7 cm, compared to approximately 2.3 x 1.5 x 1.2 cm previously. It is isoechoic well-defined and without significant vascularity.The mid nodule measures 1.6 x 0.6 x 1.4 cm, compared to 1.6 x 0.6 x 0.9 cm when remeasured using similar technique. This nodule has a more cystic colloid appearance.LEFT LOBE: 3 discrete nodules are noted in the left lobe with a stable mid nodule measuring 0.9 x 0.6 x 0.7 cm with coarse calcifications. The superior and inferior nodules measure 1.4 x 0.5 x 1.0 cm and 1.3 x 0.8 x 1.1 cm respectively and are predominantly isoechoic with cystic changes favoring colloid nodules, not significantly changed in size accounting for differences in measurement technique.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 are stable to minimally increased in size accounting for differences in measurement technique. Subcentimeter coarsely calcified mid left thyroid lobe nodule is unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid carcinoma status post thyroidectomy 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 mass or regional adenopathy"}
{"instruction": "Generate impression based on findings.", "input": "Female, 58 years old. Flank pain RIGHT KIDNEY: The right kidney measures 9.7 cm in length, with normal cortical echotexture. No shadowing stones or hydronephrosis. No perinephric collection.LEFT KIDNEY: The left kidney measures 10.9 cm in length, with normal cortical echotexture. No shadowing stones or hydronephrosis. No perinephric collection.OTHER: The visualized portions of the bladder are unremarkable.", "output": "No hydronephrosis or urinary stones."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old female, evaluate ascites. There is moderate four quadrant ascites noted.", "output": "Moderate four quadrant ascites."}
{"instruction": "Generate impression based on findings.", "input": "Male 44 years old Reason: nodule vs thyroiditis History: hyperthyroidism RIGHT LOBE MEASUREMENTS: 5.2 x 2.1 x 2.3 cmLEFT LOBE MEASUREMENTS: 5.1 x 2.3 x 2.3 cm.ISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Diffusely hypervascular mildly heterogeneous thyroid without focal nodule or cystic structure. LEFT LOBE: Diffusely hypervascular mildly heterogeneous thyroid without focal nodule or cystic structure. ISTHMUS: Hypervascular and thickened isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level 3 lymph node measures 1.5 x 0.5 x 0.9 cm and appears benign. Left level 3 lymph node measures 1.7 x 0.3 x 0.9 cm and appears benign.OTHER: No significant abnormality noted.", "output": "Findings consistent with hyperthyroidism."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C newly diagnosed myeloma LIVER: Unremarkable echogenicity without mass. Liver length 12.8 cmBILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 7.4 cm in lengthRIGHT KIDNEY: Renal cyst. 9.6 cm in length OTHER: Left renal cyst. Left kidney 8.6 cm in length. No ascites.", "output": "Unremarkable hepatic parenchyma without mass or ductal dilatation. Cholelithiasis without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old female with history of thyroid cancer status post thyroidectomy presents with palpable lymph nodes. Evaluate for lymphadenopathy. RIGHT LOBE, LEFT LOBE, ISTHMUS MEASUREMENTS: The thyroid has been surgically removed.RIGHT LOBE, LEFT LOBE, ISTHMUS: The thyroid has been surgically removed.LYMPH NODES: There are 2 suspicious cervical lymph nodes:There is a round, hypoechoic lesion with calcifications measuring approximately 0.8 x 0.5 x 1.0 cm in the right level II neck.There is a round, hypoechoic, 0.9 x 0.5 x 1.4 cm lesion with calcifications in the left level III neck.OTHER: No significant abnormality noted.", "output": "1. Bilateral suspicious lymph nodes as described above. Recommend ultrasound-guided biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Hepatocellular carcinoma screening. Hepatitis C. LIVER: 13.9 cm in length. Non-cirrhotic liver morphology. Coarsened parenchymal echogenicity. Simple and complex-appearing cysts noted. No lesions suspicious for hepatocellular carcinoma are evident. 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 11.3 cm in length. A 6.2 x 5.5 x 5.6 cm soft tissue mass is noted at the superior pole. An additional 4 mm simple appearing cyst is noted in the superior pole. No hydronephrosis is present.The left kidney is 9.0 cm in length. A 10 mm benign appearing cyst is noted in the midpole. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 7.3 cm in length, without focal lesions evident.", "output": "1. Simple and complex-appearing hepatic cysts. No lesions suspicious for hepatocellular carcinoma evident. 2. 6.2 cm right renal mass, suspicious for renal cell carcinoma. Evaluation with renal-protocol CT or MRI is recommended for further evaluation. Findings were text paged to ordering physician Dr. Rao at 9:00 AM on 12/16/2015.px3wr"}
{"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 small nodule, measuring 0.3 x 0.5 x 1.2 cm without significant change. Previously described slightly more caudal, hypoechoic region was not identified on today's examLEFT LOBE: Slightly asymmetric hypoechoic region in the left bed described previously was not identified on today's exam. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Morphologically normal lymph nodes bilaterallyOTHER: No significant abnormality noted.", "output": "No substantial interval change in right thyroid bed nodule. Several other nodules described previously are not identified on today's exam."}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine Limited examination due to body habitus.RIGHT KIDNEY: Pelvic in location and not well visualized, though without hydronephrosis.LEFT KIDNEY: 8.6 cm in length. Malrotated in configuration. Unremarkable parenchymal echogenicity. No suspicious lesions identified. No hydronephrosis.BLADDER: No significant abnormality noted.OTHER: No significant abnormalities noted.", "output": "No evidence of hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Renal transplant with acute urine output dropped RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality noted. 10.4 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 Patent renal vasculature without evidence for inflow or outflow compromise. Diastolic dampening observed.OTHER: No significant abnormality noted", "output": "Patent renal vasculature without evidence for inflow or outflow compromise. Diastolic dampening observed consistent with increased parenchymal resistance pattern. No hydronephrosis."}
{"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. Normal appearance of the gallbladder. No gallstones identified.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 11.2 cm in length. The left kidney is 11.5 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9.6 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid identified.", "output": "No specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female with thyromegaly RIGHT LOBE MEASUREMENTS: 4.2 x 1.7 x 1.9 cm.LEFT LOBE MEASUREMENTS: 4.8 x 1.6 x 1.9 cm.ISTHMUS MEASUREMENTS: 5 mmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Hypoechoic, cystic nodule in the inferior pole of the left thyroid lobe measures 5 x 3 x 4 mm, previously 4 x 4 x 2 mm. Hypoechoic nodule in the posterior mid/inferior pole of the left thyroid lobe measures 8 x 4 x 7 mm, previously 6 x 6 x 3 mm. There is a left upper lobe hypoechoic thyroid nodule measuring 4 x 2 x 5 mm, not present on the study.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Incidentally noted is mildly echogenic material in the left internal jugular vein with turbulent flow.", "output": "1.No significant change in reference left thyroid lobe nodules. New left upper lobe thyroid nodule.2.Incidentally noted is mild echogenic material in the left internal jugular vein with turbulent flow that may represent nonocclusive thrombus. Formal evaluation is recommended.The findings were discussed with Dr. Nicole Leong at 1012 on 11/30/2016."}
{"instruction": "Generate impression based on findings.", "input": "Status post LVAD with history of drive line infection. There is 1.9 x 2.3 cm hypoechoic fluid collection extending superficially from the drivelineto the skin surface, new from the prior study. This may follow the tract of previous instrumentation. There are no significant surrounding hyperemic changes.", "output": "Fluid tracking from the transplant to the skin surface. Superinfection of this fluid cannot be ruled out. The fluid may be filling a tract from prior instrumentation."}
{"instruction": "Generate impression based on findings.", "input": "48 years Female with elevated TSH and single thyroid nodule. RIGHT LOBE MEASUREMENTS: 5.8 x 2.1 x 1.3 cmLEFT LOBE MEASUREMENTS: 5.0 x 1.5 x 1.2 cmISTHMUS MEASUREMENTS: 0.2 cm in thickness. RIGHT LOBE: Heterogeneous echotexture with diffusely increased vascularity. Within the midpole of the right thyroid gland, there is an ill-defined hypoechoic area which is favored to represent parenchymal heterogeneity rather than a discrete nodule. No discrete nodules are identified.LEFT LOBE: Heterogeneous echotexture with diffusely increased vascularity. No discrete nodules.ISTHMUS: Heterogeneous echotexture with diffusely increased vascularity. PARATHYROID GLANDS: No significant abnormalities.LYMPH NODES: No significant abnormalities. OTHER: No significant abnormalities.", "output": "Findings suggestive of thyroiditis without discrete nodules."}
{"instruction": "Generate impression based on findings.", "input": "68 years old, Male, Reason: evaluate size of renal masses and characterize cysts RIGHT KIDNEY: Kidney measures 11.3 cm in length. Right renal cyst measures 2.3 x 2.8 x 2.1 cm. Previously noted mid kidney right renal mass is not well visualized on this exam. Right lower pole mass is not significantly changed in size measuring 4.7 x 5.2 x 4.4 cm, previously measuring 5.3 x 4.2 cm on most recent CT dated 7/17/14. Evidence of right-sided hydronephrosis.LEFT KIDNEY: Kidney measures 11.4 cm in length. Normal echotexture. Nohydronephrosis. Left renal cysts.OTHER: Distal tips of nephroureteral stents are noted with urinary bladder. No significant abnormality within the bladder.", "output": "1.Right lower pole renal mass not significantly changed in size since CT dated 7/17/14. Previously noted enhancing mass in the right mid kidney is not well visualized on this ultrasound examination.2.Right-sided hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Male; 69 years old. Reason: evaluate for pancreatitis, also evaluate gallbladder for stones/gallstone pancreatitis History: elevated lipase, elevated WBC LIVER: The liver contour is smooth. The parenchyma is coarse and echogenic. The liver measures 18.3 cm in length.The main portal vein is patent and demonstrates a normal direction of flow with a peak velocity 0.3 m/sec.BILIARY TRACT: The gallbladder is normal in appearance. There is no cholelithiasis. The gallbladder wall is normal thickness and there is no pericholecystic fluid. The common bile duct measures 4 mm. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas are normal in appearance. The pancreatic tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 5.6 cm in length.RIGHT KIDNEY: Right kidney measures 12.4 cm in length. The renal parenchyma is normal in echogenicity. There is no hydronephrosis. OTHER: The left kidney measures 12.1 cm in length. The renal parenchyma is normal in echogenicity. There is no hydronephrosis.Bilateral pleural effusions.", "output": "1.Normal gallbladder, no cholelithiasis.2.No evidence of pancreatitis.3.Hepatomegaly and hepatic steatosis.4.Bilateral pleural effusions"}
{"instruction": "Generate impression based on findings.", "input": "Primary biliary cirrhosis LIVER: Coarse heterogeneous liver echotexture unchanged without mass. Liver length 16.4 cmBILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation. Stable subcentimeter gallbladder polyp measuring 0.5 x 0.4 x 0.4 cm.PANCREAS: No significant abnormalities noted.SPLEEN: Mild splenomegaly; spleen length 15.1 cmRIGHT KIDNEY: No significant abnormalities noted. 10.8 cm in lengthOTHER: Left kidney 10.3 cm in length. No ascites.", "output": "Stable coarse heterogeneous liver echotexture without mass or ductal dilatation. Gallbladder sludge without acute inflammation. Stable subcentimeter gallbladder polyp. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female patient with shortness of breath, abnormal LFTs. Evaluate liver and for portal vein thrombosis. LIVER: The liver measures 11.4 in length and is nodular in contour. A subcentimeter hypoechoic nodule is again noted in the right hepatic lobe. Main portal vein flow is poorly visualized on color Doppler imaging but appears hepatopetal measuring 0.1 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. The common bile duct is dilated measuring up to 12 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 13.7 cm in length and contains two cysts with the largest measuring up to 7.6 cm. No evidence of hydronephrosis. Renal cortical echogenicity is increased. OTHER: The left kidney measures 14 cm in length. No evidence of hydronephrosis. Multiple cysts are again noted, the largest measuring 5.2 x 4.2 cm. Renal cortical echogenicity is increased.The spleen measures 15.6 cm in length. There are splenic varices. A pleural effusion is present.", "output": "1. Cirrhotic liver with limited evaluation of the portal vein which appears patent, but with sluggish flow. 2. Medical renal disease.3. Splenic varices. "}
{"instruction": "Generate impression based on findings.", "input": "83-year-old male with acute kidney failure. Urinary retention. The exam is limited by patient's inability to cooperate.RIGHT KIDNEY: Right kidney is moderately to markedly echogenic consistent with parenchymal disease measuring approximately 9.4 cm in length. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney is moderately to markedly echogenic consistent with parenchymal disease. Length is difficult to assess, but likely approximate 10 cm. No hydronephrosis, shadowing calculus or mass.URINARY BLADDER: Small amount of debris. Not highly distended.OTHER: Dependent sludge within the gallbladder on limited views.", "output": "Echogenic kidneys without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female with known CLL in remission with concern for a left anterior cervical node. Two cervical lymph nodes were palpable by the patient's physician, and this study is limited to identifying those 2 lymph nodes. The cervical lymph node on the right was identified sonographically measuring 0.5 cm x 0.3 cm x 0.5 cm and has a fatty hilum. The other cervical lymph node is identified on the left measuring 0.5 cm x 0.3 cm x 0.7 cm. This also demonstrates a fatty hilum. No suspicious adenopathy is identified.", "output": "Right and left cervical lymph nodes, corresponding to the patient's palpable lymph nodes were visualized, and demonstrate benign morphology. No suspicious adenopathy is identified."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain worse with eating LIVER: Coarse echogenic liver parenchyma without mass. Liver length 14.9 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: Obscured by overlying gasRIGHT KIDNEY: No significant abnormalities noted. 10.6 cm in lengthOTHER: Left kidney 11.1 cm in length. Spleen 11.6 cm in length. No ascites.", "output": "Coarse echogenic liver parenchyma suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Unremarkable gallbladder. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female with dysphagia, evaluate for dominant thyroid nodule. RIGHT LOBE MEASUREMENTS: 6.4 x 2.7 x 1.9 cmLEFT LOBE MEASUREMENTS: 6.5 x 2.5 x 1.6 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: 0.6 cm benign cystic right lobe nodule.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": "Small benign right thyroid pole cystic nodule. No dominant or suspicious solid nodule that would contribute to the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Female 46 years old; Reason: Diffuse goiter, check for nodules History: goiter RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 1.5 x 1.9 x 6.1 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 5.9 x 3.7 x 8.9 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.4 cm.RIGHT LOBE: Right lobe is heterogeneous with a predominantly solid nodule with cystic components measuring 2.4 cm x 1.3 cm x 1.7 cm in the mid/lower pole. There are punctate echogenic foci seen but no discrete calcifications.LEFT LOBE: The left lobe is predominantly a conglomerate of solid and highly complex cystic/spongiform nodules. The largest measures 3.3 cm x 2.4 cm x 3.6 cm and the cystic portion has complex internal echogenicity. There are several other smaller hyperechoic cyst in the left lobe.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted.", "output": "1.Multinodular goiter with no suspicious regional adenopathy identified.2.The left lobe is primarily a conglomerate of solid and highly complex cystic/spongiform nodules. A component of this may represent a hemorrhagic cyst.3.In the right lobe there is a predominantly solid nodule with cystic components which is amenable to percutaneous biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for AAA ABDOMINAL AORTA: Proximal aorta measures 2.7 x 2.5 cm with ulcerated calcified plaque within it. Mid aorta measures 2.2 x 2 cm and distal aorta measures 2 x 1.9 cm. Normal flow directionality and patency noted. The flow velocity measures 81.9 cm/s. No evidence of aneurysmal dilatation noted.The right and left iliac artery measure 1.4 x 1.4 cm and 1.1 x 1.3 cm respectively. No evidence of aneurysmal dilatation with normal flow directionality and patency noted.INFERIOR VENA CAVA: PatentOTHER: No significant abnormality noted.", "output": "Mild calcified plaques noted in the proximal aorta. No evidence of aneurysmal dilatation of the abdominal aorta and iliac arteries."}
{"instruction": "Generate impression based on findings.", "input": "Female 73 years old Reason: determine if cirrhosis History: ELEVATED INR LIVER: 18.5 cm in length. Minimally coarse texture. No focal masses.Flow in the portal vein is hepatopedal peak velocity 40 cm/sGALLBLADDER, BILIARY TRACT: Sludge in gallbladder with no evidence of gallstones. No Wall thickening or pericholecystic fluid.No intrahepatic or extrahepatic biliary dilatation. Common bile duct 0.2 cm in diameter.PANCREAS: Poorly visualized.RIGHT KIDNEY: Small 8.4 cm in length. No hydronephrosis. Mildly echogenicOTHER: Left kidney 7.7 cm in length. No hydronephrosis.Spleen 9.8 cm in length.No evidence of ascites.", "output": "Small kidneys consistent with chronic medical renal disease. No definite evidence of cirrhotic morphology. Sludge in gallbladder without evidence of biliary dilatation."}
{"instruction": "Generate impression based on findings.", "input": "History of renal transplant with rising creatinine. RIGHT ILIAC FOSSA TRANSPLANT KIDNEY: The right iliac fossa transplant kidney measures 11.1 cm in length with mild pelviectasis. Color Doppler demonstrates hilar blood flow. No shadowing nephrolithiasis. No definite peri-transplant fluid collection with adjacent probable bowel noted. OTHER: No significant abnormalities noted.", "output": "Mild pelviectasis without shadowing nephrolithiasis. Please note that spectral Doppler evaluation was not performed."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old male with history of thyroid cancer status post thyroidectomy. Follow-up examination. RIGHT LOBE MEASUREMENTS: Surgically absentLEFT LOBE MEASUREMENTS: Surgically absentISTHMUS MEASUREMENTS: Surgically absentRIGHT LOBE: No significant abnormality noted.LEFT LOBE: 2 mm cystic focus in the superior left thyroid bed is unchanged since the prior study. No new abnormalities are identified in the thyroid bed.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A mildly prominent 10 x 8 x 4 mm lymph node is identified in the left neck level five station. This lymph node demonstrates a normal fatty hilum but questionable abnormal cortical thickening and increased echogenicity.OTHER: No significant abnormality noted.", "output": "1.Postsurgical changes of thyroidectomy with unchanged small cystic focus in the left thyroid bed.2.Questionably abnormal small lymph node in the left level five station was not previously identified. This lesion raises suspicion of a new nodal metastasis."}
{"instruction": "Generate impression based on findings.", "input": "Mitral valve regurgitation with right upper quadrant pain LIVER: Prominent hepatic veins consistent with cardiac disease. No hepatic mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal normal directional flow. Liver length 16.6 cm.BILIARY TRACT: Diffusely thickened gallbladder wall without stones or ductal dilatation. Due to the patient's somnolent state, a Murphy's sign could not be elicited.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9.6 cm in lengthRIGHT KIDNEY: Mildly echogenic kidneys without mass, stone, or hydronephrosis. 10.3 cm in length. OTHER: Mildly echogenic left kidney without worrisome mass, stone, or hydronephrosis. Left kidney 10.1 cm in length. Benign appearing left renal cyst. Mild ascites. Left pleural effusion.", "output": "Diffusely thickened gallbladder wall without stones or duct dilatation. Unfortunately, due to the patient's somnolent state, a Murphy's sign could not be elicited. While this diffuse gallbladder wall thickening is nonspecific in the context of cardiac disease and congestion, some element of inflammation involving the gallbladder cannot be excluded; a nuclear medicine scan would be helpful as clinically warranted.Mildly echogenic kidneys suggestive for medical renal disease/parenchymal dysfunction without mass or stone or hydronephrosis.Mild ascites, left pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis LIVER: Cirrhotic morphology again noted without mass. Liver length 14.1 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.1 cm in lengthOTHER: Left kidney 11.7 cm in length. Spleen 12.6 cm in length. No ascites", "output": "Stable cirrhotic morphology without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Male 64 years old Reason: at the site of port-a-cath, check for abscess/ hematoma History: swelling at the site of port-a-cath There is a complex fluid collection the port pocket. This may represent hematoma, however, an abscess cannot be excluded. The collection measures 3.4 x 1.9 cm.", "output": "Complex hematoma sepsis surrounding the port."}
{"instruction": "Generate impression based on findings.", "input": "17-year-old with left breast discharge, nonspontaneous, nonbloody. She has recently started a new birth control shot. A targeted left ultrasound was performed retroareolar region. There is no solid or cystic mass identified. Comparison images of the right retroareolar region demonstrate similar normal breast tissue.", "output": "No sonographic evidence for malignancy. The patient should follow-up with her birth control provider regarding her birth control method and potential side effects and to consider other systemic causes of discharge.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"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": "Reason: Rising bilirubin and jaundice 8 months status post stem cell transplant with Busulfan conditioning. Concern for cholecystitis, cholelithiasis, GVHD, or VOD LIVER: The liver measures 18.0 cm in length. Normal hepatic echogenicity and echotexture. The portal vein is patent with normal directional hepatopedal portal venous blood flow, peak velocity 23.3 cm/s. Peak velocity of the right portal vein is -16.1 cm/s and left portal vein is 10.4 cm/s. Normal hepatic arterial directional blood flow. No focal mass.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. The gallbladder wall measures 0.1 cm. The common hepatic duct measures 0.3 cm. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 12.8 cm. Small subcentimeter nonobstructing renal stone in the mid portion of the right kidney. No hydronephrosis or masses.LEFT KIDNEY: The left kidney measures 13.3 cm. No hydronephrosis, masses, or stones.SPLEEN: The spleen measures 12.1 cm. Peak splenic vein velocity is 18.4 cm/s. Peak splenic artery velocity is 48.7 cm/s. Abnormal directional venous and arterial flow.OTHER: No ascites.", "output": "1. Subcentimeter nonobstructing right renal stone.2. Unremarkable hepatobiliary system with normal hepatopedal directional portal venous and arterial flow."}
{"instruction": "Generate impression based on findings.", "input": "41 year old female who was recalled from screening mammogram for multiple focal asymmetries, some with calcifications, in both breast presents for additional workup. Mammogram: 2 ML view and 8 spot magnification views of both breasts 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. 2 cm partially circumscribed mass in the left retroareolar region with multiple pleomorphic calcifications need further evaluation with ultrasound. A subcentimeter partially circumscribed mass is also identified in the left central slightly lateral breast.Another partially circumscribed mass with few calcifications is noted in the right upper outer quadrant approximately measuring 18 mm. These calcifications have coarse morphology.Few other benign morphology masses identified within the right breast.Ultrasound:A parallel oriented hypoechoic mass measuring 1.6 x 1.1 cm with few calcifications within it is identified in the right breast 11:00 position 2 cm from the nipple. Located slightly superior to it is another solid hypoechoic mass that measures 0.8 x 0.5 cm. Both these masses most likely correspond to the masses seen on mammogram.In the left breast 12:00 position there is an oval hypoechoic mass with multiple hyperechoic areas consistent with calcifications that measures 2.2 x 1 x 2.1 cm. This lesion demonstrates peripheral and central blood flow and most likely corresponds to the largest mass with indeterminate calcifications as seen on mammogram. Another small most likely benign morphology mass is identified at 3:00 position that measures 1.3 x 0.6 cm.", "output": "The largest mass in the left breast 12:00 position with multiple pleomorphic calcifications needs further evaluation with ultrasound-guided core biopsy. Specimen radiograph should be obtained to confirm suspicious calcifications within them.Multiple other most likely benign morphology masses in both breast. If the above-mentioned biopsies benign, annual diagnostic mammogram is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "45 year-old asymptomatic female presents for routine screening mammography. Family history of breast cancer in 2 maternal aunts. Two standard digital views of both breasts were performed with tomosynthesis 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. Asymmetry in the right upper breast seen on the MLO view appears increased in size; this is questionably seen on the CC view. Round obscured mass in the right breast 12:00 position has decreased in size and was previously confirmed to be a cyst on ultrasound. Benign coarse calcifications in the left breast are stable. No suspicious masses or microcalcifications.", "output": "Asymmetry in the right upper breast on the MLO view for 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": "56-year-old female with history of goiter. RIGHT LOBE MEASUREMENTS: 5.1 x 2.4 x 2.2 cmLEFT LOBE MEASUREMENTS: 7.0 x 3.2 x 3.5 cmISTHMUS MEASUREMENTS: 1.6 cmRIGHT LOBE: Heterogeneous multinodular thyroid. Cystic and solid nodule in the right lower pole measures 1.6 x 1.1 x 1.2 cm.LEFT LOBE: Heterogeneous multinodular thyroid. Cystic and solid nodule in the left lower pole measures 2.0 x 1.5 x 1.4 cm.ISTHMUS: Cystic and solid nodule in the isthmus measures 2.0 x 1.9 x 1.6 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multinodular thyroid as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "51 year old who is called back from screening mammogram for developing calcifications. Family history of mother and sister with breast cancer. An ML view and two spot magnification views of the left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. There are pleomorphic calcifications at posterior lower inner left breast, measuring 28 x 40 mm, distributing segmentally. No masses or distortions are associated with these calcifications.Focused ultrasound study was performed for the left breast lower inner quadrant. There are no solid or cystic masses. No increased blood flow is present.", "output": "Pleomorphic calcifications at lower inner quadrant in the left breast. Stereotactic core needle biopsy is recommended. Results and recommendations were discussed with the patient and her husband. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are digital mammographic images (1/14/2016), ultrasound images of left breast (1/14/2016), images from ultrasound guided biopsy of left breast with postprocedural left mammographic images (1/18/2016), images from ultrasound-guided wire localization of left breast and left digital mammographic images with specimen radiographs (1/22/2016) performed at Centegra Hospital. DIGITAL MAMMOGRAPHIC IMAGES (1/14/2016):Submitted images are low quality and cannot be used for diagnostic images.ULTRASOUND IMAGES OF LEFT BREAST (1/14/2016):There is an irregularly shaped hypoechoic mass measuring approximately 3.5 x 1.7 cm at 6:00 position in the left breast. There is an additional irregularly-shaped masses at 6:00 position, measuring 10 x 10 mm. Per outside radiology report, the smaller mass locates anteriorly to the larger mass.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF LEFT BREAST WITH POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES (1/18/2016):Ultrasound guided biopsy was performed for the two 6:00 masses in the left breast and an additional irregularly shaped mass, measuring 15 x 7 mm, which is located at 5:00 position in the left breast. A biopsy needle appears to reach three masses.Per Epic note, those three biopsy results were all malignant.IMAGES FROM ULTRASOUND-GUIDED WIRE LOCALIZATION OF LEFT BREAST AND LEFT DIGITAL MAMMOGRAPHIC IMAGES WITH SPECIMEN RADIOGRAPHS (1/22/2016):Wire localization was performed under ultrasound guidance for the larger mass at 6 o'clock position in the left breast and mammographic guidance for other two masses in the left breast. Because of poor quality, post-procedural mammogram cannot be interpreted. Several radiographic images of specimen are also submitted, but they are also poor in quality.Per Epic note, surgical margins are free of tumor.", "output": "Status post wire localization and lumpectomy for left breast cancer. If available, good quality mammogram should be submitted. Alternatively, right unilateral mammogram is recommended for annual survey.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with chronic kidney disease RIGHT KIDNEY: Measures 10.6 cm in length. Unremarkable echogenicity with preserved corticomedullary differentiation. No hydronephrosis or nephrolithiasis.LEFT KIDNEY: Measures 11.0 cm in length. Unremarkable echogenicity with preserved corticomedullary differentiation. No hydronephrosis or nephrolithiasis.OTHER: Increased hepatic echogenicity partially imaged.", "output": "1. Unremarkable sonographic appearance of the kidneys without hydronephrosis or nephrolithiasis.2. Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease."}
{"instruction": "Generate impression based on findings.", "input": "Reason: history of papillary thyroid carcinoma, close monitoring of lymphadenopathy, please evaluate for interval changes History: none RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Status post thyroidectomy.LEFT LOBE: Status post thyroidectomy. Redemonstration of nonspecific relatively echogenic soft tissue focus located between carotid artery and esophagus measuring 0.7 x 0.2 x 0.5 cm, not significantly changed in size.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Mildly prominent cervical lymph nodes appear similar to the prior exam. The lymph nodes demonstrate morphologic features suggestive of benignity, but continued follow-up is suggested.OTHER: No significant abnormality noted.", "output": "No significant change in subcentimeter echogenic focus in left thyroidectomy bed and mildly prominent cervical lymph nodes."}
{"instruction": "Generate impression based on findings.", "input": "83 year old male patient with history of right-sided renal mass. Evaluate for changes. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No perinephric fluid collection is identified.KIDNEY: Renal cortical echogenicity is within normal limits.COLLECTING SYSTEM/URETER: No evidence of hydronephrosis.URINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color Doppler imaging of the transplant kidney is within normal limits.OTHER: There is a 2.1 x 1.9 cm hypoechoic mass within the superior pole of the right native kidney which appears to correlate with previously identified right renal mass. Given differences in modality/technique, the mass appears similar in size to the prior study. An additional subcentimeter hypoechoic lesion is noted.", "output": "1. Similar size of a previously identified mass within the native right kidney given differences in modality/technique when compared to prior CT.2. Unremarkable transplant kidney."}
{"instruction": "Generate impression based on findings.", "input": "79-year-old male with elevated LFTs and history of alcohol abuse. Evaluate liver for portal hypertension and cirrhosis LIVER: The liver is normal in echotexture without evidence of nodular contour or other specific findings to suggest cirrhosis. Portal vein is patent with peak systolic velocity of 0.2 m/s.GALLBLADDER, BILIARY TRACT: Gallbladder wall measures 0.2 cm with the common bile duct measuring 0.2 cm.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Kidneys are normal in echotexture with the right kidney measuring 9.4 cm and left kidney measuring 10.4 cm in length.OTHER: Small bilateral pleural effusions, right greater than left", "output": "1.No sonographic evidence of cirrhosis or portal hypertension as clinically questioned.2.Small bilateral pleural effusions, right greater than left."}
{"instruction": "Generate impression based on findings.", "input": "Status post thyroidectomy for thyroid carcinoma 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": "57-year-old female patient with intermediate sharp right upper quadrant abdominal pain. LIVER: The liver measures 16.2 cm in length. No focal hepatic lesion is identified. GALLBLADDER, BILIARY TRACT: The gallbladder is filled with shadowing stones. Sonographic Murphy's sign is negative. There is no significant 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 7.2 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. A 0.9 cm anechoic lesion is noted within the right midpole.OTHER: The left kidney measures 6.2 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis.The spleen measures 7.0 cm in length.", "output": "1. Cholelithiasis without sonographic evidence of acute cholecystitis.2. Right renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter RIGHT LOBE MEASUREMENTS: 1.7 x 1.5 x 4.5 cmLEFT LOBE MEASUREMENTS: 2.4 x 1.4 x 5.7 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant change in left thyroid nodules. Dominant mixed cystic and solid nodule measures 1.9 x 1 x 1.9 cm.ISTHMUS: No change in spongiform isthmic nodule measuring 1.4 x 0.7 x 1.6 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable left and isthmic thyroid nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency and fever RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality noted. 14.6 cm in lengthCOLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: No significant abnormality notedOTHER: No significant abnormality noted", "output": "Negative right iliac fossa renal transplant. No evidence for perinephric collection, abnormal echogenicity, mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "65 year-old female with pancreatitis, evaluate for cholelithiasis. LIVER: Coarse echotexture of the liver measuring 14.0 cm in length. Portal vein is patent with appropriate directional flow. No focal hepatic lesion.GALLBLADDER, BILIARY TRACT: Shadowing calculus within the gallbladder without evidence of cholecystitis. No gallbladder wall thickening. No pericholecystic fluid. No intra or extra hepatic biliary ductal dilatation.PANCREAS: Hypoechoic pancreas.RIGHT KIDNEY: Measures 9.6 cm in length. No hydronephrosis.OTHER: Left kidney measures 10.1 cm in length. No hydronephrosis.Normal echogenicity of the spleen measuring 7.0 cm in length.", "output": "1. Cholelithiasis without evidence of acute cholecystitis.2. Coarse echotexture of the liver suggestive of parenchymal dysfunction. "}
{"instruction": "Generate impression based on findings.", "input": "Low back pain RIGHT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 10.3 cm in lengthLEFT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 10.8 cm in lengthOTHER: Bladder nondistended. Incidental note made of 1 x 1.1 x 1 cm well-circumscribed hyperechoic focus within the right lobe of the liver.", "output": "Normal renal parenchyma without mass, stone, or hydronephrosis. Incidental note made of well-circumscribed hyperechoic focus within the right lobe of the liver; statistically most probably represents a benign hemangioma."}
{"instruction": "Generate impression based on findings.", "input": "Female 62 years old Reason: cirrhosis of liver? History: chronic hepatitis B, chronic hepatitis C LIMITED ABDOMENLIVER: . Liver measures 16 cm in length. The parenchyma is echogenic. No sonographically evident lesions.BILIARY TRACT: No biliary dilatation. Status post cholecystectomy.PANCREAS: Visualized portions are unremarkable. KIDNEYS: The right kidney measures 9 cm. The cortex is of normal echogenicity . No shadowing calculi or hydronephrosis is present. The left kidney measures 10 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present. 2.7-cm renal hypocholic cystic lesion is difficult to visualize clearly, but likely a cyst.SPLEEN: The spleen measures 9 cm. in length. OTHER: No significant abnormalities noted.", "output": "1.Echogenic liver is nonspecific, but can be seen in diffuse infiltrative disease or fatty liver. This limits evaluation for focal hepatic lesions. If indicated, MRI can be useful to further evaluate the liver.2.2.7-cm probable cyst in the left kidney as described above. This can also be definitively characterized on the MRI if indicated."}
{"instruction": "Generate impression based on findings.", "input": "64 year-old female with primary hyperparathyroidism, osteopenia. Evaluate for parathyroid adenoma. RIGHT LOBE MEASUREMENTS: 4.5 cm x 1.3 cm x 1.5 cmLEFT LOBE MEASUREMENTS: 4.7 cm x 1.1 cm x 1.4 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: Normal homogeneous echotexture. Cystic nodule at the lower pole measures 6 mm x 5 mm x 6 mm with no internal vascularity or definite microcalcifications.LEFT LOBE: Normal homogeneous echotexture.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Subcentimeter cyst in the right thyroid lobe. 2. No evidence of parathyroid adenoma. "}
{"instruction": "Generate impression based on findings.", "input": "Gallbladder polyp 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. The gallbladder polyp measures 7 x 7 x 6 mm, previously 8 x 5 x 4 mm. Although the measurements do not vary significantly, the polyp demonstrates a broader base and increasingly convex contours, suggestive of some interval growth. No significant internal flow seen on color Doppler evaluation. The gallbladder is otherwise unremarkable.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 10.2 cm in length. The left kidney is 10.4 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9.6 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid identified.", "output": "Slightly increased sized of the gallbladder polyp, which is nonspecific. Continued follow up is recommended."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old male patient with epigastric pain. Evaluate for cholelithiasis. LIVER: The liver measures 16.8 cm in length. Hepatic parenchymal echogenicity is slightly coarsened. 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 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 11 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.4 cm in length. No evidence of hydronephrosis.The spleen measures 7.6 cm in length.", "output": "No cholelithiasis or sonographic evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "51 year old female with elevated PTH and calcium. RIGHT LOBE MEASUREMENTS: 1.5 x 2.5 x 5.9 cmLEFT LOBE MEASUREMENTS: 1.2 x 2.5 x 5.4 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: The right thyroid lobe is normal in morphology, echogenicity and size without a discrete dominant nodule.LEFT LOBE: The left thyroid lobe background parenchyma is normal in echogenicity. There is a 1.4 x 0.9 x 0.6 cm superior pole solid hypoechoic nodule with well defined margins. No hypervascularity or associated calcifications. Additional, 8 x 5 x 7 mm inferior pole hypoechoic nodule with minimal vascularity and well-defined margins. No associated calcifications. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Immediately dorsal to the inferior pole of the left thyroid lobe is a 1.1 x 0.7 x 1.4 cm hypoechoic lesion without significant vascularity which may represent a parathyroid adenoma. LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. 1.4 cm lesion immediately dorsal to the inferior pole of the left thyroid lobe may represent a parathyroid adenoma; correlate with nuclear medicine study.2. 1.4 cm left thyroid lobe solid indeterminate nodule."}
{"instruction": "Generate impression based on findings.", "input": "Male 67 years old; Reason: assess for cholecystitis History: sepsis LIVER: The liver is incompletely visualized however numerous ill-defined lesion seen within the liver on prior CT are not visualized on this study.GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.9 mm but is difficult to define in this study. Several small shadowing echogenic foci are seen within the gallbladder. Negative sonographic Murphy sign. There is a trace amount of pericholecystic fluid which is likely compatible with patient's current ascites, seen better on prior CT. The common bile duct was unable to be visualized due to difficulty with technique and overlying bowel gas.", "output": "1. Cholelithiasis without overt sonographic evidence of acute cholecystitis. There is a trace amount of pericholecystic fluid which is likely compatible with patient's ascites. This study is limited however and acute cholecystitis, although unlikely, cannot be entirely ruled out.2.The common bile duct was not able to be visualized due to difficulty in technique and overlying bowel gas.3. Multiple ill-defined lesions within the liver seen on CT are not well visualized on this ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Patient with weakness and mild transaminitis History: Weakness LIVER: The liver measures 17.7 cm in length. Increased parenchymal echogenicity is compatible with fatty infiltration/parenchymal dysfunction. Hepatic cyst as seen on prior CT without additional focal hepatic lesions identified, though sensitivity limited. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.23 m/s.BILIARY TRACT: Cholelithiasis including stones in the gallbladder neck without associated 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 4 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 10.7 cm in length. RIGHT KIDNEY: Kidney measures 18.6 cm in length (including cyst). Normal echotexture. No frank hydronephrosis. Large upper pole cyst.LEFT KIDNEY: Kidney measures 13.0 cm in length. Normal echotexture. Mild hydroureteronephrosis appearing similar to recent CT.OTHER: No significant abnormalities noted.", "output": "1.Echogenic liver compatible hepatic steatosis/parenchymal dysfunction. No suspicious focal hepatic lesions are identified, however, sensitivity is limited.2.Cholelithiasis without evidence of acute cholecystitis or biliary ductal dilatation.3.Mild left hydroureteronephrosis appearing similar to recent CT."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal LFTs LIVER: Coarse echogenic liver parenchyma without mass. Liver length 15.4 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 10.4 cm in length.OTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. Left kidney 9 cm in length. Trace ascites.", "output": "Coarse echogenic liver parenchyma consistent with fatty infiltration/parenchyma dysfunction without mass or ductal dilatation. Cholelithiasis without acute inflammation. Trace ascites. 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 with pain along right of umbilicus. Evaluate for hernia. In the region of the palpable area noted by the patient along the right periumbilical area is a benign appearing lymph node measuring 1.8-cm x 1.0 cm x 0.3 cm. No solid or cystic masses noted in this region. No evidence of hernia.", "output": "Benign appearing lymph node in the right periumbilical region corresponding to the palpable area noted by the patient. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Bracy is a 62-year-old female who was recalled from screening mammogram of 08/12/16 for a new partially obscured mass in the left upper outer breast. She has no family history of breast cancer. An ML view 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, unchanged in pattern and distribution. Again seen is a partially obscured mass in the left outer breast at 3:00. A subsequent targeted ultrasound was performed.ULTRASOUND", "output": "There is a simple cyst in the left breast at the 3:00 position correlating to the partially obscured mass on the 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": "Globus sensation RIGHT LOBE MEASUREMENTS: 1.6 x 5 x 1.5 cm.LEFT LOBE MEASUREMENTS: 1.7 x 4.1 x 1.2 cmISTHMUS MEASUREMENTS: 0.1 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": "Negative thyroid ultrasound. No evidence for acute, inflammatory, or neoplastic process. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male with diffuse large B-cell lymphoma evolved from CLL and MUD stem cell transplant. Disseminated mycobacterial infection. Abnormal liver function. LIVER: Liver is mildly echogenic which is non--- specific. Liver is normal in size and there is no focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Multiple dependent, shadowing gallstones within the gallbladder without wall thickening or focal pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.SPLEEN: Upper normal in size to mildly enlargedRIGHT KIDNEY: Highly echogenic consistent with parenchymal disease. No hydronephrosis. OTHER: Left kidney is highly echogenic consistent with parenchymal disease. No hydronephrosis. Mildly complex/septated 1.3 cm left renal cyst.Small amount of ascites.Pericardial effusion.", "output": "Mildly echogenic liver. Gallstones without complication.Small amount of ascites.Highly echogenic kidneys.Borderline splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "History of renal stones RIGHT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. Right kidney 10.1 cm in lengthLEFT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. Left kidney 11.3 cm in lengthOTHER: Bladder nondistended", "output": "Negative renal ultrasound. Normal parenchymal echogenicity without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male for follow-up of right thyroid cystic mass. RIGHT LOBE MEASUREMENTS: 4.3 x 1.6 x 2.3 cmLEFT LOBE MEASUREMENTS: 4.0 x 1.3 x 2.2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Homogeneous in echotexture. In the right lobe there is again noted a predominately cystic mass with slight eccentric nodularity and calcification. This is most likely benign, and measures 0.7 x 1 x 1 cm, unchanged from the prior exam.LEFT LOBE: Homogeneous in echotexture. In the most inferior left lobe of the thyroid and poorly visualized as a predominantly cystic mass with small eccentric echogenic focus measuring 0.4 x 0.6 x 0.7 cm, highly likely benign.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Stable complex cystic right thyroid mass likely benign.2. Smaller complex cystic left thyroid mass highly likely benign. Although not noted on the prior exam, the inferior left lobe is very difficult to visualize to this may have been present."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old female with renal failure. RIGHT KIDNEY: The right kidney measures 9.9 cm in length, and is highly echogenic consistent with parenchymal disease. There is no hydronephrosis or shadowing calculus. There is a 1.9 cm cyst in the lower pole. There is diffuse and focal parenchymal loss. There is an echogenic focus in the midportion of the kidney and I cannot exclude a small nonobstructive stone. LEFT KIDNEY: The left kidney measures 12.6 cm in length. Cortex is thinned and highly echogenic consistent with parenchymal disease. There is no hydronephrosis, shadowing calculus or mass.URINARY BLADDER: Poorly distended without gross abnormality.OTHER: No significant abnormalities noted.", "output": "Echogenic kidneys bilaterally with parenchymal loss, progressive on the right.Right renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female patient with history of CLL status post SCT. Anasarca and ascites. LIVER: The liver measures 19.2 cm in length. Hepatic parenchymal echogenicity is within normal limits. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: There is cholelithiasis. The gallbladder wall is borderline thickened, which is nonspecific in the setting of ascites. 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 10.2 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.4 cm in length. No evidence of hydronephrosis.The spleen is not visualized.There is mild ascites.", "output": "1. Mild hepatomegaly and mild ascites.2. Cholelithiasis with borderline gallbladder wall thickening, which is non-specific in the setting of ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 65 years old; Reason: c/f portal vein thrombosis in pt with advanced cirrhosis History: pt w/ cirrhosis c/f portal vein thrombosis 2/2 reversal of flow on previous u/s LIVER: The liver measures 10.1 cm in length. There is increased, coarse, heterogeneous echogenicity of the liver parenchyma with cirrhotic morphology. Multiple solid parenchymal lesions seen with \"bull's-eye\" appearance being an echogenic center surrounded by hypoechoic rim. The left-sided lesion measures approximate 1.7 x 1.7 x 1.6 cm which is increased from the prior study and the right-sided lesion measures proximal 2.1 x 2.4 x 2.0 cm. . No intrahepatic ductal dilation is seen. The main portal vein is patent with hepatofugal flow measured at 10.5 cm/s. There is no evidence of thrombus. GALLBLADDER/BILIARY TRACT: The gallbladder wall is circumferentially thickened. No stones are seen, however dependent hypoechoic material partially fills the gallbladder, consistent with sludge. No pericholecystic fluid. The common bile duct measures 1.9 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.1 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 8.0 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 8.6 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: There is marked ascites again noted.", "output": "1. Hepatofugal flow of the portal vein as described above without evidence of thrombus.2. Cirrhotic morphology with lesions concerning for metastases which have slightly increased in size since the prior examination.3. Diffuse gallbladder wall thickening which is nonspecific in the setting of ascites."}
{"instruction": "Generate impression based on findings.", "input": "71 year old female with nontoxic multinodular goiter and dysphagia for follow-up. RIGHT LOBE MEASUREMENTS: 6.2 by 2.7 x 2.2 cmLEFT LOBE MEASUREMENTS: 7.4 x 3 x 2.7 cmISTHMUS MEASUREMENTS: 1.6 cmRIGHT LOBE: Complex nodule with cystic components in the inferior right lobe measures 1.6 x 2.4 by 3.6 cm without significant change. Multiple other nodules likely stable.LEFT LOBE: Nodules are less well-defined on today's study. Anterior upper pole nodule which is solid but demonstrates comet tail artifact suggestive of colloid measures 0.7 x 1.2 cm in transverse which is unchanged. Not adequately visualized in longitudinal dimension for measurement.Posterior left lobe solid nodule with cystic component measures are 0.6 x 0.6 cm in transverse which is unchanged. Not adequately visualized in longitudinal dimension for measurement. Other nodules appear slightly more confluent on today's exam.ISTHMUS: Spongiform during nodule measures 1.4 x 2.7 by 3 cm without significant change.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Although the thyroid measures slightly bigger than prior study and some nodules are less well-defined, reference nodules appear stable."}
{"instruction": "Generate impression based on findings.", "input": "99-year-old female with right-sided abdominal pain. RIGHT KIDNEY: Measures 9.3 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 9.0 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Distended bladder containing echogenic debris.OTHER: No significant abnormalities noted.", "output": "1. Increased renal echogenicity consistent with medical renal disease. 2. No nephrolithiasis, hydronephrosis, or suspicious mass. "}
{"instruction": "Generate impression based on findings.", "input": "Hyperparathyroidism RIGHT LOBE MEASUREMENTS: 4.2 x 1.4 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.8 x 1.6 x 1.7 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Upper pole spongiform nodule measuring 1 x 0.7 x 0.9 cmLEFT LOBE: Multiple spongiform nodules. A representative mid pole nodule measures 1 x 0.8 x 0.9 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: 1.7 x 1.2 x 0.9 cm hypoechoic extrathyroidal focus projecting posterior and inferior to the right thyroid gland. This hypoechoic focus demonstrates what appears to be a fatty hilum.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral spongiform thyroid nodules; favor benign etiology. Hypoechoic extrathyroidal focus projecting posterior and inferior to the right thyroid gland. While this lesion's morphology favors a lymph node, a parathyroid adenoma cannot be excluded. Would recommend correlation with radionuclide study. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old female with enlarged gland on exam. RIGHT LOBE MEASUREMENTS: 5.7 x 2.2 x 1.0 cm.LEFT LOBE MEASUREMENTS: 5.1 x 2.2 at 1.2 cm.ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: Right thyroid lobe echogenicity is homogeneous without dominant lesion.LEFT LOBE: Left thyroid lobe echogenicity is homogeneous without focal lesion.ISTHMUS: Isthmus demonstrates homogeneous echogenicity without focal lesion.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small perivascular lymph nodes are noted.OTHER: A subcentimeter nodule posterior and inferior to the right thyroid lobe may represent an exophytic thyroid nodule, parathyroid gland, or lymph node.", "output": "No dominant thyroid lesion is identified."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Chavez is a 39-year-old female with known left breast malignancy and biopsy-proven left axillary lymph node. She presents today for ultrasound reevaluation of left axillary lymph node. A targeted left axillary ultrasound was performed. A total of 3 lymph nodes are identified in the left axilla. The lymph node labeled #1 is the most superficial of the 3 and probably represents the previously biopsied lymph node based on depth of this node when compared to original ultrasound exam from 09/2015. Lymph node #1 measures approximately 1.1 x 0.5 x 0.9 cm. No biopsy clip is identified in this lymph node.Lymph node #2 measures 1.2 x 0.6 cm and is identified just inferiorly. Lymph node #3 measures 0.6 x 0.4 cm and is seen medially.", "output": "Total of three left axillary lymph nodes identified. The first one (labelled lymph node #1) is probably the previously biopsied lymph node. No biopsy clip is present in this node. Ultrasound-guided needle localization of this node could be considered if clinically indicated.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "88-year-old man with history of urinary tract infection. RIGHT KIDNEY: The right kidney measures 10.1 cm in length and shows normal echotexture. Right upper pole cyst contains no septations, debris or calcifications and measures 4.8 x 4.4 x 4.2 cm. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.8 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.URINARY BLADDER: The urinary bladder is normal in appearance.OTHER: There is no free or loculated fluid. Prostate appears enlarged.", "output": "Right upper pole simple renal cyst. Prostate appears enlarged. No hydronephrosis or focal bladder abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Melanoma with diarrhea fevers and elevated LFTs LIVER: No significant abnormalities noted. 17.1 cm in lengthGALLBLADDER, BILIARY TRACT: Probable interval increase in size of large mass arising from the gallbladder now measuring approximately 11.9 x 9.9 x 11.3 cm. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.4 cm in lengthOTHER: Left kidney 12.1 cm in length. Spleen 11.2 cm in length. No ascites", "output": "Probable interval increase in size of large gallbladder/gallbladder fossa mass suggestive for melanoma metastasis. Unremarkable liver echotexture without intrahepatic mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Jadotte is a 55-year-old female presenting with bilateral breast tenderness and self palpated lumps. She has a personal history of bilateral cyst aspiration. Right breast: Upon physical exam at the patient's area of concern in the right breast, no discrete mass is appreciated. A right breast ultrasound is performed for the patient's area of concern. In the right breast 8 o'clock location, approximately 3 cm from the nipple, a normal 4-mm lymph node is identified. There is no suspicious cystic or solid mass seen.Left breast: Upon physical exam of the patient's area of concern in the left breast, no discrete mass is appreciated. A left breast ultrasound is performed for the patient's area of concern. In the left breast 3 o'clock location, approximately 3 cm from the nipple, a 4 mm simple breast cyst is identified. There is no suspicious cystic or solid mass seen.", "output": "Benign intramammary lymph node in the right breast. Simple breast cyst in the left breast. No sonographic evidence for malignancy. Patient should follow-up with her primary care physician for bilateral breast tenderness as clinically warranted. As long as the patient's physical examination remains normal, bilateral screening mammogram is next due in Sept 2015. All results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "91-year-old male with history of elevated liver enzymes. Evaluate for obstructive liver disease. Evaluation was limited by patient's poor acoustic window.LIVER: No biliary dilatation or other significant abnormality. The liver measured 15 cm.BILIARY TRACT: Cholelithiasis, without findings of cholecystitis. No biliary dilatation.PANCREAS: Pancreas is not clearly visualized.SPLEEN: No significant abnormalities noted. Spleen measures 8.5 cm.RIGHT KIDNEY: Hyperechoic renal parenchyma. Right kidney measures 10 cm. OTHER: Hyperechoic left kidney parenchyma. Left kidney measures 10 cm.", "output": "Limited exam, without significant abnormality to explain the patient's elevated liver enzymes. Incidentally noted cholelithiasis and other findings as above."}
{"instruction": "Generate impression based on findings.", "input": "Right nodule suspicious for malignancy; assess cervical lymph nodes RIGHT LOBE MEASUREMENTS: 5.4 x 1.5 x 1.2 cmLEFT LOBE MEASUREMENTS: 5.6 x 1.7 x 1 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: 0.8 x 0.5 x 0.4 cm hypoechoic nodule within the right isthmus with possible internal microcalcifications.LEFT LOBE: 2 subcentimeter hypoechoic nodules within the left thyroid gland. Lower pole nodule measures 0.7 x 0.5 x 0.8 cm; the mid pole nodule measures 0.6 x 0.3 x 0.2 cm.ISTHMUS: Subcentimeter hypoechoic nodule within the right isthmus was possible internal microcalcifications as described.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Subcentimeter hypoechoic nodule within the right isthmus with possible internal microcalcifications. Additional subcentimeter hypoechoic nodules within the left thyroid gland. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old female presents for thyroid ultrasound. RIGHT LOBE MEASUREMENTS: 4.2 x 1.6 x 1.4 cm LEFT LOBE MEASUREMENTS: 4.5 x 1.8 x 1.3 cm ISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Heterogeneous parenchyma without discrete noduleLEFT LOBE: Heterogeneous parenchyma without discrete noduleISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered cervical lymph nodes with benign morphologic features. OTHER: Incidental note of heavy atherosclerotic calcification of the left carotid artery.", "output": "1. Heterogeneous thyroid parenchyma without discrete nodule. 2. Incidental note of heavy atherosclerotic calcification of the left carotid artery. A dedicated duplex Doppler ultrasound of the carotid arteries is recommended for further evaluation. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: Patient with neutropenic fevers, pericholecystic fluid seen on CT. Assess for cholecystitis LIVER: The liver measures 20.5 cm in length, enlarged. The hepatic parenchymal echotexture and echogenicity is coarse and echogenic. There is no focal mass. No biliary ductal dilatation. The portal vein is patent with normal directional hepatopedal flow and waveform, peak velocity 39.5 cm/s.BILIARY TRACT: The gallbladder appears unremarkable. There is no pericholecystic fluid. There is no evidence of stones or sludge. The gallbladder wall measures 4 mm. The common bile duct measures 5 mm.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen measures 13.7 cm.RIGHT KIDNEY: The right kidney measures 16.1 cm in length. There is no focal mass or hydronephrosis. LEFT KIDNEY: The left kidney measures 16.8 cm in length. There is no focal mass or hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1. Coarse, echogenic liver possibly representing hepatic parenchymal dysfunction or hepatic steatosis.2. Normal gallbladder."}
{"instruction": "Generate impression based on findings.", "input": "19 year-old female with history of urinary frequency, and feelings of incomplete voiding. Evaluate for urinary retention. Bladder:Pre-void bladder volume was 270 mL, and postvoid bladder volume was 3 mL. No significant retention.", "output": "No significant abnormal urinary retention."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIMITED ABDOMENLIVER: Mildly coarse and echogenic liver echotexture without mass. Liver length 14.9 cm.BILIARY TRACT: Gallbladder absent. No ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 13.2 cm in length RIGHT KIDNEY: No significant abnormalities noted. 10.8 cm in lengthOTHER: Left kidney 11.7 cm in length. No ascites.", "output": "Mildly coarse and echogenic liver echotexture suggestive for 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": "Patient with benign morphology mass in the right breast 8:00 position for follow-up ultrasound A targeted right ultrasound was performed. Stable parallel oriented lobulated benign morphology mass in the right breast 8:00 position measures 11 x 6 x 13 millimeters, previously measured 10 x 7 x 11 mm, mostly unchanged from prior study. No suspicious masses noted.This mass appears to be slightly palpable on physical examination.", "output": "Stable benign morphology mass in the right breast 8:00 position most consistent with a benign fibroadenoma. Patient is scheduled for surgical follow-up today.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Benign renal cysts. Right kidney 12.1 cm in lengthLEFT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Left kidney 9.1 cm in lengthOTHER: Bladder nondistended", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female patient with a right thyroid nodule. Evaluate for nodular growth or lymphadenopathy. RIGHT LOBE MEASUREMENTS: 5.1 x 2.7 x 2.6 cm, previously 5.2 x 2.6 x 2.4 cm.LEFT LOBE MEASUREMENTS: 4.2 x 1.7 x 1.9 cm, previously 5.3 x 1.8 x 1.8 cm.ISTHMUS MEASUREMENTS: 3 mm in thickness.RIGHT LOBE: The right thyroid lobe is heterogeneous in echogenicity. A well defined, subcentimeter hyperechoic nodule is not significantly changed in size or appearance. LEFT LOBE: The left thyroid lobe is heterogeneous in echogenicity.ISTHMUS: The isthmus is heterogeneous in echogenicity. PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-morphology lymph nodes are noted in the neck.OTHER: No significant abnormality noted.", "output": "Heterogeneous thyroid gland with unchanged subcentimeter right thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "65 years old, Female, Reason: HCV cirrhosis, evaluate for HCC History: HCV cirrhosis LIVER: The liver measures 16.6 cm in length. Coarse nodular liver consistent with cirrhosis. No focal hepatic lesion identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s. A nonoccluding thrombus of the main portal vein is identified.BILIARY TRACT: Cholelithiasis and sludge are present within the gallbladder without evidence of 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 10.1 cm in length. RIGHT KIDNEY: Kidney measures 11.8 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. No evidence of hydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 11.0 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. No evidence of hydronephrosis or shadowing calculus.", "output": "1.Coarse nodular liver consistent with cirrhosis without evidence of focal hepatic mass.2.Nonoccluding thrombus of the main portal vein.3.Increased echogenicity of the kidneys, may reflect medical renal disease in the correct clinical context.4.Cholelithiasis and sludge present within the gallbladder without evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Female, 39 years old. Recurrent UTI, r/o bladder obstruction. Recurrent suprapubic fullness RIGHT KIDNEY: The right kidney measures 9.3 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.8 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The bladder is distended, without significant wall thickening.", "output": "1.No hydronephrosis.2.Increased renal cortical echogenicity, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Rawles is a 46-year-old female recalled from screening mammogram for possible left breast cyst. She has a personal history of right breast cysts and benign left breast excisional biopsy. A targeted left breast ultrasound was performed for the mammographic area of concern. In the left breast 2:00 location, approximately 4 cm from the nipple, there is an oval anechoic lesion identified measuring approximately 2.1 x 1.5 x 2.3 cm, corresponding to the previously described mammographic finding. Sonographic findings are compatible with a simple cyst.", "output": "Simple cyst of the left breast. No sonographic evidence of malignancy in the left breast. As well as the patient's physical examination remains unchanged, an annual screening mammogram is recommended annually, due next in July 2017. All results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Benign renal cyst. Right kidney 12.2 cm in lengthLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 13 cm in lengthOTHER: Bladder collapsed", "output": "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 called back from screening mammography for an asymmetry in the right breast. Three standard views of the right breast with additional 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. There is a persistent lobulated asymmetry at the 12:00 position. An adjacent circumscribed round asymmetry is also present. ULTRASOUND", "output": "Benign cyst in the right upper breast, but no definite sonographic correlate for the lobulated mammographic asymmetry in the right upper breast. The patient has filed for submission of prior mammograms. If these are obtained, they will be reviewed and an addendum will be issued. Otherwise, a right unilateral diagnostic mammogram is recommended in 6 months to confirm stability. Results and recommendation 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": "Transaminitis LIVER: Unremarkable echogenicity without mass. Liver length 17.3 cmGALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.3 cm in lengthOTHER: Left kidney 10.8 cm in length. Spleen 11.3 cm in length. No ascites. Bilateral pleural effusions.", "output": "Gallbladder sludge without acute inflammation or ductal dilatation. Unremarkable liver parenchyma without mass or abnormal echogenicity."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male with HCV cirrhosis. Evaluate for HCC. LIVER: The liver contour is nodular and the parenchyma is moderately coarsened, consistent with cirrhosis. No discrete mass or intrahepatic biliary ductal dilatation evident. Normal hepatopetal portal venous blood flow is present at 20 cm/sec.BILIARY TRACT: The common bile duct at the level of the pancreatic head is normal in caliber, measuring 3 mm. A partially contracted gallbladder is noted with no wall thickening, pericholecystic fluid, focal tenderness or gallstones.PANCREAS: The visualized pancreatic head and body are unremarkable.SPLEEN: The spleen is mildly enlarged, measuring 13.7 cm in length without a discrete lesion.RIGHT KIDNEY: The right kidney measures 11.6 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 13.4 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow.There is mild ascites.", "output": "Cirrhotic liver morphology, mild splenomegaly, and small volume ascites. No discrete liver lesion or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "45 year old male patient with cirrhosis. Screening HCC. LIVER: The liver measures 16.1 cm in length and demonstrates coarsened hepatic echotexture as noted previously. The liver contour is nodular. No focal hepatic lesion is identified although sensitivity is decreased given heterogeneity and contour nodularity. Main portal vein flow is patent with flow toward the liver.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. Pancreatic duct measures 0.1 cmRIGHT KIDNEY: The right kidney measures 11.7 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 12.5 cm in length. No evidence of hydronephrosis.The spleen measures 12.4 cm in length.", "output": "No substantial interval change. Markedly heterogeneous nodular liver with no dominant lesions identified."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Focal hepatic parenchymal calcification again noted unchanged. No worrisome mass. Liver length 14.3 cm BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 7.7 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. Right renal cyst. 12.1 cm in lengthOTHER: Left kidney 10.3 cm in length. Left pleural effusion", "output": "Cholelithiasis without acute inflammation or ductal dilatation. Otherwise negative for acute hepatobiliary abnormality. Left pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "History of left breast probable fat necrosis presents for follow-up. A targeted left ultrasound was performed for the known area of concern. At the left breast 2:00 position, a mixed echogenicity area measuring 1.0 x 1.1 cm is compatible with fat necrosis. These measurements represent interval decrease in size.", "output": "Imaging findings compatible with resolving benign fat necrosis. The patient is due for a bilateral diagnostic mammogram in December of this year.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "22-year-old female with right flank pain. Early pregnancy. RIGHT KIDNEY: Right kidney measures 10.2 cm in length. Echotexture is normal. There is no hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Left kidney measures 10.1 cm in length. Echotexture is normal. There is no hydronephrosis, shadowing calculus or mass.OTHER: Limited views of the bladder demonstrate no abnormality.Early intrauterine pregnancy noted. Complete OB study not performed.Mildly echogenic liver, likely due to fatty infiltration.", "output": "Normal kidneys.Mild fatty liver.Early IUP.US RENAL LTD, 11/18/2016 10:08 AMCLINICAL INFORMATION:22-year-old female with right flank pain. Early pregnancy.COMPARISON: Limited views from 11/26/2011 ultrasound TECHNIQUE: Real-time ultrasound images were obtainedFINDINGS:RIGHT KIDNEY: Right kidney measures 10.7 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Left kidney measures 10.1 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.OTHER: Mildly echogenic liver likely due to fatty infiltration.Early IUP noted but not evaluated."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female with history of thyroid cancer post thyroidectomy. Evaluate for recurrent disease. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: 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 local recurrence or nodal disease."}
{"instruction": "Generate impression based on findings.", "input": "3-year-old female with left cutaneous ureterostomy takedown and reimplantation 10/04/16. History of cloacal reconstruction, left solitary kidney with obstructing megaureter with left pyeloplasty. Assess for possible improvement in dilation of bladder and left upper tracts. BLADDER  Wall Thickness: Moderate wall thickening.  Contents: There is slight decrease in the debris within the bladder, with the bladder appearing slightly more decompressed as compared to prior exam. Distal Ureter -- SFU Grade**  Left: 0 , no significant ureter dilatation is observed on this exam.   Ureteral Jets  Left: Not observed LEFT KIDNEY  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Left: 3, small amount of debris is identified within the left renal pelvis. Dilatation of the renal pelvis measures 2.5 cm anteroposteriorly, as compared to 2.8 cm on the prior exam.   Length*** Left: 8.4 cm   Mean for age: 7.3 cm  Range for age: 6.1 - 8.1 cmADDITIONAL OBSERVATIONS: No significant abnormalities noted", "output": "Persistent left hydronephrosis with debris in the renal pelvis and bladder. Ureteral dilatation is no longer visualized.*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": "Reason: Rule out hepatobiliary disease (cholelithiasis vs cholecystitis) History: RUQ pain LIVER: The liver measures 15.1 cm in length. Hepatic parenchymal echogenicity is suggestive of hepatic steatosis or parenchymal dysfunction. Normal hepatopedal portal venous blood flow, 25.4 cm/s.BILIARY TRACT: No significant abnormalities noted. No shadowing gallstones or sludge. Probable adenomyomatosis in the gallbladder fundus. The gallbladder wall measures 3 mm. The common bile duct measures 2 mm. No intrahepatic or extrahepatic biliary ductal dilatation. Negative sonographic Murphy sign.PANCREAS: Obscured due to overlying bowel gas.SPLEEN: The spleen measures 8.6 cm in length. Several scattered microcalcifications are noted.KIDNEYS: The right kidney measures 10 cm in length. The left kidney measures 11 cm in length. 2.4 x 2.2 x 1.9 cm anechoic left lower pole cyst.OTHER: No significant abnormalities noted.", "output": "Echogenic liver, which may reflect parenchymal dysfunction or hepatic steatosis. No cholelithiasis, evidence of cholecystitis or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Increasing LFTs LIVER: Mildly coarse heterogeneous echotexture without mass. Liver length 18 cmGALLBLADDER, BILIARY TRACT: Gallbladder sludge and stones without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right kidney 10.3 cm in length OTHER: Left kidney 10.7 cm in length. Spleen 12.8 cm in length. No ascites.", "output": "Mildly coarse heterogeneous echotexture suggestive for parenchymal dysfunction/fatty infiltration without mass or ductal dilatation. Gallbladder sludge and stones without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Macklin is a 28 year old female with a known history of multicentric right breast cancer and metastatic right axillary lymph node. She is currently undergoing neoadjuvant chemotherapy and presents for ultrasound evaluation to assess for treatment response in the known metastatic right axillary lymph node. Targeted right axillary ultrasound was performed.The known metastatic right axillary lymph node with centrally located biopsy marker clip measures 1.4 x 0.4 x 1.3 cm, previously measuring 1.5 x 0.6 cm.In addition to the biopsied right axillary lymph node there are two additional abnormal morphology lymph nodes identified, the largest one of which measures approximately 1.7 x 0.8 x 1.6 cm.", "output": "No significant change in size of known metastatic right axillary lymph node with centrally located biopsy marker clip. Patient should continue to follow up with her breast surgeon as clinically warranted. All results and recommendations were discussed with the patient and her mother.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. "}
{"instruction": "Generate impression based on findings.", "input": "41 year-old female with right upper quadrant pain with history of RYGB and lap band placement. Evaluate for cholelithiasis, cholecystitis. LIVER: Normal echogenicity of the liver measuring 18.3 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate direction of flow; peak velocity measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening or pericholecystic fluid. Sonographic Murphy's sign is negative. Common bile duct measures 4 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are normal in echogenicity.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 11.2 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the left kidney measuring 11.1 cm in length. No hydronephrosis or shadowing calculi noted.Normal echogenicity of the spleen measuring 10.6 cm.", "output": "No sonographic findings of cholelithiasis."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female patient with primary hyperparathyroidism. Assess for adenoma and thyroid nodule. RIGHT LOBE MEASUREMENTS: 5.7 x 1.8 x 1.7 cm.LEFT LOBE MEASUREMENTS: 5.8 x 1.1 x 1.8 cm.ISTHMUS MEASUREMENTS: 3 mm in thickness.RIGHT LOBE: There are three mostly solid, hypoechoic subcentimeter nodules within the right thyroid lobe. The largest within the medial inferior pole measures 0.9 x 0.8 x 0.5 cm.LEFT LOBE: The left thyroid lobe contains a complex cystic subcentimeter nodule within the superior pole measuring 0.5 x 0.4 x 0.2 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Subcentimeter bilateral thyroid nodules.2. No focus concerning for a parathyroid adenoma is identified."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old female with nausea/vomiting/abdominal pain. LIVER: Increased hepatic echogenicity without discrete focal lesion.GALLBLADDER, BILIARY TRACT: Cholelithiasis without gallbladder wall thickening or pericholecystic fluid. No sonographic Murphy sign was elicited during the examination. There is no biliary ductal dilation.PANCREAS: No significant abnormalities noted.KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "1.Cholelithiasis without evidence of acute cholecystitis.2.Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease."}
{"instruction": "Generate impression based on findings.", "input": "Patient recalled for 2 circumscribed masses identified within the right breast on screening mammogram. Three standard views of the right breast and 2 spot magnification views of the right central breast posterior depth 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. There are 2 subcentimeter circumscribed masses within the right central breast posterior depth, the largest measuring up to 7 mm. ULTRASOUND", "output": "Follow-up demonstrated two benign-appearing lesions. 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": "Hematuria RIGHT KIDNEY: 10.1 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 10.3 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No specific findings to account for the patient's hematuria."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old male with hepatitis C cirrhosis. Evaluate for hepatocellular carcinoma. LIVER: Liver is enlarged measuring 22 cm in length and coarsely echogenic with cirrhotic morphology. No focal hepatic masses identified. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Gallbladder is poorly distended due to postprandial state and therefore wall cannot be well assessed. There is again noted a nondependent focal echogenic area in the gallbladder wall measuring 2 to 3 mm consistent with polyp. Biliary tract is normal in caliber.PANCREAS: Limited due to bowel gasSPLEEN: Upper normal mildly enlargedRIGHT KIDNEY: No significant abnormalities noted. . No mass identified.OTHER: Periportal lymph nodes which are nonspecific in face with cirrhosis.", "output": "Stable exam with cirrhotic liver"}
{"instruction": "Generate impression based on findings.", "input": "34-year-old female with history of known right breast cancer who presents with a palpable right axillary lymph node from breast clinic for sonographic evaluation. A right axillary ultrasound was performed for the area of concern. There is a benign morphology right axillary lymph node measuring 4 x 8 mm.", "output": "No sonographic evidence for abnormal lymph node in the right axilla.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female with mediastinal mass, evaluate for lymphadenopathy. Enlarged rounded hypoechoic lymphadenopathy in the right level four station. Three abnormally enlarged lymph nodes are identified, measuring 1.3 x 1.3 cm, 0.9 x 1.1 cm, and 1.0 x 1.3 cm. No abnormal lymph nodes are identified on the left.", "output": "Right cervical lymphadenopathy as detailed above. "}
{"instruction": "Generate impression based on findings.", "input": "54-year-old male patient with new ascites fluid. Question of portal vein thrombosis. LIMITED ABDOMENLIVER: The liver measures 14.3 cm in length, is coarsened in echotexture, and nodular in contour. BILIARY TRACT: There is a single shadowing gallstone. The gallbladder wall measures 9 mm in thickness which is nonspecific in the setting of ascites. The common duct measures 4 mm in diameter.PANCREAS: The pancreas is not visualized on this examination.SPLEEN: The spleen measures 12.8 cm in length. RIGHT KIDNEY: The right kidney measures 10.1 cm in length. No evidence of hydronephrosis.OTHER: There is moderate to marked ascites.", "output": "1. Questioned partial thrombosis of the main portal vein with poor visualization of the right and left portal veins.2. Patent hepatic arteries and veins.3. Cirrhotic morphology of the liver with moderate to marked ascites.Findings discussed with ordering service prior to dictation."}
{"instruction": "Generate impression based on findings.", "input": "Male, 46 years old. Reason: 46M s/p L partial nephrectomy now with rising creatinine. RIGHT KIDNEY: The right kidney measures 11.6 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 12.1 cm in length, with increased cortical echogenicity. A mid to lower pole cystic lesion measures 4.1 x 3.3 x 3.8 cm. Corresponds with a simple cyst seen on prior CT imaging Additional previously identified solid left renal lesions are not seen on this exam, likely due to partial lumpectomy. No shadowing stones or hydronephrosis.OTHER: The bladder is incompletely distended.", "output": "1.Increased renal cortical echogenicity compatible with medical renal disease or parenchymal dysfunction. No hydronephrosis.2.Interval changes of left partial nephrectomy. Please note that based on the patient's body habitus, continued surveillance with CT imaging will be preferred over ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "Status post liver transplant with increasing abdominal girth and lower extremity edema LIMITED ABDOMENLIVER: No hepatic mass. Liver length 12.7 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: 11.7 cm in length RIGHT KIDNEY: No significant abnormalities noted. 11.3 cm in length OTHER: Left kidney 10.1 cm in length. No ascites.", "output": "Status post liver transplant without evidence for mass or ductal dilatation. No ascites. Patent hepatic vessels with normal directional flow."}
{"instruction": "Generate impression based on findings.", "input": "64 year-old female with incidental finding of a thyroid nodule on CT of the neck. RIGHT LOBE MEASUREMENTS: 4.0 x 1.4 x 1.5 cm.LEFT LOBE MEASUREMENTS: 5.7 x 1.7 x 1.8 cm.ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: Note is made of a 3 x 4 x 2 mm anechoic collection with a punctate focus of increased echogenicity and associated comet tail artifact, without internal vascularity or microcalcification, consistent with a colloid cyst. LEFT LOBE: 9 x 8 x 9 mm spongiform nodule in the superior pole of the left lobe of the thyroid without internal vascularity or microcalcification.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral benign morphology thyroid nodules, as detailed above. "}
{"instruction": "Generate impression based on findings.", "input": "53 years old, Male, Reason: cirrhosis? in 53M with AML and new diagnosis of hep C; bedside US if possible History: hep C active LIVER: The liver is mildly enlarged measuring 18.4 cm in length. The hepatic parenchyma is normal in echogenicity. 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. No definite nodularity of the liver contours to suggest cirrhosis.BILIARY TRACT: There is gallbladder sludge without evidence of 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 11.6 cm in length. RIGHT KIDNEY: Kidney measures 11.7 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 12.8 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No evidence of ascites.", "output": "1.No nodularity of the liver to suggest cirrhosis. No focal hepatic lesions.2.Gallbladder sludge without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Female 34 years old; Reason: Assess for evidence of HCC History: Chronic hepatitis B infection LIVER: The liver measures 14.4 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 19.1 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.5 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 1.3 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 8.6 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right 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 in the superior pole measuring 1.8 cm x 1.3 cm x 1.4 cm.LEFT KIDNEY: The left kidney measures 11.1 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "The liver has a coarse increased echogenicity compatible with fatty infiltration/hepatocellular dysfunction. No focal hepatic masses are seen."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old female with a history of left mastectomy 20 years ago and biopsy proven right breast cancer presents from surgery clinic with possible right axillary lymph node. A targeted right axillary ultrasound was performed for the palpable area of concern. There is an elongated lymph node in the right axilla measuring 4.1 x 1.2 x 2.8 cm within the eccentrically thickened cortex measuring 8 mm in thickness with eccentric vascularity. A second lymph node with benign morphology was also seen measuring 1.4 x 0.9 x 1.4 cm.", "output": "Right axillary lymph node with eccentrically thickened cortex. Ultrasound guided biopsy can be performed if desired.Please submit prior mammograms and ultrasound for comparison.BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old male with history of polycystic kidney disease. RIGHT KIDNEY: The right kidney measures 10.0 cm in length and shows normal echotexture. No cysts, worrisome mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 13.0 cm in length and shows normal echotexture. Numerous renal cysts are seen, with the largest in the left mid pole region measuring 5.3 x 4.8 x 5.2 cm. No mass, stone or hydronephrosis.URINARY BLADDER: The urinary bladder is normal in appearance.OTHER: There is no free or loculated fluid.", "output": "Multiple left renal cysts. No worrisome mass."}
{"instruction": "Generate impression based on findings.", "input": "40 year-old male with history of significant alcohol abuse, elevated transaminases. Evaluate for liver pathology. LIVER: Increased echogenicity of the liver measuring 19.2 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. Sonographic Murphy's sign is negative. Common duct measures 2 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Distal body and tail of the pancreas obscured by overlying bowel gas. The visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: Measures 10.1 cm in length. No hydronephrosis or shadowing calculi or noted.OTHER: Left kidney measures 10.8 cm in length. No hydronephrosis or shadowing calculi or noted.Normal echogenicity of the spleen measuring 8.3 cm in length.", "output": "Increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "Elevated liver enzymes. Cardiac arrest. 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. 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 11.2 cm in length. The left kidney is 12.9 cm in length. The renal parenchymal echogenicity is increased bilaterally. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 9.0 cm in length, without focal lesions evident.AORTA: Patent, without aneurysmal dilation.OTHER: No significant abnormalities noted. No ascites identified.", "output": "1. Mildly increased hepatic echogenicity, compatible with parenchymal dysfunction.2. Increased renal parenchymal echogenicity, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "31 years old, Female, Reason: Abdominal pain, bloating gas, no emesis, no stool, possible association with greasy foods LIVER: The liver measures 15.5 cm in length. Echogenicity of the hepatic parenchyma is within normal limits. 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 two mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 10.3 cm in length. RIGHT KIDNEY: Kidney measures 11.0 cm in length. Normal echotexture. No evidence of hydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 10.6 cm in length. Normal echotexture. No evidence of hydronephrosis or shadowing calculus.OTHER: No significant abnormalities noted.", "output": "1.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Male 68 years old Reason: Thyroid nodule. Assess stability. RIGHT LOBE MEASUREMENTS: 2.2 x 2.8 x 6.5 cmLEFT LOBE MEASUREMENTS: 3.8 x 3.3 x 7.1 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Right thyroid lobe is normal background echogenicity. No nodules.LEFT LOBE: Left thyroid lobe has a predominantly cystic nodule with internal septations likely representing a colloid nodule. This nodule is unchanged in size measuring 3.6 x 2.4 x 3.6 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Colloid appearing nodule in the left thyroid lobe is unchanged in size and appearance."}
{"instruction": "Generate impression based on findings.", "input": "VHL status post right nephrectomy; evaluate left renal cysts RIGHT KIDNEY: Status post nephrectomyLEFT KIDNEY: No significant change in numerous left renal cysts. No evidence for worrisome cyst complexity or mass. Largest cyst within the mid pole measures 2.9 x 2.4 x 2.5 cm. No hydronephrosis. Left kidney 14.9 cm in length. OTHER: Bladder nondistended.", "output": "No significant change in numerous left renal cysts without evidence for worrisome cysts complexity or mass. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Prostate cancer. Chronic cholecystitis. Chronic kidney disease. Fever. LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. An ill-defined 3.4 cm cystic-appearing lesion is noted in the right hepatic lobe. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Pneumobilia is noted, similar to the prior CT. The gallbladder is contracted with gallstones and biliary sludge.PANCREAS: The pancreas is obscured by bowel gas.KIDNEYS: The right kidney is 12.3 cm in length, with a benign-appearing 4.4 cm cyst. The left kidney is 9.1 cm in length, with a benign-appearing 5.7 cm cyst. The renal parenchyma is echogenic bilaterally. No suspicious renal lesions are evident. No hydronephrosis is seen.BLADDER: No significant abnormality noted.SPLEEN: 9.1 cm in length, without focal lesions evident.ABDOMINAL AORTA: Patent, without significant abnormality noted.INFERIOR VENA CAVA: Patent, without significant abnormality noted.OTHER: No significant abnormality noted. No significant abdominal free fluid is identified.", "output": "1. 3.4 cm cystic-appearing lesion in the right hepatic lobe. Further evaluation with CT is recommended.2. Echogenic renal parenchyma bilaterally, compatible with medical renal disease.Findings and recommendations discussed with the ordering physician by telephone at 3:00 PM on 12/16/2015."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old female with nephrotic syndrome. Ultrasound guidance was provided for biopsy of the patient's right kidney.", "output": "Ultrasound guidance."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old male with HCV and cirrhosis. Evaluate for hepatocellular carcinoma. LIVER: The liver is coarsely echogenic without underlying mass. Overall hepatic size is within normal limits. Morphology is cirrhotic. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: On today's study, no definite gallstones, polyp or significant wall thickening. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Renal cysts.OTHER: Left renal cysts. Splenic size normal.", "output": "Stable appearance the liver without mass."}
{"instruction": "Generate impression based on findings.", "input": "Female 72 years old Reason: thyroid nodules, please assess for changes History: thyroid nodules RIGHT LOBE MEASUREMENTS: 6.8 x 3.6 x 2.0 cmLEFT LOBE MEASUREMENTS: 6.7 x 2.2 x 2.5 centimetersISTHMUS MEASUREMENTS: 1.4 cmRIGHT LOBE: Heterogeneous parenchymal echotexture with multiple cystic and subcentimeter solid nodules. Hypoechoic inferior pulmonary nodule is unchanged in size measuring 0.8 x 1.1 x 0.7 cmLEFT LOBE: Heterogeneous parenchymal echotexture with multiple cystic and septated nodules. Cystic and septated mid thyroid nodules unchanged in size measuring 1.9 x 1.8 x 2.0 cm.ISTHMUS: Cystic isthmus nodule with septations is unchanged in size measuring 2.3 x 3.4 x 1.4 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing lymph nodes are identified.OTHER: No significant abnormality noted.", "output": "Enlarged thyroid with multiple cystic nodules with septations bilaterally, which are unchanged in size. No regional lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old female presents for follow-up of hepatic lesions. LIVER:Measures 14.3 cm. Increased and coarse echogenicity of liver limits evaluation of the parenchyma. Several hypoechoic lesions are noted again on the current study, but definite evaluation of these cannot be performed due to increased echotexture and decreased penetration of ultrasound beam. GALLBLADDER, BILIARY TRACT: The lumen is anechoic. No stones or sludge. The wall measures 2.1 cm. The common hepatic duct is 6.1 cm. No pericholecystic fluid.PANCREAS: Pancreas has uniformly increased echogenicity, compatible with fatty infiltration.SPLEEN: Measures 9.3 cm. No sonographic abnormalities.KIDNEYS: Right kidney is 11.2 cm. Left kidney is 10.2 cm. Cortex disease have normal echogenicity. No shadowing I, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "1. Coarse and increased echogenicity of liver consistent with chronic liver disease/parenchymal dysfunction.2. Several hypoechoic lesions as described above inadequately evaluated on this study. Could be better evaluated with multiphasic CT exam.3. Increased echogenicity of pancreas consistent with fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "Reason: s/p renal and pancreas transplant History: elevated Cr. Ultrasound guidance was provided to the clinical service for biopsy of transplant kidney in right iliac fossa.", "output": "Ultrasound guidance for transplant kidney biopsy."}
{"instruction": "Generate impression based on findings.", "input": "21-year-old male with right testicular pain to palpation. Evaluate for torsion. RIGHT TESTIS: Measures 5.7 cm x 2.3 cm x 3.6 cm. Normal homogeneous echotexture. No hydrocele. There is appropriate arterial and venous flow present on Doppler exam. LEFT TESTIS: Measures 5.6 cm x 2.6 cm x 3.6 cm. Normal homogeneous echotexture. No hydrocele. There is appropriate arterial and venous flow present on Doppler exam. RIGHT EPIDIDYMIS: Measures 3.9 cm x 1.0 cm x 1.0 cm. Normal echotexture with appropriate flow.LEFT EPIDIDYMIS: Measures 4.9 cm x 1.2 cm x 1.2 cm. Normal echotexture with appropriate flow.OTHER: No significant abnormalities noted.", "output": "Unremarkable examination."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with history of bacteremia. LIVER: Mild amount of perihepatic ascites. The liver is enlarged, measuring 20.5 cm and has the appearance of steatosis. No biliary dilatation or focal masses. Posteroinferior to the liver is an area of increased echogenicity that is either complex fluid or soft tissue, but is incompletely evaluated given the depth of location. This may be further evaluated with CT if clinically indicated.GALLBLADDER, BILIARY TRACT: The gallbladder is decompressed. No biliary dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Increased renal echogenicity, without hydronephrosis or hydroureter. The right kidney measures 11.2 cm.OTHER: Subtle increased echogenicity of the left kidney. The left kidney measures 10.9 cm. No left kidney hydronephrosis. Redemonstration of splenic hypoattenuating foci, nonspecific.", "output": "Mild ascites, and hepatic steatosis. Nonspecific splenic lesions are again seen. An area of increased echogenicity posterior to the liver may represent complex fluid versus bowel that is incompletely evaluated due to the depth of this area. Consider contrast enhanced CT if clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 39 y.o. Male with PTC. Please evaluate RIGHT LOBE MEASUREMENTS: 6.1 x 2.6 x 2.1 cmLEFT LOBE MEASUREMENTS: 6.4 x 2.4 x 2.2 cmISTHMUS MEASUREMENTS: 0.2 cm in the AP dimensionRIGHT LOBE: No significant abnormality noted. No suspicious nodules identified.LEFT LOBE: Large solid nodule with a hypoechoic rim lacks significant vascularity or definite microcalcifications and measures 2.2 x 2.0 x 1.7 cm. No other suspicious nodules identified.ISTHMUS: No significant abnormality noted. No suspicious nodules identified.PARATHYROID GLANDS: None visualized.LYMPH NODES: There are several elongated, benign-appearing bilateral lymph nodes with fatty hila. No suspicious or enlarged cervical lymph nodes.Left level 3 node measures 2.9 x 0.7 x 0.5 cm.Right level 2 node measures 1.7 x 0.8 x 0.2 cm.OTHER: No significant abnormality noted.", "output": "Large solid left thyroid nodule highly suspicious for malignancy, consistent with history of biopsy-proven papillary carcinoma. No cervical lymphadenopathy or suspicious cervical lymph nodes."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid carcinoma status post resection RIGHT LOBE: Status post thyroidectomy without massLEFT LOBE: Status post thyroidectomy without worrisome mass. 0.4 x 0.3 x 0.5 cm benign-appearing lymph node within the left thyroidectomy bedISTHMUS: 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 mass or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Renal stones RIGHT KIDNEY: Upper pole stone again noted measuring 0.7 x 0.9 x 0.9 cm. No worrisome mass. No hydronephrosis. Right kidney 11.7 cm in lengthLEFT KIDNEY: Stable nonobstructing left renal stone measuring 1 x 0.5 x 0.5 cm. No worrisome mass. No hydronephrosis. Left kidney 10.4 cm in length.OTHER: Bladder nondistended", "output": "Stable nonobstructing bilateral renal stones."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old male, rule out HCC LIVER: Coarse echotexture of the liver measuring 15.8 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. Focal hyperechoic focus with ring down artifact in the of the gallbladder fundus is again seen and likely representing focal adenomyomatosis. There is an echogenic nonmobile focus along the nondependent wall of the gallbladder likely a gallbladder polyp measuring 4 mm x 4 mm x 5 mm. Common duct measures 4 mm in caliber. No intra or extrahepatic biliary ductal dilatation.PANCREAS: Not well seen due to overlying bowel gas.RIGHT KIDNEY: Measures 10.6 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 9.5 cm in length. No hydronephrosis or shadowing calculi are noted.Spleen is not visualized.", "output": "1. Coarse echotexture of the liver suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesions.2. Subcentimeter gallbladder polyp along the nondependent portion of the gallbladder wall. 3. Focal adenomyomatosis of the gallbladder is again seen. "}
{"instruction": "Generate impression based on findings.", "input": "Acute on chronic renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 10.5 cm in lengthLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 10.4 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": "52-year-old female with right upper quadrant pain and tenderness, palpable cord in the right abdomen. LIVER: Normal echogenicity of the liver measuring 16.5 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 thickened. No pericholecystic fluid. Sonographic Murphy's sign is negative. 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 11.7 cm in length. Cyst at the upper pole measures 1.6 x 1.7-cm x 1.6 cm. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 11.7 cm in length. Cyst at the lower pole measures 1.4 cm x 1.0 cm x 1.1 cm. No hydronephrosis or shadowing calculi are noted.Normal echogenicity of the spleen measuring 8.9 cm in length.", "output": "Bilateral renal cysts. Otherwise unremarkable examination. "}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules RIGHT LOBE MEASUREMENTS: 6.2 x 2.4 x 2.3 cmLEFT LOBE MEASUREMENTS: 6 x 2.3 x 2.6 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Stable right thyroid nodules. Reference inferior pole nodule measures 2.5 x 2.2 x 1.2 cm.LEFT LOBE: Stable spongiform nodules. Reference inferior pole nodule measures 1.7 x 1.2 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": "Stable bilateral thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for possible acalculus cholecystitis in a patient with neutropenic fever, septic shock LIVER: Liver measures 23.6 cm, severely echogenic. No specific hepatic lesions noted. Smooth contour of the liver noted. Main portal vein demonstrates normal flow directionality and patency. No intrahepatic biliary ductal dilatation.BILIARY TRACT: Common bile duct measures up to 5 mm. Gallbladder is well-distended with multiple gallstones within it. Gallbladder wall is thickened and measures 6 mm. No evidence of pericholecystic fluid noted.PANCREAS: Cannot be visualized due to overlying bowel gas.SPLEEN: Spleen measures 13 cm, mildly increased in size, without any focal lesions.RIGHT KIDNEY: Right kidney measures 12.3 cm left kidney measures 13 cm. No renal stones or focal lesions or hydronephrosis noted. Normal echotexture noted. OTHER: No ascites", "output": "Distended gallbladder with gallstones within it and increased gallbladder wall thickening in comparison with prior examination suspicious for acute cholecystitis. No definite pericholecystic fluid noted.Mild splenomegaly.Mild hepatomegaly with fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "Female 6 months old Reason: Rule out mass due to torticollis History: neck mass, torticollisVIEWS: Chest AP/lateral (two views) 10/5/2015, 2142 Cardiomediastinal silhouette is normal. No focal airspace opacity, pleural effusion or pneumothorax. No neck mass is identified, however if there is ongoing concern ultrasound may be obtained for further evaluation.", "output": "No neck mass is identified, however if there is ongoing concern, neck ultrasound may be obtained for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Painful lump adjacent to the rib cage on the right. Limited ultrasound was performed at the site of the patient's palpable and painful lump. There is no evidence of a soft tissue mass in this region and it is possible that the palpable abnormality is within or extending from the rib cage (this area cannot be evaluated by ultrasound). Consider correlation with rib series as clinically indicated.", "output": "We could not visualize any soft tissue mass or fluid collection at the site of the lump. Consider rib series as clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "Reason: RUQ; h/o HCV; abdominal pain. Per electronic medical record, also history of end-stage renal disease. LIVER: The liver measures 19.2 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 0.25 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 5 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 9.4 cm in length. RIGHT KIDNEY: Kidney measures 12.5 cm in length. Most of the renal parenchyma is replaced by innumerable cysts, some with internal complexity.LEFT KIDNEY: Kidney measures 14.0 cm in length. Most of the renal parenchyma is replaced by innumerable cysts, some with internal complexity.OTHER: No significant abnormalities noted.", "output": "1.Innumerable cysts in both kidneys compatible with acquired cystic renal disease in the setting of dialysis.2.No focal hepatic lesions identified."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old female patient with history of multiple nodules. Evaluate for interval change. RIGHT LOBE MEASUREMENTS: 2.0 x 2.4 x 5.6 cmLEFT LOBE MEASUREMENTS: 1.8 x 2.4 x 4.7 cmISTHMUS MEASUREMENTS: 5 mm in thickness.RIGHT LOBE: Multiple heterogeneous nodules are again noted in the right thyroid lobe. The largest measures 1.2 x 0.9 x 0.9 cm in the superior pole, previously 1.0 x 0.9 x 0.8 cm. LEFT LOBE: Multiple heterogeneous nodules, some with cystic components are noted in the left thyroid lobe. The largest measures 1.8 x 1.1 x 1.3 cm in the superior pole, previously 1.9 x 1.1 x 1.2 cm.ISTHMUS: A hypoechoic nodule within the isthmus measures 0.4 x 0.3 x 0.5 cm, previously 0.6 x 0.5 x 0.3 cm. PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-morphology lymph nodes are noted in neck.OTHER: No significant abnormality noted.", "output": "Bilateral thyroid nodules without significant interval change. "}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma again noted without mass, stone, or hydronephrosis. 10.2 cm in lengthLEFT KIDNEY: Echogenic parenchyma again noted without mass, stone, or hydronephrosis. 9.3 cm in length.OTHER: Bladder nondistended.", "output": "Echogenic renal parenchyma again noted consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine RIGHT KIDNEY: 8.6 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 7.7 cm in length. The left kidney is not well visualized, due to poor acoustic penetration. Increased renal parenchymal echogenicity. No hydronephrosis.BLADDER: Collapsed.OTHER: No significant abnormality noted.", "output": "Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Female 73 years old Reason: eval for cholecystitis History: s/p perc chole on 9/27 LIVER: Partially imaged liver is normal in appearance. Main portal vein is patent with normal directional flow and a peak velocity of 23.7 cm/s.BILIARY TRACT: Gallbladder has a drain within it. Patient is status post percutaneous cholecystostomy on 9/27/2016. The gallbladder is nondistended. There is no pericholecystic fluid or fluid collection. The partially visualized gallbladder wall measures 2 mm. No intrahepatic or extrahepatic biliary ductal dilatation. Common bile duct measures 3 mm.OTHER: No significant abnormalities noted.", "output": "Drain is present within the nondistended gallbladder. No evidence of complication."}
{"instruction": "Generate impression based on findings.", "input": "Ms Minor is a 15-year-old female presenting with a history of bilateral clear nipple discharge over the last few months. Patient denies any palpable breast lump. However, her physician detected bilateral breast masses with bilateral nipple skin changes. On physical exam, bilateral areolar dryness and cracking are noted, left more than right.Bilateral whole breast ultrasound was performed. There is no cystic or solid mass in either breast.", "output": "No sonographic findings to explain patient's bilateral nipple discharge. The patient should follow up with her primary care physician as clinically warranted, presuming these results are concordant with the physical exam findings. Of note, patient has an appointment to be seen by Dr. Bao for further evaluation. All results and recommendations were discussed with the patient and her mother.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Reason: concern for cholecystitis on CT scan History: epigastric abdominal pain BILIARY TRACT: The gallbladder is mildly distended and contains layering sludge. No shadowing gallstones are identified. No 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.", "output": "Sludge in a mildly distended gallbladder without specific sonographic evidence of acute cholecystitis. If there is persistent clinical concern for acute cholecystitis, nuclear medicine HIDA scan may be considered as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Liver ultrasound chronic hepatitis B carrier LIVER: The liver measures 13.5 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 0.53 m/s.BILIARY TRACT: Contracted gallbladder without evidence of cholecystitis. 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 8.8 cm in length. RIGHT KIDNEY: Kidney measures 10.1 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 9.9 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Findings suggestive of chronic liver disease without focal lesions identified."}
{"instruction": "Generate impression based on findings.", "input": "Nonalcoholic steatohepatitis. Hepatitis C. LIVER: Non-cirrhotic liver morphology. 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 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 9.8 cm in length, with a subcentimeter benign-appearing cyst. The left kidney is 8.9 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.4 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites.", "output": "Increased hepatic echogenicity compatible with steatosis, without suspicious hepatic lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "51 year-old female with right upper quadrant pain and chills. LIVER: Normal in size and echotexture.GALLBLADDER, BILIARY TRACT: Dependent gallstone in the gallbladder without wall thickening, distention or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: Head and body are normal. Tail is not well seenRIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Dependent gallstone without complication."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old pregnant female presents for right axillary ultrasound following physical examination where her physician noted a palpable area. A targeted right axillary ultrasound was performed for the patient\u2019s area of concern. There is no suspicious solid or cystic mass identified. A normal appearing right axillary lymph node is present measuring 1.8 x 0.8 cmm, with normal hilar vascularity.", "output": "No sonographic evidence for malignancy. Normal morphology right axillary lymph node. Clinical follow up is recommended to ensure that this result is concordant with physical exam. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Mildly coarse liver echotexture without worrisome mass. Stable minimally complex benign-appearing left hepatic lobe cyst measuring 1.4 x 1.3 x 1.8 cm. Liver length 10.7 cm in lengthBILIARY TRACT: Stable cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 7.8 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 11.3 cm in lengthOTHER: Left kidney 10.5 cm in length. No ascites", "output": "Mildly coarse liver echotexture suggestive for chronic liver disease without worrisome mass. Stable minimally complex benign-appearing left hepatic lobe cyst. Stable cholelithiasis without acute inflammation or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Stated history of nontoxic multinodular goiter. RIGHT LOBE MEASUREMENTS: 0.9 x 0.6 x 4 cmLEFT LOBE MEASUREMENTS: 0.8 x 0.4 x 3.1 cmISTHMUS MEASUREMENTS: 1 mmRIGHT LOBE: Mildly atrophic right thyroid gland with mildly heterogeneous background parenchyma. 3 x 3 x 4 mm hypoechoic well marginated lesion in the superior portion of the right thyroid. Previously this measured 5 x 4 x 7 mm.In the inferior portion of the right thyroid lobe there is a 5 x 3 x 9 mm solid lesion with vascularity and probable small cystic components previously measuring 9 x 5 x 10 mm.LEFT LOBE: Atrophic left thyroid gland with mildly heterogeneous background parenchyma. 2 mm cystic nodule is noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Subcentimeter right thyroid nodules without specific suspicious sonographic features are relatively stable in size."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male patient with AMS. Concern for myxedema. Limited evaluation of the left thyroid lobe secondary to an IV obstructing probe placement. RIGHT LOBE MEASUREMENTS: 1.8 x 3.0 x 5.2 cm.LEFT LOBE MEASUREMENTS: 1.7 x 1.4 cm (measured in the trans).ISTHMUS MEASUREMENTS: 3 mm in thickness.RIGHT LOBE: The right thyroid lobe is homogeneous in echogenicity and contains a few tiny cysts. Vascularity is within normal limits on color Doppler imaging.LEFT LOBE: Limited evaluation of the left thyroid lobe is without focal lesion. Vascularity is within normal limits on color Doppler imaging.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Limited evaluation of the thyroid though without definite abnormality. "}
{"instruction": "Generate impression based on findings.", "input": "59 year-old male with right upper quadrant pain and nausea. LIVER: Coarsened liver architecture. Smooth liver contour. No focal mass lesions are identified. The portal vein flow is hepatopetal.GALLBLADDER, BILIARY TRACT: The gallbladder is incompletely distended. No gallstones are identified. No findings to suggest acute cholecystitis. No common duct stones are seen.PANCREAS: No significant abnormalities noted although partially of by overlying bowel gas.SPLEEN: Mild splenomegaly.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "1. Coarsened liver echotexture may be seen in chronic liver disease.2. Mild splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Female 66 years old; Reason: Change in nodules History: Multinodular goiter, dominant right nodule with previous benign FNA RIGHT LOBE MEASUREMENTS: 7.9 x 5.0 x 3.8 cm (previously 8.0 x 6.1 x 5.4 cm)LEFT LOBE MEASUREMENTS: 3.3 x 1.0 x 1.3 cm (previously 4.6 x 1.0 x 1.3 cm)ISTHMUS MEASUREMENT: 0.3 cm (previously 0.2 cm)RIGHT LOBE: In the right inferior thyroid lobe is a predominantly solid nodule with an internal calcification which appears similar to the prior study. This measures 6.4 x 4.0 x 2.9 cm (previously 7.2 x 5.6 x 4.5 cm).LEFT LOBE: 0.5 x 0.7 x 0.4 cm solid nodule in the inferior pole previously measured 0.6 to 0.4 x 0.7 cm.ISTHMUS: No significant abnormality noted.OTHER: Scattered prominent cervical lymph nodes are seen with fatty hila and a benign appearance.", "output": "1.Interval decrease in the size of the right lobe nodule. Stable left thyroid nodule.2.No suspicious lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Enlarging cystic lesion left side of neck with history of multinodular goiter RIGHT LOBE MEASUREMENTS: 3.4 x 3.3 x 5.8 cmLEFT LOBE MEASUREMENTS: 2.3 x 6 x 7 cm ISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Diffusely heterogeneous gland again noted with dominant mixed cystic and solid nodule measuring 4.2 x 3.8 x 3.2 cm. The cystic component of this nodule now demonstrates extensive internal debris.LEFT LOBE: Diffusely heterogeneous gland with relatively stable dominant mixed cystic and solid nodule measuring 3.9 x 3 x 2.6 cm.ISTHMUS: Diffusely heterogeneous glandPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No significant change in bilateral dominant mixed cystic and solid nodules. Cystic component of right dominant thyroid nodule demonstrates significant internal debris."}
{"instruction": "Generate impression based on findings.", "input": "Renal stone RIGHT KIDNEY: AbsentLEFT KIDNEY: Echogenic renal parenchyma without worrisome mass. Benign-appearing cyst. 0.3 x 0.3 cm echogenic focus within the lower pole consistent with nonobstructing subcentimeter stone. Interval decrease in degree of hydronephrosis which is now minimal. Left kidney 11.5 cm in length.OTHER: Bladder nondistended", "output": "Absent right kidney. Echogenic left renal parenchyma consistent with medical renal disease/chronic parenchymal dysfunction without worrisome mass. Interval decrease in degree of hydronephrosis which is now minimal. Subcentimeter nonobstructing lower pole left renal stone."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Is there an aneurysm? History: Reported history of AAA LIVER: The liver measures 18.9 cm in length. The hepatic parenchymal echotexture and echogenicity is coarse. There is a mildly nodular hepatic contour, concerning for a cirrhotic liver morphology. There are no focal masses. The main portal vein is patent with normal directional hepatopedal flow, maximum systolic velocity 19.4 cm/s.GALLBLADDER, BILIARY TRACT: The common hepatic duct measures 2 mm in diameter. The gallbladder is moderately distended. There is a small echogenic focus in the dependent portion of the gallbladder with posterior acoustic shadowing, consistent with a small stone. There is no pericholecystic fluid. The gallbladder wall measures 2 mm. There is no biliary ductal dilatation. Murphy's sign was negative.PANCREAS: Obscured by bowel gas.SPLEEN: The spleen measures 16.9 cm in length.KIDNEYS: The left kidney measures 11.8 cm in length. The right kidney measures 11.9 cm in length. No hydronephrosis. ABDOMINAL AORTA: The abdominal aorta is obscured by bowel gas distally. The abdominal aorta measures 3.2 cm proximally and 2.9 cm more distally in the AP diameter. The distal abdominal aorta was nonvisualized. The arterial waveform is pulsatile, consistent with reported history of intra-aortic balloon pump.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Left pleural effusion. No free intraperitoneal fluid.", "output": "1. Echogenic coarse hepatic parenchyma with nodular contour, concerning for cirrhosis.2. Cholelithiasis without evidence of cholecystitis.3. Limited evaluation of the abdominal aorta without evidence of abdominal aortic aneurysm."}
{"instruction": "Generate impression based on findings.", "input": "67 year old female patient with a right thyroid nodule. Evaluate thyroid. RIGHT LOBE MEASUREMENTS: 5.0 x 2.5 x 2.3 cm.LEFT LOBE MEASUREMENTS: 4.2 x 1.9 x 2.1 cm.ISTHMUS MEASUREMENTS: 0.3 cm in thickness. RIGHT LOBE: The right thyroid lobe is heterogeneous in echogenicity. There is a dominant solid appearing, partially calcified nodule within the upper pole measuring 0.9 x 0.9 x 1.3 cm. An additional solid nodule near the isthmus measures 1.2 x 1.0 x 1.0 cm. Additional nodules have imaging features of colloid nodules.LEFT LOBE: The left thyroid lobe is heterogeneous in echogenicity. There is a solid nodule within the left lower pole with a hypoechoic rim measuring 1.2 x 0.8 x 0.8 cm. Additional nodules have imaging features of colloid nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A left level III lymph node is present.OTHER: No significant abnormality noted.", "output": "Multinodular goiter as above."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old female with a history of thyroid cancer status post right thyroid lobectomy presents for follow-up. RIGHT LOBE MEASUREMENTS: The right lobe is absent.LEFT LOBE MEASUREMENTS: 5.9 x 1.8 x 1.7 cm.ISTHMUS MEASUREMENTS: 0.2 cm.RIGHT LOBE: The right lobe is absent.LEFT LOBE: Unremarkable echotexture. There are multiple nodules as below.Nodule 1: Measures approximately 1.1 x 0.6 x 1.3 cm in the mid left thyroid. Appears smaller and may have involuted since the prior study.Nodule 2: Measures approximately 1.4 x 0.8 x 1.7 cm in the mid left thyroid. Appears larger since the prior study.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. One reference nodule smaller, the other larger."}
{"instruction": "Generate impression based on findings.", "input": "Rule out recurrence history of thyroid cancer 2 year follow-up RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: No suspicious areas of recurrence or residual tumor noted.LEFT LOBE: No suspicious foci or residual tumor notedISTHMUS: No suspicious areas of recurrence or residual tumor notedPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal morphology lymph nodes are again noted in the right level 1B and in the left neck level 3. Both these lymph nodes are stable from prior examOTHER: No significant abnormality noted.", "output": "Stable examination without evidence of residual/recurrent disease"}
{"instruction": "Generate impression based on findings.", "input": "Renal stones RIGHT KIDNEY: Normal echogenicity without mass. Lower pole nonobstructing stone measuring 1.4 x 1 x 1.2 cm. Minimal hydronephrosis. Right kidney 11.9 cm in lengthLEFT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. Left kidney 13.4 cm in length.OTHER: Bladder collapsed. Coarse echogenic liver parenchyma again noted consistent with known chronic liver disease.", "output": "Nonobstructing right lower pole renal stone. Minimal right hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old female with bilateral fibroadenomas, biopsy proven in the left breast 12:00 position and right breast 7:00 position. Follow-up examination. Mild intermittent pain, otherwise no new breast complaints. Ultrasound of both breasts was performed, redemonstrating five fibroadenomas, three in the right breast and two in the left breast, with measurements as follows.Right breast:7:00 position, 4 cm from the nipple: 2.7 x 1.4 x 2.0 cm, previously 3.1 x 2.5 x 1.8 cm.9:00 position, 3 cm from the nipple: 2.0 x 1.1 x 1.9 cm, previously 2.0 x 2.0 x 1.3 cm.Retroareolar region: 1.8 x 1.1 x 2.0 cm, previously 2.0 x 1.2 x 2.2 cm.Left breast:4:00 position, 2 cm from the nipple: 2.4 x 1.1 x 2.6 cm, previously 2.1 x 1.8 x 1.1 cm.12:00 position 1 cm from the nipple: 2.2 x 1.6 x 2.6 cm, previously 3.3 x 3.5 x 2.1 cm.", "output": "Bilateral solid masses consistent with fibroadenomas, which are overall stable or decreased in size compared with the prior studies dating back to 2013. No further ultrasound follow-up is necessary at this time. Additional imaging may be performed in the setting of new symptoms or as warranted clinically. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old male patient with recent acute pancreatitis. Evaluate for gallstones, CBD dilatation, peripancreatic fluid collection. LIVER: The liver measures 18 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 is a gallstone near the neck of the gallbladder which moves with dependent positioning. There is no significant gallbladder wall thickening or pericholecystic fluid. The common duct measures 9 mm in diameter, appearing larger in diameter compared to prior MRCP. The duct is not visualized distally.PANCREAS: Heterogeneous echogenic material is noted within the region of the pancreatic head consistent with inflammatory changes of pancreatitis. No discrete fluid collection is noted within this region.RIGHT KIDNEY: The right kidney measures 11.7 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 12.7 cm in length. No evidence of hydronephrosis.The spleen is not adequately visualized on this examination. Fluid is noted within the left upper quadrant.", "output": "1. Echogenic material within the region of the pancreatic head consistent with history of pancreatitis. No discrete collection is seen in this region, however, CT is a better means of evaluation for complications of pancreatitis.2. Common bile duct dilatation, increased in size compared to prior studies; MRCP may be considered for further evaluation. 3. Cholelithiasis without sonographic evidence of acute cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: worsening kidney function RIGHT KIDNEY: The right kidney measures 8.5 cm in length. Echogenic renal parenchyma. Subcentimeter non-obstructing right upper pole shadowing renal calculus. No hydronephrosis or focal mass.LEFT KIDNEY: The left kidney measures 9.2 cm in length. Echogenic renal parenchyma. No shadowing renal calculi, hydronephrosis, or focal mass.OTHER: Unremarkable bladder. Ureteral tracts are visualized.", "output": "1. Echogenic renal parenchyma, consistent with medical renal disease.2. Subcentimeter nonobstructive left renal stone."}
{"instruction": "Generate impression based on findings.", "input": "Female 58 years old Reason: evaluate medial side of elbow for possible infection History: pain and swelling s/p surgery There is a small, ill-defined fluid collection measuring 1.3 x 0.5 x 1.4 cm abutting the left epicondyle.No other fluid collections are seen", "output": "Small ill-defined fluid collection.Dr. Meagan Meislin informed."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Rule out abscess formation at the site of prior abdominal chest tube sites. Drainage and purulence at the sites. Sonographic images of the anterior superficial abdominal wall demonstrate tracts related to prior drains/tubes without associated discrete, drainable fluid collections identified.", "output": "No drainable fluid collections identified."}
{"instruction": "Generate impression based on findings.", "input": "Reason: enlarged thyroid gland on exam RIGHT LOBE MEASUREMENTS: 6.8 x 2.1 x 2.2 cm.LEFT LOBE MEASUREMENTS: 7.2 x 2.8 x 2.1 cm. ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: Markedly heterogeneous echotexture with increased internal vascularity, limiting evaluation for discrete nodules. Reference right mid pole nodule measures 1.5 x 1.4 x 0.5 cm.LEFT LOBE: Markedly heterogeneous echotexture with increased internal vascularity, limiting evaluation for discrete nodules. Subcentimeter dystrophic calcifications are noted in the left mid thyroid lobe.ISTHMUS: Markedly heterogeneous echotexture.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Thyromegaly and markedly heterogeneous thyroid echotexture."}
{"instruction": "Generate impression based on findings.", "input": "15-year-old with palpable right breast mass. On physical exam, there is a palpable mobile mass in the right breast 9:00 position.A targeted right ultrasound was performed for the palpable area of concern. In the right breast 9:00 position 2 cm from nipple there is a circumscribed hypoechoic mass with internal vascularity, measuring 2.7 x 1.2 x 2.6 cm. Sonographic features are highly suggestive of a fibroadenoma. Suggest FNA and/or percutaneous biopsy for tissue confirmation.", "output": "2.7 x 1.2 x 2.6 cm circumscribed right breast mass, highly suggestive of a fibroadenoma. Surgical consultation for consideration of FNA or biopsy via palpable guidance is recommended. Findings are recommendations were discussed with the patient and her mother at time of exam.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "83 year old female status post right lumpectomy and complete axillary dissection in 2006 for IDC and DCIS, presents with palpable abnormality with the left axilla noted on physical examination. Patient received radiation, chemotherapy, and Arimidex. No current breast complaints. No family history of breast cancer. On physical examination, there is a 1.0 cm mobile circumscribed mass in the low left axilla. A targeted left axillary ultrasound was performed for the palpable area of concern. At the area of palpable abnormality, there are two adjacent lymph nodes. The first measures 0.7 x 0.7 x 0.7 cm, with cortical thickening measuring up to 0.5 cm, and effacement of the fatty hilum. No significant abnormal vascularity is identified within this node. The second measures 0.7 x 0.5 x 1.0 cm with complete effacement of the fatty hilum, and no appreciable vascularity on Doppler imaging.", "output": "Two indeterminant adjacent lymph nodes within the low left axilla, at the site of palpable abnormality. Ultrasound guided biopsy of these lymph nodes is recommended for definitive histologic diagnosis. These findings were discussed with the patient, and Joly Jose, APN, at the time of the examination.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate RUQ, liver, gallbladder History: Nausea, vomiting, RUQ pain Examination mildly limited by overlying bowel gas.LIVER: The liver measures 20.5 cm in length. The liver demonstrates increased parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions or masses are identified, though sensitivity limited. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.26 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 3.8 mm in diameter.PANCREAS: The pancreas is not well-visualized.SPLEEN: No significant abnormalities noted. The spleen measures 15.0 cm in length. RIGHT KIDNEY: Kidney measures 11.9 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 11.9 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Enlarged, echogenic liver suggestive of hepatic steatosis/parenchymal dysfunction. 2.No evidence of acute cholecystitis or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Chronic kidney disease RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 9.3 cm in lengthLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 8.5 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": "Male; 25 years old. Reason: elevated ALT, evaluate for fatty liver History: elevated ALT LIVER: The liver measures 16.6 cm in length. The liver surface is smooth, the parenchyma is diffusely increased in echogenicity and coarsened in echotexture which limits sensitivity for detection of hepatic masses. Within this limitation, no worrisome mass identified. There are geographic areas of focal sparing, particularly along the gallbladder fossa. The portal vein is patent and demonstrates hepatopetal flow with peak velocity 0.3 m/sec.BILIARY TRACT: The gallbladder is normal in appearance. There is no cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The common duct measures 2 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 10.6 cm in length.KIDNEYS: The right kidney measures 11.5 cm in length. The left kidney measures 11.8 cm in length. The renal cortex is normal in echogenicity bilaterally. There is no hydronephrosis or shadowing renal stone bilaterally.", "output": "Borderline hepatomegaly and coarse, echogenic liver compatible with hepatic steatosis/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Mildly coarse liver echotexture without mass. Liver length 15.1 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.8 cm in lengthOTHER: Left kidney 11.5 cm in length. Left renal cyst. Spleen 11 cm in length. No ascites.", "output": "Mildly coarse liver echotexture suggestive for parenchymal dysfunction/fatty infiltration without mass or ductal dilatation. Unremarkable gallbladder. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "81 years old, Male, Reason: evaluate L scrotal edema History: L scrotal edema. No testicular tenderness. RIGHT TESTIS: Heterogeneous right testis without focal lesions appearing similar to the prior exam. There is blood flow within the right testis. Right testicle measures 3.9 x 1.9 x 2.7 cm.LEFT TESTIS: Heterogeneous testis without any focal lesions appearing similar to the prior exam. Left testis measures 3.5 x 2 .0 by 2.7 cm.RIGHT EPIDIDYMIS: Small epididymal cyst. The right epididymis is within normal limits. No evidence of hydrocele. LEFT EPIDIDYMIS: The left epididymis appears smaller in size than on the prior study and is not significantly hyperemic.OTHER: No significant abnormalities noted.", "output": "1. Testes are heterogeneous bilaterally appearing similar to the prior exam. 2. Left epididymis appears smaller than on the prior study is not significantly hyperemic."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old female with right upper quadrant pain. LIVER: Liver is normal in size and is mildly to moderately echogenic. This may be due to fatty infiltration although not specific. There is a rounded, small and echogenic 6 mm mass arising from the posterior lateral segment of left lobe consistent with hemangioma. No other abnormality is limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal veinGALLBLADDER, BILIARY TRACT: Gallbladder is well-visualized and appears normal without cholelithiasis, wall thickening or pericholecystic fluid. The intrahepatic biliary tract is normal in caliber and the common duct is normal the level of the porta hepatis. More distally, the common duct increases to 9 mm which is above normal range for this age although no obstructing mass or stone is seen.PANCREAS: Pancreas is normal in size but appears heterogeneous in echotexture.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "1. Enlargement of distal common bile duct without intrahepatic dilatation of uncertain significance.2. Presumed fatty liver.3. Small hepatic hemangioma.4. Heterogeneous pancreatic parenchymaGiven the above findings, correlation with liver function enzymes would be useful."}
{"instruction": "Generate impression based on findings.", "input": "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. A targeted right breast and axillary ultrasound was performed.In the right breast at the 9:00 position 6 cm from the nipple there is revisualization of an irregular hypoechoic mass with a centrally located biopsy marker clip. The mass measures 8 x 4 x 6 mm, decreased in size from prior 11 x 9 x 8 mm.In the right axilla there is revisualization of a lymph node with a centrally located biopsy marker clip. The lymph node measures 13 x 7 mm, decreased in size from prior 15 x 9 mm.", "output": "Interval decrease in size of right breast index malignancy and metastatic right axillary lymph node. Continued surgical consultation is recommended. Recommendations and results were discussed with the patient.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Male 64 years old Reason: Cirrhosis, eval for HCC History: Cirrhosis LIVER: Echogenic and nodular appearance of liver is consistent with cirrhosis. No suspicious focal hepatic mass. Hypoechoic structure with posterior acoustic enhancement is compatible with a hepatic cyst in the left hepatic lobe measuring 1.0 x 0.8 x 0.8 cm. This is not significantly changed previously measuring 0.8 x 0.8 x 0.7 cm. Main portal vein is patent with normal direction of flow and a peak velocity of 13.4 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. 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 obscured by overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 12.6 cm in length.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or solid mass. Right kidney measures 11.5 cm in length. Left kidney measures 11.4 cm in length. There is a small cystic-appearing structure in the superior pole the right kidney measuring 1.1 x 1.5 x 1.4 cm.OTHER: No significant abnormalities noted.", "output": "Cirrhotic liver morphology with an unchanged hepatic cyst. No suspicious hepatic lesions are identified."}
{"instruction": "Generate impression based on findings.", "input": "79 year old female with history of cirrhosis, HCV. Evaluate for hepatocellular carcinoma. LIVER: No focal masses or biliary dilatation. The liver measures 13.7 cm in length. Smooth liver contour. Diffuse increased echogenicity, similar to prior.BILIARY TRACT: No biliary dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. Spleen measures 7.4 cm.RIGHT KIDNEY: No significant abnormalities noted. Right kidney measures 10.4 cm. Small right renal cyst measuring approximately 1 cm, similar to prior.OTHER: No significant abnormalities noted. Left kidney measures 9.7 cm, and has a small cysts measuring approximately 1.6 cm. The left kidney appearance is otherwise unchanged.", "output": "Slightly increased hepatic parenchyma echogenicity, similar to prior. No focal masses or biliary dilatation."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female patient with history of right breast cancer containing LCIS and DCIS. Evaluate for interval change status post holistic therapy. Patient feels that tumor is different in size. A targeted right breast ultrasound was performed. There is an ill-defined mass in the right upper outer quadrant with hyperechoic calcifications. A portion of this mass at the 10:30 position, 6 cm from the nipple, in the right breast measures 2.3 x 1.1 x 2.0 cm, previously 2.5 x 1.3 x 2.5 cm. A second portion of the mass towards the nipple at the 10:30 position measures 3.8 x 2.4 x 1.6, previously approximately 3.4 x 2.2 x 2.7 cm. The total extent of the mass measures 6.5 x 3.0 cm.", "output": "No significant interval change in size of known right breast malignancy compared to prior ultrasound given differences in technique.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Leukocytosis. Elevated lipase. Please evaluate for gallbladder or bile duct pathology or signs of pancreatitis. LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: Minimal intrahepatic biliary ductal dilation. No extrahepatic biliary ductal dilation. Normal appearance of the gallbladder. No cholelithiasis.PANCREAS: No sonographic abnormality evident in the visualized pancreatic neck. The head, body, and tail are obscured by bowel gas.RIGHT KIDNEY: The right kidney is 11.6 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: Not well visualized, secondary to difficulty positioning the patient due to medical condition.OTHER: No significant abnormalities noted. No upper abdominal ascites identified.", "output": "No specific findings to account for the patient's clinical presentation. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Gayton is a 91-year-old female presenting with a palpable right breast mass, identified one month previous. History of benign left breast cyst. Three standard views of both breasts and two additional 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. A trying a marker is placed at the site of palpable abnormality in the right upper inner breast. Underlying this marker, is a dense, spiculated, poorly circumscribed mass. Multiple additional benign calcifications, including arterial calcifications, are present bilaterally. ULTRASOUND", "output": "(1) 2.5 cm suspicious mass in the right upper inner breast, corresponding to the patient's palpable area of concern. An ultrasound-guided biopsy with placement is recommended for further evaluation. (2) Abnormal right axillary lymph node. An ultrasound-guided biopsy with clip placement is recommended for further evaluation.The patient does take Xarelto and has been asked to hold this medication for 5 days prior to the biopsy. All results and recommendations were discussed with the patient and her caretaker at time of dictation. BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Female 30 years old Reason: RUE fluctuating mass, abscess vs lipoma vs hematoma? Site of heparin shot Lobulated hypoechoic fluid collection measuring 2.3 x 1.2 x 1.1 cm in the right upper extremity. This may represent hematoma or an abscess. No solid soft tissue mass.", "output": "Lobulated fluid collection the right upper extremity may represent a hematoma or an abscess. No soft tissue mass."}
{"instruction": "Generate impression based on findings.", "input": "Female 64 years old Reason: r/o HCC History: cirrhosis, HCV LIMITED ABDOMENLIVER: The liver measures 20.1 cm in length. Echogenic parenchyma with nodular contour. No suspicious hepatic lesions. Left hepatic lobe lesion with mixed color flow compatible with intrahepatic portosystemic shunt. Liver cyst measures 1.1 cm The portal vein is patent with normal directional flow. BILIARY TRACT: No intrahepatic biliary ductal dilation. The common bile duct measures 5 mm in diameter. Status post cholecystectomy.PANCREAS: No significant abnormality noted.KIDNEYS: The right kidney measures 11.2 cm. The left kidney measures 12.2 cm. There is a 1.2 cm nonobstructive stone in the left kidney. No evidence of hydronephrosis or mass.SPLEEN: The spleen measures 11.8 cm in length. OTHER: No significant abnormalities noted.", "output": "1.Cirrhosis without suspicious focal lesion to suggest HCC.2.Left hepatic lobe portosystemic shunt is unchanged.3.Nonobstructive left renal pelvis stone."}
{"instruction": "Generate impression based on findings.", "input": "26 year old with palpable left breast mass. On physical exam, there is a palpable mass in the inferior left breast.A targeted left ultrasound was performed for the palpable area of concern. In the left breast 6:00 location to-4 cm nipple, there is a 1.9 x 2.1 x 2.3 cm well-circumscribed hypoechoic mass with posterior acoustic enhancement and without significant internal vascularity, suggestive of fibroadenoma. This correlates with the possible abnormality. A surgical consultation and possible FNA of this mass is recommended.", "output": "Well-circumscribed mass in the left breast 6:00 measuring up to 2.3 cm, corresponding to the palpable abnormality. Sonographic features favor a fibroadenoma. A surgical consult is recommended. Findings and recommendations were discussed with the patient at the time of the exam.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male patient status post islet cell transplant. LIVER: The liver measures 16.2 cm in length and is mildly heterogeneous. An echogenic focus within the right hepatic lobe is unchanged and may correlate to embolization coils. 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 3 mm in diameter.PANCREAS: The pancreas is poorly visualized on this examination. RIGHT KIDNEY: The right kidney measures 11.7 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.1 cm in length. No evidence of hydronephrosis.The spleen measures 7. cm in length.", "output": "1. Patent portal vein.2. Mildly heterogeneous liver parenchyma and stable echogenic focus in the right hepatic lobe which may represent embolization coils."}
{"instruction": "Generate impression based on findings.", "input": "Viral hepatitis LIVER: Stable cirrhotic morphology without worrisome mass. Stable hepatic cyst. Liver length 15.2 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: Moderate dilatation of extrahepatic bile duct again noted with maximal diameter of 1.2 cm.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 12.2 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.8 cm in lengthOTHER: Left kidney 12.8 cm in length. No ascites.", "output": "Stable cirrhotic morphology without worrisome mass. Stable moderate dilatation of extra hepatic bile duct. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female with acute kidney injury on chronic kidney disease. Please evaluate for hydronephrosis, sizes of the kidneys, and echogenicity. RIGHT KIDNEY: The right kidney measures 8.3 cm in length (prior 8.6 cm). Borderline hyperechoic renal parenchyma. No hydronephrosis, shadowing calculi, or worrisome masses.LEFT KIDNEY: The left kidney measures 9.2cm (prior 9.4 cm). Borderline hyperechoic renal parenchyma. No hydronephrosis, shadowing calculi, or suspicious masses.URINARY BLADDER: The urinary bladder is collapsed and not well evaluated.OTHER: No significant abnormalities noted.", "output": "1. Borderline hyperechoic renal parenchyma consistent with medical renal disease. No hydronephrosis.2. Relatively small kidneys, but stable in size."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for fatty liver disease History: Heavy ETOH use, abnormal liver function tests. LIVER: The liver measures 22.7 cm in length. The liver parenchymal echotexture is coarse. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating hepatopetal flow with a velocity of 0.45 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 2 mm in diameter.PANCREAS: The visualized head and body of the pancreas are mildly hypoechoic.SPLEEN: No significant abnormalities noted. The spleen measures 9.3 cm in length. RIGHT KIDNEY: Kidney measures 13.1 cm in length. Increased parenchymal echogenicity. No hydronephrosis. Lower pole simple cyst.LEFT KIDNEY: Kidney measures 12.3 cm in length. Increased parenchymal echogenicity. No hydronephrosis. Lower pole simple cyst.OTHER: No significant abnormalities noted.", "output": "1.Hepatomegaly. Echogenic liver suggestive of parenchymal dysfunction/fatty infiltration.2.Echogenic kidneys suggestive of medical renal disease.3.Diffusely decreased echogenicity of the pancreas which is nonspecific but can be seen with infiltrative processes such as edema. "}
{"instruction": "Generate impression based on findings.", "input": "History of thyroiditis with small thyroid nodules RIGHT LOBE MEASUREMENTS: 4.7 x 1.3 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.9 x 1.2 x 1.2 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Heterogeneous echotexture. Spongiform nodule measures 0.8 x 0.8 x 0.6 cm, unchanged in size, although it appears more exophytic than previously.LEFT LOBE: Heterogeneous echotexture. Left midpole nodule with hypoechogenic rim measures 0.4 x 0.6 x 0.3 cm, previously 0.5 x 0.8 x 0.3 cm.ISTHMUS: Left isthmus hypoechoic nodule measures 0.4 x 0.6 x 0.3 cm, unchanged.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Essentially unchanged bilateral thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Left deltoid nodule: lipoma History: firm nodule on L deltoid. Patient with painless lump and area for 6 years. Isoechoic soft tissue mass measuring 4.6 x 2.1 x 4.6 cm without vascularity is noted.", "output": "Isoechoic soft tissue mass, which is nonspecific."}
{"instruction": "Generate impression based on findings.", "input": "28 year old male patient with history of diabetes and hypertension with intermittent crampy abdominal pain after fatty food intake. Evaluate for gallstones. LIVER: The liver measures 18.1 cm in length demonstrates increased hepatic parenchymal echogenicity. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.4 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 pancreas is poorly visualized on this examination.RIGHT KIDNEY: The right kidney measures 12.3 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 13.4 cm in length. No evidence of hydronephrosis.The spleen measures 11.6 cm in length.", "output": "1. Increased hepatic echogenicity likely secondary to hepatic steatosis/hepatic parenchymal dysfunction.2. Mild hepatomegaly.3. No cholelithiasis. "}
{"instruction": "Generate impression based on findings.", "input": "History of hypercalcemia. Evaluate for renal stones. RIGHT KIDNEY: The right kidney measures 9.8 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion evident. Color Doppler demonstrates hilar blood flow. Normal corticomedullary differentiation.LEFT KIDNEY: The left kidney measures 9.7 cm without hydronephrosis, shadowing nephrolithiasis or discrete lesion evident. Color Doppler demonstrates hilar blood flow. Normal corticomedullary differentiation.OTHER: Normally distended urinary bladder. A right ureteral jet was observed.", "output": "No hydronephrosis or shadowing nephrolithiasis as clinically questioned."}
{"instruction": "Generate impression based on findings.", "input": "Reason: enlarged thyroid History: dysphagia RIGHT LOBE MEASUREMENTS: 3.7 x 1.3 x 1.9 cm.LEFT LOBE MEASUREMENTS: 4.2 x 1.5 x 2.9 cm.ISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: Normal homogenous thyroid tissue without nodules or masses.LEFT LOBE: Normal homogenous thyroid tissue without nodules or masses.ISTHMUS: Normal homogenous thyroid tissue without nodules or masses.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted. No lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Normal thyroid appearance and size without focal nodules or masses."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old female with right axillary swelling. The patient states that the swelling increases during her menstrual cycle. With my physical examination, there is an area of thickness at right axilla. Focused ultrasound is performed for the right axilla. No solid masses or cystic masses are seen in this area. Normal fat the tissue with possible breast glandular tissue is present.", "output": "No sonographic evidence for malignancy. Accessory breast tissue in the right axilla is suspected.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "29 year-old male with a history of right suboccipital lymphadenopathy. Note is made of a 7 x 9 x 2 mm normal morphology lymph node with an apparent tiny fatty hilum, in the soft tissues along the posterior aspect of the head/neck. No suspicious mass or lymphadenopathy are identified.", "output": "No evidence of lymphadenopathy, as clinically questioned."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old female patient with brain mass. Evaluate for tumor. LIVER: The liver measures 17.0 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 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 7.1 cm in length and demonstrates increased renal cortical echogenicity. No evidence of hydronephrosis. There is a subcentimeter right lower pole simple renal cyst.OTHER: The left kidney measures 10.7 cm in length and demonstrates increased renal cortical echogenicity. No evidence of hydronephrosis. There is a 1.9 x 2.3 x 1.9 cm left lower pole simple renal cyst.The spleen measures 8.1 cm in length.", "output": "1. Atrophic right kidney.2. Medical renal disease and bilateral renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 60 y/o female with thrombocytosis and INR 3.3 with large right knee effusion. Evaluate for bleeding/hematoma in right knee/thigh History: edema, immobility, pain in right leg Lateral to the right knee, extending a few centimeters above the right knee to a few centimeters below the right knee is a 10.8 x 2.1 cm heterogenous collection, about 2.5 cm deep to the skin on its most superficial aspect and 4.2 cm deep to the skin on its deepest aspect. A smaller simple collection is noted in the medial aspect of the left knee measuring 5 x 1.3 cm.", "output": "1.Large heterogenous collection in the lateral aspect of the right knee, as above.2.Small collection in the medial aspect of the left knee, as above."}
{"instruction": "Generate impression based on findings.", "input": "Coagulopathy and elevated ammonia LIVER: Mildly coarse liver echotexture without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 15.6 cm.BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9.2 cm in length RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 9.1 cm in length OTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. Left kidney 10.3 cm in length. Small bilateral pleural effusions", "output": "Mildly coarse liver echotexture suggestive for parenchymal dysfunction/fatty infiltration without mass or ductal dilatation. Gallbladder sludge without acute inflammation. No ascites. Small bilateral pleural effusions.Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Male; 70 years old. Reason: tender mass in upper part of left testicle, s/p AUS 1 week ago, not sure if fluid filled, if reservoir from surgery or solid mass History: tender mass in upper part of left testicle, s/p AUS 1 week ago, not sure if fluid filled, if reservoir from surgery or solid mass RIGHT TESTIS: Right testicle measures 2.8 x 4.6 x 2.4 cm. No intratesticular mass. Normal arterial and venous flow.LEFT TESTIS: Left testicle measures 3 x 4.3 x 2.1 cm. No intratesticular mass. Normal arterial and venous flow. No hyperemia to suggest orchitis.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: Increased size and vascularity of the left epididymis, suggestive of left epididymitis.OTHER: Reservoir is seen in the subcutaneous soft tissues of the left lower quadrant with tubing seen extending down the left inguinal canal and lateral to the left testicle within the scrotal soft tissues. In the patient's area of palpable abnormality near an incision in the left groin, there is an ill-defined area of heterogeneous echotexture and increased vascularity measuring up to 3.6 x 5 x 3.2 cm, which may represent cellulitis and phlegmonous change. No well-formed, drainable abscess is evident.Small left hydrocele.", "output": "1. Findings suggestive of left epididymitis without evidence of adjacent left orchitis.2. Findings suggestive of cellulitis and phlegmonous change in the patient's area of palpable concern near an incision in the left groin. No well-formed, drainable abscess is evident. Follow-up examination can be performed as clinically indicated.3. Left reservoir and tubing in expected location."}
{"instruction": "Generate impression based on findings.", "input": "Recent pyelonephritis with ongoing back discomfort RIGHT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 9.9 cm in lengthLEFT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 10.1 cm in length.OTHER: Bladder nondistended.", "output": "Negative renal ultrasound without evidence for mass, stone, hydronephrosis, or acute inflammatory process."}
{"instruction": "Generate impression based on findings.", "input": "Known right breast cancer with satellite lesion and axillary lymphadenopathy presents for right breast ultrasound to evaluate treatment response A targeted right breast and axillary ultrasound was performed. Index cancer in the right breast 9 to 10:00 position measures 2.9 x 1.7 x 3 cm, previously measured 3.2 x 1.5 x 3 cm, mostly stable to unchanged from prior study. A satellite lesion at 12:00 position measures 9 x 7 x 9 mm, previously measured 9 mm.Right axillary lymph node measures 3.4 x 2 x 3.6 cm, previously measured 2.4 x 1.1 cm, increased in size from prior study.", "output": "1. Stable to minimal interval decrease in size of right breast index cancer.2. Stable satellite lesion right breast 12:00 position.3. Interval increase in right axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Chronic renal insufficiency RIGHT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 9 cm in lengthLEFT KIDNEY: Mildly echogenic renal parenchyma without mass or hydronephrosis. Possible subcentimeter nonobstructing lower pole stone. Left kidney 9.5 cm in lengthOTHER: Bladder collapsed", "output": "Mildly echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass or hydronephrosis. Possible nonobstructing subcentimeter lower pole left renal stone."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Reisetter is a 31-year-old female with strong family history of breast cancer (mother, maternal aunt) presenting for short-term follow-up for biopsy-proven fibroadenoma. Upon physical exam, a superficial soft mobile mass is appreciated in the left lower outer breast.- In the left breast 5:00 position, approximately 3 cm from the nipple, demonstrates a 2.1 x 1.3 x 2.0 cm circumscribed oval hypoechoic mass in parallel orientation with internal vascularity, previously measuring 1.9 x 1.4 x 1.6 cm. This is the biopsy proven fibroadenoma.- Again seen adjacent and inferior to this mass is a 0.6 x 0.4 cm well-circumscribed hypoechoic mass without internal vascularity, previously measuring 0.6 x 0.4 cm. - Superior to this mass is a 0.4 cm well-circumscribed hypoechoic mass without internal vascularity, previously measuring 0.5 cm.", "output": "Interval increase in size of biopsy proven fibroadenoma of the left breast. Additional two smaller masses are stable and presumed benign. Continued management with breast surgery is recommended. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic 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": "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. A simple cyst is identified in the left lower outer breast. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy. Simple cyst of the left breast.BIRADS: 2 - Benign. RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "90 year-old female with transaminitis postop. Evaluate portal vein and liver and for obstructive nephropathy. LIVER: Increased in echogenicity measuring 14.2 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate directional flow; peak velocity measures 0.4 m/sec.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. Common hepatic duct measures 8 mm in caliber with diffuse prominence of the intrahepatic biliary ducts. No common duct dilatation. PANCREAS: Incompletely visualized. SPLEEN: Not well visualized.KIDNEYS: Right kidney measures 15.1 cm in length. Cyst at the upper pole measures 8.3 cm x 6.8 cm x 8.1 cm. No hydronephrosis or shadowing calculi are noted.Left kidney incompletely visualized containing multiple cysts, the largest of which measures approximately 7.2 cm x 5.3 cm x 6.0 cm. No definite hydronephrosis or shadowing calculi are noted.ABDOMINAL AORTA: Patent with appropriate direction of flow. The proximal aorta measures 2.6 cm x 2.3 cm x 1.9 cm. The mid aorta measures 1.9 cm x 1.9 cm x 1.6 cm.INFERIOR VENA CAVA: The visualized IVC is patent with appropriate directional flow.OTHER: No significant abnormality noted.", "output": "1. Increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. There is diffuse prominence of the intrahepatic biliary ducts with normal caliber of the common hepatic duct suggestive of hepatic hilar mass/masses or stricture. Recommend CT or MRI for further evaluation. 2. Bilateral renal cysts. "}
{"instruction": "Generate impression based on findings.", "input": "Female 66 years old Reason: R knee pain/fullness - evaluate for Baker's cyst History: pain Focused ultrasound performed over the right popliteal fossa at the site of patient's symptoms. No evidence of Baker's cyst. No significant fluid to suggest Baker's cyst rupture.", "output": "No evidence of Baker's cyst."}
{"instruction": "Generate impression based on findings.", "input": "Acute liver failure LIMITED ABDOMENLIVER: Diffusely heterogeneous gland with innumerable bilobar mass lesions.BILIARY TRACT: No ductal dilatation. Gallbladder not identified.PANCREAS: Not visualized due to overlying gas.SPLEEN: Not visualized due to overlying gas OTHER: No significant abnormalities noted.", "output": "Diffusely heterogeneous liver with numerous bilobar hepatic lesions worrisome for metastatic disease. No ductal dilatation. Hepatic vessels patent with normal directional flow; however main portal vein velocity is diminished."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old male with hyperparathyroidism, evaluate for parathyroid adenoma. RIGHT LOBE MEASUREMENTS: 5.5 x 2.5 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.8 x 2.2 x 1.8 cmISTHMUS MEASUREMENTS: 2.2 cmRIGHT LOBE: Normal in echogenicity without discrete noduleLEFT LOBE: Normal in echogenicity without discrete noduleISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No discrete parathyroid lesions are identified.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No parathyroid adenoma identified."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for suspicious cervical lymphadenopathy in the central and lateral neck in a patient s/p total thyroidectomy for papillary carcinoma with right modified neck dissection in 1997 with a new suspicious mass. Also history of primary hyperparathyroidism. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy. Within the right thyroidectomy bed, there is a heterogeneous, predominantly solid mass measuring 4.2 x 5.7 x 4.8 cm which demonstrates internal vascularity.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy. RIGHT LOBE: Status post thyroidectomy.LEFT LOBE: Status post thyroidectomy.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: See above. LYMPH NODES: Few benign morphology lymph nodes in the right level 3 and left level 2 and 3 stations.OTHER: No significant abnormality noted.", "output": "Solid mass within the right thyroidectomy bed measuring up to 5.7 cm which is nonspecific but could reflect recurrent neoplasm or parathyroid adenoma. The lesion would be amenable to fine-needle aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Reason: please assess for gallstones/cholecystitis, liver abnormalities, spleen abnormalities History: R-sided abdominal pain. LIVER: The liver measures 23.9 cm in length and mildly irregular in contour. The liver demonstrates increased parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions or masses are identified. The hyperechoic lesion seen on the 1/20/2014 examination is not seen. The portal vein is patent demonstrating hepatopetal flow with a velocity of 0.42 m/s.BILIARY TRACT: There is no evidence of cholelithiasis or convincing gallbladder wall thickening. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common hepatic 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 12.7 cm in length. RIGHT KIDNEY: Kidney measures 12.6 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 14.8 cm in length. Normal cortical echotexture. No hydronephrosis. Previously described possible left hilar hypoechoic lesion is not seen.OTHER: No significant abnormalities noted.", "output": "1.Hepatomegaly, increased hepatic echogenicity, and irregular hepatic contour compatible with chronic liver disease. No mass.2.No evidence of cholelithiasis or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter RIGHT LOBE MEASUREMENTS: 2.5 x 2.1 x 5.2 cmLEFT LOBE MEASUREMENTS: 2.9 x 2.9 x 6.3 cmISTHMUS MEASUREMENTS: 0.8 cmRIGHT LOBE: Multiple subcentimeter mixed cystic and solid as well as spongiform nodules. An upper pole nodule measures 0.9 x 0.7 x 1 cm; a mid pole nodule measures 0.7 x 0.7 x 0.9 cm; and inferior nodule measures 0.9 x 0.9 x 0.9 cm.LEFT LOBE: Ill-defined predominantly solid lower pole nodule measuring 3 x 3.2 x 1.9 cm. Additional solid mid pole nodule measuring 1 x 0.9 x 1.2 cm.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 predominantly solid lower pole left thyroid nodule. This lesion is amenable to ultrasound-guided FNA biopsy. Additional bilateral thyroid nodules; favor benign etiology. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Elevated bilirubin sepsis and abdominal pain LIVER:Coarse echogenic liver echotexture without mass. Liver length 18.7 cm.GALLBLADDER, BILIARY TRACT: Mild gallbladder wall thickening with trace pericholecystic fluid. Negative Murphy's sign. No ductal dilatation. Multiple nonmobile subcentimeter gallbladder wall foci.PANCREAS: No significant abnormality noted.SPLEEN: Spleen length is 18 cmKIDNEYS: No significant abnormality noted. Right kidney 12.6 cm in length. Left kidney 12 cm in length.ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No ascites", "output": "Hepatosplenomegaly associated with coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascitesMildly thickened gallbladder wall with trace pericholecystic fluid. Although there is no Murphy's sign, some element of inflammation is suspected.Nonmobile stones or gallbladder polyps."}
{"instruction": "Generate impression based on findings.", "input": "84-year-old male with hyperbilirubinemia and lower extremity edema. Evaluate for cause of conjugated hyperbilirubinemia, concern for hepatic congestion secondary to heart failure. LIVER: Normal echogenicity of the liver measuring 13.3 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measuring 0.3 m/sec with a pulsatile waveform likely due to congestive heart failure.GALLBLADDER, BILIARY TRACT: Gallbladder is not well distended limiting evaluation for wall thickening. Shadowing gallstones within the gallbladder. Focal adenomyosis of the gallbladder. No pericholecystic fluid. Sonographic Murphy's sign is negative. Common bile duct measures 5 mm in caliber. No intra-or extrahepatic biliary ductal dilatation. PANCREAS: Visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: Mild increased echogenicity of the kidney measuring 9.2 centers in length. Cyst measures 3.8 cm x 3.9 cm x 3.6 cm. no hydronephrosis or shadowing calculi are noted.OTHER: Mild increased echogenicity of the left kidney measuring 10.4 cm in length. No hydronephrosis or shadowing calculi are noted.Normal echogenicity of the spleen measuring 11.1 cm in length.", "output": "1. Cholelithiasis with the gallbladder not well distended limiting evaluation for wall thickening, however there is no sonographic evidence of cholecystitis. 2. Patent portal vein with pulsatile waveform likely related to congestive heart failure.2. Mild increased echogenicity of the kidneys suggestive of parenchymal dysfunction. "}
{"instruction": "Generate impression based on findings.", "input": "Gallstone pancreatitis LIVER: No significant abnormalities noted. 17.1 cm in length.GALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: Pancreas obscured by gasRIGHT KIDNEY: No significant abnormalities noted. 9.9 cm in lengthOTHER: Left kidney 11.5 cm in length. Spleen 8.8 cm in length. Large fibroid uterus again noted.", "output": "Cholelithiasis without acute inflammation or ductal dilatation. Pancreas obscured by gas."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Gill is a 31 year old female with a personal history of biopsy-proven fibroadenoma in the left breast diagnosed in February 05/20/2015. She presents today for short term ultrasound evaluation of this lesion. Upon physical exam at the patient's area of concern, there is a soft mobile superficial mass appreciated. Targeted ultrasound of the left breast demonstrates a 2.5 x 0.7 x 1.5 cm well-circumscribed mass, parallel to the skin, at 11:00 radian, 8 cm from nipple. There is minimal associated vascularity. This palpable mass is unchanged in morphology and size from the prior ultrasound study.", "output": "Stable size of biopsy-proven fibroadenoma of the left breast. Patient should continue to follow-up with her primary care team as clinically warranted. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Female; 82 years old. Reason: Please evaluate etiology of visible and palpable probable foreign body in left upper quadrant History: Patient states this is been present since her surgery approximately 45 years ago however, the patient's daughter and physician were not aware of it until a few weeks ago. Within the subcutaneous soft tissues left upper abdominal wall in the region of the palpable abnormality and just deep to a well healed surgical scar is a looped tubular structure. It is followed to its termination at only one end near the liver with no definite intraperitoneal penetration.", "output": "Looped tubular foreign body suspicious for tubing seen in the area of the patient's palpable abnormality. The termination is seen at only one end with no definite intraperitoneal penetration."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male with cardiogenic shock. Screening for LVAD work. LIVER: Increased echogenicity of the liver measuring 16.9 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. Common bile duct measures 3 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are unremarkable.SPLEEN: Spleen measures 9.6 cm in length.KIDNEYS: Increased echogenicity of the right kidney measuring 11.8 cm in length. No hydronephrosis or shadowing calculi are noted. Increased echogenicity of the left kidney measuring 11.6 cm in length. No hydronephrosis or shadowing calculi are noted. ABDOMINAL AORTA: The visualized abdominal aorta is normal in caliber with appropriate directional flow. The proximal aorta measures 1.9-cm x 1.8 cm x 1.8 cm.INFERIOR VENA CAVA: The visualized IVC is patent with appropriate directional flow.OTHER: Foley within a decompressed bladder limiting evaluation.", "output": "1. Increased echogenicity of the liver compatible with fatty infiltration2. Increased echogenicity of the kidneys suggestive of parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female complains of right knee pain. There is a clinical concern for a Baker's cyst. No fluid collection is seen in the posterior right knee suggestive of a Baker's cyst.", "output": "Normal ultrasound of the posterior right knee without evidence of Baker's cyst."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with history of NASH cirrhosis evaluated for HCC. LIVER: Measures 20 cm in length. Cirrhotic hepatic morphology and increased echogenicity without discrete focal lesion.BILIARY TRACT: Mild biliary sludge but no cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.SPLEEN: Enlarged spleen measures 17.6 cm in length without focal lesion.KIDNEY: Bilateral renal cysts without septation or suspicious nodular component. No hydronephrosis.OTHER: Trace ascites.", "output": "1.Cirrhotic liver morphology and increased hepatic echogenicity consistent with chronic liver disease, without evidence of discrete lesion.2.Hepatosplenomegaly and trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "83-year-old male with history of chronic kidney disease now with acute kidney injury. The exam is limited due to prominent bowel gas and limited mobility of the patient.RIGHT KIDNEY: The right kidney is atrophic measuring 8.4 cm in length. Increased parenchymal echogenicity. No hydronephrosis. No shadowing calculi.LEFT KIDNEY: Very limited visualization of the left kidney. The left kidney measures 12.4 cm in length. No hydronephrosis. The previously seen left lower pole renal cyst is not clearly evaluated on this exam.URINARY BLADDER: The urinary bladder is collapsed and incompletely evaluated.OTHER: No significant abnormalities noted.", "output": "1. Echogenic renal parenchyma compatible with history of chronic kidney disease.2. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis with history of TIPS LIVER: Cirrhotic morphology again noted. No mass. Liver length 12.1 cm. Limited Doppler interrogation of the TIPS demonstrates a patent TIPS. Patent main portal vein with normal directional flow. Main portal vein velocity 48 cm/s. GALLBLADDER, BILIARY TRACT: Cholelithiasis again noted. Moderate bilobar and extrahepatic ductal dilatation again noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.8 cm in lengthOTHER: Left kidney 11.2 cm in length. Spleen 8.8 cm in length. No ascites.", "output": "Technically limited study. Patent main portal vein with normal directional flow. Patent TIPS. Cirrhotic morphology without obvious mass. Moderate bilobar and hepatic ductal dilatation again noted. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old female with thyroid nodules. Rule out growth of nodules or suspicious features. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 5 x 1.7 x 1 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 3.6 x 0.9 x 1.3 cm.ISTHMUS MEASUREMENTS: The isthmus measures 0.4 cm in thickness.RIGHT LOBE: There are 2 nodules again identified in the right thyroid lobe. In the right lower pole is a 0.9 x 0.6 x 0.6 cm hyperechoic solid nodule (prior 0.7 x 0.4 x 0.9 cm). In the right mid thyroid lobe, there is a 1.4 x 0.9 x 0.9 cm spongiform nodule (prior 1.2 x 1 x 0.8 cm). These nodules are unchanged in appearance.LEFT LOBE: Normal homogeneous appearance of the left thyroid lobe.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable solid, hyperechoic and spongiform nodules of the right thyroid lobe."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old female with history of microscopic papillary carcinoma status post lobectomy. Evaluate for nodules in the contralateral lobe. RIGHT LOBE MEASUREMENTS: The right lobe measures 5.7 x 1.9 x 1.5 cm.LEFT LOBE MEASUREMENTS: Status post left lobectomy.ISTHMUS MEASUREMENTS: Status post left lobectomy.RIGHT LOBE: The right lobe is homogeneous in echotexture without evidence of a focal nodule.LEFT LOBE: Surgically absent.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing bilateral level 3 lymph nodes.OTHER: No significant abnormality noted.", "output": "Postoperative changes of left lobectomy without evidence of a nodule in the right thyroid lobe."}
{"instruction": "Generate impression based on findings.", "input": "Right flank pain, elevated bilirubin; metastatic colon cancer LIVER: Mildly coarse echogenic liver echotexture. Bilobar hepatic metastases again noted. Liver length 16.2 cmBILIARY TRACT: Gallbladder sludge without acute inflammation. Minimal intrahepatic ductal dilatation without significant extra hepatic ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 12.9 cm in length.RIGHT KIDNEY: No significant abnormalities noted. Renal cyst again noted. 10.3 cm in lengthOTHER: Left kidney 12.9 cm in length. Left renal cyst again noted. No ascites.", "output": "Bilobar hepatic metastases again noted. Mildly coarse echogenic liver echotexture suggestive for parenchymal dysfunction. Gallbladder sludge without acute inflammation. Minimal intrahepatic ductal dilatation without significant extrahepatic ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Right inguinal hernia, please evaluate the left side Normal peristalsis of the bowel loops noted. No evidence of inguinal hernia on the left side.", "output": "No evidence of left inguinal hernia."}
{"instruction": "Generate impression based on findings.", "input": "24-year-old female with elevated LFTs. Evaluate for liver/gallbladder abnormalities. LIVER: Normal echogenicity of the liver measuring 20.5 cm in length. No focal hepatic lesions. The main portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. Common duct measures 3 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 11.8 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 10.6 cm in length. No hydronephrosis or shadowing calculi are noted.Spleen is not visualized.Several small peripancreatic lymph nodes are noted.", "output": "Hepatomegaly with no focal hepatic lesions. "}
{"instruction": "Generate impression based on findings.", "input": "97-year-old with large suspicious left breast mass with skin nodules. Bilateral MLO, bilateral ML and 2 right CC views were performed digitally and reviewed with the aid of R2 CAD 9.3. Left CC views could not be performed due to patient discomfort. The breast parenchyma is composed of scattered fibroglandular density. The left breast is highly dense compatible with a large underlying mass. Left breast skin thickening is also noted throughout. Benign calcifications in the right breast are largely arterial in etiology. A presumed intramammary lymph node is noted in the right upper breast. ULTRASOUND", "output": "Findings compatible with diffuse left breast cancer with associated skin thickening and a suspicious left axillary lymph node. The patient is to be seen in breast surgery clinic immediately after this imaging.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Check right thyroid nodule. Assess stability. RIGHT LOBE MEASUREMENTS: 3.4 x 1.3 x 1.3 cm.LEFT LOBE MEASUREMENTS: 3.9 x 1.3 x 0.8 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: There is a 1.0 x 0.8 x 1.0 cm mildly hypoechoic, solid, interpolar nodule without increased vascularity or associated calcifications. The margins are well-defined. It appears stable. LEFT LOBE: The left thyroid lobe is mildly heterogeneous without a discrete nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Morphologically unremarkable and normal sized bilateral cervical lymph nodes are present.OTHER: No significant abnormality noted.", "output": "Stable right 1 cm solid nodule. No additional significant interval change."}
{"instruction": "Generate impression based on findings.", "input": "History kidney stone RIGHT KIDNEY: 1 x 0.8 x 0.9 cm echogenic focus with posterior shadowing consistent with nonobstructing stone. No hydronephrosis. No worrisome mass. Right kidney 12 cm in lengthLEFT KIDNEY: AbsentOTHER: Bladder nondistended", "output": "1 cm nonobstructing right renal stone. No hydronephrosis. No worrisome mass."}
{"instruction": "Generate impression based on findings.", "input": "Soft tissue induration. Painful \"cyst.\" There is a 2.2 x 1.2 x 2.0 cm heterogeneously hypoechoic collection 4 mm deep to the skin with peripheral vascularity compatible with an abscess given the clinical history.", "output": "2.2 cm collection compatible with abscess identified."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury. RIGHT KIDNEY: The right kidney measures 10.6 cm. The cortex is normal in echogenicity. There is no evidence of hydronephrosis, shadowing calculi or mass.LEFT KIDNEY: The left kidney measures 10.0 cm. The cortex is normal in echogenicity. There is no evidence of hydronephrosis, shadowing calculi or mass.URINARY BLADDER: The bladder is distended with anechoic fluid. There are multiple bladder diverticuli.OTHER: Cholelithiasis incidentally noted.", "output": "1.No evidence of hydronephrosis, renal calculi or mass.2.Cholelithiasis incidentally noted.3.Distended bladder with diverticuli again noted."}
{"instruction": "Generate impression based on findings.", "input": "60 year-old female with abnormal liver function. LIVER: Mildly echogenic. Main portal vein patent with appropriate flow direction.GALLBLADDER, BILIARY TRACT: Mild intrahepatic ductal dilatation with marked dilatation of the common duct as previously noted.PANCREAS: Limited with pancreatic ductal dilatation associate with patient's known pancreatic head mass.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Spleen not visualized.", "output": "Mildly echogenic liver with dilated biliary tract as previously noted. Pancreatic ductal dilatation as previously noted."}
{"instruction": "Generate impression based on findings.", "input": "History of Non-Hodgkin's Lymphoma and Papillary Thyroid Cancer. RIGHT LOBE: Status post thyroidectomy with no evidence of residual or recurrent disease in the right thyroidectomy bed.LEFT LOBE: Status post thyroidectomy. Within the inferior left thyroidectomy bed there is a poorly defined heterogeneously hypoechoic lesion measuring 1.3 x 1.2 x 2.2 cm compared to 1.3 x 1.4 x 1.3 cm previously.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Prominent right level 1B, level 2 and level 5 lymph nodes. Prominent left level 2/3 lymph nodes. These demonstrate a fatty hilum.The referenced right lymph node measures 1.7 x 1.3 x 0.7 cm on today's study compared to 1.5 x 0.7 x 2.1 cm previously.The referenced lymph node on the left measures 1.7 x 1.8 x 0.5 cm compared to 1.2 x 0.8 x 2.5 cm previously.OTHER: No significant abnormality noted.", "output": "1. Persistent heterogeneous hypoechoic focus within the left thyroidectomy bed. This is amenable to percutaneous biopsy to exclude a thyroidectomy bed recurrence. 2. Prominent bilateral lymph nodes, similar to prior study."}
{"instruction": "Generate impression based on findings.", "input": "52 year old female with a history of hepatitis B. Presents for HCC screening LIVER: The liver is normal in size, morphology, and echotexture. It measures 15.5 cm in craniocaudal dimension. Stable simple appearing cyst in the left hepatic lobe measuring 1.1 cm. No suspicious focal hepatic lesion is identified. No intrahepatic biliary ductal dilatation. Normal hepatopetal portal venous blood flow at 20 cm/sec.GALLBLADDER, BILIARY TRACT: A normally distended gallbladder is present without cholelithiasis, wall thickening or pericholecystic fluid. No extrahepatic biliary ductal dilatation with the common bile duct measuring 4 mm.PANCREAS: The visualized portions of the pancreas are normal.RIGHT KIDNEY: The right kidney measures 10.9 cm in length. No hydronephrosis, shadowing calculus or discrete lesion.OTHER: The spleen is normal in size, measuring 8 cm. The left kidney measures 9.6 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident.Incidental 2.4 x 1.7 x 3.1 cm anechoic, immobile simple cystic fluid collection at the left lung base, likely representing a loculated pleural effusion.", "output": "1. No focal hepatic lesion or biliary ductal dilatation.2. Incidental small left loculated pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for whole breast ultrasound for dense breast screening. Personal history of benign left breast biopsy in 1980. She has a family history of breast cancer in her sister, diagnosed at age 57, and her daughter, diagnosed at age 31. 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.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: Coarse echogenic liver parenchyma without mass. Liver length 13.6 cm. Limited Doppler interrogation the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 10.6 cm in lengthRIGHT KIDNEY: Absent OTHER: Left kidney 13.5 cm in length. No ascites. Right pleural effusion", "output": "Coarse echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Gallbladder sludge without acute inflammation. Right pleural effusion. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "33 year old female with a history of von Hippel-Lindau disease status post right partial nephrectomy in 2009 for clear cell renal cell carcinoma. Evaluate for cysts or masses in both kidneys. RIGHT KIDNEY: Note is made of postsurgical changes consistent with the stated history of partial nephrectomy. The right kidney measures 11.9 cm in length. There is a 3.1 x 3.0 x 3.6 cm complex cystic lesion with internal echogenicity and mild peripheral vascularity in the superior pole of the right kidney. There is a 0.9 x 1.2 x 1.2 cm, complex, cystic lesion in the superior pole of the right kidney, without internal vascularity.LEFT KIDNEY: There is an 8.7 x 7.7 x 8.3 cm, complex cystic lesion in the inferior pole of the left kidney, with associated thick septation. There is no internal vascularity. Multiple additional complex cysts with thin septation identified in the inferior pole of the left kidney.OTHER: The bladder is incompletely distended, limiting evaluation.", "output": "Multiple bilateral complex renal cystic lesions, the largest of which measures 8.7 cm in the inferior pole of the left kidney. Submission of prior examinations for comparison is recommended. If prior examinations are not available, further evaluation with a dedicated renal CT examination is recommended to better characterize cystic renal lesions described."}
{"instruction": "Generate impression based on findings.", "input": "Palpable axillary lesion. Recent normal mammography and MRI. A targeted right ultrasound was performed for the patient\u2019s area of concern. A normal size and morphology lymph node is present at the patient's site of concern. There is no suspicious solid or cystic mass identified.", "output": "Normal size and morphology lymph node in the right axillary region at the site of patient's concern.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female. CHF presenting with right upper quadrant abdominal pain, back pain, positive UA from OSH. Evaluate for pyelonephritis, liver/gallbladder, biliary tree. LIVER: Diffusely increased echogenicity of the liver consistent with hepatic steatosis/dysfunction. The liver is 19.7 cm in length. No focal lesion is identified. Hepatoportal venous flow.GALLBLADDER, BILIARY TRACT: No biliary ductal dilatation. The common duct is 7 mm in caliber, at the upper limits of normal. Status post cholecystectomy.PANCREAS: Visualized portions of the pancreatic head are normal echogenicity. The remainder of the pancreas is obscured by bowel gas.SPLEEN: No significant abnormality noted.KIDNEYS: Right kidney is 12.2 cm. Left kidney is 13.9 cm. Normal echogenicity of both kidneys. No hydronephrosis. No evidence of an abscess.ABDOMINAL AORTA: Aorta is patent. 3.3 cm in caliber in the proximal aorta, 2.6 cm in the mid aorta, 1.8 cm in the distal aorta.INFERIOR VENA CAVA: Patent.OTHER: Bladder is underdistended.", "output": "Findings consistent with hepatic steatosis/dysfunction and hepatomegaly. No hydronephrosis or evidence of a renal abscess. Mildly ectatic proximal abdominal aorta."}
{"instruction": "Generate impression based on findings.", "input": "34-year-old female s/p thyroidectomy presents with a feeling of enlarging neck masses. RIGHT LOBE, ISTHMUS: The thyroid has been surgically removed.LEFT LOBE: The thyroid has been surgically removed. There are two nodules noted in the left thyroid bed.Nodule 1 is well defined, oval, and hypoechoic, measuring approximately 0.6 x 0.2 x 0.3 cm and appears stable when compared to the prior exam.Nodule 2 is oval, hypoechoic, measuring 0.3 x 0.2 x 0.2 cm and appears stable when compared to the prior exam. LYMPH NODES: There are two lymph nodes seen in level III of the right .The first is oblong and measures approximately 1.7 x 0.3 x 0.5 cm and is favored to be reactive.The other is well defined and hypoechoic measuring approximately 1.4 x 0.5 x 1.0 cm and is stable since the prior examination. OTHER: No significant abnormality noted.", "output": "1. Stable nodules in the left thyroid bed as described above.2. Favor reactive node right level III node however special attention on subsequent examinations is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Male 44 years old Reason: s/p renal transplant-evaluate for rejection History: elevated Cr Ultrasound guidance and technical assistance was provided for a renal transplant in right iliac fossa The procedure was successfully completed. 3 18-gauge passes were performed by Dr. Cunningham.", "output": "Successful ultrasound guided biopsy of the renal allograft in the right iliac fossa."}
{"instruction": "Generate impression based on findings.", "input": "80 year-old male with thyroid nodule. Evaluate for interval change. RIGHT LOBE MEASUREMENTS: 3.4 cm x 1.1 cm x 0.9 cmLEFT LOBE MEASUREMENTS: 3.5 cm x 1.5 cm x 1.8 cmISTHMUS MEASUREMENTS: 2 mm in thicknessRIGHT LOBE: No discrete nodules or masses are seen.LEFT LOBE: Hypoechoic solid nodule at the inferior pole is again seen measuring 1.9 cm x 1.6 cm x 1.0 cm, previously 1.9 cm x 1.1 cm x 1.4 cm. There is some internal vascularity; no definite microcalcifications are 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 significant interval change in solid left thyroid nodule. This has been biopsied previously."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male with acute kidney injury. RIGHT KIDNEY: The right kidney measures 10.6 cm in length. No hydronephrosis. Mildly echogenic renal parenchyma. No discrete lesions.LEFT KIDNEY: The left kidney measures 12.6 cm in length. No hydronephrosis. Mildly echogenic renal parenchyma. No discrete lesions.URINARY BLADDER: Partially distended urinary bladder without acute abnormality.OTHER: No significant abnormalities noted.", "output": "Mildly echogenic renal parenchyma suggesting chronic renal disease. No hydronephrosis or discrete lesions."}
{"instruction": "Generate impression based on findings.", "input": "Follicular and papillary thyroid carcinoma status post resection. Outside ultrasound suggests worrisome lesion right thyroid bed RIGHT LOBE: Status post thyroidectomy. Vague hyperechoic region and right thyroid bed without increased vascularity unchanged from 11/1/2013.LEFT LOBE: Status post thyroidectomy. Subcentimeter hypoechoic foci within the left thyroid bed. The largest measures 0.8 x 0.3 x 0.7 cm. Given differences in transducer acquisition parameters, it is unclear whether not these foci have significantly changed from the prior studies.ISTHMUS: Status post thyroidectomyPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional adenopathy.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy. Echogenic focus within the right thyroid bed unchanged from 2013; favor benign etiology such as scar. Accordingly, no biopsy was performed.Subcentimeter hypoechoic foci within left thyroid bed. Given differences in transducer acquisition parameters, it is unclear whether not these foci have significantly changed from prior studies. While these may represent benign residual thyroid tissue, would recommend follow-up scan in 4 months to document temporal stability."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for choledocholithiasis, cholecystitis History: hyperbilirubinemia Examination limited by patient body habitus.LIVER: The liver measures 19.9 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 0.43 m/s.BILIARY TRACT: The gallbladder is contracted with diffuse gallbladder wall thickening measuring up to 6 mm. Debris/sludge is present within the gallbladder lumen. 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: Not visualized.RIGHT KIDNEY: Kidney measures 13.0 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Not visualized.OTHER: No significant abnormalities noted.", "output": "1.Limited exam.2.Hepatomegaly. Diffusely coarse and echogenic liver, compatible with fatty infiltration/parenchymal dysfunction.3.Contracted gallbladder which contains sludge. No biliary duct dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Status post renal transplant. Guidance for Biopsy Ultrasound guidance was provided for a transplant renal biopsy. Transplant is located in the right iliac fossa", "output": "Ultrasound guidance for transplant renal biopsy"}
{"instruction": "Generate impression based on findings.", "input": "Reason: ? Outflow obstruction History: hepatomegaly LIVER: The liver measures 22.9 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 0.42 m/s.BILIARY TRACT: Cholelithiasis 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 10.7 cm in length. RIGHT KIDNEY: Kidney measures 13.6 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 12.8 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Persistent hepatomegaly. 2.Cholelithiasis without sonographic evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old female with abdominal distention. Elevated bilirubin. LIVER: The liver is highly echogenic which decreases penetration and visualization. This is likely due to severe fatty liver.There is again noted a non--- specific lobulated hypoechoic 2 cm mass in the right lobe which is stable. No other abnormality. Color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder is collapsed and mildly thick walled. No gallstones or pericholecystic fluid. The biliary tract is normal in caliber. PANCREAS: Not visualized due to body habitus and bowel gas.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Right pleural effusion.", "output": "Collapsed gallbladder without stones or pericholecystic fluid.Highly echogenic liver likely due to fatty infiltration.Stable lobulated hepatic mass.Right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "27 years old, Female, Reason: Please evaluate RUQ, especially liver and biliary tree, given elevated LFTs. Please assess area around ileostomy to evaluate for abscess History: elevated liver enzymes LIVER: The liver measures 18 cm in length. The parenchyma is normal in appearance. No focal hepatic lesion identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.4 m/s.BILIARY TRACT: There is gallbladder sludge without evidence of gallbladder wall thickening or peri-cholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 0.3 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 13.5 cm in length. RIGHT KIDNEY: Kidney measures 11.2 cm in length. Mild hydronephrosis.LEFT KIDNEY: Kidney measures 10 cm in length. Mild hydronephrosis.OTHER: The bladder is collapsed and not well visualized. No evidence of subcutaneous abscess or fluid collection in the area of the ileostomy. Note is made of incompletely imaged fetus.", "output": "1.Gallbladder sludge without evidence of acute cholecystitis.2.Bilateral mild hydronephrosis, which is likely physiologic given known pregnancy.3.No evidence of subcutaneous abscess or fluid collection in the area of the ileostomy as clinically questioned."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic small cell carcinoma with liver abnormalities LIVER: Diffusely heterogeneous liver with multiple bilobar confluent hypoechoic mass lesions. Liver length 27.2 cmDoppler interrogation of hepatic vessels demonstrate a possible filling defect in the main portal vein. Main portal vein flow remains pedal with a velocity 15.8 cm/s. Hepatic artery and hepatic veins appear patent.GALLBLADDER, BILIARY TRACT: No significant abnormality noted.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. 8.1 cm in length KIDNEYS: Right kidney 12 cm in length Left kidney 11.6 cm in length ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Porta hepatis adenopathy. No ascites. Right pleural effusion.", "output": "Diffusely heterogeneous liver with bilobar confluent mass lesions worrisome for metastatic disease. No ductal dilatation. While the hepatic vessels appear patent with normal directional flow, there may be a nonobstructing filling defect within the main portal vein. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old male with right upper quadrant pain, elevated LFTs LIVER: Echogenic hepatic parenchyma without discrete focal lesion.GALLBLADDER, BILIARY TRACT: Nondistended gallbladder without cholelithiasis. Mild nonspecific edema of the surrounding hepatic parenchyma.PANCREAS: No significant abnormalities noted.KIDNEYS: Partially imaged circumscribed hyperechoic lesion in the mid polar left kidney. No hydronephrosis.OTHER: Small pleural effusion", "output": "1.Nondistended gallbladder with normal wall thickness. No evidence of cholelithiasis or acute cholecystitis. 2.Partially imaged hyperechoic lesion in the mid polar left kidney is incompletely characterized and may represent a angiomyolipoma, though nonspecific.3.Small pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old male complains of right upper quadrant pain. Evaluate for cholelithiasis. LIVER:Measures 19.0 cm. The parenchyma is echogenic. Difficult to penetrate sound beam. No masses, ascites, intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. Wall measures 0.2 cm. No stones, sludge, or pericholecystic fluid. The common bile duct measures 0.2 cm. Negative sonographic Murphy's sign.PANCREAS: Evaluation of the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 11.4 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 9.8 cm. Left kidney measures 12.9 cm. Normal echogenicity. No hydronephrosis, shadowing calculi, or focal mass. OTHER: No significant abnormality noted.", "output": "1. Echogenic liver parenchyma consistent with fatty infiltration and chronic liver disease/parenchymal dysfunction. No mass or ascites.2. No sonographic evidence of cholelithiasis or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female with a history of Crohn's disease presents for evaluation of hydronephrosis. RIGHT KIDNEY: The right kidney measures 12.7 cm. The cortex has normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass.LEFT KIDNEY: The left kidney measures 11.1 cm. The cortex has normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass.OTHER: There is a diverticula of the wall of the bladder; a benign variant.", "output": "1. Normal ultrasound of the kidneys without evidence of nephrolithiasis or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Congestive heart failure with suspected thyrotoxicosis RIGHT LOBE MEASUREMENTS: 2.1 x 5.3 x 2 cm.LEFT LOBE MEASUREMENTS: 2.2 x 5 x 2.9 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Diffusely heterogeneous gland without increased vascularity. 0.6 cm hypoechoic mid gland nodule.LEFT LOBE: Diffusely heterogeneous gland without increased vascularity. Benign subcentimeter colloid nodules. The largest measures 0.7 x 0.4 cm.ISTHMUS: Diffusely heterogeneous gland without increased vascularity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland without increased vascularity raises the possibility of chronic thyroiditis. Bilateral subcentimeter nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male patient with history of hepatitis C and hepatitis B infection. Question of any virally induced damage to liver. Transplant evaluation for emphysema. LIVER: The liver measures 15.3 cm in length. There is a 1.3 x 0.7 x 0.8 cm anechoic lesion within the left hepatic lobe consistent with a cyst. GALLBLADDER, BILIARY TRACT: There are a few subcentimeter non-shadowing echogenic foci within the gallbladder but no gall bladder wall thickening or pericholecystic fluid. Common tail artifact within gallbladder wall is consistent with adenomyomatosis. 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 11.1 cm in length. No evidence of hydronephrosis. A 0.7 x 0.5 x 0.7 right lower pole renal cyst is noted.OTHER: The left kidney measures 10.1 cm in length. No evidence of hydronephrosis.The spleen measures 8.4 cm in length.", "output": "1. Left hepatic cyst and right renal cyst.2. Subcentimeter non-shadowing echogenic foci within the gallbladder may represent small polyps or non-shadowing gallstones. Adenomyomatosis of the gallbladder."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with incidental finding of left thyroid nodule on carotid ultrasound. RIGHT LOBE MEASUREMENTS: 4.7-cm x1.6 cm x 1.6 cm.LEFT LOBE MEASUREMENTS: 4.4 cm x 1.2 cm x 1.3 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: Complex nodule in the lower pole measures 1.1-cm x 1.0 cm x 1.0 cm. LEFT LOBE: Complex nodule in the midpole measures 1.5-cm x 0.7 cm x 0.9 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing right neck lymph node measures 1.2 cm x 1.1 cm x 0.4 cm.OTHER: No significant abnormality noted.", "output": "Bilateral complex thyroid nodules, more heterogeneous on the right which would be amenable to biopsy if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old male with urinary retention. Assist with a suprapubic tube placement in operating room. Sonographic guidance was used intraoperatively for placement of a suprapubic catheter. Postprocedural images demonstrate catheter retention balloon within the urinary bladder.", "output": "Sonographic guidance was used intraoperatively for placement of a suprapubic catheter. Postprocedural images demonstrate catheter retention balloon within the urinary bladder."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old male patient with recurrent cirrhosis status post OLT. Evaluate for HCC and vascular patency. LIMITED ABDOMENLIVER: The liver measures 17.8 cm in length, demonstrates increased parenchymal echogenicity, and is nodular in contour. No focal hepatic lesion is identified.BILIARY TRACT: The gallbladder is absent. There is no intra or extrahepatic biliary ductal dilatation. The common duct measures 3 mm in diameter.PANCREAS: The head of the pancreas demonstrates normal echogenicity. The remaining pancreas is not visualized secondary to overlying bowel gas.SPLEEN: The spleen measures 15.0 cm in length. RIGHT KIDNEY: The right kidney measures 8.3 cm in length. No evidence of hydronephrosis.OTHER: The left kidney measures 10.0 cm in length. No evidence of hydronephrosis. There is a 9 mm left lower pole renal stone.No ascites.", "output": "1. Cirrhotic morphology of the liver with patent hepatic vasculature. 2. Mild splenomegaly.3. Non-obstructing left nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Kidney failure RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 10.7 cm in length.LEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 11.3 cm in length.OTHER: Bladder nondistended. Trace ascites. Bilateral pleural effusions.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old female with a painful palpable mass in the right breast near the areola presents for right breast ultrasound A targeted right breast ultrasound was performed for the palpable area of concern. On physical examination, a 1 cm palpable, tender mass is noted at the 9 o'clock position of the right areola. Patient indicates interval increase in size of the mass in last 10 days. Ultrasound demonstrates a complex cystic mass with internal echoes and increased blood flow measuring 2.3 x 1.2 by 1.6 cm most likely representing an abscess.", "output": "Palpable mass right breast 9 o'clock position most likely corresponds to an abscess. Findings conveyed to Donna Christian, Dr. Chhablani's nurse at the time of the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with history of hepatitis C and cirrhosis. Evaluate for HCC. LIVER: The liver is nodular with a coarse echotexture compatible with cirrhosis. No focal hepatic lesion is identified. No intrahepatic biliary ductal dilatation. There is normal hepatopetal portal venous blood flow at 30 cm/sec.GALLBLADDER, BILIARY TRACT: A large gallstone is noted within a normally distended gallbladder. The gallbladder wall measures 3 mm in thickness without focal tenderness or pericholecystic fluid. No extrahepatic biliary ductal dilatation with the common bile duct measuring 3 mm.PANCREAS: The visualized portions of the pancreas are normal.RIGHT KIDNEY: The right kidney measures 9.1 cm in length without hydronephrosis or shadowing nephrolithiasis.OTHER: The left kidney measures 10.6 cm in length without hydronephrosis or shadowing nephrolithiasis. The spleen is normal in size measuring 7 cm.", "output": "1. Cirrhosis without a discrete liver lesion or biliary ductal dilatation.2. Cholelithiasis without evidence of acute gallbladder inflammation."}
{"instruction": "Generate impression based on findings.", "input": "Female 47 years old Reason: r/o growth of nodules, adenopathy History: thyroid nodules. 1 year follo wup study RIGHT LOBE MEASUREMENTS: 6.0 x 1.7 x 1.0 cmLEFT LOBE MEASUREMENTS: 5.3 x 1.4 x 1.1 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Unchanged appearance of a heterogeneous, solid right lower pole nodule with coarse internal calcifications. Nodule measures 1.8 x 1.0 x 1.2 cm, previously 2.1 x 1.0 x 1.2 cm. This nodule has been previously biopsied.LEFT LOBE: The left thyroid lobe there is a hypoechoic nodule measuring 0.4 x 0.3 x 0.3 cm, previously 0.4 x 0.2 x 0.5 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Unchanged dominant right thyroid nodule with internal calcifications. This nodule has been previously biopsied."}
{"instruction": "Generate impression based on findings.", "input": "79-year-old female with left thyroid lobe cystic nodule, previously measured as 1.4 x 1.4 x 1.6 cm. RIGHT LOBE MEASUREMENTS: 4.6 x 1.3 x 1.7 cm.LEFT LOBE MEASUREMENTS: 4 x 1.4 x 1.7 cm.ISTHMUS MEASUREMENTS: 0.16 cm.RIGHT LOBE: The right thyroid lobe has a mildly heterogenous echotexture. In the posterior right mid thyroid lobe, there is a 0.8 x 0.5 x 0.7 cm predominantly isoechoic nodule with a benign spongiform appearance. There are a few small scattered thyroid cysts.LEFT LOBE: The left thyroid lobe has a mildly heterogenous echotexture. In the lateral inferior left thyroid lobe, there is a 0.7 x 0.7 x 1 cm complex cystic nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Minimally enlarged thyroid gland with benign appearing bilateral thyroid nodules. A 0.7 x 0.7 x 1 cm complex cystic nodule is noted in the inferior-lateral left thyroid lobe. "}
{"instruction": "Generate impression based on findings.", "input": "Male 55 years old with acute kidney injury of unclear cause. Evaluate for obstructive uropathy. RIGHT KIDNEY: The right kidney measures 10.0 cm in length. There is no hydronephrosis, shadowing renal stone or suspicious renal mass. The renal parenchyma is normal in echogenicity.LEFT KIDNEY: The left kidney measures 9.8 cm in length. There is no hydronephrosis, shadowing renal stone or suspicious renal mass. The renal parenchyma is normal in echogenicity.OTHER: The bladder is mildly distended and without sonographic abnormality.", "output": "Slightly atrophic kidneys. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Female, 36 years old. Acute kidney failure. RIGHT KIDNEY: The right kidney measures 11.4 cm in length, with normal cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.3 cm in length, with normal cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The bladder is distended without significant wall thickening. An approximately 1 cm echogenic structure is noted in the right hepatic lobe along the margin of the right kidney, may represent a small hemangioma.", "output": "1. No hydronephrosis.2. An echogenic structure in the right hepatic lobe may represent a hemangioma, and can be followed up on continued sonographic imaging or with cross-sectional imaging."}
{"instruction": "Generate impression based on findings.", "input": "Reason: RUQ pain with elevated LFTs, assess for cholecystitis LIVER: The liver measures approximately 15.2 cm in length. Pneumobilia and intrahepatic biliary ductal dilation again seen, similar to recent CT. The main portal vein is patent with apparently elevated hepatopetal flow, peak velocity 164.2 cm/s. Echogenic internal biliary stent is partially visualized.GALLBLADDER, BILIARY TRACT: Echogenic sludge within the dependent portion of the gallbladder. No shadowing stones are identified. No pericholecystic fluid or inflammation. Negative sonographic Murphy's sign. The gallbladder wall measures 0.2 cm and the common bile duct measures 0.2, although the common bile duct stent is not visualized.PANCREAS: No significant abnormalities noted.KIDNEYS: The right kidney measures 11.4 cm in length. The left kidney measures 12.1 cm in length. Bilaterally echogenic renal parenchyma. The proximal portions of bilateral nephroureteral stents are visualized with mild residual hydronephrosis bilaterally. No shadowing renal calculi.OTHER: Mild to moderate volume ascites. The spleen measures 11.6 cm in length.", "output": "1. Gallbladder sludge without evidence of acute inflammation. Negative sonographic Murphy's sign.2. Persistent pneumobilia and intrahepatic biliary ductal dilatation, similar to prior CT.3. Bilateral echogenic renal parenchyma, consistent with medical renal disease.4. Mild bilateral hydronephrosis.5. Mild to moderate volume ascites."}
{"instruction": "Generate impression based on findings.", "input": "Febrile, hypotensive, rule out gallbladder pathology LIVER: Liver measures 17.6 cm with increased echogenicity compatible with fatty liver. No focal lesions noted. No intrahepatic biliary ductal dilatation noted. BILIARY TRACT: Gallbladder is markedly distended with sludge layering within it. Few hyperechoic small stones could be noted within the gallbladder. No evidence of gallbladder wall thickening. Patient cannot lie injected disposition therefore limited evaluation as per the technologist.On bile duct at the porta hepatis measures 1.5 cm.PANCREAS: Limited evaluation due to overlying bowel gas.SPLEEN: Spleen measures 10 cm without any focal lesions.KIDNEY: Right kidney measures 13 cm and left kidney measures 13.4 cm. Both kidneys demonstrate increased echogenicity compatible with chronic medical renal disease. No hydronephrosis or focal lesions.OTHER: Ascites noted", "output": "Hepatic steatosisDistended gallbladder with sludge and small stones without acute cholecystitisIncreased echogenicity of the kidneys consistent with chronic medical renal disease.Ascites"}
{"instruction": "Generate impression based on findings.", "input": "59 years old, Female, Reason: HBV, eval for HCC History: HBV LIVER: The liver measures 15.3 cm in length. Coarsened echotexture of the hepatic parenchyma. 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: Patient status post cholecystectomy. 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 7.3 cm in length. RIGHT KIDNEY: Kidney measures 10.7 centimeters and is located within the pelvis, similar to prior exam. Normal echotexture. No hydronephrosis or shadowing calculus. Subcentimeter renal cyst.LEFT KIDNEY: Kidney measures 11.1 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "Coarsened echotexture of the hepatic parenchyma without focal hepatic lesions or evidence of cirrhosis."}
{"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.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old female with a known right breast fibroadenoma presents for follow-up A targeted right ultrasound was performed for the palpable area of concern. On physical examination a pea sized palpable nontender mass identified in the right breast 1:00 position. Ultrasound demonstrates benign morphology homogeneous oval circumscribed mass compatible with a fibroadenoma measuring 1.5 x 0.8 x 1.7 cm, mostly unchanged from prior study when it measured 1.7 x 1 x 1.7 cm.", "output": "Stable known fibroadenoma in the right breast.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "16-year-old female at 28 weeks gestation with palpable left breast lump. On physical examination, there is a pea-sized mobile mass along the medial inframammary fold. A targeted left ultrasound was performed for the palpable area of concern. A 0.4 x 0.3 x 0.3 cm cyst is present subjacent to the area of palpable concern at the 8:00 position, 10 cm from the nipple. This cyst has a tail extending to the cutaneous surface, compatible with a sebaceous cyst.", "output": "Sebaceous cyst corresponding to the area of palpable concern in the left breast. No sonographic evidence for malignancy. The patient was instructed to return to her referring physician for clinical management.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"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. Subcentimeter gallstones. No gallbladder wall thickening, pericholecystic fluid, or 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 10.9 cm in length. The left kidney is 12.1 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 11.1 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.", "output": "Cholelithiasis without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old female with history of papillary thyroid carcinoma status post thyroidectomy in 2011. THYROID: The patient is status post thyroidectomy. RIGHT THYROIDECTOMY BED: Status post thyroidectomy with no evidence of residual or recurrent disease. LEFT THYROIDECTOMY BED: Status post thyroidectomy with no evidence of residual or recurrent disease. ISTHMUS BED: Status post thyroidectomy with no evidence of residual or recurrent disease. LYMPH NODES: Bilateral morphologically unremarkable and normal-sized lymph nodes are identified, including a right level 2 lymph node measuring 0.9 x 0.3 x 1.5 cm, compared to 0.9 x 0.4 x 1.9 cm previously and a left level 4 lymph node measuring 1.0 x 0.6 x 2.1 cm, compared to 0.6 x 0.5 x 2.1 cm previously, with a prominent fatty-hilum.", "output": "No evidence of tumor recurrence or suspicious lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Epigastric pain, exclude pancreaticobiliary abnormalities History: Epigastric pain, exclude pancreaticobiliary abnormalities LIVER: The liver measures 18.5 cm in length, enlarged. Heterogeneous, hyperechoic hepatic parenchyma. The portal vein is patent with normal directional hepatopedal flow, peak velocity 47.1 cm/s. The portal venous waveform is pulsatile and the hepatic veins appear dilated. No focal masses.GALLBLADDER, BILIARY TRACT: Small polyp on the nondependent aspect of the gallbladder body. No shadowing stones or sludge. No significant biliary ductal dilatation. The gallbladder wall measures 0.3 cm. The common bile duct measures 0.2 cm.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 12.5 cm in length. The left kidney measures 12.6 cm in length. No hydronephrosis or shadowing stones.OTHER: No ascites. The spleen measures 14.2 cm.", "output": "1. Findings consistent with hepatic steatosis or parenchymal dysfunction. 2. Dilated hepatic veins and pulsatile portal venous waveform are suggestive of hepatic congestion or some degree of congestive heart failure.3. Gallbladder polyp should be followed up with repeat ultrasound in 3-6 months."}
{"instruction": "Generate impression based on findings.", "input": "Renal stones RIGHT KIDNEY: Echogenic parenchyma again noted. New mild right hydronephrosis. 0.4 x 0.3 cm lower pole stone. Stable lower pole renal cyst. Right kidney 10.3 cm in length.LEFT KIDNEY: Echogenic renal parenchyma again noted. No worrisome mass or hydronephrosis. Questionable punctate echogenic foci. Left kidney 12.1 cm in length.OTHER: Bladder nondistended", "output": "New mild right hydronephrosis. Subcentimeter right lower pole stone again noted. Questionable left punctate renal stone without left hydronephrosis. Stable echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass."}
{"instruction": "Generate impression based on findings.", "input": "52 year-old male with chronic hepatitis C and cirrhosis. Evaluate for HCC. LIVER: The liver is moderately coarse in echogenicity and nodular in contour. It measures 12.9 cm in length without a focal lesion or intrahepatic biliary ductal dilatation evident. Normal hepatopetal portal venous blood flow at 22 cm/sec.BILIARY TRACT: The gallbladder is partially contracted. No extrahepatic biliary ductal dilatation with the common bile duct measuring 3 mm.PANCREAS: The pancreas is obscured by overlying bowel gas shadowing.SPLEEN: Moderate splenomegaly, measuring 15.1 cm without a discrete lesion.RIGHT KIDNEY: The right kidney measures 9.6 cm in length without hydronephrosis. OTHER: The left kidney measures 10.1 cm in length without hydronephrosis.", "output": "Cirrhotic liver morphology, without a discrete lesion. Splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "85-year-old female with elevated alkaline phosphatase. LIVER: Mildly heterogeneous hepatic echotexture without discrete focal lesion.BILIARY TRACT: Status post cholecystectomy. No biliary ductal dilation.PANCREAS: The pancreas is not well-visualized due to bowel gas.SPLEEN: The spleen is partially visualized due to bowel gas, measures 7.7 cm. RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Mild increased hepatic echogenicity may represent hepatic steatosis or parenchymal disease. No additional findings to account for the patient's symptoms. "}
{"instruction": "Generate impression based on findings.", "input": "51 year old female with hepatic steatosis evaluate progression. LIVER: Increased hepatic echogenicity without significant interval change since the prior study. Subcentimeter hepatic cysts. No new or suspicious lesions. BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.KIDNEY: Bilateral renal cysts, including a simple left renal cyst measuring 3.6 cm and a 2.8 cm left renal cyst with thin internal septations, without acute interval change. No hydronephrosis. OTHER: No significant abnormalities noted.", "output": "1. Increased hepatic echogenicity compatible with hepatic steatosis or parenchymal disease, without significant interval change. 2. Bilateral renal cysts without significant change. "}
{"instruction": "Generate impression based on findings.", "input": "Female 68 years old Reason: assess enlarged L cervical node, plan for FNA History: tender enlarged L cervical node No abnormality or enlarged lymph nodes are noted in the site that the patient previously felt a lump.", "output": "No abnormality or enlarged lymph nodes are noted in the site that the patient previously felt a lump."}
{"instruction": "Generate impression based on findings.", "input": "Left medial thigh fluid collection. Soft tissue appears edematous without evidence of discrete fluid collection.", "output": "Soft tissue swelling without discrete fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "25 year old female with a history of lower quadrant abdominal wall mass previously characterized as lipoma on ultrasound. Targeted ultrasound of the patient's right lower quadrant superficial soft tissues demonstrates an echogenic lobulated malleable mass with well-defined margins and minimal vascularity compatible with a lipoma. On today's examination it measures approximately 6 x 1.7 x 3.9 cm compared to 4.6 x 1.7 x 4.2 cm previously; essentially unchanged given the differences in technique.", "output": "Findings compatible with a lipoma, appearing similar to the prior study."}
{"instruction": "Generate impression based on findings.", "input": "Left sided mass. Possible varicocele. RIGHT TESTIS: 4.1 x 1.9 x 2.5 cm. Normal parenchymal echogenicity and vascularity, without focal lesions.LEFT TESTIS: 3.9 x 1.7 x 2.5 cm. Normal parenchymal echogenicity and vascularity, without focal lesions.RIGHT EPIDIDYMIS: 3.9 x 0.9 x 0.9 cm, with normal vascularity.LEFT EPIDIDYMIS: 3.6 x 0.8 x 0.8 cm, with normal vascularity.OTHER: Left-sided varicocele is identified.", "output": "Left varicocele. No intratesticular mass identified."}
{"instruction": "Generate impression based on findings.", "input": "49 year old male with pancreatitis, epigastric abdominal pain. Evaluate for gallstones. LIVER: Measures 24.1 cm in length. No focal hepatic lesion. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.4 m/s. GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. Gallbladder wall measures 4 mm in thickness. No pericholecystic fluid. Common duct measures 8 mm in caliber which tapers distally to 6 mm. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Not well visualized due to overlying bowel gas.RIGHT KIDNEY: Right kidney measures 13.9 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Spleen measures 14.8 cm in length.Left measures 13.9 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "1. Hepatosplenomegaly with heterogeneous echotexture of the liver suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesion. 2. No evidence of cholelithiasis. "}
{"instruction": "Generate impression based on findings.", "input": "89-year-old male with history of elevated BUN/Cr, incontinence. RIGHT KIDNEY: Measures 7.0 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 9.2 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.", "output": "1. Atrophic kidneys with increased echogenicity consistent with medical renal disease. 2. No nephrolithiasis, hydronephrosis, or suspicious mass. "}
{"instruction": "Generate impression based on findings.", "input": "26-year-old male with history of HBV, evaluate for HCC structural disease. LIVER: Normal echogenicity of the liver measuring 15.9 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: Gallbladder is contracted limiting evaluation for wall thickening. No pericholecystic fluid. Common duct measures 2 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Not well visualized due to overlying bowel gas.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 10.1 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the spleen measuring 9.3 cm in length.Normal echogenicity of the left kidney measuring 9.2 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "Unremarkable examination."}
{"instruction": "Generate impression based on findings.", "input": "Male 55 years old Reason: pre liver transplant work up; assess vasculature liver, inflow/outflow studies of vessels, ascites, portal vein thrombosis, lesions, masses History: cirrhosis, partial PVT, ascites LIVER: Extremely limited evaluation of the liver. Visualized portions are coarse.BILIARY TRACT: Cannot be evaluated on this examPANCREAS: No significant abnormalities noted.SPLEEN: The visualized portions of the spleen are normal in appearance measuring 13.8 cm. KIDNEYS: Kidneys are also not well visualized. Unchanged cystic lesion in the left kidney measures 3.3 x 5.9 x 7.2 cm.OTHER: No significant abnormalities noted.ABDOMINAL DOPPLER: Color and spectral Doppler were performed on inflow and outflow vessels.PORTAL VENOUS: Portal vasculature is not well visualized, however the there is suggestion of normal directional flow in the region of the portal vein. Splenic vein and artery are patent with normal directional flow.HEPATIC ARTERIES: Not well visualized. HEPATIC VEINS: Not well visualizedINFERIOR VENA CAVA: No significant abnormalities noted.", "output": "Extremely limited evaluation of the hepatic inflow and outflow vessels, which appear grossly patent. Very limited evaluation of the hepatic parenchyma. If further evaluation is clinically warranted, cross-sectional imaging with CT or MRI is recommended."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female with history of dense breasts. For technical repeat. A targeted right breast ultrasound was performed at the 8:00 position, and redemonstrated a known benign-appearing oval hypoechoic well circumscribed mass measuring 2.0 x 0.5 x 1.7 cm. There is no associated internal vascularity.Targeted right breast ultrasound was also performed at the 1:00- 2:00 position, and demonstrated no solid or cystic mass.", "output": "No sonographic evidence for malignancy. Stable benign-appearing mass within the right lateral breast. As long as the patient's physical examination remains normal, bilateral screening mammogram, with possible additional bilateral whole breast ultrasound examination given patient's heterogeneously dense fibroglandular tissue, is recommended annually. Results and recommendation were discussed with the patientBIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "History of goiter RIGHT LOBE MEASUREMENTS: 7.8 x 3.2 x 3.6 cmLEFT LOBE MEASUREMENTS: 7.8 x 3 x 3 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Diffusely heterogeneous gland with reticular background. Multiple benign-appearing colloid nodules. The largest within the mid gland measures 1 x 0.5 x 0.6 cm.LEFT LOBE: Diffusely heterogeneous gland with reticular background. Multiple benign-appearing colloid nodules. The largest within the upper pole measures 1.2 x 0.8 x 1.2 cm. ISTHMUS: Diffusely heterogeneous gland with reticular backgroundPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely mildly enlarged heterogeneous gland with reticular background suggestive for chronic thyroiditis. Multiple bilateral benign-appearing colloid nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "26 years old, Female, Reason: elevated Cr History: elevated Cr Transplanted kidney: Renal transplant is identified in the right iliac fossa. Echogenic renal parenchyma is consistent with medical renal disease. No hydronephrosis is identified. No focal mass or shadowing calculus. No perinephric fluid collection.Doppler exam:Color and spectral Doppler were performed on inflow and outflow vessels. No significant abnormality noted. Peak velocities and resistive indices appear similar to the prior exam.Peak systolic velocities are as follows:Right iliac artery: 1.0 m/sec.Anastomosis: 0.8 m/sec, resistive index of 0.8Renal arteryproximal: 0.6 m/secmid: 0.6 m/secdistal: 0.5 m/secIntrarenal resistive indices measure from 0.5 to 0.68Urinary bladder: No significant abnormalities noted.", "output": "1.Increased parenchymal echogenicity of the kidneys consistent with medical renal disease.2.No evidence of hydronephrosis or evidence of stenosis within the transplant vasculature."}
{"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 9.3. Additional right MLO view was performed. The breast parenchyma is composed of scattered fibroglandular density. Benign intramammary lymph nodes in bilateral upper quadrants are noted. Small partially circumscribed mass measuring 5 mm in the right upper outer quadrant requires further evaluation with spot compression views and possible ultrasound (annotated on pacs).", "output": "Small partially circumscribed mass in the right upper outer quadrant requires further evaluation with spot compression views and possible ultrasound.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "50 year-old woman with thyroid nodules. Please assess RIGHT LOBE MEASUREMENTS: 5.2 x 1.8 x 1.7 cmLEFT LOBE MEASUREMENTS: 5.5 x 1.4 x 2.0 cmISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: New subcentimeter nodule in the right measuring 7 mm in diameter.LEFT LOBE: Unchanged 5 x 4 x 2 mm hypoechoic nodule in the midportion of the gland.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small bilateral lymph nodes measuring up to 0.9 cm in maximal diameter.OTHER: No significant abnormality noted.", "output": "Stable tiny left thyroid nodule. New subcentimeter right thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Coarse echotexture again noted. No mass. Liver length 16 cmGALLBLADDER, BILIARY TRACT: Stable gallbladder subcentimeter polyps. The largest measures 0.3 x 0.4 x 0.2 cm.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic renal parenchyma again noted with multiple cysts. No hydronephrosis. Right kidney 9.1 cm in length.OTHER: Echogenic left renal parenchyma again noted with multiple cysts. Left kidney 11.9 cm in length. Spleen 11.2 cm in length. No ascites.", "output": "Stable coarse liver echotexture consistent with chronic liver disease without mass or ductal dilatation. No ascites. Stable gallbladder subcentimeter polyps. No change in echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Male; 65 years old. Reason: Nodules History: Thyroid cancer s/p thyroidectomy RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: No evidence of recurrence in the thyroid bed.LEFT LOBE: No evidence of recurrence in the thyroid bed.ISTHMUS: No evidence of recurrence in the thyroid bed.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No suspicious lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy with no evidence of recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "89-year-old male with history of thyroid cancer status post thyroidectomy. RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT 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 evidence of recurrent or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Reason: RUQ, rule out obstruction History: new elevated bilirubin LIVER: Coarse, echogenic hepatic parenchyma. The liver measures 17.5 cm in length. The portal vein is patent with normal directional hepatopedal portal venous blood flow, peak velocity 25.6 cm/s.GALLBLADDER, BILIARY TRACT: Shadowing mobile echogenic stone is seen in the gallbladder neck along with layering sludge. No evidence of pericholecystic inflammation or fluid. The gallbladder wall measures up to 3 mm. The common bile duct measures 0.2 cm. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 9.9 cm in length. No hydronephrosis, masses, or stones.LEFT KIDNEY: The left kidney measures 10.47 m in length. No hydronephrosis, masses, or stones.OTHER: No ascites. The spleen measures 9.5 cm in length.", "output": "1. Single stone in the gallbladder neck and layering sludge without evidence of cholecystitis.2. Coarse, echogenic hepatic parenchyma, consistent with hepatic steatosis or parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Reason: cholecystitis? History: RUQ pain, elevated white blood cell count LIVER: The liver measures 17.4 cm in length. Mildly coarse echotexture and. No intrahepatic or extrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow. Portal venous flow = 34.1 cm/second.GALLBLADDER, BILIARY TRACT: The gallbladder is mildly distended. Cholelithiasis, one of which is within the gallbladder neck (measures 24 mm), with possible small volume layering sludge. The gallbladder wall measures 1 mm. The common bile duct measures 7 mm, borderline dilated. No intrahepatic biliary duct dilatation appreciated. No pericholecystic fluid or gallbladder wall thickening. Negative sonographic Murphy's sign.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 12.6 cm in length. No hydronephrosis.LEFT KIDNEY: The left kidney measures 11.3 cm in length. No hydronephrosis.SPLEEN: The spleen measures 8.6 cm in length.OTHER: No significant abnormalities noted.", "output": "1. Mildly distended gallbladder with cholelithiasis, one located in the gallbladder neck measures 24 mm, no evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old female with increase in creatinine and potassium. Limited examination secondary to patient body habitus and surgical bandages.RIGHT KIDNEY: Measures 9.1 cm in length. No hydronephrosis. No nephrolithiasis identified.LEFT KIDNEY: Measures 9.6 cm in length. No hydronephrosis. No nephrolithiasis identified.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Limited study as detailed above. No hydronephrosis or evidence of nephrolithiasis. "}
{"instruction": "Generate impression based on findings.", "input": "Male 47 years old Reason: any ischemia/necrosis observed, renal perfusion History: s/p cardiac arrest, renal failure, anuria RIGHT KIDNEY: 10.9 cm in length. Mild increased echogenicity. No hydronephrosis or hydroureter.LEFT KIDNEY: 11.2 cm length. Mild increased echogenicity. No hydronephrosis or hydroureter.OTHER: Limited color Doppler shows blood flow to both kidneys.Urinary bladder is collapsed with Foley catheter in place.Well-demarcated echogenic lesion in the right lobe of the liver is identified measuring 1.8 x 1.6 cm consistent with hemangioma.", "output": "Mildly echogenic kidneys suggesting medical renal disease. No hydronephrosis. Incidental small echogenic lesion in the liver likely hemangioma."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old male with prior thyroidectomy for thyroid cancer. Follow-up exam. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massesLEFT LOBE: Previously described heterogeneous region in the left thyroid bed is visualized, but cannot be measured in 3 dimensions. Clearly this is unchanged from prior exams and likely represents an area of scarring rather than discrete mass.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable postoperative appearance post thyroidectomy."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are ultrasound 5/27/2016; ultrasound biopsy 6/6/2016 performed at North Shore University Health System. No comparisons are available. Right Ultrasound 5/27/2016: 3 lesions were identified on ultrasound. A right 12:00 circumscribed benign appearing lobulated mass measures 1.6 x 0.8 x 1.5 cm. At site of palpable concern, adjacent to this mass (12:00) there is an irregular hypoechoic mass with acoustic shadowing involving the right upper central breast. A second area of palpable concern (6:00), appear similars, with an irregular hypoechoic area with acoustic shadowing.Right breast ultrasound 6/6/2016: Limited images demonstrate core needle biopsy of the right breast 6:00 hypoechoic shadowing mass, identified on 5/27/2016. Additional images demonstrate biopsy of the hypoechoic shadowing mass in the upper right breast. A third biopsy was performed of the 12:00 circumscribed 1.6 cm mass identified 5/27/2016. Pathology results: 1. Right breast 6:00 core needle biopsy: Invasive lobular carcinoma.2. Right breast upper central invasive lobular carcinoma. 3. Right breast 12:00 invasive lobular carcinoma and fibroadenoma.", "output": "1. Hypoechoic shadowing mass 6:00 right breast, invasive lobular carcinoma, concordant. 2. Hypoechoic shadowing mass involving the upper central and 12:00 right breast, invasive lobular carcinoma, concordant. 3. Right breast 12:00 circumscribed lobulated mass, fibroadenoma, concordant.BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Reason: please evaluate liver to assess for liver disease/cirrhosis History: elevated INR, low albumin LIVER: The liver measures 16.5 cm in length. Echogenic hepatic parenchyma with smooth peripheral contour. The portal vein is patent with normal directional hepatopedal flow, peak velocity 32.4 cm/s. The hepatic veins appear dilated. No focal mass.GALLBLADDER, BILIARY TRACT: Echogenic debris in the dependent aspect of the gallbladder may represent sludge. No shadowing stones. The gallbladder wall measures 0.2 cm. The common bile duct measures 0.2 cm. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney measures 12.7 cm in length. The left kidney measures 9.9 cm in length. Echogenic renal parenchyma. No shadowing stones or hydronephrosis.OTHER: The spleen measures 8.5 cm in length. Trace ascites. Bilateral pleural effusions.", "output": "1. Echogenic liver, consistent with parenchymal dysfunction or chronic liver disease.2. Bilateral pleural effusions and trace ascites.3. Dilated hepatic veins, suggestive of CHF.4. Echogenic debris in the dependent portion of the gallbladder may represent sludge."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal LFTs LIVER: Coarse echogenic liver echotexture without mass. Liver length 17.5 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.6 cm in lengthOTHER: Spleen 7.9 cm in length. No ascites", "output": "Coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Palpable area of concern in the left upper outer breast marked by the clinical service. History of right breast cancer. A targeted left ultrasound was performed for the area marked by the clinical service. There is no solid or cystic mass identified. Dense parenchymal elements are noted, similar to the stable dense tissue seen on multiple mammograms.", "output": "No sonographic evidence for malignancy. Clinical correlation is recommended to ensure that these findings are concordant with physical exam. If that is the case, then a routine diagnostic mammogram would be due in March 2017.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodule RIGHT LOBE MEASUREMENTS: 4.8 x 1.6 x 1.6 cm. Reticular background echotexture and increased vascularity.LEFT LOBE MEASUREMENTS: 5.1 x 2.2 x 1.6 cm. Reticular background echotexture and increased vascularity.ISTHMUS MEASUREMENTS: 7 mm in AP dimensionRIGHT LOBE: No discrete nodules identified.LEFT LOBE: 1.8 cm hyperechoic solid nodule identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Small cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "1. Reticular background thyroid gland with increased vascularity, suggestive of thyroiditis.2. 1.8 cm left thyroid nodule. This is amenable to percutaneous biopsy."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old male with abdominal pain and leukocytosis. Evaluate for cholecystitis. LIVER: Liver appears mildly echogenic without focal abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein. GALLBLADDER, BILIARY TRACT: Gallbladder is adequately visualized without wall thickening, pericholecystic fluid or definite gallstones. However, the patient was unable to turn for decubitus views which limits this exam.PANCREAS: Not adequately visualized due to bowel gas.RIGHT KIDNEY: Limited without hydronephrosis.OTHER: Left upper quadrant could not be evaluated due to patient's inability to cooperate", "output": "No gallbladder abnormality on limited exam."}
{"instruction": "Generate impression based on findings.", "input": "21-year-old male with fever of unknown origin. LIVER: Echogenicity of the hepatic parenchyma is diffusely increased. The liver measures 23.6 centimeters in length. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts.The main portal vein is patent with normal hepatopedal flow and velocity of 24.9 cm/s.GALLBLADDER, BILIARY TRACT: A subcentimeter gallbladder stone or polyp is noted. There is no pericholecystic fluid, gallbladder wall thickening or cholelithiasis. The common bile duct measures 0.3 cm in diameter. PANCREAS: The head and proximal body of the pancreas are normal. The tail is obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 17.3 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.OTHER: There is no free or loculated fluid.", "output": "Moderate hepatomegaly and fatty infiltration of the liver. A subcentimeter gallbladder stone or polyp is noted. No evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male. Abdominal pain, fevers. Evaluate for hydronephrosis or fluid collection. RIGHT KIDNEY: Increased echogenicity. No focal mass, shadowing stone, or hydronephrosis.LEFT KIDNEY: Increased echogenicity. No focal mass, shadowing stone, or hydronephrosis.OTHER: Dependent debris in the bladder. Moderate bilateral pleural effusions. Limited images of the liver demonstrate increased echogenicity suggestive of fatty infiltration.", "output": "Echogenic kidneys consistent with medical renal disease. No hydronephrosis. Moderate bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "83-year-old female with urinary sepsis. Acute kidney injury. Evaluate for hydronephrosis/pyelonephritis. The exam is limited by patient motion and breathing.RIGHT KIDNEY: The right kidney measures approximately 11.4 cm in length. The kidney is moderately echogenic consistent with parenchymal disease. There is no hydronephrosis. Arising from the lower pole is a renal sinus and cortical cysts measuring 4.1 cm in greatest diameter. Trace of perirenal fluid.LEFT KIDNEY: Not adequately visualized due to shadowing bowel gas and patient motion.URINARY BLADDER: Collapsed with Foley catheter.OTHER: No significant abnormalities noted.", "output": "Echogenic right kidney with cyst and no hydronephrosis.Inadequate visualization of the left kidney."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Johnson is a 48 year old female with a personal history of right breast mastectomy with implant-based reconstruction in 03/2014 for IDC/DCIS. She presents for whole breast ultrasound for dense breast screening. 3-D whole breast ultrasound was performed for the left breast and images were reviewed on an independent workstation. In the left inferior breast, there is a lobulated hypoechoic mass identified measuring approximately 0.8 x 0.4 cm. Left breast implant partially visualized.", "output": "Incompletely characterized 0.8 cm mass in the left inferior breast. Additional imaging, including spot compression views and dedicated ultrasound, are recommended for further evaluation. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "Idiopathic aplastic anemia. Other disorders of bilirubin metabolism. Evaluate for etiology of conjugated hyperbilirubinemia. LIVER: Diffusely hyperechoic liver suggestive of hepatic steatosis. The liver measures 17.4 cm in the longitudinal plane. Normal portal venous flow.GALLBLADDER, BILIARY TRACT: Several hyperechoic stones are seen along with intraluminal sludge. The largest stone in the gallbladder neck is mobile and measures 1.65 cm. The common hepatic duct measures 0.4 cm and common bile duct measures 0.5 cm. The gallbladder wall measures up to 2 mm. No gallbladder wall thickening or pericholecystic fluid. PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic kidneys, suggestive of medical renal disease.OTHER: No significant abnormalities noted.", "output": "1. 1.6 cm mobile gallstone in the gallbladder neck and without evidence of cholecystitis.2. Echogenic liver and kidneys, suggestive of hepatic steatosis and medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs and right upper quadrant pain. LIVER: Mildly echogenic liver. The liver is normal in morphology and size, measuring 12.8 cm in craniocaudal dimension. No focal lesion or intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 25 cm/s.BILIARY TRACT: Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid or focal tenderness. No extrahepatic biliary ductal dilatation with the common duct measuring 6 mm.PANCREAS: The visualized portions of the pancreatic body and head are unremarkable. The remainder is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 7.6 cm without a focal lesion.RIGHT KIDNEY: The right kidney measures 10.1 cm in length without hydronephrosis.OTHER: The left kidney measures 10.3 cm in length without hydronephrosis.", "output": "Mildly echogenic liver may represent fatty infiltration. Otherwise, no specific findings to account for the patient's right upper quadrant pain. Trace pleural effusion."}
{"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. Benign morphology mass in the right lower inner breast is compatible with the previously noted biopsy proven fibroadenoma. A few scattered subcentimeter cysts are present as well. There is no suspicious solid or cystic mass identified. Exam was double read by 2 attending breast radiologists.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old with history of left breast mass for the last 11 months. A targeted left ultrasound was performed for the palpable area of concern. In the left breast 4:00 position, an oval circumscribed mass measuring 1.9 x 1.8 cm is present.", "output": "Left breast mass measuring 1.9 cm at the site of palpable concern is probably a fibroadenoma. Surgical consultation is recommended for consideration of palpably guided FNA and further management. The patient has already scheduled an appointment for surgical consultation.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Hyperparathyroidism RIGHT LOBE MEASUREMENTS: 3.6 x 1 x 1.9 cmLEFT LOBE MEASUREMENTS: 4 x 1.2 x 1.3 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Mildly heterogeneous gland without nodule.LEFT LOBE: Mildly heterogeneous gland. 0.4 x 0.2 x 0.2 hyperechoic nodule inferiorlyISTHMUS: Mildly heterogenous gland without nodulePARATHYROID GLANDS: 0.6 x 0.5 x 0.4 hypoechoic extrathyroidal focus projecting posterior and inferior to the left thyroid gland.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Subcentimeter hypoechoic extrathyroidal focus projecting posterior and inferior to the left thyroid gland consistent with parathyroid adenoma candidate.Mildly heterogeneous gland; subcentimeter hyperechoic left thyroid nodule"}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine RIGHT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. Right kidney 9.1 cm in lengthLEFT KIDNEY: Mildly echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Left renal cyst. Left kidney 9.6 cm in lengthOTHER: Bladder nondistended", "output": "Mildly echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female with history of thyroid nodules. Rule out growth of nodules, adenopathy. If nodule is growing, is it amenable to FNA? RIGHT LOBE MEASUREMENTS: 6 x 1.9 x 2 cmLEFT LOBE MEASUREMENTS: 5 x 1.8 x 1.7 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Heterogenous echotexture. In the right lower pole, a 1.8 x 0.8 x 1.2 cm isoechoic nodule with a hypoechoic rim is stable in size and appearance since the 1/18/2016 exam.LEFT LOBE: Heterogenous echotexture. In the left upper pole, a 1.8 x 1 x 1.2 cm isoechoic nodule is stable in size and appearance. A 1 x 0.6 x 1.1 cm hypoechoic nodule of the posterior left mid pole was not specifically measured on the prior exam but is not significantly changed.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Mildly enlarged thyroid gland with stable bilateral nodules."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old recalled from screening for focal asymmetry in the right upper-outer breast 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 heterogeneously dense, which may obscure small masses(BiRads Density Category C), unchanged in pattern and distribution. ML view redemonstrates an asymmetry in the right upper breast posterior depth identified on screening mammogram. Spot compression views persistence of the mass with obscured margins. Targeted ultrasound of the right breast was then performed at the site of the patient's mammographic abnormality. In the right upper outer breast 10:00 radian 4 cm from the nipple there is a simple cyst which measures 6 x 5 x 8 mm. No suspicious mass lesions were identified.", "output": "Simple cyst corresponding to the site of the patient's mammographic abnormality. 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": "48-year-old male status post LVAD with drainage around the drive line. Evaluate for fluid collection. A targeted portable ultrasound was performed of the left lower quadrant along the course of the LVAD drive line. There is no discrete fluid collection.", "output": "No discrete fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female with bilateral breast pain and areas of palpable concern for a few months. History of bilateral benign core breast biopsies. Personal history of renal cancer diagnosed at age 45. Family history of breast cancer in mother and three maternal great aunts. DIAGNOSTIC MAMMOGRAM", "output": "Patient's palpable areas of concern in the upper outer quadrants of the right and left breast correspond to dense parenchymal tissue with a benign cyst in the left upper quadrant. No sonographic or 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": "Reason: History of nephrolithiasis History: HTN RIGHT KIDNEY: The right kidney measures 11.1 cm in length. Small echogenic stone in the inferior pole of the right kidney measures 0.4 x 0.3 x 0.4 cm. No hydronephrosis.LEFT KIDNEY: The left kidney measures 12.5 cm in length. Small echogenic stone in the inferior pole of the left kidney measures 0.3 x 0.3 x 0.2 cm. No hydronephrosis.OTHER: No significant abnormalities noted. Renal jets visualized.", "output": "Small bilateral renal calculi without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "89-year-old male with decreased appetite, abnormal LFTs, weight loss LIVER: Liver is normal in size and is mildly heterogeneously echogenic which may be due to irregular fatty infiltration. There is no focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Gallbladder contains small amount of dependent sludge. No shadowing gallstones are identified. Although the gallbladder wall is mildly thickened, there is ascites associated and therefore the finding is not specific. Visualized portions of the biliary tract are normal in caliber.PANCREAS: Limited due to bowel gas. Body appears normal.SPLEEN: No significant abnormalities noted.KIDNEY: Right kidney is highly echogenic and small on limited views. Small right renal cyst. Limited views of the left kidney demonstrates likely mild increased echogenicity without hydronephrosis. Left kidney appears relatively small as well. OTHER: Mild ascites.", "output": "Mildly heterogeneous increased liver echogenicity which may be due to fatty infiltration.Small amount of gallbladder sludge. Mild wall thickening associated with ascites. No stones.Highly echogenic right kidney and mildly echogenic left kidney. Both kidneys appear small.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old with history of excisional biopsy of papilloma in the right breast in 2010. BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAPHY: Three standard views of both breasts and 2 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. Stable postsurgical changes in the right retroareolar region. There are 3 new clustered asymmetries in the left upper outer quadrant, which persist on spot compression. No suspicious microcalcifications in either breast. TARGETED LEFT BREAST ULTRASOUND: Targeted left upper outer quadrant ultrasound demonstrated a cluster of circumscribed anechoic to hypoechoic foci measuring up to 7 x 5 x 5 mm without internal vascularity; findings compatible with multiple simple cysts.", "output": "Findings consistent with left upper outer quadrant multiple simple cysts. 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 bilateral breast masses. Currently 5 months pregnant. Previous left breast surgery for a fibroadenoma. A targeted bilateral ultrasound was performed for the areas where the patient states she has known masses. Numerous bilateral typically benign morphology masses are present. In the left breast, multiple masses are seen at the 10:00, 3:00 and 1:00 positions. The largest masses are located near 3:00, with measurements of up to 2.2 cm. Within the right breast, multiple benign morphology masses are also present, at the 6:00, 7:00, 9:00 and 12:00 positions. The largest of these measures up to about 2.4 cm.", "output": "Numerous bilateral benign morphology masses measuring up to several centimeters in size. These are highly likely to represent fibroadenomas. Correlation with physical examination is recommended. Biopsy or surgical intervention could be considered for the largest masses based on symptoms. If no tissue is obtained, then a 6 month ultrasound follow-up is suggested.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Male; 31 years old. Reason: 31 y/o M with unexplained nausea, vomiting, RUQ u/s requested to rule out gallstones or other etiology History: as above LIVER: The liver has a smooth contour, the parenchyma is normal in echogenicity. It measures 17.7 cm in length. The main portal vein is patent and demonstrates normal direction of flow with a peak velocity of 20 cm/sec.BILIARY TRACT: The gallbladder is unremarkable with no cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The common bile duct measures 2 mm. There is no intrahepatic biliary ductal dilatation.PANCREAS: The visualized head of the pancreas is unremarkable. The body and tail of the pancreas obscured by overlying bowel gas.SPLEEN: The spleen measures 13.2 cm in length.RIGHT KIDNEY: Right kidney measures 10.6 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis. OTHER: The left kidney measures 10.8 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis.", "output": "No cholelithiasis or other ultrasound finding to explain the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female with prior left thyroidectomy for cancer. Evaluate for recurrent disease. RIGHT LOBE MEASUREMENTS: 4.6 x 1.8 x 1.8 cmLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: Heterogeneous in echotexture without focal mass.LEFT LOBE: Post thyroidectomy. No mass identified within the surgical bed.ISTHMUS: Post thyroidectomyPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal-appearing cervical lymph nodes bilaterally.OTHER: No significant abnormality noted.", "output": "No evidence for right thyroid mass. No recurrent disease identified in the left thyroid bed or nodal chains."}
{"instruction": "Generate impression based on findings.", "input": "Goiter with growth, evaluate with thyroid ultrasound RIGHT LOBE MEASUREMENTS: 8 x 3.4 x 3.2 cm, heterogenous, mostly unchanged from prior exam when it measured 8.5 x 3.1 x 2.7 cmLEFT LOBE MEASUREMENTS: 10.1 x 4 x 5.6 cm, heterogenous and increased in size from prior examination when it measured 9.2 x 5.8 x 3.7 cm.ISTHMUS MEASUREMENTS: 2 cmRIGHT LOBE: 2 adjacent solid hypoechoic nodules identified in the right lobe, upper pole nodule measures 4.4 x 2.6 x 3 cm previously measured 3.5 x 3.2 x 2.2 cm. The lower/inferior pole nodule has infraclavicular extension and cannot be completely visualized by ultrasound, now measures 4.6 x 4 cm, previously measured 3.4 x 3.2 x 2.2 cmLEFT LOBE: At least 2 enlarged nodules identified in the left lobe, the upper to midpole nodule has multiple increased microcalcifications in the further evaluation with tissue sampling. It has increased from prior examination, currently measures 5.5 x 3.4 x 4.9 cm, previously measured 5.2 x 5.8 x 3.7 cm. The second solid nodule along the inferior pole measures 4.6 x 4 x 4.3 cm, previous measured 5 x 3.9 x 2.3 cm. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal morphology bilateral neck lymph nodes level 3 noted. Largest lymph node in the right lateral neck measures 2.3 x 0.3 x 1.2 cm.OTHER: No significant abnormality noted.", "output": "1. Multinodular goiter with interval increase in size and microcalcifications within the left upper pole nodule, consider tissue sampling."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female with hepatitis C. Evaluate for hepatocellular carcinoma. LIVER: Mildly and coarsely echogenic. Morphologically normal. No focal hepatic abnormality.BILIARY TRACT: The biliary tract is normal in caliber. Color appears unremarkablePANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Mildly echogenic liver without mass."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old female with pancreatitis evaluation for gallstone pancreatitis or biliary obstruction. LIVER: The liver measures 15.2 cm in length. There are some areas of coarse increased echogenicity within the liver. There are no dilated ducts within the liver seen. The portal vein is patent with hepatopedal flow measuring 27.8 cm/s. BILIARY TRACT: The gallbladder is visualized without stones or significant sludge. The gallbladder wall measures 0.3 cm. The common bile duct measures 0.3 cm. PANCREAS: No obvious complications of acute pancreatitis are seen, such as fluid collections or pancreatic duct dilatation.SPLEEN: The spleen measures 9.5 cm. No significant abnormalities are noted.KIDNEY: The right kidney measures 9.95 cm. The renal cortex is normal in echogenicity. No worrisome masses, hydronephrosis, or stones are seen. The left kidney measures 11.3 cm. The cortex of the left kidney is normal echogenicity, there is no any masses, hydronephrosis, or stones seen in the left kidney.", "output": "1. No obvious complications of acute pancreatitis are noted on this study. There are no peripancreatic fluid collections and no dilation of the pancreatic duct. The common bile duct is within normal caliber, and no gallstones are seen.2.There are some areas of mild coarse increased echogenicity within the liver which may represent possible fatty infiltration/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female presents with evaluation of thyroid nodule. RIGHT LOBE MEASUREMENTS: 2.1 x 1.8 x 4.9 cm.LEFT LOBE MEASUREMENTS: 2.2 x 2.0 x 5.2 cm.ISTHMUS MEASUREMENTS: 0.2 cm.RIGHT LOBE: Multiple benign-appearing nodules in the right thyroid the largest of which measures approximately 0.6 x 0.4 x 0.6 cm, appear unchanged since the prior exam.LEFT LOBE: A nodule measuring approximate 1.2 x 1.3 x 2.0 cm is \"taller than it is wide\". It has a mixed echogenicity. There are well-defined borders. It appears unchanged since the prior examination, though given this morphology would recommend biopsy.ISTHMUS: Benign-appearing nodule measuring approximately 1.3 x 0.8 x 1.1 cm, appears unchanged since the prior examination.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Suspicious nodule in the left thyroid. Recommend biopsy."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old male with acute renal failure. Tubular necrosis. Ultrasound guidance was provided for biopsy of the patient's left kidney.", "output": "Ultrasound guidance."}
{"instruction": "Generate impression based on findings.", "input": "Reason: History of left lobectomy. Now with fullness neck sensation. Assess Right lobe. RIGHT LOBE MEASUREMENTS: 2.3 x 1.3 x 4.9 cm.LEFT LOBE MEASUREMENTS: Status post left lobectomy.ISTHMUS MEASUREMENTS: 0.1 cm in AP diameter.RIGHT LOBE: The right thyroid lobe appears diffusely heterogeneous. There is a mixed cystic and solid subcentimeter nodule in the mid pole measuring 0.5 x 0.4 x 0.5 cm without calcifications, favored benign.LEFT LOBE: Status post left lobectomy without evidence of disease recurrence.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is no regional lymphadenopathy.OTHER: No significant abnormality noted.", "output": "1. Diffusely heterogeneous right thyroid with a subcentimeter mixed cystic and solid nodule which is favored to be benign.2. Status post left lobectomy without evidence of disease recurrence or regional lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Thigh hematoma. Downtrending hemoglobin. Low GFR. Increasing BUN. RIGHT KIDNEY: 10.3 cm in length. Lobular renal cortex, suggestive of scarring. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 9.7 cm in length. Lobular renal cortex, suggestive of scarring. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: Collapsed. Foley catheter identified.OTHER: No significant abnormality noted. No perinephric collection identified.", "output": "1. Lobular renal cortices, compatible with scarring.2. No perinephric collection identified to suggest hematoma. "}
{"instruction": "Generate impression based on findings.", "input": "Female 57 years old; Reason: Evaluate for etiology of nausea with RUQ ultrasound History: Constant nausea LIVER: The liver measures 16.5 cm in length. There is increased echogenicity of the liver parenchyma. In the left lobe hepatic cyst is seen measuring 1.9 cm x 1.5 cm x 1.6 cm. A hepatic cyst is seen in the right lobe of the liver on the periphery measuring 3.0 cm x 3.7 cm x 3.4 cm. Another smaller hepatic cysts seen in the right lobe measuring 1.0 cm x 1.1 cm x 1.2 cm. The main portal vein is patent with normal hepatopetal flow measured at 25.9 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.0 mm. Multiple shadowing stones are seen. No sonographic Murphy sign. No pericholecystic fluid. The common bile duct measures 5.0 mm in diameter. No intrahepatic ductal dilation is seen.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9.1 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.6 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.5 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. Cholelithiasis is seen without evidence of acute cholecystitis.2. The liver is increased echogenicity compatible with hepatocellular dysfunction/fatty infiltration. Focal hepatic cysts are seen in the right and left lobes."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Coarse echogenic liver without mass. Liver length 18.6 cmGALLBLADDER, BILIARY TRACT: Moderate bilobar intrahepatic ductal dilatation associated with extrahepatic ductal dilatation. Maximal diameter of common bile duct 1 cm. The distal common bile duct is obscured by gas. Status post cholecystectomy.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.9 cm in lengthOTHER: Left kidney 10.4 cm in length. Spleen 8.3 cm in length", "output": "Coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass. Status post cholecystectomy. Moderate bilobar intrahepatic ductal dilatation associated with extra hepatic biliary dilatation. The distal bile duct is obscured by gas; cannot evaluate for the presence of the distal obstructing lesion. Would recommend correlation with dedicated cross sectional imaging as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Reason: US of liver, evaluate for radiographic evidence of cirrhosis History: hepatitis C LIVER: The liver measures 15.3 cm in length and smooth 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 0.21 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 6 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: The spleen is mildly prominent measuring 12.3 cm in length. RIGHT KIDNEY: Kidney measures 10.9 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.5 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No ascites.", "output": "Mildly increased hepatic echogenicity suggestive of chronic liver disease without focal lesions identified."}
{"instruction": "Generate impression based on findings.", "input": "Male; 52 years old. Reason: r/o adenopathy, recurrence History: h/o thyroid cancer. 1 year follow up study RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: No suspicious mass in the right thyroid bed.LEFT LOBE: Redemonstrated 3 x 3 x 6 mm hyperechoic focus in the left thyroid bed (previously 4 x 3 x 5 cm), unchanged. A new 4 x 3 x 5 mm hypoechoic lesion with flow on color Doppler is seen in the left thyroid bed.ISTHMUS: No suspicious mass in the isthmus bed.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right: Level 6 lymph node measures 6 x 3 x 7 mm with increased vascularity.Left: A 3 x 3 x 4 mm level 4 and a subclavicular 5 x 3 x 4 mm lack a normal fatty hilum.OTHER: No significant abnormality noted.", "output": "Abnormal lymph nodes and a new lesion in the left thyroid bed suspicious for recurrence. The thyroid bed lesions are small and may not be amenable to biopsy. The lymph nodes are amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Generalized abdominal pain LIVER: Mild hepatomegaly. Heterogeneous echotexture without mass. Liver length 18.1 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9.3 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 13.4 cm in lengthOTHER: Upper pole left renal cyst. Left kidney 11.3 cm in length. No ascites.", "output": "Mild hepatomegaly and heterogeneous liver echotexture suggestive for fatty infiltration without mass or ductal dilatation. Unremarkable gallbladder. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "31 years old, Female, Reason: Needs U/S of Thyroid - Rule Out Thyromegaly vs. Other. History: Dysphagia. Sticking Sensation in Throat. RIGHT LOBE MEASUREMENTS: 3.7 x 1.1 x 1.7 cmLEFT LOBE MEASUREMENTS: 3.7 x 1.1 x 1.5 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: No significant abnormality noted. Homogeneous echotexture of the thyroid lobe without evidence of nodules.LEFT LOBE: No significant abnormality noted. Homogeneous echotexture thyroid lobe without evidence of nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No evidence of thyromegaly or thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old male history of right inguinal hernia repair 2007 with persistent right groin pain Flow within the femoral artery and vein appears patent and in the appropriate direction. Several benign-appearing lymph nodes with a fatty hilum are identified. Images with and without Valsalva were taken and no evidence of hernia are present.", "output": "No evidence for a recurrent right inguinal hernia are seen sonographically."}
{"instruction": "Generate impression based on findings.", "input": "Male, 28 years old. Groin pain, difficulty voiding, hematuria. RIGHT KIDNEY: The right kidney measures 11.5 cm in length, with normal cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.0 cm in length, with normal cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The bladder is distended, without significant wall thickening or debris.", "output": "Distended bladder. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Female 76 years old Reason: r/o problem with the gallstones History: abd pain with nausea. CT in the past showed gallstones. her pain is mid abd LIVER: Questionable nodular contour of the liver, which may indicate hepatic disease. No focal hepatic mass. Liver measures 18.1 cm. Main portal vein is patent with normal directional flow and peak velocity of 16.5 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Gallstones are present within the gallbladder. No evidence of acute inflammation. Common bile duct measures 2 mm.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas. .SPLEEN: Spleen is normal in appearance measuring 10.2 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 10.3 cm. Left kidney measures 10.3 cm.OTHER: No significant abnormalities noted.", "output": "1.Cholelithiasis without evidence of acute cholecystitis. 2.Questionable nodular contour of the liver, which may indicate chronic hepatic disease. Recommend correlation with lab values."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with history of left renal mass. Please evaluate change. RIGHT KIDNEY: Right kidney measures 10.6 cm in length. No evidence of hydronephrosis, renal mass, or shadowing renal stone.LEFT KIDNEY: Left kidney measures 11.2 cm in length. Left renal cyst is noted in the interpolar region of the left kidney. An exophytic protrusion of the interpolar region of the left kidney measures 1.0 x 0.7 x 1.0 cm. This may represent normal parenchyma, cyst, or underlying lesion.OTHER: Bladder is unremarkable.", "output": "Indeterminate left renal lesion; follow-up by CT rather than ultrasound is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Female; 63 years old. Reason: Rising creatinine, decreased urine output, hematuria 3 days ago History: Rising creatinine recent stem cell transplant on chemo. RIGHT KIDNEY: Right kidney measures 9.6 cm in length. Renal cortex is normal in echogenicity. There is no hydronephrosis, shadowing renal stone, suspicious mass.LEFT KIDNEY: The left kidney measures 12.4 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis, shadowing renal stone or suspicious mass.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "No hydronephrosis."}
{"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. Bilateral simple cysts are identified. No suspicious cystic or solid mass is identified.This exam was interpreted by two radiologists.", "output": "Simple cysts of both breasts. No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "HBV LIVER: Mildly heterogeneous liver echotexture without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 21 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 11.7 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 12.7 cm in lengthOTHER: Left kidney 12.6 cm in length. No ascites.", "output": "Heterogeneous liver echotexture with mild hepatomegaly again noted without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Male; 39 years old. Reason: s/p orchiectomy for relapsed ALL on 3/2/15 with persistent severe pain of unclear cause. Exclude hematoma or other History: pain RIGHT TESTIS: 3.6 by 2.6 x 2.7 cm. Normal vascularity. Within the right testicle at the level of the previously seen hypoechoic lesion is a 1.5 x 1.6 x 2.1 cm hyperechoic focus with an internal hypoechoic portion. LEFT TESTIS: 4.2 x 2.2 x 2.6 cm. Normal echotexture and vascularity. The previously seen hypoechoic lesion is no longer identified. Dystrophic appearing calcifications redemonstrated.RIGHT EPIDIDYMIS: 5.9 x 2.6 x 4.4 cm and hypervascular.LEFT EPIDIDYMIS: 2.9 x 0.7 x 1.3 cm, normal in appearance.OTHER: Edema in the soft tissues of the right groin and in the area of the incision but no drainable fluid collection.Orchiopexy clips noted on the right.Small right and minimal left hydrocele.", "output": "Findings compatible with acute epididymitis on the right.Postsurgical changes in the right groin and testicle. Heterogeneous 1.6 cm hyperechoic focus with hypoechoic component in the testicle, entity most likely reflects a hematoma given patient's history, correlation with patient's procedural history recommended to confirm interval removal of entirety of previously seen focal hypoechoic lesion in right testicle, abscess is considered less likely as there is no evidence of increased vascularity.Interval resolution of hypoechoic left testicle lesion.Findings discussed with Dr Artz by telephone at 4:50 pm."}
{"instruction": "Generate impression based on findings.", "input": "Short term follow-up ultrasound for a probable area of fat necrosis. Per the patient, this area was easily palpable in the past and has now completely resolved to her. A targeted left ultrasound was performed at the site of the previously palpable abnormality. At the site of previous palpable concern, in the left breast 10:00 position, there is a mixed echogenicity circumscribed lesion with hyperechoic components measuring 5 x 4 mm compatible with resolving fat necrosis/oil cyst formation. Note that though the current measurements are slightly larger than the prior measurements reported, the prior measurements included only the central cystic component and not the surrounding hyperechoic fat necrosis. When the surrounding hyperechoic areas included on the old exam, the finding previously measured up to 9 mm.", "output": "Resolving fat necrosis/oil cyst formation. As long as the patient's physical examination remains normal and no palpable abnormality can be re-appreciated at this site, routine clinical follow-up is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female patient with neck pressure, difficulty swallowing, known left thyroid nodule with significant family history. Evaluate for thyroid nodule size and location, and abnormal lymph nodes. RIGHT LOBE MEASUREMENTS: 4.2 x 1.9 x 1.7 cm.LEFT LOBE MEASUREMENTS: 3.5 x 1.4 x 1.4 cm.ISTHMUS MEASUREMENTS: 0.2 cm RIGHT LOBE: The right thyroid lobe is normal in echogenicity without focal lesion.LEFT LOBE: The left thyroid lobe is normal in echogenicity without focal lesion.ISTHMUS: There is a circumscribed, ovoid, hypoechoic lesion within the left lateral aspect of the isthmus measuring approximately 0.8 x 0.5 x 0.9 cm. This lesion has internal vascularity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There are two subcentimeter right level three and level four lymph nodes. Subcentimeter left level three and level four lymph nodes are present.OTHER: No significant abnormality noted.", "output": "Solid left lateral isthmus thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male with history of renal mass, evaluate for change in size. RIGHT KIDNEY: Measures 10.9 cm in length. Unchanged 2.1 cm right renal cyst without septation or suspicious nodular component. No hydronephrosis. Increased renal echogenicity.LEFT KIDNEY: Measures 11.1 cm in length. Solid left upper pole mass measures 1.9 x 1.8 x 1.7 cm on today's study, not significantly changed compared with the previous examination. A left lower pole renal cyst is also unchanged. Increased renal echogenicity.OTHER: No significant abnormalities noted.", "output": "No significant interval change in left upper pole renal mass, which remains suspicious for malignancy."}
{"instruction": "Generate impression based on findings.", "input": "Patient complains of tender palpable areas of concern in each outer breast. Family history of breast cancer in her mother at age 37. A targeted bilateral ultrasound was performed for the patient\u2019s identified areas of concern. There is no solid or cystic mass identified. Areas of dense breast tissue are seen, appearing similar to breast tissues in other portions of her breasts.", "output": "Sonographic appearance compatible with dense breast tissue, but no focal mass lesion at the patient's palpable tender areas of concern. Clinical correlation is recommended to ensure physical exam findings are concordant with this exam.Also recommended is referral to cancer risk clinic, given her family history. The patient may benefit from genetic testing and or additional imaging with MRI.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old male with history of alcohol abuse. LVAD workup. Evaluate for cirrhosis. LIVER: Liver is enlarged measuring 21 cm in length and appears moderately echogenic which is non---- specific. There is no focal hepatic abnormality. There is relative enlargement of the left and caudate lobes suggestive cirrhosis. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder appears unremarkable without cholelithiasis, wall thickening or pericholecystic fluid. Visualized portions of the biliary tract are normal in caliber.PANCREAS: Limited due to bowel gas.RIGHT KIDNEY: The right kidney measures 10.8 cm in length and is mildly echogenic consistent with parenchymal disease.OTHER: Left kidney is also echogenic consistent with parenchymal disease measuring approximately 10.5 cm in length with a 3 cm exophytic simple cyst. Splenic size is within normal limits. Small amount of ascites.", "output": "Cirrhotic-appearing liver with small amount of ascites.Echogenic kidneys."}
{"instruction": "Generate impression based on findings.", "input": "Left thyroid nodule RIGHT LOBE MEASUREMENTS: 1.9 x 1.3 x 4.4 cmLEFT LOBE MEASUREMENTS: 1.7 x 1.4 x 4.7 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: 1.2 x 0.8 x 1.5 cm mixed cystic and solid inferior left thyroid noduleISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Mixed cystic and solid inferior left thyroid nodule. This nodule will be biopsied today."}
{"instruction": "Generate impression based on findings.", "input": "Male, 28 years old. Elevated LFTs, h/o Crohn's disease, on MTC. LIVER: The liver measures 13.2 cm, with mildly heterogeneous echotexture, and no focal lesion.The main portal vein is patent, with normal hepatopetal flow.GALLBLADDER, BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilatation. The common bile duct measures 0.2 cm. Gallbladder wall thickness is normal. No stones.PANCREAS: The visualized portions of the pancreas are normal.RIGHT KIDNEY: 11.1 cm in length, with normal echotexture. No shadowing stones or hydronephrosis.LEFT KIDNEY: 10.8 cm in length, with normal echotexture. No shadowing stones or hydronephrosis.SPLEEN: 9.8 cm in length, without focal lesion.OTHER: No significant abnormalities noted.", "output": "Mildly heterogeneous liver echotexture, suggestive of fatty infiltration or parenchymal dysfunction. No masses, evidence of acute cholecystitis, or other acute abnormality."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with question of thyroid nodule RIGHT LOBE MEASUREMENTS: 4.7 x 1.5 x 1.5 cmLEFT LOBE MEASUREMENTS: 5.0 x 1.4 x 1.3 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Tiny benign subcentimeter cystic nodules.LEFT LOBE: Tiny benign subcentimeter cystic nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Tiny benign subcentimeter cystic nodules. No suspicious lesions identified. "}
{"instruction": "Generate impression based on findings.", "input": "50 year-old female with history of thyroid cancer status post thyroidectomy. Evaluate for growth of lesions or other adenopathy, or any suspicious lesions that would be amenable to FNA. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Hypoechoic nodule inferior to the right thyroidectomy bed is again seen measuring 5 mm x 5 mm x 4 mm, previously 4 mm 4 mm x 4 mm. Additional hypoechoic nodule inferior to the right thyroidectomy bed and posterior to the right carotid artery measures 8 mm x 5 mm x 5 mm, previously 9 mm x 5 mm x 6 mm.LEFT LOBE: No nodules in the thyroidectomy bed.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right neck level 5 benign appearing lymph node measures one 1.0 cm x 0.3 cm x 1.0 cm. No pathologic lymphadenopathy. OTHER: No significant abnormality noted.", "output": "Two hypoechoic nodules, one within and one adjacent to the right thyroidectomy bed are unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Left flank pain RIGHT KIDNEY: 9.3 cm in length. Mildly echogenic renal parenchyma. 19 mm benign-appearing cyst noted in the midpole. No renal stone identified. No suspicious lesions. No hydronephrosis.LEFT KIDNEY: 10.8 cm in length. Mildly echogenic renal parenchyma. 13 mm benign-appearing cyst noted in the inferior pole. No renal stone identified. No suspicious lesions. No hydronephrosis.BLADDER: No significant abnormality noted.OTHER: No significant abnormalities noted.", "output": "No specific findings to account for the patient's flank pain."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain and tenderness. LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No intrahepatic biliary ductal dilation. Subcentimeter gallstones identified. Mild dilation of the common bile duct up to 8 mm, previously 7 mm. No choledocholithiasis evident. No gallbladder wall thickening, pericholecystic fluid, or sonographic Murphy 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 11.5 cm in length. The left kidney is 11.3 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 11.9 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid identified.", "output": "1. Cholelithiasis without evidence of cholecystitis.2. Mild dilation of the common bile duct, also seen on 10/12/2015 when patient presented with similar symptoms. Correlation for obstructive pattern of liver function tests and possibly MRCP may be considered."}
{"instruction": "Generate impression based on findings.", "input": "42 year-old female with Murphy's, questionable wall thickness, positive stone. Evaluate for cholecystitis. LIVER: Increased 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 0.4 m/sec.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. Common duct measures 5 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: Measures 9.0 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 8.2 cm in length. No hydronephrosis or shadowing calculi are noted.Normal echogenicity of the spleen measuring 6.6 cm in length.", "output": "Increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. No sonographic evidence of cholelithiasis or cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female with history of thyroid nodules. Evaluate stability. RIGHT LOBE MEASUREMENTS: 1.1 x 1.2 x 4.3 cmLEFT LOBE MEASUREMENTS: 1.0 x 1.3 x 3.7 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: There again noted several hypoechoic nodules in the right thyroid. Previously noted nodule in the upper pole measures 0.4 x 0.6 x 0.8 cm without change. Other smaller nodules appear unchanged as well as. Lobe is heterogeneous in echotexture.LEFT LOBE: There again noted several hypoechoic nodules in the left lobe. Previously measured mildly complex nodule in the upper pole measures 0.3 x 0.4 cm x 0.8 cm, slightly increased in size.ISTHMUS: Right ovoid and mildly echogenic isthmus nodule measures 0.4 x 0.9 x 1.2 cm without change.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Slight increase in upper pole nodule on the left. Otherwise, stable thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "23-year-old female patient with tenderness to palpation and right upper quadrant abdominal pain. Previous sludge ultrasound. LIVER: The liver measures 13.8 cm in length. 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 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 9.8 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.2 cm in length. No evidence of hydronephrosis.The spleen measures 10.7 cm in length.", "output": "No specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old male patient with frequent nausea, undergoing cardiac transplant evaluation. LIVER:The liver measures 16.0 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/s.GALLBLADDER, BILIARY TRACT: No gallstones, gallbladder wall thickening, or pericholecystic fluid is identified. There is no intra or extra hepatic biliary ductal dilatation. The common duct measures 4 mm in diameter.PANCREAS: No significant abnormality noted.SPLEEN: The spleen measures 8.3 cm in length.KIDNEYS: The right kidney measures 10.0 cm in length and the left kidney measures 10.0 cm in length. No evidence of hydronephrosis. ABDOMINAL AORTA: The proximal aorta measures 2.6 x 3.0 cm in diameter, the mid aorta measures 2.3 x 2.0 cm, and the distal aorta measures 2.0 x 2.1 cm.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: The bladder is distended with fluid.", "output": "No acute sonographic findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female with transaminitis. Evaluate for fatty liver. LIVER:Measures approximately 16.4 cm. Normal echotexture. Hyperechoic foci measuring approximately 0.7 x 1.0 x 0.6 cm in the right lobe of uncertain etiology. No ascites or intrahepatic biliary dilation.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. The wall measures 0.1 cm. No pericholecystic fluid, stones, or sludge. The common bile duct measures 0.2 cm.PANCREAS: Evaluation of the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 10.2 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 9.3 cm. Left kidney measures 11.6 cm. Normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "1. Hyperechoic foci in the right lobe of the liver as described above statistically favors a benign entity, such as a hemangioma, however it is incompletely characterized on this study. Given the patient's personal history of breast cancer, dedicated cross-sectional imaging may be helpful if further characterization is desired."}
{"instruction": "Generate impression based on findings.", "input": "History of bladder stones RIGHT KIDNEY: No significant abnormalities noted. No evidence for mass, stone, or hydronephrosis. 11.7 cm in lengthLEFT KIDNEY: No significant abnormalities noted. No evidence for mass, stone, or hydronephrosis. 12 cm in lengthOTHER: Bladder nondistended. Multiple subcentimeter bladder stones again noted. Enlarged prostate again noted.", "output": "No change in multiple subcentimeter bladder stones. No evidence for renal mass, upper tract stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Male, 77 years old. UTI. Evaluate for urinary obstruction. RIGHT KIDNEY: The right kidney measures 11.5 cm in length, with normal cortical echogenicity. An upper pole exophytic simple cystic structure measures 1.5 x 1.3 x 1.4 cm. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.7 cm in length. A mid pole cystic structure measures 1.6 x 1.4 x 1.7 cm, with suggestion of peripheral soft tissue nodularity. No shadowing stones or hydronephrosis.OTHER: The bladder is decompressed.", "output": "1.No hydronephrosis.2.A 1-2 cm left renal cyst with suggestion of a peripheral soft tissue nodular component. Follow-up contrast enhanced CT is recommended for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Female 76 years old; Reason: eval for cirrhosis and splenomegaly History: low albumin, elevated INR LIVER: The liver measures 12.8 cm in length. There is 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. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.5 mm. No stones are seen. Pericholecystic fluid is seen. The common bile duct measures 2.6 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 6.2 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 9.7 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen. A right renal cyst is seen and is unchanged when compared to the prior study.LEFT KIDNEY: The left kidney measures 9.0 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: Small bilateral pleural effusions.", "output": "1. Liver echotexture could be compatible with cirrhosis in the correct clinical context.2. Ascites3. Bilateral pleural effusions.4. Echogenic small kidneys without obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: Markedly coarse echogenic liver echotexture without obvious mass. Liver length 20.1 cm. Limited interrogation of the main portal vein by Doppler demonstrates a patent 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. 11.2 cm in lengthOTHER: Left kidney 11 cm in length. Spleen 12.4 cm in length. No ascites.", "output": "Markedly coarse echogenic liver echotexture consistent with fatty infiltration/parenchymal dysfunction associated with moderate hepatomegaly. While no obvious mass is appreciated, this degree of fatty infiltration diminishes the sensitivity of ultrasound to detect a subtle mass lesion.Gallbladder sludge without acute inflammation or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain. Nausea and vomiting. LIVER: The liver parenchyma is mildly coarse and echogenic. The liver measures 16.2 cm in craniocaudal dimension. In the left hepatic lobe there is a 4.8 x 4.0 x 4.5 cm hypoechoic lesion with enhanced through transmission and small septations likely representing a complex cyst. Additional 1.1 cm left hepatic lobe cyst. Right hepatic lobe 2.6 x 1.9 x 1.9 cm lobular septated cyst.Normal hepatopedal portal venous blood flow at 0.2 m/s.BILIARY TRACT: The common duct is normal in caliber measuring 3 mm.The gallbladder is normally distended without wall thickening pericholecystic fluid or focal tenderness. There are small mobile shadowing gallstones.PANCREAS: The partially visualized pancreatic head and neck is unremarkable. The main pancreatic duct is normal in caliber. The remainder the pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen is normal in size measuring 8.7 cm without a discrete lesion.RIGHT KIDNEY: The right kidney measures 10.5 cm in length without hydronephrosis or shadowing nephrolithiasis. OTHER: The left kidney measures 12.1 cm in length without hydronephrosis or shadowing lithiasis.", "output": "1. Coarse and echogenic liver parenchyma suggestive of steatosis.2. Several hepatic cysts some of which are minimally complex.3. Cholelithiasis without specific evidence of acute cholecystitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "82-year-old male with hematuria. RIGHT KIDNEY: Measures 9.8 cm. Mildly echogenic parenchyma. No shadowing calculi, hydronephrosis, or focal mass.LEFT KIDNEY: Measures 10.6 cm. Mildly echogenic parenchyma. No shadowing calculi, hydronephrosis, or focal mass.URINARY BLADDER: Bladder is nondistended.OTHER: Large prostate.", "output": "1. Echogenic kidneys consistent with medical renal disease/parenchyma dysfunction. No hydronephrosis.2. Prostatomegaly."}
{"instruction": "Generate impression based on findings.", "input": "History of proteinuria and hematuria, ultrasound guidance for renal biopsy. Ultrasound guidance was provided for percutaneous biopsy of left kidney. Three passes were performed.", "output": "Ultrasound guidance for percutaneous biopsy of left kidney."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B LIVER: Stable segment 2 hemangioma measuring 1.6 x 1.4 cm. Stable right lobe hepatic cyst. Mildly coarse liver echotexture. Liver length 11.8 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.8 cm in lengthOTHER: Left kidney 11.3 cm in length. Spleen 6.5 cm in length. No ascites", "output": "Mildly coarse liver echotexture suggestive for chronic liver disease without worrisome mass or ductal dilatation. No ascites. Stable left lobe hemangioma and right lobe hepatic cyst."}
{"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 female patient with elevated INR, hyperammonemia, altered mental status, leukocytosis, sepsis. Evaluate hepatic vasculature, ducts for cause of synthetic liver failure. Study is limited secondary to patient body habitus. LIMITED ABDOMENLIVER: The liver measures 23.8 cm in length and demonstrates increased parenchymal echogenicity.BILIARY TRACT: The gallbladder is surgically absent. There is no definite intra or extrahepatic biliary ductal dilatation. The common duct measures 5 mm in diameter.PANCREAS: The pancreas is not visualized on this examination.SPLEEN: The spleen measures 8.6 cm in length. RIGHT KIDNEY: The right kidney measures 10 cm in length. No evidence of hydronephrosis.OTHER: The left kidney measures 10.9 cm in length. No definite evidence of hydronephrosis.", "output": "1. Limited study though with hepatomegaly and increased hepatic parenchymal echogenicity which can be seen with hepatic parenchymal dysfunction/hepatic steatosis.2. Patent hepatic vasculature. "}
{"instruction": "Generate impression based on findings.", "input": "Abnormal gallbladder seen on recent CT BILIARY TRACT: Cholelithiasis with trace pericholecystic fluid and mild diffuse gallbladder wall thickening. Negative Murphy's sign. No ductal dilatation.OTHER: No significant abnormalities noted.", "output": "Cholelithiasis with trace pericholecystic fluid and mild diffuse gallbladder wall thickening. Negative Murphy's sign. Findings are suggestive for chronic gallbladder inflammation; equivocal evidence for acute inflammation."}
{"instruction": "Generate impression based on findings.", "input": "Cholecystitis in the past. Declined operative intervention. 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. 1-2 cm gallstones identified. No gallbladder wall thickening, pericholecystic fluid, or definite 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 10.2 cm in length. The left kidney is 12.5 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 10.1 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid.", "output": "Cholelithiasis without specific evidence of cholecystitis."}
{"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. Dolehide is a 29-year-old female patient with mass felt by primary care physician in the 10:00 position of the right breast. Patient cannot feel lump. Physical exam was performed and no palpable abnormality was felt. A targeted right ultrasound was performed in the area of concern. There is no solid or cystic mass identified.", "output": "Normal glandular tissue seen in the right upper outer breast. No sonographic evidence for malignancy. If there is continued clinical concern for a mass, the palpable area of concern can be marked on the skin and a repeat ultrasound can be performed. 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 recommendations were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Renal failure RIGHT KIDNEY: The right kidney measures 11.6 cm in length. Echogenic renal parenchyma. Multiple anechoic cysts are again seen, the largest right upper pole cyst measures 2.9 x 2.5 x 2.7 cm. No hydronephrosis or shadowing stones.LEFT KIDNEY: The left kidney measures 10.4 cm in length. Echogenic renal parenchyma. Left lower pole cyst measures 5.9 x 5.7 x 4.9 cm, increased in size compared to prior exam. No hydronephrosis or shadowing stones.OTHER: The bladder is decompressed, limiting its evaluation.", "output": "1. Echogenic renal parenchyma, consistent with medical renal disease.2. Multiple large simple bilateral renal cysts, stable to mildly increased in size."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female. Recall from screening for a small mass in the right lower inner quadrant. 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, unchanged in pattern and distribution. The circumscribed small round mass in the lower inner quadrant of the right breast persisted on spot compression views.RIGHT BREAST ULTRASOUND: Targeted ultrasound of the right lower inner quadrant showed an anechoic 3 x 3 mm focus without internal vascularity in the retroareolar region at 5:00 o'clock, most likely a cyst and corresponding to the mass seen on mammography.", "output": "Small mass in the right lower inner quadrant on mammography most likely corresponds to a cyst. Ultrasound guided aspiration is recommended to confirm that it is a cyst. The results and recommendations were discussed with the patient at the completion of the exam, and the patient elected to schedule the ultrasound-guided aspiration.BIRADS: 3 - Probably benign finding.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Reason: gallbladder, cholelithiasis on CT, now pain in RUQ LIVER: The liver measures 15.2 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 0.29 m/s.BILIARY TRACT: Cholelithiasis including large gallstone without associated 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 4 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 6.9 cm in length. RIGHT KIDNEY: Right pelvic kidney measures 9.9 cm in length. Increased cortical echogenicity. No hydronephrosis.LEFT KIDNEY: Kidney measures 11.6 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Cholelithiasis without sonographic evidence of acute cholecystitis or biliary ductal dilatation. 2.Increased hepatic echogenicity raising the possibility of parenchymal dysfunction/fatty infiltration.3.Increased echogenicity of right pelvic kidney raising the possibility of medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old male with a history of brain cancer in remission. Smoking. Presents with left neck palpable abnormality. Targeted ultrasound was performed of the patient's left neck palpable abnormality. The abnormality corresponds to an asymmetric prominence of the tubercle of the left greater cornu of the hyoid bone when compared to the right. There is no soft tissue abnormality or lymphadenopathy.", "output": "The palpable abnormality corresponds to an asymmetric prominence of the tubercle of the greater cornu of the hyoid bone; of no clinical significance. No soft tissue mass or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Mobile subcutaneous palpable mass in the posterior aspect of the occipital scalp. Targeted grayscale and color Doppler ultrasound of the occipital scalp showed no discrete fluid collection or mass. Significant acoustic shadowing limits evaluation of the soft tissue.", "output": "No discrete fluid collection or mass. Study limited by significant acoustic shadowing."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old female patient with abdominal pain. LIVER: The liver measures 12.3 cm in length. There is a subcentimeter cyst within the left hepatic lobe. The liver parenchyma is echogenic. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. No intra- or extrahepatic biliary ductal dilatation is identified. The common bile duct measures 6 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 10.1 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.9 cm in length. No evidence of hydronephrosis.The spleen measures 7.5 cm in length.", "output": "1. Echogenic hepatic parenchyma which can be seen with hepatic steatosis. 2. Simple left hepatic cyst."}
{"instruction": "Generate impression based on findings.", "input": "Persistent frequency and pressure following UTI. The prevoid bladder volume is approximately 200 mL. The post void bladder volume is approximately 12 mL. No significant abnormality is identified.", "output": "No significant postvoid residual identified."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old male with history of hepatitis B. Evaluate for HCC. LIVER:Measures 14.5 cm. Parenchyma is coarse and echogenic. There is approximately 1.3 x 1.0 hyperechoic lesion seen in the right lobe that was not present on the prior study. It was only able to be imaged in one oblique plane. Otherwise, no ascites or intrahepatic biliary dilation. Portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: Gallbladder is nondistended. The wall measures 0.2 cm. No stones, sludge, or pericholecystic fluid. The common bile duct measures 0.2 cm.PANCREAS: Unable to fully evaluate due to overlying bowel gas.SPLEEN: Measures 11.0 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 10.1 cm. Kidney measures 10.8 cm. Kidneys are mildly echogenic. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "1. Hyperechoic lesion seen in the right lobe of the liver that was not present on the prior study of uncertain etiology. Further characterization with MRI is recommended.2. Increased, coarse echotexture of liver consistent with chronic liver disease/parenchymal dysfunction.3. Increased echogenicity of the kidneys consistent with medical renal disease/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Female, 48 years old. Fevers, recurrent UTIs. RIGHT KIDNEY: The right kidney measures 9.8 cm in length, with normal cortical echotexture. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 8.8 cm in length, with normal cortical echotexture. No shadowing stones or hydronephrosis.OTHER: The bladder is incompletely distended. The liver is partially imaged and has increased echogenicity.", "output": "1.Normal sonographic appearance of the kidneys. No hydronephrosis.2.Increased hepatic echogenicity, compatible with fatty infiltration or parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female presents with transaminitis. LIVER:Measures 12.4 cm. Normal echogenicity. No focal mass, intrahepatic biliary dilation, or ascites. Portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: Nondistended with an anechoic lumen. Wall measures 2.5 mm. No stones or sludge. No pericholecystic fluid. Common bile duct measures 6.8 mm.PANCREAS: Evaluation the pancreas is limited due to overlying bowel gas.SPLEEN: Spleen measures 7.5 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 9.2 cm. Left kidney measures 10.4 cm. Normal echogenicity. No shadowing calculi, hydronephrosis, focal mass. OTHER: No significant abnormality noted.", "output": "1. Normal ultrasound of the abdomen without sonographic explanation for patient's elevated liver enzymes."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old female patient with elevated LFTs. Question of nonalcoholic fatty liver disease. LIVER: The liver measures 19.2 cm in length and demonstrates increased hepatic parenchymal echogenicity. A 1.4 x 1.0 x 1.5 cm anechoic lesion within the left hepatic lobe with posterior acoustic enhancement is compatible with a cyst. Main portal vein flow is hepatopetal and measures 0.2 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 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 12.8 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 13.4 cm in length. No evidence of hydronephrosis.The spleen measures 10.9 cm in length.", "output": "1. Increased hepatic parenchymal echogenicity consistent with hepatic steatosis.2. Left hepatic cyst.3. Cholelithiasis without sonographic evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Male; 69 years old. Reason: neutropenic fever abdominal pain please r/o infection LIVER: Liver is 18.3-cm in length. Normal parenchymal echotexture. Minimally complex, predominantly anechoic cystic lesion in the right hepatic lobe measures 3.4 x 2.2 x 2.8 cm with a similar but smaller cystic lesion in the left hepatic lobe, as seen on preceding CT and for which benign etiology is favored. No intrahepatic biliary ductal dilation. Main portal vein is patent with normal directional flow.GALLBLADDER, BILIARY TRACT: Gallbladder is filled with numerous shadowing calculi. No definite gallbladder wall thickening, though evaluation is limited due to the cholelithiasis. No pericholecystic fluid, gallbladder fossa hepatic parenchymal hyperemia, or sonographic Murphy's sign to suggest acute cholecystitis. Normal caliber of the common bile duct measuring 4 mm.PANCREAS: Limited images of the pancreatic head are within normal limits. The remainder of the pancreas obscured by overlying bowel gas.RIGHT KIDNEY: Stable appearance of both kidneys since prior renal ultrasound with the right kidney measuring up to 12.4-cm and a septated cyst seen in the upper pole as well as additional smaller cysts.OTHER: Spleen measures 12.8-cm in length. No focal splenic lesions.", "output": "1. Cholelithiasis without evidence of acute cholecystitis.2. No findings to explain the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male with right flank pain and history of kidney stones. Evaluate for nephrolithiasis. RIGHT KIDNEY: The right kidney measures 12.6 cm in length. Arising from the upper pole is a 3 cm cyst which may be minimally complex and has been identified on prior exams. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 14.5 cm in length and likely has a duplex collecting system. Shadowing, non--- obstructive calculus in the lower pole. No hydronephrosis or mass.OTHER: Within the urinary bladder posterior, focal echogenic foci likely represent stones and there is a small amount of debris as well as. Splenomegaly with echogenic masses as previously noted.", "output": "Nonobstructive left nephrolithiasis and calculi with debris in the urinary bladder.Minimally complex right renal cyst.Splenomegaly with echogenic foci as previously described."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for whole breast ultrasound for dense breast screening. Personal history of benign left breast stereotactic biopsy in 2013 for fibrocystic changes. 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.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Right testicular pain and swelling RIGHT TESTIS: 3.0 x 2.9 x 2.9 cm. Normal parenchymal echotexture. A moderate sized right hydrocele is noted. Subcentimeter extratesticular calcification may represent prior microtrauma or prior torsion of the appendix of the testicle.LEFT TESTIS: 2.8 x 2.6 x 4.2 cm. Normal parenchymal echotexture.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Mobile soft tissue in the right hemiscrotum appears to be bowel, suggestive of an indirect hernia.DOPPLER", "output": "1. No evidence of testicular torsion.2. Right hydrocele.3. Mobile soft tissue in the right hemiscrotum appears to be bowel, suggestive of an indirect hernia."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old male with palpable soft tissue mass involving the lateral, anterior abdominal wall. Region of pelvic abnormality, there is some deep soft tissue asymmetry adjacent to or involving the deep musculature. This is not changed appreciably with Valsalva maneuver. Differential considerations would include hernia, hematoma or less likely soft tissue mass. MR may provide superior soft tissue differentiation.", "output": "Soft tissue asymmetry in the deep subcutaneous tissues of the right abdomen as noted above. MR may provide better characterization."}
{"instruction": "Generate impression based on findings.", "input": "16 year old with palpable lump in right breast. With physical exam, a mobile mass was palpated near the nipple in right breast. Whole breast ultrasound was performed for both breast, by patient's mother's request. In the right breast, there is a circumscribed mass, measuring 19 x 10 mm, at 3 o'clock position, 1 cm from nipple, at the site of palpable lump. Color Doppler study shows a peripheral blood flow. This mass is likely a fibroadenoma. Elsewhere, no solid or cystic mass is present in either breast.", "output": "A palpable lump in the right breast, likely a fibroadenoma. Clinical correlation is recommended. If imaging follow up is clinically indicated, follow up ultrasound in 6 months is recommended. Results and recommendations were discussed with the patient and her mother.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Hepatic steatosis. Renal stones. LIVER: Non-cirrhotic liver morphology. 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 gallbladder.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEYS: Evaluation of the kidneys is limited by poor acoustic penetration. The right kidney is 14.9 cm in length. Several echogenic foci may represent nonobstructing stones, measuring up to 9 mm. No suspicious renal lesions. No hydronephrosis.The left kidney is 14.3 cm in length. Several echogenic foci may represent nonobstructing stones, measuring up to 13 mm. No suspicious renal lesions. No hydronephrosis.BLADDER: No significant abnormality noted.SPLEEN: 9.1 cm in length, without focal lesions evident.ABDOMINAL AORTA: Patent and measuring up to 2.3 cm, without aneurysmal dilation.INFERIOR VENA CAVA: Patent.OTHER: No significant abnormality noted. No significant abdominal free fluid identified.", "output": "1. Hepatomegaly with nonspecific mildly coarsened echogenicity, compatible with parenchymal dysfunction.2. Several echogenic foci in the kidneys bilaterally may represent nonobstructing renal stones, however evaluation of total renal stone burden is limited by ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "Female 79 years old Reason: AKI, history of hydronephrosis, eval for hydro History: see above RIGHT KIDNEY: The right kidney measures 14.3 cm in length and demonstrates increased cortical echogenicity compatible medical renal disease. There is persistent mild hydronephrosis. No nephrolithiasis or ureterolithiasis is evident.LEFT KIDNEY: The left kidney has been removed surgically.OTHER: No significant abnormalities noted.", "output": "1.Persistent mild right hydronephrosis. 2.Increased cortical echogenicity of the right kidney compatible medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female patient with right upper quadrant pain. Evaluate for gallstones or biliary obstruction. LIVER: The liver measures 19.6 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.16 m/sec.GALLBLADDER, BILIARY TRACT: There is biliary sludge, but 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 12.3 cm in length. There is mild to moderate hydronephrosis. Right hydroureter is partially visualized.OTHER: The left kidney measures 12.6 cm in length. There is mild hydronephrosis.The spleen measures 8.1 cm in length.There is trace ascites.The bladder is decompressed by a Foley catheter.", "output": "1. Biliary sludge without sonographic evidence of acute cholecystitis.2. Mild to moderate right and mild left hydronephrosis.3. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Wassenhove is a 87 year female with known left breast cancer undergoing neoadjuvant hormonal therapy. She presents today for follow-up ultrasound to evaluate treatment response. A targeted left breast ultrasound was performed at the site of known malignancy. In the left breast 2:00 location, approximately 4 cm from the nipple, the index malignancy now measures 2.1 x 1.3 x 1.9 cm, compared to 1.6 x 1.1 x 2.0 cm. There continues to be minimal associated vascularity.", "output": "Slight interval increase in known left breast cancer. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "53 year old female with history of hepatitis C and cirrhosis. LIVER: Subtle increased hepatic echotexture, suggestive of hepatic steatosis. No focal masses or other significant abnormality. The liver measures 16.3 cm.GALLBLADDER, BILIARY TRACT: No biliary dilatation or other significant abnormality. Postcholecystectomy.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. The right kidney measures 11.1 cm, and there is a small 0.5-cm right kidney simple cyst.OTHER: No significant abnormalities noted. Left kidney measures 11.7 cm, and is within normal limits.", "output": "Findings suggestive of hepatic steatosis, similar to prior. No focal mass or other significant abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Right thyroid enlargement RIGHT LOBE MEASUREMENTS: 4.9 x 1.7 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.6 x 1.7 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Multiple predominantly cystic and spongiform nodules. The largest within the upper pole measures 0.6 x 0.4 x 0.4 cm.LEFT LOBE: Multiple spongiform nodules. The largest within the lower pole measures 1.1 x 0.5 x 0.8 cm.ISTHMUS: Spongiform nodule within the right isthmus measuring 1.9 x 1 x 1.7 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple bilateral and right isthmic cystic and spongiform nodules; a benign etiology is favored. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old male with renal transplant post biopsy. Evaluate for hematoma. RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: There is a small anterior fluid collection adjacent to the transplanted kidney measuring 1.5 x 1.3 x 3.7 cm. This does not extend to the region of the hilum.KIDNEY: Kidney measures approximately 9.6 cm in length. Echotexture is normal and there is no parenchymal abnormality.COLLECTING SYSTEM/URETER: There is no hydronephrosis.URINARY BLADDER: Not examined.OTHER: No significant abnormality noted", "output": "Small anterior fluid collection adjacent to the transplant kidney."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female with history of thyroidectomy. Evaluate for change in nodes. THYROID: Status post thyroidectomy with no findings to suggest residual or recurrent disease.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Previously noted left supraclavicular, right level 5 lymph nodes are not identified on this current examination.OTHER: No significant abnormality noted.", "output": "No lymph nodes are identified on this current examination. No change in the thyroidectomy bed."}
{"instruction": "Generate impression based on findings.", "input": "Male 61 years old Reason: US-guided FNA to r/o thyroid cancer History: h/o thyroid cancer. also has CLL. now with increasing lesion in left thyroid bed Small mixed solid cystic lesion in the left thyroid bed was targeted.Written informed consent was obtained. Skin was prepped injected in sterile fashion and anesthetized with lidocaine. Cytology was present. Under ultrasound guidance eight 25-gauge fine-needle aspiration biopsy samples were obtained. Preliminary report was done diagnostic final report follow.", "output": "Although targeting of the lesion was successful with good visualization preliminary cytology nondiagnostic full report to follow.Less than 5 cc blood loss. No complications. Patient discharged to home in good condition."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old with grade 2 endometrial cancer, SBO, now resolved with bacteremia LIVER: Liver measures 20.4 cm with increased echogenicity consistent with hepatic steatosis. No focal lesions noted within the liver. Mild intrahepatic biliary ductal dilatation.BILIARY TRACT: Gallbladder is well-distended without any gallstones. No evidence of gallbladder wall thickening. Persistent the dilated common bile duct noted today measuring up to 1 cm, mostly unchanged from the recent CT scan.PANCREAS: Limited evaluation of the head of the pancreas without any abnormality. Tail of the pancreas not visualized due to overlying bowel gas.SPLEEN: Spleen measures 11.3 cm without any focal lesions.RIGHT KIDNEY: Right kidney measures 10.8 cm and left kidney measures 14.4 cm. Both kidneys appear slightly echogenic. OTHER: No significant abnormalities noted.", "output": "Mild bilateral echogenic kidneys.Persistently dilated common bile duct measuring up to 1 cm mostly unchanged from recent CT scan, MRCP can be performed if clinically indicated. Mild intrahepatic blurred ductal dilatation noted. Gallbladder appears unremarkable without cholelithiasis.Hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old female with protruding palpable mass in epigastric region. 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": "Ms. David is a 40 year old female with a personal history of left breast lumpectomy in 2014 for IDC followed by adjuvant chemotherapy and radiation. She 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. Unfortunately, due to a technical error, the top half of the skin/breast anatomy is not included in the field-of-view on imaging.", "output": "Technical repeat necessary due to incomplete evaluation of both breasts. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: R - Technical Repeat Views."}
{"instruction": "Generate impression based on findings.", "input": "Congestive heart failure. Elevated LFTs. LIVER: Non-cirrhotic liver morphology. Increased parenchymal echogenicity. 19 cm in length. No focal hepatic lesions. Normal direction of portal venous blood flow, with pulsatility and distended hepatic veins compatible with right heart failure.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. No cholelithiasis. The gallbladder wall is thickened, which may be seen in the setting of ascites. 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 8.0 cm in length. The renal parenchyma is echogenic. No suspicious renal lesions are evident. No hydronephrosis is present.The left kidney is 8.8 cm in length. The renal parenchyma is echogenic. There is a 5.3 cm solid and cystic mass at the inferior pole. No hydronephrosis is present.SPLEEN: 14.9 cm in length, without focal lesions evident.OTHER: Mild ascites is noted. Right pleural effusion, partially imaged.", "output": "1. Hepatomegaly with increased hepatic echogenicity compatible with parenchymal dysfunction. Multiple additional findings compatible with of congestive heart failure.2. 5.3 cm solid and cystic mass at the inferior pole of the left kidney, suspicious for neoplasm. Dedicated renal protocol CT or MRI is recommended for further evaluation.3. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "75 year-old female with hypertension, history of stenosis of right main renal artery. ULTRASOUND KIDNEYSRIGHT KIDNEY: Increased echogenicity of the right kidney measuring 8.7 cm in length. No hydronephrosis or shadowing calculi are noted. LEFT KIDNEY: Increased echogenicity of the left kidney measuring 9.0 cm in length. No hydronephrosis or shadowing calculi are noted. At the upper pole there is a hypoechoic lesion measuring 1.2 cm x 1.3 cm x 1.4 cm which does not have the classic appearance of a cyst.OTHER: No significant abnormalities noted.", "output": "1. No Doppler evidence of renal artery stenosis.2. Bilateral increased renal echogenicity suggestive of parenchymal dysfunction. Hypoechoic lesion in the upper pole of the left kidney does not have the classic appearance of a cyst, recommend CT for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Female 86 years old Reason: Elevated LFTs History: none LIVER: Echotexture of the liver is slightly coarse. There is minimal increased nodularity of the liver. Liver measures 12.7 cm. There is a simple cyst in the left lobe of the liver measuring 0.9 cm.BILIARY TRACT: Gallbladder is not visualized. No evidence of intra or extra hepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 7.9 cm.RIGHT KIDNEY: Right kidney measures 8.8 cm. No evidence of focal lesions or hydronephrosis. Left kidney measures 10 cm. Mild calyectasis involving the left kidney.OTHER: No significant abnormalities noted.", "output": "Slightly coarse echotexture of the liver. Mild calyectasis involving the left kidney."}
{"instruction": "Generate impression based on findings.", "input": "60 year-old female. Microscopic hematuria. RIGHT KIDNEY: Normal echogenicity. 11.6 cm in length. Focal bulge of the cortex in the midpole may relate to a Dromedary hump. Multiple cysts, the largest in the lower pole, measures 7.8 x 5.9 x 8.1 cm. No shadowing stone.LEFT KIDNEY: Normal echogenicity. 10.5 cm in length. Mild pelvocaliectasis. No shadowing stone. OTHER: Partially collapsed bladder.", "output": "Right renal cysts. No solid mass or shadowing stone."}
{"instruction": "Generate impression based on findings.", "input": "Female, 39 years old. Worsening transplant kidney function. The right iliac fossa transplant kidney measures 10.6 cm in length, with increased cortical echogenicity. A midpole simple cyst measures 1.5 x 1.0 x 1.1 cm. No shadowing stones or hydronephrosis. No perinephric collection.OTHER: The bladder is incompletely distended.", "output": "Increased renal cortical echogenicity, similar to prior, compatible with medical renal disease. No hydronephrosis or perinephric collection."}
{"instruction": "Generate impression based on findings.", "input": "CKD, hyperkalemia, renal insufficiency RIGHT KIDNEY: AbsentLEFT KIDNEY: Left kidney measures 11.5 cm with mild increased echogenicity. Benign-appearing cyst is identified in the upper pole measuring 1.2 x 1.4 x 0.1 cm. Interval decrease in the degree of minimal lower pole hydronephrosis, now almost resolved. Previously described nonobstructing subcentimeter stone could not be reproduced in the lower pole. Hyperechoic focus measuring 0.5 x 0.3 x 0.4 cm most likely represents a vascular calcification.OTHER: Well-distended urinary bladder without any focal lesions.", "output": "Interval resolution of left renal hydronephrosis. There is a described left lower pole nonobstructing stone is not reproduced, probably patient passed the stone.Mild increased echogenicity of the left kidney consistent with chronic medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Male 64 years old Reason: lvad work up History: lvad workup LIVER:Liver is normal in appearance without evidence of focal hepatic mass. Liver measures 14.3 cm. Main portal vein is patent with normal directional flow and a peak velocity of 33 cm/s.GALLBLADDER, BILIARY TRACT: No intra or extrahepatic biliary duct dilatation. Common bile duct measures approximately 4 mm. Small amount of sludge is present within the gallbladder. No evidence of acute inflammation of the gallbladder.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 9.4 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or solid mass. Right kidney measures 11.6 cm. Left kidney measures approximately 10 cm. Superior pole of the left kidney there is a large simple appearing anechoic renal cyst measuring 6.0 x 6.3 cm.ABDOMINAL AORTA: The abdominal aorta is normal with a normal waveform.INFERIOR VENA CAVA: IVC is patent and has a normal waveform.OTHER: Bladder is decompressed around a Foley.", "output": "No sonographic abnormality of the visualized abdominal viscera."}
{"instruction": "Generate impression based on findings.", "input": "The patient submitted outside mammograms dated 3/2/2012, 4/11/2012, 6/20/2013 and outside ultrasounds dated 3/22/2012 and 4/11/2012 from Metrosouth Medical Center. Submitted outside study was compared to the current mammogram dated 7/17/2015. A T-shaped clip is identified within the left breast at the 6:00 position which corresponds to a fibroadenoma on prior biopsy performed on 4/11/2012. All the masses in left breast are stable and most likely correspond to benign cysts or fibroadenomas corresponding to the ultrasound dated 3/22/2012. A lesion seen on ultrasound from 3/22/2012 in the right retroareolar region was not reproduced on ultrasound dated 4/11/2012 and therefore biopsy was not performed.", "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": "46 year old female patient with history of known right breast cancer with metastases to the right axilla presents for follow up after 12 cycles of neoadjuvant chemotherapy. A right breast ultrasound was performed. The previously identified lesion in the right breast in the 10:00 o'clock position currently measures 1.6 x 1.1 x 1.1 cm, previously 3.6 x 2.6 x 2.6 cm. Previously biopsied right axillary lymph node with clip measures 0.9 x 0.6 x 0.3 cm, previously 1.7 x 0.9 x 1.1 cm.", "output": "Moderate response to chemotherapy of right breast cancer and axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodule RIGHT LOBE MEASUREMENTS: 4.1 x 1.4 x 1.4 cmLEFT LOBE MEASUREMENTS: 7.7 x 4.1 x 5.3 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Large predominately solid nodule occupying much of the left thyroid gland measuring 7.3 x 4.0 x 5.5 cm. Coarse internal calcification 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 predominantly solid nodule occupying much of the left thyroid gland. This lesion is amenable to ultrasound-guided biopsy. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Male 62 years old Reason: MTC; mapping ultrasound History: MTC; mapping ultrasound RIGHT LOBE MEASUREMENTS: 5.4 x 2.2 x 2.2 cmLEFT LOBE MEASUREMENTS: 4.5 x 1.3 x 2.1 cm.ISTHMUS MEASUREMENTS: 0.12 cmRIGHT LOBE: In the mid right thyroid lobe is a hypoechoic irregular nodule measuring 0.9 x 0.9 x 0.9 cm with questionable punctate calcifications. Adjacent and deep to this hypoechoic nodule is a more solid-appearing nodule measuring 1.2 x 0.8 x 0.9 cm.LEFT LOBE: Hypoechoic nodule in the left inferior thyroid lobe measures 0.6 x 0.6 x 1.0 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is a very large heterogeneous right level 2 lymph node measuring 5.3 x 3.8 x 3.3 cm. There is a enlarged right level 3 lymph node measuring 2.0 x 1.0 x 2.3 cm. There is also an enlarged left level 3 lymph node measuring 1.1 x 0.5 x 1.0 cm.OTHER: No significant abnormality noted.", "output": "1.Hypoechoic irregular nodule in the right thyroid lobe is concerning for malignancy, and may be the primary, given history of MTC. 2.Very large right neck lymph nodes are concerning for metastatic disease. Enlarged left neck lymph nodes are also concerning for metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old male with history of thyroid cancer. Evaluate for adenopathy, recurrence. 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: Left level 2 lymph node measures 1.5 x 0.9 x 0.3 cm., unchanged. Previously described right lymph node not clearly demonstrated.OTHER: No significant abnormality noted.", "output": "Stable exam. Left cervical lymph nodes with benign morphology. No evidence of recurrence."}
{"instruction": "Generate impression based on findings.", "input": "Male 63 years old Reason: 63 yo with cirrhosis, RUQ pain R/o cholelithiasis and possible ascites History: RUQ pain LIVER: Increased echogenicity of liver without change. Liver measures 15.1 cm. No focal mass. Main portal vein is patent with normal directional flow velocity of 13 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Common bile duct measures 4 mm. The gallbladder is visualized and echogenic focus along the nondependent portion of the gallbladder wall, which may represent adenomyomatosis versus a small adherent stone. No evidence of acute inflammation of the gallbladder. No other gallstones are identified.PANCREAS: Visualized portions of the pancreas are normal.SPLEEN: Spleen is within normal limits measuring 10.5 cm.KIDNEYS: Normal cortical echogenicity bilaterally. No hydronephrosis. Subcentimeter nonobstructing stone in the inferior portion of the right kidney measures 0.6 x 0.3 x 0.4 cm, similar to the prior exam. Nonobstructing stone in the inferior left kidney measures 1.0 x 0.4 x 0.8 cm.OTHER: No ascites.", "output": "1.No evidence of acute cholecystitis. Focal echogenic area in the gallbladder may represent adenomyomatosis versus a small adherent stone. No other shadowing gallstones are identified. 2.Nonobstructing bilateral renal stones measuring up to 1.0 cm.3.Unchanged morphology and echogenicity of the liver . No suspicious masses are identified."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female with HCV, cirrhosis. Evaluate for HCC. LIVER: Nodular hepatic contour and mildly coarsened hepatic echogenicity without discrete focal lesion.BILIARY TRACT: No significant abnormalities noted.PANCREAS: Portions of the pancreas not clearly visualized due to bowel gas. The visualized portions of the pancreas appear unremarkable.SPLEEN: Splenic granulomata. KIDNEY: No significant abnormalities noted. OTHER: 1.8 cm peripancreatic lymph node with benign morphologic features.", "output": "Nodular hepatic contour and increased echogenicity consistent with chronic liver disease, without discrete lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with right upper quadrant pain and question cholecystitis. LIVER: No significant abnormalities noted. No intrahepatic biliary ductal dilation.GALLBLADDER, BILIARY TRACT: Nondistended gallbladder with gallbladder wall measuring up to 1.2 cm. Pericholecystic fluid is also visualized. 2 echogenic foci are visualized within the gallbladder neck and likely represent stones.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY/TRANSPLANT KIDNEY: The right kidney appears atrophic and fibrotic. Transplant kidney appears similar in size prior exam, 14 cm without change in morphology.OTHER: Patient is post void and there is incomplete evaluation of the bladder.", "output": "In the appropriate clinical setting, findings are consistent with cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Screening for HCC, hepatitis B infection LIVER: Liver measures 17.9 cm with mild increased echogenicity consistent with hepatic steatosis. No focal lesions noted. Portal vein demonstrates normal flow directionality and patency.BILIARY TRACT: Gallbladder is mildly contracted. Murphy sign is negative. Common hepatic duct measures up to 3 mm within normal limits.PANCREAS: The tail of the pancreas is obscured by bowel gas, otherwise no significant abnormality noted.SPLEEN: Spleen measures 11 cm without an focal lesions.RIGHT KIDNEY: Right kidney measures 13.4 and left kidney measures 13.6 cm. No hydronephrosis or focal lesions. OTHER: No ascites", "output": "Hepatic steatosis without any focal hepatic lesion."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Marazas is a 58-year-old female with a personal history of left breast mastectomy in 2013 for DCIS papillary type and right silicone breast implant. She has no current breast-related complaints. Upon physical exam at the mammographic area of concern, no discrete mass is appreciated. Targeted ultrasound of the right inner breast demonstrates five masses correlating to the mammographic findings, four of which have benign morphologic features consistent with benign cysts, but the other of which is solid with internal flow and calcifications. The solid mass measures 5 x 4 x 3 mm (images time stamped 9:50:08 through 9:50:57, labeled right breast 3:00 4 cm from the nipple), with internal calcifications and vascularity. The additional benign appearing lesions are as follows: Right breast 3:00 5 cm from the nipple: simple cyst measuring 4 x 4 x 3 mm. Right breast 3:00 4 cm from the nipple: simple cyst measuring 4 x 3 x 2 mm.Right breast 2:00 2 cm from the nipple: simple cyst measuring 6 x 5 x 6 mm. Right breast 1:00 2 cm from the nipple: septated cyst without vascularity or internal solid component measuring 5 x 5 x 5 mm.", "output": "Several new masses in the right medial breast, one with indeterminate features as described above, for which ultrasound guided core biopsy with clip placement is recommended. The other lesions are consistent with simple benign cysts. These findings and recommendation were discussed with the patient at the time of the examination. The patient does not take blood thinning medications. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Epigastric pain LIVER: No significant abnormalities noted. Liver length 14.4 cmBILIARY TRACT: Cholelithiasis without acute inflammation or duct dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9.5 cm in lengthRIGHT KIDNEY: Nonobstructing subcentimeter renal stone. Right kidney 8.2 cm in length OTHER: Nonobstructing subcentimeter left renal stone. Left renal cyst. Left kidney 8.9 cm in length. No ascites.", "output": "Cholelithiasis without acute inflammation or ductal dilatation. Bilateral nonobstructing subcentimeter renal stones. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Grelck is a 69-year-old female presenting for short term 6 month follow-up ultrasound for multiple cysts of the right breast. She has a personal history of left breast lumpectomy for invasive ductal carcinoma in 2007. On physical examination, no palpable masses were identified.A targeted right ultrasound was performed for the mammographic area of concern. In the right breast 7:00 position, approximately 3 cm from the nipple, there is an anechoic round circumscribed lesion with posterior acoustic enhancement measuring 6 mm x 3 mm x 6 mm, unchanged. No internal flow is present on Doppler imaging. This is compatible with a cyst. In the right breast 8:00 position, approximately 3 cm from the nipple, there is a cluster of round anechoic lesions with posterior acoustic enhancement measuring 9 mm x 2 mm. No internal flow is present on Doppler imaging. These are also compatible with cysts and are unchanged.No solid masses were identified.", "output": "Stable benign cysts of the right breast. No sonographic evidence for malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 6 months in order to ensure stability of these findings, due next in Jan 2017. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic 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": "54-year-old female with history of left breast asymmetries on recent mammogram. Occasional breast pain. Three standard views of the left breast with spot compression 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. Subcentimeter masses in the left inner breast persist 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: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Moore is a 49 year old female who was recalled from screening for left breast focal asymmetry. An ML, exaggerated left CC, 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 heterogeneously dense, which may obscure small masses (BiRads Density Category C), unchanged in pattern and distribution. Focal asymmetry in left outer breast at posterior depth does not disperse on compression views. The appearance suggests a benign etiology. ULTRASOUND", "output": "Circumscribed subcentimeter mass is present at the 1:00 position of the left breast, posterior depth, and may represent a complicated cyst versus solid mass. Ultrasound-guided cyst aspiration versus core biopsy is recommended for further evaluation.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Female 68 years old Reason: has unexplained palpable nodule in epigastrium History: patient can show you- rule out fibroma vs hernia Focal circumscribed area of heterogeneous hyperechogenicity measures 2.4 x 1.2 x 1.1 cm. No abnormally increased vascular flow is present within the mass. No evidence of bowel containing hernia.", "output": "Findings representing nonspecific soft tissue mass, which may represent a lipoma or fibroma. No bowel containing hernia as clinically questioned."}
{"instruction": "Generate impression based on findings.", "input": "50 year-old male with abnormal liver function LIVER: The liver is normal in size and is moderately to markedly echogenic. Although not specific, this may be due to fatty infiltration. No focal hepatic abnormality. Limited spectral and color Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder appears normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Echogenic liver."}
{"instruction": "Generate impression based on findings.", "input": "Right lower quadrant pain. Evaluate for hernia. No hernia is present. The subcutaneous soft tissues in the patient's area of concern are unremarkable.", "output": "No hernia or subcutaneous findings to account for the patient's right lower quadrant pain."}
{"instruction": "Generate impression based on findings.", "input": "Female 64 years old; Reason: previous history of nodules, please re-evaluate History: thyroid nodules RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 3.0 x 2.2 x 7.3 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 2.4 x 1.7 x 5.4 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.6 cm.RIGHT LOBE: The right lobe appears enlarged and heterogeneous. At the inferior portion of the right lobe there is a heterogeneous dominant nodule redemonstrated from prior ultrasound, measuring 4.1 cm x 2.6 cm x 3.6 cm. This previously measured 4.1 cm x 2.6 cm x 3.2 cm. No internal microcalcifications are seen and minimal internal vascularity.LEFT LOBE: The left lobe is enlarged and heterogeneous. At the inferior portion of the left lobe there is a heterogeneous iso to hyperechoic nodule measuring 2.4 cm x 1.9 cm x 1.3 cm. This previously measured 2.7 cm x 1.5 cm x 1.6 cm. There is coarse calcification redemonstrated from prior ultrasound.ISTHMUS: A mixed cystic and solid nodule is reidentified within the isthmus. This measures 2.4 cm x 1.2 cm x 2.4 cm and was previously measured 2.5 cm x 1.0 cm x 2.4 cm.LYMPH NODES: No suspicious adenopathy noted.", "output": "1. Multinodular goiter, the dominant nodule in the inferior right lobe and isthmus that appears stable from prior ultrasound. No suspicious adenopathy is identified.2. The dominant nodule in the inferior left lobe has coarse calcification which was seen previously. This nodule is amenable to biopsy, however it does appear stable in size from prior ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal bilirubin LIVER: Mildly heterogeneous and echogenic liver echotexture without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent portal vein with normal directional flow. Liver length 13.6 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma again noted without mass, stone, or hydronephrosis. Right kidney 16.4 cm in length.OTHER: Echogenic left renal parenchyma again noted without mass, stone, or hydronephrosis. Left kidney 13 cm in length. Spleen 11.2 cm in length. Bilateral pleural effusions.", "output": "Mildly coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Pritchett is a 41-year-old female with history of head and neck cancer as well as right breast IDC status post right lumpectomy in 2015 followed by chemotherapy and radiation therapy. Patient also has a history of left breast reconstruction. Patient presenting for short-term evaluation of a prominent left axillary lymph node identified on CT dated 9/2/2016. Ultrasound evaluation of the left axilla redemonstrates a normal morphology lymph node measuring 1.1 x 0.6 x 1.1 cm, with normal hilar vascular flow. This lymph node appears stable in appearance dating back to prior ultrasound study of 9/14/2016.", "output": "Normal-appearing left axillary lymph node stable in appearance dating back to 9/14/2016. No sonographic evidence for malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually, due May 2017. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old woman history of two right breast masses resembling fibroadenomas presents for diagnostic mammogram. Patient states that her physician palpated a third mass right breast 12:00 position which FNA showed results suggestive of fibroadenoma. DIAGNOSTIC MAMMOGRAM", "output": "Four right breast masses, largest at 12:00 position, with imaging characteristics suggestive of fibroadenomas. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Reason: patient with abnormal LFTs, elevated Alk phos, want to eval for pathology History: abnormal LFTs LIVER: The liver measures 15.2 cm in length. The hepatic parenchymal echotexture and echogenicity are unremarkable. The portal vein is patent with normal directional hepatopetal blood flow, peak velocity 38.7 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: Contracted gallbladder. No evidence of cholelithiasis or pericholecystic fluid. The gallbladder wall measures 0.2 cm and the common bile duct measures 0.2 cm. No biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.6 cm in length. Echogenic renal parenchyma. No shadowing stones were hydronephrosis.LEFT KIDNEY: The left kidney measures 9.9 cm in length. 1.1 cm lower pole shadowing renal calculus. No hydronephrosis, however the upper pole the left kidney is not visualized.OTHER: Fibroid uterus, similar to prior exam. No free pelvic fluid.", "output": "1. No acute hepatobiliary abnormality.2. 1.1 cm left lower pole nonobstructing renal stone. No hydronephrosis, however the upper pole is not visualized.3. Echogenic kidneys, consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Status post thyroidectomy for papillary thyroid carcinoma 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: Two slightly enlarged left level 3/4 lymph nodes. The largest measures 0.7 x 0.4 x 0.4 cm. Internal morphology of these lymph nodes demonstrates effacement of normal fatty hilum.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy. 2 slightly enlarged left level 3/4 lymph nodes with effacement of normal fatty hilum. While these may represent reactive lymph nodes, would recommend follow-up ultrasound in 4-6 months to document stability."}
{"instruction": "Generate impression based on findings.", "input": "Female 60 years old Reason: Palpable approximately 1 x 1 cm vertically oriented firm lesion in the left anterior cervical chain. ? Lymph node. Please evaluate. History: As above Probable nodule is identified is an elliptical hypoechoic solid area consistent with a lymph node measuring 1.7 x 0.3 cm by 0.6-cm. Homogeneous texture. Fatty hilum not clearly identified. Mild vascularity and color Doppler imaging.", "output": "Based on shape likely benign superficial lymph node corresponds to the palpable abnormality."}
{"instruction": "Generate impression based on findings.", "input": "History ductal dilatation LIVER: Coarse echogenic liver parenchyma without mass. Liver length 15 cmGALLBLADDER, BILIARY TRACT: Gallbladder not visualized. Minimal intrahepatic ductal dilatation. Mildly prominent extrahepatic duct with maximal diameter of 0.8 cm.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11 cm in lengthOTHER: Left kidney 11.3 cm in length. Spleen 6.8 cm in length. No ascites.", "output": "Coarse echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without mass. Minimal intrahepatic ductal dilatation with mildly prominent extra hepatic duct. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "22 year old female with left flank pain and frequency. RIGHT KIDNEY: The right kidney measures 11 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow.LEFT KIDNEY: The left kidney measures 10.7 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow.URINARY BLADDER: The urinary bladder is normally distended with anechoic urine. No ureteral jets are visualized.", "output": "Normal sonogram of the kidneys and bladder."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female post thyroidectomy for papillary carcinoma. Evaluate for recurrent disease. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: In the right thyroid bed there is a somewhat heterogeneous, hypoechoic mass measuring 0.6 x 0.6 x 0.6 cm. This was present on the preoperative scan and given interval thyroidectomy this may be extrathyroidal in nature and is stable.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: In the right supraclavicular region there are several rounded-appearing lymph nodes and normal morphology cannot be demonstrated with certainty. These are all subcentimeter in size. At level for in the left neck there is a prominent 0.5 x 0.9 x 1 cm node, and normal morphology cannot be demonstrated with certainty.OTHER: No significant abnormality noted.", "output": "Residual hypoechoic mass in the right thyroid bed is unchanged from preoperative images. This may be extrathyroidal in nature.Abnormal-appearing lymph nodes right supraclavicular and level 4 left."}
{"instruction": "Generate impression based on findings.", "input": "Hematuria and UTI RIGHT KIDNEY: Unremarkable echogenicity without mass or stone or hydronephrosis. 10.4 cm in lengthLEFT KIDNEY: Unremarkable echogenicity without mass, stone, or hydronephrosis. 10.8 cm in lengthOTHER: Asymmetrical polypoid wall thickening involving the left bladder wall", "output": "Asymmetrical polypoid wall thickening involving the left bladder wall; a malignancy must be excluded. Would recommend correlation with cystoscopy. Unremarkable kidneys without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: pt with gastric submucosal nodule, biopsied History: LUQ abdominal pain, nausea LIVER: The liver measures 20.4 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 0.18 m/s.BILIARY TRACT: There are several nonmobile, non-shadowing small, round structures along the gallbladder wall compatible with gallbladder polyps. The largest measures up to 6 mm. No intrahepatic or extrahepatic biliary ductal dilatation is seen.PANCREAS: The pancreas is largely obscured.SPLEEN: No significant abnormalities noted. The spleen measures 11.0 cm in length. RIGHT KIDNEY: Kidney measures 10.3 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or massLEFT KIDNEY: Kidney measures 2.1 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or massOTHER: No significant abnormalities noted.", "output": "1.Mild hepatomegaly. Increased hepatic echogenicity suggestive of fatty infiltration/parenchymal dysfunction.2.Several gallbladder polyps measuring up to 6 mm."}
{"instruction": "Generate impression based on findings.", "input": "Reason: enlarged thyroid RIGHT LOBE MEASUREMENTS: 5.2 x 2.1 x 1.5 cmLEFT LOBE MEASUREMENTS: 5.4 x 1.7 x 1.4 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 sized thyroid without focal nodules or masses."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter after surgery. Microcarcinoma found on pathology. RIGHT LOBE MEASUREMENTS: Status post right lobectomyLEFT LOBE MEASUREMENTS: 4.9 x 2.7 x 3.1 cm.ISTHMUS MEASUREMENTS: 0.9 cm.RIGHT LOBE: Status post right lobectomy. Minimal residual tissue and subcentimeter lymph node LEFT LOBE: Heterogeneous gland. Dominant upper pole solid echogenic nodule with hypoechoic halo has increased slightly in size compared to prior and measures 2.3 x 1.7 x 2.3 cm. Additional small nodules are again noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Patient was extremely anxious during examination and was unable to lay supine.", "output": "Slight interval enlargement of dominant nodule left lobe. Status post right lobectomy. Findings were discussed with the patient at the time of the exam."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old woman history of locally advanced multicentric left breast cancer with metastasis to lymph nodes on systemic chemotherapy presents for evaluation. MAMMOGRAM: 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, unchanged in pattern and distribution. Overall, there is decreased density of the left breast. The biopsy-proven 4:00-6:00, 1:00 and retroareolar left breast cancers are not discretely visualized. Scattered microcalcifications are stable in distribution.Biopsy clip is noted anterior to a low-lying lymph node in the left axilla, slightly decreased in size and density, measuring 5 mm (previously 8 mm).ULTRASOUND:On physical exam, there is no visible or palpable abnormality.Targeted ultrasound of the left breast was performed for the mammographic areas of concern. In the left breast 6:00 position (8 cm from nipple) a few small ill-defined masses are seen with largest measuring 2.4 x 1.3 x 1.6 cm. The largest mass previously seen in this area measured 5.4 cm in largest dimension on ultrasound 4/15/2015. No discrete mass is seen in the left retroareolar breast. No discrete mass is seen in the left breast 1:00 position.In the left axilla near the 1:00 position there is a small lymph node measuring 0.8 x 0.5 x 0.6 cm with maximum cortical thickness of 0.3 cm, normal. A biopsy clip is not identified within this lymph node. It is unclear whether this is the previously biopsied lymph node which had a maximal cortex of 0.7cm.", "output": "Interval decrease in size 4:00-6:00 and left breast masses described. Resolution of left retroareolar and 1:00 breast mass. Normal morphology left axillary node, unclear whether this is the previously biopsied lymph node. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female patient with thyrotoxic symptoms. Evaluate for multinodular goiter, Grave's. RIGHT LOBE MEASUREMENTS: 4.8 x 2.3 x 1.7 cm.LEFT LOBE MEASUREMENTS: 4.4 x 2.5 x 1.8 cm.ISTHMUS MEASUREMENTS: 1.1 cm in thickness.RIGHT LOBE: The right thyroid lobe is heterogeneous in echogenicity without focal lesion. Vascularity is within normal limits on color Doppler imaging.LEFT LOBE: The left thyroid lobe is heterogeneous in echogenicity without focal lesion. Vascularity is within normal limits on color Doppler imaging.ISTHMUS: There is a 1.4 x 0.8 x 0.8 cm heterogeneously hyperechoic solid nodule within the right aspect of the isthmus. The nodule has internal vascularity and no shadowing calcification.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Heterogeneous thyroid gland; correlate with history of thyroiditis.2. Solid right isthmus nodule, which could be related to thyroiditis."}
{"instruction": "Generate impression based on findings.", "input": "Male 44 years old Reason: left upper thigh lesion, c/w lipoma, large, over 6 cm, enlarging causing discomfort. History: as above Ultrasound shows echogenic material only suggestive of possible lipoma. There are no fluid density areas. The tissue is relatively hypovascular color Doppler imaging. If clinically indicated, lipoma could be confirmed with CT or MR.", "output": "Palpable abnormality is solid echogenic material."}
{"instruction": "Generate impression based on findings.", "input": "Hyperthyroidism RIGHT LOBE MEASUREMENTS: 5.5 x 3.1 x 3 cmLEFT LOBE MEASUREMENTS: 5.3 x 2.7 x 2.4 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Diffusely heterogeneous gland without discrete nodule. Borderline increased vascularityLEFT LOBE: Diffusely heterogeneous gland without discrete nodule. Borderline increased vascularityISTHMUS: Diffusely heterogeneous gland without discrete nodule. Borderline increased vascularityPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous mildly enlarged gland without discrete nodule. Borderline increased vascularity. Findings favor thyroiditis slightly over Graves disease; cannot assess for acute component."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old with a history of left mastectomy in 2008 for DCIS. Three standard views of the right breast were performed digitally with spot compression views 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. A focal asymmetry with distortion in the right upper breast at the 12:00 position persists on spot compression images, more suspicious on the CC view. Repeat mammograms after placement of a BB over the site of the below-mentioned sonographic abnormality corresponds to this focal asymmetry. ULTRASOUND", "output": "Indeterminate 12 mm mass in the right upper breast at the 12:00 position. Ultrasound guided biopsy is recommended. Findings were discussed with the patient. Clip placement will be especially important in order to determine correlation between the sonographic finding for biopsy and the mammographic distortion. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old male with hyperparathyroidism. Evaluate for stones. RIGHT KIDNEY: The right kidney measures 12.9 cm without hydronephrosis, shadowing nephrolithiasis or discrete lesion evident.LEFT KIDNEY: The left kidney measures 12.5 cm without hydronephrosis, shadowing nephrolithiasis, or discrete lesion evident.OTHER: No significant abnormalities noted.", "output": "No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female with hyperparathyroidism. Evaluate for renal stone. RIGHT KIDNEY: The right kidney measures 8.8 cm in length. No hydronephrosis, definite shadowing calculus or mass. Echotexture within normal limits.LEFT KIDNEY: The left kidney measures 9.8 cm in length. No hydronephrosis or reproducible shadowing calculus. No mass identified. Echotexture within normal limits.OTHER: No significant abnormalities noted.", "output": "No definite nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Stated history of CHF and leg edema. Mild LFT abnormality. LIVER: The liver is normal in morphology and size, measuring 18 cm in craniocaudal length. No focal lesion or intrahepatic biliary ductal dilatation. The hepatic veins are normal in caliber. Normal hepatopedal portal venous blood flow at 15 cm/s. Note is made of echogenic shadowing granulomata.BILIARY TRACT: No extra hepatic biliary ductal dilatation with the common duct measuring 3 mm. Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid or focal tenderness.PANCREAS: The visualized pancreatic body and head is unremarkable.SPLEEN: The spleen measures 10.8 cm in length with multiple granulomata.RIGHT KIDNEY: The right kidney measures 9.7 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow. The cortex is echogenic.OTHER: The left kidney measures 10.5 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow. The cortex is echogenic.", "output": "Echogenic renal cortices compatible with medical renal disease.Normal liver morphology without focal abnormality or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Age: 21 years. Sex : Male. Reason for study: shoddy bilateral posterior cervical lymph nodes, also reports soreness in the bilateral submandibular area Ultrasound of the neck revealed numerous prominent cervical lymph nodes.Right submandibular benign appearing node: 1.8 x 0.6 cm.Right posterior cervical benign appearing lymph node: 0.7 x 0.2 cm.Right posterior cervical hypoechoic lesion, presumably representing a small lymph node: 1.2 x 0.3 x 0.65 cm Normal appearing submandibular glands and thyroid gland.", "output": "Hypoechoic lesion in the right posterior cervical triangle corresponding to region of palpable tenderness measures 1.2 x 0.3 cm and presumably represents a small lymph node."}
{"instruction": "Generate impression based on findings.", "input": "The patient submitted outside mammogram dated 10/12/2007, from presence St. Joseph Hospital. Submitted outside study was compared to the current mammogram dated 12/15/2015. There is no significant change between these two studies in the left breast. Focal asymmetry in the left upper-outer quadrant with calcifications and cluster of calcifications in central left breast are mostly unchanged.Segmental distribution calcifications in the right upper-outer quadrant spanning approximately 6 cm with associated focal asymmetry has increased from prior exams and needs further evaluation with spot magnification views and ultrasound.", "output": "Segmental distribution calcifications in the right upper-outer quadrant spanning approximately 6 cm with associated focal asymmetry has increased from prior exams and needs further evaluation with spot magnification views and ultrasound.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Nodules? History: Thyroid cancer s/p resection of residual thyroid tissue identified on previous ultrasound. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Status post thyroidectomy. No suspicious nodules in the thyroidectomy bed.LEFT LOBE: Status post thyroidectomy. No suspicious nodules in the thyroidectomy bed. Previously seen solid mass is no longer present.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A few morphologically normal cervical lymph nodes are present.OTHER: No significant abnormality noted.", "output": "No suspicious masses within the thyroidectomy bed."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female with history of right breast cancer with metastatic right axillary lymph node involvement status post neoadjuvant chemotherapy. Follow-up examination. Three standard 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), unchanged in pattern and distribution. Again seen are three biopsy clips in the right upper outer breast correlating with known sites of disease. Asymmetries in the right outer breast posterior depth remain decreased in size compared with prior studies from September 2015. There is no significant mammographic asymmetry surrounding the additional anterior biopsy clip.ULTRASOUND", "output": "Favorable treatment response with decrease in size of index right breast malignancy and metastatic right axillary lymph node as described above. No measurable disease is present in the more anterior location of the previously biopsied satellite lesion.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Neutropenia with elevated LFTs and abdominal pain LIVER: Coarse heterogeneous liver echotexture without mass. Liver length 16.9 cmGALLBLADDER, BILIARY TRACT: Gallbladder sludge and stones without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. Right kidney 12.4 cm in length.OTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. Left kidney 12 cm in length. Spleen 10.2 cm in length. No ascites. Right pleural effusion.", "output": "Coarse heterogeneous liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites. Gallbladder sludge and stones without acute inflammation. Echogenic kidneys consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "53 year old female with elevated LFTs and vomiting. LIVER: The liver has normal morphology, echogenicity and size, measuring 13.4 cm in length. No focal hepatic lesion or intrahepatic biliary ductal dilatation. Normal hepatopetal portal venous blood flow at 20 cm/sec.GALLBLADDER, BILIARY TRACT: Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid, or focal tenderness.PANCREAS: The visualized pancreatic body and head are normal.RIGHT KIDNEY: The right kidney measures 10 3 cm in length without hydronephrosis, shadowing nephrolithiasis, or focal lesion evident.OTHER: Moderate splenomegaly, measuring 14.6 cm.The left kidney measures 9.9 cm without hydronephrosis, shadowing nephrolithiasis, or focal lesion evident.", "output": "1. Normal gallbladder. No biliary ductal dilatation. 2. Moderate splenomegaly. "}
{"instruction": "Generate impression based on findings.", "input": "49 years old, Male, Reason: screening into clinical trial History: none LIVER: The liver measures 12.7 cm in length. A nodular morphology of the liver is consistent with cirrhosis. Simple appearing cyst in the right hepatic lobe measures 1.6 x 1.6 x 1.5 cm. No hepatic lesion suspicious for HCC. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s.BILIARY TRACT: Patient status post cholecystectomy. Cystic structure in the gallbladder fossa appears similar to prior exam measuring 1.0 x 1.1 x 1.1 cm. 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 is enlarged measuring 15.3 cm in length. RIGHT KIDNEY: Kidney measures 10.5 cm in length. Normal echotexture. No evidence of hydronephrosis or shadowing calculus. Superior pole simple-appearing cyst measures 0.8 x 1.2 x 0.9 cm.LEFT KIDNEY: Kidney measures 13.4 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: Mild amount of ascites is present.", "output": "1.Cirrhotic morphology of the liver without any focal lesions to suggest HCC.2.Mild amount of ascites.3.Splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Female; 74 years old. Reason: kidney stone? History: flank pain, pyuria, microscopic hematuria RIGHT KIDNEY: The right kidney measures 9.9 cm in length. The renal cortex is echogenic. There is no hydronephrosis, shadowing renal stone, or worrisome mass.LEFT KIDNEY: The left kidney measures 10.3 cm in length. The renal cortex is echogenic. There is no hydronephrosis, shadowing renal stone, or worrisome mass.URINARY BLADDER: The bladder is not distended.OTHER: No significant abnormalities noted.", "output": "1.Echogenic kidneys compatible with medical renal disease.2.No shadowing renal stone or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female with submandibular neck nodule. In the region of palpable abnormality there is a small hypoechoic nodule in the superficial subcutaneous fat measuring 2 to 3 mm in diameter. The appearance is not specific and this could represent a sebaceous cyst, small lymph node or other soft tissue nodule", "output": "Small nodule in the superficial subcutaneous tissues of the neck. The appearance is not specific but this could represent a small sebaceous cyst."}
{"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. Although there is a benign mass in the left breast on mammogram, it is not visible on ultrasound study.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Looking for an explanation of this woman's epigastric and left upper abdominal pain that radiates into her back. History: 31 year old woman with recent onset of a dull pain in the epigastrium and left upper quadrant pain that radiates into her back. EGD yesterday gave no explanation. Pancreatic enzymes were normal. 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 0.35 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 diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 10.1 cm in length. RIGHT KIDNEY: Kidney measures 10.4 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.1 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "No evidence of acute cholecystitis or other specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old female with hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 4.4 x 1.1 x 1.5 cmLEFT LOBE MEASUREMENTS: 3.5 x 0.8 x 1 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: The inferior right lobe of the thyroid has a somewhat nodular appearance, measuring up to 8 mm in diameter and heterogeneously hypoechoic. This appears somewhat exophytic and is presumably thyroidal in nature. An extrathyroidal mass of be a less likely consideration.LEFT LOBE: No significant abnormality noted.ISTHMUS: Dense shadowing calcification in the right isthmus may have a surrounding nodule which is hypoechoic and solid measuring 0.3 x 0.4 x 0.5 cm.PARATHYROID GLANDS: See above discussion on the right. No masses identified on the left.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Somewhat exophytic right inferior thyroid nodule versus extrathyroidal mass.Dense calcification in the right isthmus which may be associated with a small, solid mass."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for recurrence of metastatic papillary thyroid cancer History: New Thyroglobulin Abs and new uptake on Total body scan in neck (L side) and L/central mediastinum. RIGHT LOBE: Status post thyroidectomy with no evidence of new nodules or masses.LEFT LOBE: Status post thyroidectomy with no evidence of new nodules or masses. Echogenic soft tissue focus inferior to the left thyroid bed in the supraclavicular region measures 0.8 x 0.7 x 0.5 cm, previously measured at 0.9 x 0.7 x 0.5 cm, stable.ISTHMUS: Status post thyroidectomy with no evidence of new nodules or masses.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Multiple benign appearing lymph nodes with fatty hila, with an enlarged left level 2 cervical node. Right level 3 lymph nodes measure 0.5 x 0.4 x 0.5 cm and 0.6 x 0.4 x 0.5 cm.Left level 2 lymph node measures 1.6 x 0.6 x 1.1 cm.Left level 3 lymph node measures 1.5 x 0.2 x 0.5 cm.OTHER: No significant abnormality noted.", "output": "1. Prominent left level 2 lymph node.2. Stable hypoechoic focus in the left supraclavicular region.3. Status post thyroidectomy without evidence of new nodules or masses."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury, worsening after removal of ureteral stents. RIGHT KIDNEY: 9.7 cm in length. Mild calyectasis, minimally decreased compared to prior. Increased parenchymal echogenicity.LEFT KIDNEY: 10.6 cm in length. No focal lesions or hydronephrosis. Increased parenchymal echogenicity.BLADDER: Contracted, with Foley catheter in place.OTHER: No significant abnormalities noted.", "output": "1. Increased renal parenchymal echogenicity, compatible with medical renal disease.2. Mild residual right calyectasis."}
{"instruction": "Generate impression based on findings.", "input": "Male 64 years old; Reason: Follow up previously noted thyroid mass and right cervical lymph node. RIGHT LOBE MEASUREMENTS: 4.6 x 1.9 x 1.6 cm.LEFT LOBE MEASUREMENTS: 4.3 x 2.5 x 2.0 cm.ISTHMUS MEASUREMENT: 0.5 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Again noted is a round solid nodule measuring approximately 1.4 x 1.2 cm which is stable in appearance when compared to the prior examination. Of note, these measurements are considered stable the prior measurements are corrected.ISTHMUS: No significant abnormality noted.LYMPH NODES: Again noted is a right level III lymph node measuring approximately 1.1 x 0.5 cm which appears stable in appearance to the prior study.OTHER: No significant abnormality noted.", "output": "1.Stable round solid nodule of the left lobe of the thyroid 2.Stable right level 3 mildly enlarged lymph nodes; favor benign etiology."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old female with right breast cancer presents for imaging follow-up of the lesion. A targeted right ultrasound was performed at the areas of the known breast cancer. At 10:00 location, posterior right breast, 12 cm from the nipple, there is a 12 x 7 x 10 mm hypoechoic irregular mass with spiculated margin and a centrally located biopsy clip, compatible with the known cancer, which previously measured 11 x 12 x 12 mm on 9/16/2015 and 19 x 17 mm on 6/30/2015.", "output": "Slightly decreased in size of the known malignancy in the right breast. Continued follow-up with surgery team is recommended. Results and recommendations were discussed with the patient. BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine RIGHT KIDNEY: Echogenic parenchyma with multiple cysts. No worrisome mass, stone, or hydronephrosis. Right kidney 10.7 cm in length.LEFT KIDNEY: Echogenic parenchyma with multiple cysts. No worrisome mass, stone, or hydronephrosis. Left kidney 12.4 cm in length.OTHER: Bladder nondistended", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction with multiple cysts. No worrisome mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for abscess near peritoneal dialysis catheter Portions of peritoneal dialysis catheter seen. No drainable fluid collection or abscess seen. Prominent vessels seen in subcutaneous tissues. Bilateral abdominal wall soft tissues symmetric in appearance otherwise. Incompletely imaged intra-abdominal ascites.", "output": "No evidence of abscess."}
{"instruction": "Generate impression based on findings.", "input": "Left upper quadrant LVAD drive line site wound There are no focal fluid collections in or surrounding the drive line bed.", "output": "No evidence of fluid collections."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic squamous cell carcinoma with fatigue nausea and vomiting LIVER: Persistent filling defect within middle hepatic vein measuring 0.8 x 0.6 cm. The patient's known centrally located metastatic lesion is not well demonstrated on the current examination. No ductal dilatation. Liver length 18.6 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. 11.2 cm in length OTHER: Left kidney 12.2 cm in length. Spleen 11.1 cm in length. No ascites.", "output": "Nonocclusive thrombus within the middle hepatic vein. Known central hepatic metastasis not well visualized on the current study. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow."}
{"instruction": "Generate impression based on findings.", "input": "Hip dysplasia.VIEW: Pelvis AP (1 view) 10/13/2015, 0916 The femoral head ossification centers are well located within normally formed acetabula. No osseous abnormality is identified.", "output": "Normal examination."}
{"instruction": "Generate impression based on findings.", "input": "Renal stones RIGHT KIDNEY: Unremarkable echogenicity without worrisome mass or hydronephrosis. Multiple subcentimeter nonobstructing echogenic foci again noted. Right kidney 11.4 cm in lengthLEFT KIDNEY: Unremarkable echogenicity without worrisome mass or hydronephrosis. Multiple subcentimeter nonobstructing echogenic foci again noted. Left kidney 12.2 cm in lengthOTHER: Bladder nondistended", "output": "Multiple subcentimeter nonobstructing stones bilaterally again noted. No worrisome mass or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Male 46 years old Reason: 1 year s/p islet cell transplant, please evaluate liver and flow via doppler of portal vein History: 1 year s/p islet cell transplant, please evaluate liver and flow via doppler of portal vein LIVER: Previously demonstrated heterogeneous area is no longer visualized. Unchanged echogenic foci, possibly calcifications, in the liver parenchyma adjacent to the gallbladder. No focal hepatic mass. Main portal vein, right, and left portal veins are patent. Main portal vein has a peak velocity of 19.2 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Some shadowing gallstones are present. No evidence of acute inflammation of the gallbladder.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 10.9 cm.KIDNEYS: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "1.Previously described heterogeneously hypoechoic area in the right hepatic lobe is no longer present.2.Portal veins are patent"}
{"instruction": "Generate impression based on findings.", "input": "History of primary biliary cirrhosis. LIVER: The liver is mildly coarse in echotexture and nodular in contour measuring 18 cm in craniocaudal length. No focal lesion or biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 14 cm/s. Nonspecific porta hepatis lymph node measuring 1.3 x 1.0 cm, unchanged.BILIARY TRACT: Contracted or removed gallbladder. No extrahepatic biliary ductal dilatation with the common duct measuring 6 mm.PANCREAS: The visualized pancreatic head and body is unremarkable. The remainder is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 14 cm in length without a focal lesion.RIGHT KIDNEY: The right kidney measures 10.9 cm in length without hydronephrosis, shadowing nephrolithiasis or focal lesion. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 10.7 cm in length without hydronephrosis, shadowing nephrolithiasis or focal lesion. Color Doppler demonstrates hilar blood flow.", "output": "Cirrhotic liver morphology with mild splenomegaly but no focal hepatic lesion."}
{"instruction": "Generate impression based on findings.", "input": "Proteinuria. Renal insufficiency. Ultrasound guidance provided for 3 right renal biopsy passes. No postprocedure hematoma is evident.", "output": "Ultrasound guidance provided for right renal biopsy."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female with dense breasts, past medical history of right benign breast mass excision at age 19 and Left breast benign appearing mass. On exam she has extremely dense breast, bilateral . Right no discrete masses on Left UOQ 1.5 cm smooth mass feels like fibroadenoma. A whole right breast ultrasound and targeted left upper outer quadrant breast ultrasound was performed. There is a circumscribed hypoechoic mass in the left upper outer quadrant in the 1:00 position 4 cm from the nipple measuring 1.6 x 0.5 cm and likely represents a benign fibroadenoma. Normal glandular tissue was identified in the right breast. An additional well-circumscribed hypoechoic mass was identified in the right upper outer quadrant in the 5:00 position at 6 cm from the nipple measuring 1.8 x 0.5 cm and is likely a benign fibroadenoma.", "output": "Bilateral benign-appearing masses, most compatible with benign fibroadenomas. No sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram with tomosynthesis as well as a screening whole breast ultrasound 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": "54-year-old female patient with palpable mass in the bilateral supraclavicular space. RIGHT LOBE MEASUREMENTS: 1.7 x 2.0 x 4.3 cm.LEFT LOBE MEASUREMENTS: 1.1 x 1.8 x 4.3 cm.ISTHMUS MEASUREMENTS: 4 mm in thickness.RIGHT LOBE: The right thyroid lobe is homogeneous in echogenicity and contains two subcentimeter nodules with imaging features favoring a benign etiology.LEFT LOBE: The left thyroid lobe is homogeneous in echogenicity. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Normal subcutaneous fat is identified in the region of the patient's palpable abnormality in the mid-thyroid region.", "output": "1. No dominant thyroid lesion.2. Area of patient palpable abnormality correlates to normal subcutaneous fat. "}
{"instruction": "Generate impression based on findings.", "input": "Hematuria, please evaluate Foley catheter noted within the bladder. Enlarged prostate gland is identified which measures 6.3 x 6.5 x 5.4 cm. Calcification noted within the prostate gland. No evidence of ascites.", "output": "Enlarged prostate gland noted.Foley catheter within the bladder."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old male with history of cellulitis at G-tube site, abdominal pain. Grayscale and color limited ultrasound of the site of the patient's G-tube insertion demonstrates a circumscribed round anechoic structure in the subcutaneous soft tissues consistent with the patient's G-tube balloon which has migrated into the subcutaneous soft tissues. There is surrounding induration of the subcutaneous soft tissues with punctate areas of increased echogenicity measuring approximately 1.4 cm, however no drainable collection is identified at this time.", "output": "Findings consistent with gastrostomy balloon migration into the subcutaneous tissues. Surrounding inflammatory or phlegmonous changes without evidence of drainable fluid collection or abscess. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: Elevated LFTs, NASH? LIVER: The liver measures 13.3 cm in length. Mildly increased parenchymal echogenicity. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.16 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 5 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 11 cm in length. RIGHT KIDNEY: Kidney measures 11.0 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.7 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "Mildly echogenic liver suggestive of fatty infiltration/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Assess for residual stone or hydronephrosis. Right ureteral stone status post removal. RIGHT KIDNEY: 10.3 cm in length. Normal renal parenchymal echogenicity. No focal lesions, stones, or hydronephrosis.LEFT KIDNEY: 10.7 cm in length. Normal renal parenchymal echogenicity. No focal lesions, stones, or hydronephrosis.BLADDER: Distended, without significant abnormality evident.OTHER: No significant abnormalities noted.", "output": "No hydronephrosis or stone identified."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female with history of cirrhosis. Evaluate for HCC. LIVER: Measures 13.9 cm in length. Cirrhotic morphology and increased hepatic echogenicity without definite 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: Measures 10.4 cm in length. Echogenic foci in the spleen are without significant interval change since the prior study.KIDNEY: Again not clearly visualized, likely markedly atrophic and echogenic secondary to chronic kidney disease. Focal increased echogenicity in the right renal fossa described on prior studies is not significantly changed.OTHER: No significant abnormalities noted.", "output": "1. Cirrhosis and increased hepatic echogenicity consistent with chronic liver disease, without focal lesion.2. Nonvisualization of the kidneys and increased echogenicity in the right renal fossa likely representing sequela of chronic kidney disease, without significant interval change. Echogenic foci in the spleen also without significant interval change."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female with history of thyroidectomy for papillary carcinoma. Palpable tissue left bed. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: In the right thyroid bed there is a somewhat rounded, echogenic focus measuring approximately 0.3 x 0.4 x 0.4 cm.LEFT LOBE: No mass seen in the left bed.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: On the right, there are post enlarged nodes without calcification and nodes with suspicious calcification.Level 2 node measuring 1.1 x 2 x 2.5 cm without hilum. Level 3 node with shadowing calcification measuring 0.7 x 0.9 x 1.2 cm level 4 node with calcification measuring 0.6 x 0.6 x 0.9 cm.On the left, morphologically normal lymph nodes are identified. There is one larger but morphologically normal lymph node at level 2 measuring 1.4 x 1.6 x 3 cm which may represent the palpable abnormality.OTHER: No significant abnormality noted.", "output": "1. Rounded, echogenic material in the right thyroid bed. No calcification.2. Malignant lymph nodes right neck.3. Morphologically normal lymph nodes on the left."}
{"instruction": "Generate impression based on findings.", "input": "34 year old female with a small palpable lump in the right breast With physical exam, a small, mobile mass is palpated at 9:00 position near the nipple in the right breast. With focused ultrasound, there is an oval shaped simple cyst, measuring 5 x 4 mm at the site of palpable lump in the right breast.", "output": "Simple cyst in the right breast BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female with hepatitis B, evaluate for HCC. LIVER: Measures 13.6 cm in length. Increased hepatic echogenicity without discrete focal lesion.BILIARY TRACT: Gallbladder polyp measuring up to 9 mm, without interval change compared with prior studies. No gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilation.PANCREAS: The pancreas is incompletely visualized due to bowel gas. The imaged portions of the pancreas appear unremarkable.SPLEEN: No significant abnormalities noted.KIDNEY: 0.7 cm left renal cyst. No hydronephrosis. OTHER: No significant abnormalities noted.", "output": "1.Increased hepatic echogenicity consistent with chronic liver disease.2.9 mm gallbladder polyp without significant interval change. Continued follow-up recommended."}
{"instruction": "Generate impression based on findings.", "input": "Male 84 years old Reason: Hx of abd pain, vomiting, pls evaluate for cholecystitis History: abd pain LIMITED ABDOMENLIVER: The liver measures 19.7 cm. Hyperechoic hepatic parenchyma is noted. No focal hepatic lesion. The portal vein is patent with normal directional flow.BILIARY TRACT: Distended gallbladder with echogenic sludge and stones. The gallbladder wall thickness measures 0.5 cm. No pericholecystic fluid. No Murphy's sign per the technologist. No biliary ductal dilation. Common bile but measures slightly 4 mm in diameter.SPLEEN: The spleen measures 9.7 cm in length.PANCREAS: No significant abnormality noted.KIDNEYS: The right kidney measures 10.2 cm. The left kidney measures 9.6 cm. No hydronephrosis or mass.", "output": "1.Distended gallbladder with stones and gallbladder wall thickening is equivocal for acute cholecystitis in the absence of a positive Murphy's sign and pericholecystic fluid.2.Hepatomegaly and hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "History of right breast lumpectomy for breast cancer in May 2016 and is currently on radiation treatment, presents with a palpable left axillary lump for ultrasound evaluation. Patient felt the lump for past few days. A targeted left axillary ultrasound was performed for the patient\u2019s area of concern. On physical examination, a 1 cm superficial tender soft mass is palpated in the higher axillary region. Ultrasound demonstrates a superficial mixed echogenic mass measuring 1.6 x 0.7 cm consistent with a sebaceous cyst.Normal morphology at least 2 axillary lymph nodes were identified. There is no solid or cystic mass identified.", "output": "Palpable abnormality in the left axillary region corresponds to a sebaceous cyst.Normal left axillary lymph nodes noted.Patient is due for a bilateral diagnostic mammogram in November 2016BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Female; 52 years old. Reason: critically ill patient with renal failure History: critically ill patient with renal failure RIGHT KIDNEY: The right kidney measures 10 cm in length. The renal cortex is echogenic. A 2 .2 cm simple cyst is again seen in the lower pole. There is no hydronephrosis.LEFT KIDNEY: The left kidney is not clearly seen.URINARY BLADDER: The bladder is decompressed by Foley catheter.OTHER: No significant abnormalities noted.", "output": "1.Echogenic right kidney consistent with medical renal disease. The left kidney is not well visualized.2.No hydronephrosis on the right.3.Stable exam."}
{"instruction": "Generate impression based on findings.", "input": "Reason: please eval thrombus in IVC; compare to previous US History: hx of thrombus in IVC There is been interval removal of a central venous catheter. There is echogenic material within the suprarenal IVC. Additionally, no flow is seen on color Doppler images, indicating thrombosis. The infrarenal IVC is not visualized. The left and right common iliac veins are grossly patent.", "output": "Persistent thrombosis within the suprarenal IVC."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with localized swelling, mass and lump in the neck. Assess right neck swelling. Scans to the right neck show normal vascular structures with normal carotid artery and jugular veins. Homogeneous thyroid is seen with small subcentimeter sonolucent zone. Lateral to the thyroid in the soft tissues of the neck are normal muscle and fascial plane seen without evidence of mass or lymphadenopathy. Scans extended through 5 cervical neck levels without evidence of lymph node or mass.", "output": "No mass lesion seen in the soft tissues of the neck as suspected clinically."}
{"instruction": "Generate impression based on findings.", "input": "Female; 67 years old. Reason: elevated LFT's; liver ultrasound History: Lymphoma and elevated LFT's LIVER: The liver measures 18.7 cm in length. The liver contour is smooth. The parenchyma is diffusely increased in echogenicity and demonstrates a coarsened echotexture. The right lobe of liver, adjacent to the gallbladder fossa is a geographic area of increased echogenicity likely represents focal fatty infiltration or fibrosis. There is no ascites.The main portal vein is patent with hepatopetal flow and a peak velocity of 0.16 m/sec.BILIARY TRACT: The gallbladder is normal in appearance. The common duct measures 3 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreas is normal in appearance. The body and tail are obscured by overlying bowel gas.SPLEEN: The spleen measures 12.6 cm in length.RIGHT KIDNEY: The right kidney measures 10.5 cm in length. The cortex is normal in echogenicity. There is minimal hydronephrosis. No shadowing stone or worrisome renal mass is identified. LEFT KIDNEY: The left kidney measures 10.9 cm in length. The cortex is normal in echogenicity. There is mild hydronephrosis. A ureteral stent is seen within the collecting system. No shadowing renal stone or worrisome mass is identified.OTHER: A ureteral stent is seen within the nondistended bladder.", "output": "1.Mild hepatomegaly.2.Increased echogenicity and coarse echotexture compatible with hepatic dysfunction/fatty infiltration.3.Bilateral hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old male patient with alcohol cirrhosis with SBP, sepsis. Question of portal vein thrombosis. LIVER: The liver measures 14.4 cm in length. No focal hepatic lesion is identified. GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. No intrahepatic biliary ductal dilatation is identified.PANCREAS: The pancreas is obscured on this examination.RIGHT KIDNEY: The right kidney measures 14 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 13.9 cm in length. No evidence of hydronephrosis.The spleen measures 19.5 cm in length.There is moderate ascites.", "output": "1. Chronic liver disease with patent, but reversed portal venous flow.2. Splenomegaly and moderate ascites. "}
{"instruction": "Generate impression based on findings.", "input": "Male; 55 years old. Reason: stones Supernumerary kidneys fused at the midline.RIGHT KIDNEY: The right superior kidney measures 10.8 cm in length. Renal cortex is normal in echogenicity. At least two nonobstructing, shadowing stones with twinkle artifact are seen in the right kidney. The largest measures 0.6 cm. There are two collecting systems on the right, the inferior collecting system is prominent similar to CT. In the inferior aspect of the right duplicated inferior kidney is a 2.4 x 1.7 x 1.8 cm hypoechoic lesion with some internal echoes, a septation, and no internal flow on color Doppler. This corresponds to the lesion seen on recent CT.LEFT KIDNEY: The left superior kidney measures 14.6 cm. The renal cortex is normal in echogenicity. There are two collecting systems. There is no hydronephrosis or shadowing renal stone on the left.BLADDER: The bladder is nondistended.", "output": "1.Supernumerary kidneys fused at the midline.2.At least 2 nonobstructing stones on the right. Prominent inferior right collecting system, similar to prior CT exam, no significant hydronephrosis otherwise.3.2.4 cm hypoechoic lesion in the inferior right duplicated kidney corresponds to the lesion seen on recent CT. This is indeterminant on ultrasound and may be further evaluated with MRI if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Female 69 years old; Reason: history of left thyroid lobectomy. Follow up ultrasound of remaining lobe History: history of left thyroid lobectomy. Follow up ultrasound of remaining lobe RIGHT LOBE MEASUREMENTS: 4.5 x 2.1 x 2.4 cmLEFT LOBE MEASUREMENTS: Status post left thyroid lobectomy.ISTHMUS MEASUREMENT: 0.5 cmRIGHT LOBE: Solid cystic nodule measuring 0.9 x 0.7 x 0.7 cm in the mid right thyroid lobe with shadowing and increased shine through suggestive of colloid nodule. An additional homogenous solid nodule with faint hypoechogenicity in the lower thyroid pole measuring 1.8 x 1.3 x 1.3 cm, which is nonspecific.LEFT LOBE: No evidence of residual left thyroid tissue.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious lymphadenopathy.OTHER: No significant abnormality noted.", "output": "1.Homogenous solid nodule with faint hypoechogenicity in the lower right thyroid lobe, which is nonspecific.2.Solid cystic nodule in the mid right thyroid lobe suggestive of colloid nodule."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old male with right upper quadrant pain. LIVER: Measures 13.9 cm in length. There is increased hepatic echogenicity. Anechoic structure in the left hepatic lobe measures 1.6 x 1.2 x 1.5 cm consistent with a cyst. No additional lesions identified.GALLBLADDER, BILIARY TRACT: No cholelithiasis. No gallbladder wall thickening or pericholecystic fluid. No biliary duct dilation.PANCREAS: No significant abnormalities noted.KIDNEY: Suggestion of a small parapelvic cyst in the inferior pole of the right kidney. No hydronephrosis. OTHER: No significant abnormalities noted.", "output": "1. Increased hepatic echogenicity consistent with steatosis or parenchymal disease.2. No evidence of cholelithiasis or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female presents with right upper quadrant pain. LIVER:Measures 17.8 cm. Increased, coarse echogenicity. No focal mass, intrahepatic biliary dilation, or ascites. Portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: Gallbladder is nondistended with an anechoic lumen. Wall measures 0.2 cm. Common duct measures 0.6 cm. No stones or sludge.PANCREAS: Evaluation appears limited due to overlying bowel gas.OTHER: No significant abnormality noted.", "output": "1. Increased, coarse echogenicity of liver consistent with fatty infiltration and chronic liver disease/parenchymal dysfunction. No mass or ascites."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter; history papillary carcinoma. RIGHT LOBE MEASUREMENTS: 2.7 x 2 x 6.3 cmLEFT LOBE MEASUREMENTS: 2.5 x 2.3 x 6.4 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: No significant change in multiple predominantly solid nodules. Reference inferior nodule measures 2.7 x 2.1 x 3 cm.LEFT LOBE: No significant change in multiple predominantly solid left thyroid nodules. Reference inferior nodule measures 2 x 1.4 x 2.1 cm. Mid pole reference nodule measures 1.2 x 1.4 x 2.2 cm. Reference superior pole nodule measures 0.9 x 0.9 x 1.3 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Stable extrathyroid hypoechoic foci consistent with parathyroid adenomas. The largest again measures 1.2 x 1.4 x 2.2 cm.LYMPH NODES: Left level 3 normal sized lymph nodes that demonstrate hypoechogenicity and possible microcalcifications. A representative left level 3 lymph node measures 0.6 x 0.5 x 0.8 cm.OTHER: No significant abnormality noted.", "output": "No significant interval change in numerous bilateral predominantly solid thyroid nodules. Stable left parathyroid adenomas.Left level 3 normal sized lymph nodes that demonstrate somewhat unusual hypoechogenicity and possible microcalcifications. Metastatic disease cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": "Female 19 years old Reason: r/o hydronephrosis History: AKI in setting of prior hydronephrosis and chronic rejection RENAL TRANSPLANT: Transplant kidney measures 14 2.2 cm slightly enlarged. Echogenicity of the transplant kidney is significantly increased. There is increased medullary echogenicity. These findings are unchanged from previous study. Focal hydronephrosis involving the lateral pole of the transplant kidney is unchanged.LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: Please see the discussion aboveCOLLECTING SYSTEM/URETER: Focal dilatation of the lateral pole of the transplant kidney.URINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels No significant abnormality noted. Resistivity indices range between 0.6 and 0.5. Transplant vein is patent.OTHER: No significant abnormality noted", "output": "Again noted echogenic, enlarged transplant kidney with focal pole or hydronephrosis. Patent vessels."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old female with history of kidney stones and hydronephrosis. RIGHT KIDNEY: The right kidney measures approximately 11.9 cm, and again shows mild hydronephrosis. An approximately 1 cm calculus in the inferior pole, and approximately 8mm renal calculus in the midpole, are again seen.LEFT KIDNEY: The left kidney measures approximately 11.6 cm, and has mild hydronephrosis, unchanged. Left renal stone in the inferior pole measures approximately 1 cm, similar to prior.OTHER: The bladder is collapsed, and not clearly visualized.", "output": "Bilateral mild hydronephrosis and renal stones, without significant interval change."}
{"instruction": "Generate impression based on findings.", "input": "Female 2 months old; New gross hematuria. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. 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: 2 Left: 3  Length*** Right: 3.9 cm Left: 4.2 cm   Mean for age: 4.2 cm  Range for age: 3.9 - 5.9 cmADDITIONAL OBSERVATIONS: In the left kidney there are kidney stones at the inferior calix and pelvis. In the right kidney there is a kidney stone at the inferior calix.", "output": "Bilateral kidney stones and hydronephrosis.*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": "71 year old male patient with CKD, history of alcohol abuse. Evaluate liver and kidneys. LIVER: The liver measures 14.9 cm in length. Hepatic parenchymal echogenicity is increased. There is slight nodularity of the liver contour. 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 9.5 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11 cm in length. No evidence of hydronephrosis.The spleen measures 10.8 cm in length.A left pleural effusion is noted.", "output": "1. Findings suggestive of chronic liver disease.2. Left pleural effusion. "}
{"instruction": "Generate impression based on findings.", "input": "Miss Jonesbey is a 14-year-old female with a painful, palpable mass in the right breast for the past 1 week ago. She denies any overlying skin changes or nipple discharge. On physical examination, a small mobile mass is palpated at the superior periareolar region in the right breast.A targeted right breast ultrasound was performed for the palpable area of concern. In the right breast periareolar region, there is a circumscribed, hypoechoic mass with internal cystic component identified, measuring approximately 8 x 6 x 8 mm.", "output": "0.8 cm benign morphology mass at the site of palpable concern in the right periareolar region, with sonographic findings suggestive of a fibroadenoma. Given palpability, a breast surgical consultation is recommended for further evaluation. All results and recommendations were discussed with the patient and the patient's mother. BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Male, 56 years old. Flank pain and hematuria. Evaluate for recurrent kidney stones. The kidneys are fused at the midline.RIGHT KIDNEY: The right kidney area measures approximately 11.3 cm with normal cortical echotexture. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney area measures approximately 14.8 cm with normal cortical echotexture. No shadowing stones or hydronephrosis.OTHER: The bladder is incompletely distended.", "output": "Horseshoe kidney with no renal stones or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old female with sickle cell disease, nephrolithiasis, hematuria. RIGHT KIDNEY: Measures 10.8 cm in length. Mildly prominent echogenic renal pyramids. No nephrolithiasis or hydronephrosis.LEFT KIDNEY: Measures 11.8 cm in length. Mildly prominent echogenic renal pyramids. 1.4 cm left renal cyst without septation or solid component. No nephrolithiasis or hydronephrosis.URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.", "output": "1.No evidence of nephrolithiasis or hydronephrosis.2.Mildly enlarged kidneys with echogenic renal pyramids may represent sickle cell nephropathy."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male patient with previously noted hypoechoic region adjacent to the gallbladder fossa. Urination hourly, nocturia x3. Assess for hydronephrosis. LIVER:The liver measures 15.0 cm in length and demonstrates increased parenchymal echogenicity. A region of hypoechogenicity adjacent to the gallbladder fossa measures approximately 3.7 x 3.0 cm, similar to the prior study, and likely represents focal fatty sparing. Main portal vein flow is hepatopetal and measures 0.2 m/s.GALLBLADDER, BILIARY TRACT: No gallstones, gallbladder wall thickening, or pericholecystic fluid is identified. There is no intra or extra hepatic biliary ductal dilatation. The common duct measures approximately 4 mm in diameter. PANCREAS: The visualized head of the pancreas demonstrates normal echogenicity. The remaining pancreas is not visualized secondary to overlying bowel gas.SPLEEN: The spleen measures 8 cm in length.KIDNEYS: The right kidney measures 8.9 cm and the left kidney measures 10.3 cm in length. No evidence of hydronephrosis. There is a 1.2 x 1.4 cm left mid to lower pole renal cyst.ABDOMINAL AORTA: The proximal abdominal aorta measures 2.5 x 3.0 cm, the midportion measures 2.2 x 2.2 cm, and the distal abdominal aorta measures 2.3 x 2.2 cm.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: The bladder is decompressed.", "output": "1. Increased hepatic parenchymal echogenicity consistent with hepatic steatosis with focal fatty sparing near the gallbladder fossa, appearing similar to the prior study.2. Left renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "Intra-abdominal and pelvic swelling, patient with a cherry sized ovoid mass between the umbilicus and pubic symphysis No focal suspicious cystic or solid mass noted. Abdominal fat noted.", "output": "No focal suspicious cystic or solid mass within the palpable area of concern"}
{"instruction": "Generate impression based on findings.", "input": "Neck swelling. Hypothyroidism. RIGHT LOBE MEASUREMENTS: 2.4 x 2.2 x 6.1 cmLEFT LOBE MEASUREMENTS: 2.6 x 3.5 x 6.3 cmISTHMUS MEASUREMENTS: 6 mm in the AP dimension.RIGHT LOBE: Heterogeneous background thyroid gland with increased vascularity. Several homogeneous slightly hyperechoic solid nodules are noted, the largest of which measures 1.6 cm.LEFT LOBE: Heterogeneous background thyroid gland with increased vascularity. Several homogeneous slightly hyperechoic solid nodules are noted, the largest of which measures 2.0 cm, with mild cystic changesISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Heterogeneous thyroid gland with increased vascularity, which may be seen with acute or chronic thyroiditis.2. Multiple thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal failure RIGHT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Benign-appearing renal cyst. Right kidney 10.8 cm in lengthLEFT KIDNEY: Echogenic parenchyma without worrisome mass or stone. Mild to moderate left hydronephrosis. Left kidney 10.8 cm in lengthOTHER: Bladder nondistended", "output": "Echogenic parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass or stone. Mild to moderate left hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with coagulopathy and ascites. Evaluate for liver disease. LIVER: Liver measures 16 cm in length. Echotexture is mildly coarsened, and the contour is scalloped. There is widening of fissures and enlargement of the lateral segment left lobe. The appearance is consistent with cirrhosis. There is no focal hepatic mass. 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.BILIARY TRACT: Gallbladder contains dependent stones and sludge. Gallbladder wall thickness is upper normal but this is not specific in the face of ascites.PANCREAS: Inadequately visualized due to bowel gas.SPLEEN: Normal in size.RIGHT KIDNEY: No significant abnormalities noted. OTHER: Mild to moderate ascites.", "output": "Cirrhotic liver without mass. Main portal vein patent.Gallstones."}
{"instruction": "Generate impression based on findings.", "input": "32 year-old female with right upper quadrant pain. Evaluate for abscess underneath right upper quadrant incision. LIVER: The liver is normal in morphology, echogenicity and size, measuring 16 7 cm in craniocaudal dimension. No intrahepatic biliary ductal dilatation or focal hepatic lesion is evident. There is normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: A 1.3 cm mobile gallstone is noted in a normally distended gallbladder without wall thickening, pericholecystic fluid, or focal tenderness. No extrahepatic biliary duct dilatation with the common bile duct measuring up to 3 mm.PANCREAS: The visualized pancreatic head and body are unremarkable.SPLEEN: The spleen measures 10.5 cm in length without a discrete abnormality.RIGHT KIDNEY: The right kidney measures 10.2 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow. OTHER: Targeted ultrasound was performed of the right upper quadrant incision site and demonstrates no discrete fluid collection.The left kidney measures 10.8 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow.", "output": "Cholelithiasis without evidence of acute cholecystitis. No fluid collection at the site of the patients right upper quadrant incision. "}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female with history of right breast lumpectomy for breast cancer in 1996 followed by recurrence (ILC), in November 2009, underwent right breast mastectomy in January 2010 and left breast reduction surgery in November, 2014 in New Orleans. Patient presents to evaluate a physician palpated lump in the left breast and denies a mammogram, due to discomfort and pain associated with the compression. A targeted left breast ultrasound was performed for the palpable area of concern at 3 to 4:00 position. On physical Examination, a 2-cm lump is palpated. Ultrasound demonstrates a oval mixed echogenic area measuring 1.3 x 0.8 x 1 cm, corresponding to the palpable abnormality, most consistent with area of fat necrosis.", "output": "Palpable abnormality in the left breast corresponds to area of fat necrosis. Surgical consultation is recommended. Patient is scheduled to see her plastic surgeon from New Orleans next week. No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bialteral diagnostic mammogram is recommended, due in October 2014. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs. LIVER: Non-cirrhotic liver morphology. Echogenic hepatic mass identified, which measures 11.5 x 7.0 x 8.8 cm. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Cholelithiasis and biliary sludge noted in the gallbladder. No gallbladder wall thickening or sonographic Murphy 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 10.3 cm in length. A questionable echogenic area in the midpole may be artifactual or represent a soft tissue mass. No hydronephrosis is present.The left kidney is 10.1 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 10.2 cm in length, without focal lesions evident.ABDOMINAL AORTA: Patent, without aneurysm.INFERIOR VENA CAVA: Patent.OTHER: No ascites. Prostatomegaly, measuring 7 cm in widest dimension.", "output": "1. 11.5 cm indeterminate hepatic mass. Evaluation with CT or MRI is recommended.2. Possible right renal mass versus artifact. Evaluation with CT or MRI is recommended.3. Cholelithiasis without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old female patient status post islet cell transplant. Two year follow-up. LIVER: The liver measures 15.4 cm in length and is increased in parenchymal echogenicity. A few well circumscribed echogenic foci, likely calcified, within the right hepatic lobe appear similar to the prior study and are likely benign in etiology. The main portal vein is patent with hepatopetal flow measuring approximately 16 cm/s.BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. There is no intra or extrahepatic biliary duct dilatation. The common bile duct measures 1 mm in diameter.PANCREAS: The head and proximal body of the pancreas appear normal in echogenicity. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 10 cm in length.RIGHT KIDNEY: The right kidney measures 10.6 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.9 cm in length. No evidence of hydronephrosis.", "output": "1. Patent portal vein with stable, likely benign echogenic foci within the right hepatic lobe.2. Increased hepatic parenchymal echogenicity suggestive of hepatic steatosis. "}
{"instruction": "Generate impression based on findings.", "input": "Evaluate posterior nodule RIGHT LOBE MEASUREMENTS: 3.8 x 1.4 x 1.2 cmLEFT LOBE MEASUREMENTS: 3.9 x 1.5 x 1.1 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Nonspecific hypoechoic lesion posterior to the left thyroid gland is unchanged in size from the prior exam measuring 0.5 x 0.4 x 0.6 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.", "output": "Nonspecific hypoechoic lesion posterior to the left thyroid lobe is stable in size compared to the prior exam and likely benign."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Blaszka is a 69-year-old female with biopsy-proven left breast IDC on hormonal therapy for 6 weeks, presenting for sonographic evaluation of treatment response. On physical exam, a fixed mass is palpated within the left upper inner quadrant.Targeted ultrasound of the left breast was performed for the patient's area of concern. In the left breast 11:00 location, approximately 5 cm from the nipple, there is revisualization of the biopsy proven malignancy now measuring approximately 3.1 x 2.0 x 2.2 cm, previously measuring 3.2 x 2.2 cm. Internal echogenic focus is compatible with percutaneously placed biopsy marker clip.", "output": "No significant interval change in biopsy proven malignancy of the left breast. Continued surgical consultation is recommended at this time. All results and recommendations were discussed with the patient. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "50 year-old female with hepatitis C cirrhosis. For hepatocellular carcinoma. LIVER: Liver is mildly enlarged and coarsely echogenic without significant change. Within the lateral segment left lobe there is again noted a mildly echogenic mass measuring approximately 1 0.2 x 1 at one . 5 cm. Measurements have increased in compared to prior exam.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: Normal in size, contour and echogenicity.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Morphologically normal peripancreatic lymph node.", "output": "Mild interval enlargement of left lobe mass. This has been determined on prior CT represent a hemangioma."}
{"instruction": "Generate impression based on findings.", "input": "History of sickle cell disease with, with elevated liver function tests and alkaline phosphatase. LIMITED ABDOMEN", "output": "1.Small sized spleen compatible with sickle cell patient.2.Mildly enlarged liver with normal echotexture."}
{"instruction": "Generate impression based on findings.", "input": "Fatty liver LIVER: Coarse echogenic liver echotexture again noted consistent with fatty infiltration. Stable right lobe minimally complex cyst measuring 2.3 x 2 x 1.4 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.8 cm in lengthOTHER: Left kidney 12.5 cm in length. Spleen 10.5 cm in length. No ascites.", "output": "Stable coarse echogenic liver echotexture consistent with fatty infiltration without worrisome mass or ductal dilatation. No ascites. Stable right lobe hepatic minimally complex cyst."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal liver function tests, history of bile duct stent, and liver lesion seen on prior CT, and history of right renal cell carcinoma. LIVER:The liver measures 14 cm in length. The echogenicity of the liver parenchyma is normal. The known dome lesion within segment 8 of the liver, seen on prior CT, cannot be visualized on this ultrasound due to its proximity to the lung. No new worrisome masses are noted. There is no intrahepatic ductal dilation seen. No ascites. The portal vein is patent with hepatopetal flow measuring 49.7 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is surgically absent. Common bile duct stent is unchanged.PANCREAS: The pancreas is not well-visualized due to bowel gas.SPLEEN: The spleen measures 13.5 cm in length. No significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 12.9 cm in length. The echogenicity of the cortex is normal. There is no hydronephrosis seen, no stones, and no new worrisome masses. The right kidney defect is again demonstrated, seen on prior CT. This defect measures 3.1 cm x 2 cm x 3.8 cm.LEFT KIDNEY: The left kidney measures 13.4 cm in length. The cortex has normal echogenicity. There is no hydronephrosis, no stones, and no new worrisome masses noted.", "output": "1. Liver parenchyma appears normal, no new worrisome masses, intrahepatic ductal dilation, or ascites is seen. Common bile duct stent is visualized appears unchanged.2. The known dome lesion within segment 8 of the liver is not well-visualized on this ultrasound due to its proximity to the lung. This was seen on prior CT.3. Defect in the right kidney is again demonstrated as seen on prior CT."}
{"instruction": "Generate impression based on findings.", "input": "Right-sided flank pain RIGHT KIDNEY: 9.6 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 9.9 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female patient with hypoxic respiratory failure, shock, ARDS, GVHD of liver, elevated bilirubin. Evaluate for venoocclusive disease. LIMITED ABDOMENLIVER: The liver measures 15.2 cm in length and demonstrates increased echogenicity.BILIARY TRACT: No gallstones are identified. Gallbladder wall thickening measuring 6 mm is nonspecific in the setting of ascites. There is no intra or extrahepatic biliary ductal dilatation. The common duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen measures 12.6 cm in length. KIDNEYS: The right kidney measures 13.1 cm and the left kidney measures 14 cm in length. No evidence of hydronephrosis.OTHER: There is moderate ascites.", "output": "1. Patent hepatic vasculature. 2. Increased hepatic echogenicity which can be seen with hepatic parenchymal dysfunction.3. Moderate ascites. "}
{"instruction": "Generate impression based on findings.", "input": "21-year-old female with hemoglobin SC and venoocclusive disease. Generalized abdominal pain. LIVER: Hepatic size is within normal limits. Echotexture appears perhaps minimally coarsened which is nonspecific. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates appropriate flow direction and patency in the main portal vein with velocity of 20 cm/s.BILIARY TRACT: Gallbladder is well-visualized and is normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: Limited due to bowel gas.SPLEEN: Upper normal in size without focal abnormality.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Mildly coarsened liver echotexture with splenic size upper normal. These findings are not significant change from prior exam."}
{"instruction": "Generate impression based on findings.", "input": "Female 37 years old Reason: Localization of parathyroid glands for patient with secondary hyperparathyroidism, assess for thyroid nodules History: Secondary hyperparathyroidism RIGHT LOBE MEASUREMENTS: 5.2 x 2.0 x 1.5 cm.LEFT LOBE MEASUREMENTS: 4.4 x 1.9 x 1.5 cm.ISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: Normal echogenicity of the right thyroid lobe without nodules.LEFT LOBE: Normal echogenicity of the left thyroid lobe without nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Inferior and separate to the left thyroid lobe is a hypoechoic focus measuring 0.7 x 0.3 x 0.5 cm, which may represent a parathyroid gland or small adenoma.LYMPH NODES: No significant abnormality noted. No regional lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Inferior to the left thyroid lobe is a hypoechoic nodule likely representing a hyperplastic parathyroid gland or small parathyroid adenoma. Please see same day nuclear medicine study for additional findings."}
{"instruction": "Generate impression based on findings.", "input": "Female 68 years old; Reason: multiple thyroid nodules, follow up. History: thyroid nodules. RIGHT LOBE MEASUREMENTS: 4.2 x 1.7 x 1.5 cmLEFT LOBE MEASUREMENTS: 4.2 x 1.4 x 1.2 cmISTHMUS MEASUREMENT: 0.2 cmRIGHT LOBE: The right thyroid lobe is homogeneous in echogenicity.LEFT LOBE: The left thyroid lobe is homogeneous in echogenicity and contains a calcified nodule measuring 0.8 x 0.5 x 0.6 cm, previously measured 0.5 x 0.5 x 0.4 cm. There is an additional simple cystic lesion more superiorly measuring 0.3 x 0.4 x 0.3 cm, previously measured 0.2 x 0.2 x 0.2 cm.ISTHMUS: No significant abnormality noted.LYMPH NODES: A single left benign-appearing level 5 lymph node is noted measuring 1.2 x 3.4 x 0.6 cmOTHER: No significant abnormality noted.", "output": "1.Thyroid nodules as described above.."}
{"instruction": "Generate impression based on findings.", "input": "17-year-old female with left breast lump at the 2:00 position. A targeted left breast ultrasound was performed for the palpable area of concern.At 3:00, 2 cm from the nipple, there is a 1.8 x 0.9 x 1.6 cm circumscribed oval hypoechoic mass with internal vascularity.", "output": "Solid mass at the 3:00 position in the left breast, corresponding to the palpable abnormality is probably a fibroadenoma. Consultation with a breast surgeon is recommended for further management. If no further intervention is planned based on physical exam, a short term ultrasound follow up in 6 months could be considered. Results and recommendation were discussed with the patient and the patient's mother.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female with history of thyroid cancer status post thyroidectomy, chemotherapy, radioactive iodine. Of note she also had lymph nodes in her right neck dissected . 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: No adenopathy.OTHER: No significant abnormality noted.", "output": "1. Surgical changes of a thyroidectomy without evidence of recurrence."}
{"instruction": "Generate impression based on findings.", "input": "4-year-old male with history of hematuria and questionable bladder polyp on prior ultrasound. Assess for resolution. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. 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: 0 Left: 0  Length*** Right: 7.2 cm Left: 7.3 cm   Mean for age: 7.5 cm  Range for age: 6.5 - 8.5 cmADDITIONAL OBSERVATIONS: None", "output": "Normal examination.*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": "50 year old female with a thyroid cyst, fatigue. Evaluate for progression RIGHT LOBE MEASUREMENTS: 5.3 cm x 2.4 cm x 2.7 cmLEFT LOBE MEASUREMENTS: 5.1 cm x 1.4 cm x 2.4 cmISTHMUS MEASUREMENTS: 0.3 cm in thicknessRIGHT LOBE: At the upper pole there is a mixed solid cystic nodule measuring 1.6 cm x 0.9 cm x 1.7 cm previously measured 1.5 cm x 1.7 cm x 1.9 cm. At the inferior pole there is an additional heterogeneous vascular nodule measuring 1.2 cm x 0.7 cm x 1.6 cm previously measured 1.2 cm x 0.8 cm x 1.7 cm. LEFT LOBE: At the midpole there is a heterogeneous nodule measuring 0.6 cm x 0.3 cm x 0.6 cm, previously measured 0.7 cm x 0.6 cm x 0.4 cm. there is no internal vascularity or definite microcalcifications. At the inferior pole there is an additional solid nodule measuring 0.7 cm x 0.4 cm x 0.6 cm previously measured 0.7 cm x 0.5 cm x 0.6 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign appearing right neck level 2 lymph node measures 6 mm x 3 mm x 10 mmOTHER: No significant abnormality noted.", "output": "No significant interval change in the bilateral thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "Left breast mass for one month palpated by the doctor and the patient. Family history of breast cancer in grandmother. On physical examination, a 1 cm mobile mass identified in the left breast 12:00 position 1 cm from the nipple. Targeted left breast ultrasound was performed. Ultrasound demonstrates a superficial lobulated parallel oriented hypoechoic mass that measures 1.7 x 1.3 x 1.7 cm with central blood flow. No suspicious solid mass noted.", "output": "Palpable abnormality left breast 12:00 position corresponds to a benign fibroadenoma based on imaging. Findings conveyed to the patient and her mother in detail.Patient will be followed by Dr. Deborah Loeff for surgical consultation. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Reason: History of HBV. Evaluate for HCC LIVER: The liver measures 14.6 cm in length. Coarse echogenic liver parenchyma, consistent with hepatic steatosis/parenchymal dysfunction. No focal masses. The portal vein is patent with normal hepatopedal directional flow and peak velocity of 32.6 cm/s.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. No sonographic evidence of cholelithiasis or biliary ductal dilatation. Gallbladder wall measures 0.3 cm.PANCREAS: Obscured due to overlying bowel gas.RIGHT KIDNEY: Atrophic, echogenic right kidney, measuring 6.6 cm in length. No significant hydronephrosis or shadowing renal calculi.LEFT KIDNEY: Not visualized.SPLEEN: The spleen measures 13.0 cm in length.OTHER: Right iliac fossa renal transplant measures 11.8 cm in length and demonstrates normal echogenicity without shadowing renal calculi or hydronephrosis. No ascites.", "output": "1. Coarse echogenic liver echotexture, consistent with hepatic parenchymal dysfunction, hepatic steatosis, or chronic liver disease without focal mass or biliary ductal dilatation.2. Right iliac fossa renal transplant without shadowing renal calculi or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Tubular interstitial nephritis RIGHT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. 10.3 cm in length. No perinephric collection.LEFT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. 9.3 cm in length. No perinephric collection.OTHER: Bladder nondistended", "output": "Negative renal ultrasound. Normal parenchymal echogenicity without mass, stone, or hydronephrosis. No perinephric collection."}
{"instruction": "Generate impression based on findings.", "input": "56 year old female with history of HCV cirrhosis with abdominal pain, ascites, fever. Evaluate for acute cholecystitis, liver structure, portal veins, and IVC. LIVER: Cirrhotic liver morphology. No focal hepatic lesions. Main portal vein is patent with appropriate direction of flow; peak velocity measures 0.4 m/sec.GALLBLADDER, BILIARY TRACT: Gallbladder is markedly thick chest walls although this is not specific in the face of ascites. No shadowing gallstones. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Moderate ascites.", "output": "Gallbladder wall thickening which is not specific with associated ascites. No gallstones.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "History of urothelial cancer, acute kidney injury, rule out hydronephrosis or obstruction RIGHT KIDNEY: Measures 7.5 cm. Echogenic renal parenchyma. Small renal cyst measuring 1.3 cm. No hydronephrosis or mass.LEFT KIDNEY: Measures 12.2 cm. Echogenic renal parenchyma. Multiple cysts measuring up to 1.4 cm. No hydronephrosis or mass.OTHER: Foley catheter in decompressed bladder.", "output": "Medical renal disease without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Female 44 years old Reason: Pain LUQ - Have been told she has hernia. History: Pain LUQ - Have been told she has hernia. No free likely than fluid. Lateral segment left lobe appears normal.Normal peristalsing stomach is seen.Prominent small bowel loop is seen dorsal to the stomach questionable clinical significance. On some images there is an appearance of transient intussusception which I could not reproduce when scanning myself.No evidence of abdominal wall hernia.", "output": "No evidence of abdominal wall hernia.Prominent jejunal loops in left upper quadrant of questionable clinical significance. Possible transient jejunal intussusception. Patient reported no nausea vomiting or postprandial symptoms. Correlate clinically."}
{"instruction": "Generate impression based on findings.", "input": "Reason: elevated Bilirubin History: Abd pain LIVER: Echogenicity of the hepatic parenchyma is currently increased. Pneumobilia is again noted. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts.", "output": "Severe fatty infiltration. Pneumobilia is seen, but no ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Male 35 years old; Reason: to determine NASH staging History: none LIVER: The liver measures 21.9 cm in length. There is significantly increased echogenicity of the liver parenchyma which appears heterogeneous. There is also slight nodular appearance. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 22.9 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.0 mm. A single shadowing and movable stone is seen within the gallbladder. This measures 0.5 cm x 0.3 cm. No pericholecystic fluid. The common bile duct measures 3.5 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 13.1 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.9 cm in length. The cortex hasnormal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 12.5 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "The liver has significantly increased echogenicity compatible with fatty infiltration. There is also some slight nodularity which may represent early cirrhotic morphology. No worrisome masses are seen within the liver however detection of masses is limited due to significantly echogenic liver."}
{"instruction": "Generate impression based on findings.", "input": "79-year-old female with significant soft tissue swelling and purulent discharge from the dorsum of right foot. Patient is diabetic. In the region of swelling on the dorsum of the foot there is a highly complex fluid collection measuring 1 x 3.5 x 4 cm. No definite gas shadowing identified.", "output": "Complex fluid collection in the subcutaneous tissues of the dorsum of the right foot. The appearance is consistent with abscess."}
{"instruction": "Generate impression based on findings.", "input": "Gallbladder polyp 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. The 3 mm gallbladder polyp is unchanged compared to 7/24/2015. Otherwise unremarkable appearance of the gallbladder.PANCREAS: The visualized portions of the body and tail are asymmetrically prominent. The remaining head and tail are obscured by bowel gas.KIDNEYS: The right kidney is 11.5 cm in length. The left kidney is 12.3 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 11.2 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.", "output": "1. Unchanged appearance of the 3 mm gallbladder polyp.2. Asymmetric prominence of the partially visualized pancreatic body and tail. This may represent focal pancreatitis or an underlying neoplasm. Correlation with medical history and any outside prior labs or imaging is recommended if available."}
{"instruction": "Generate impression based on findings.", "input": "12 month old male patient with hydronephrosis. Follow-up examination. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. 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: 1  Length*** Right: 7 cm Left: 6.3 cm   Mean for age: 6.5 cm  Range for age: 5 - 7.5 cmADDITIONAL OBSERVATIONS: None", "output": "Normal examination.*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": "29 years, Female. Reason: abdominal distention, high TF residual History: abdominal distention, high TF residual Paucity of bowel gas without definite evidence of fluid-filled distended loops. Ultrasound showed generalized ascites.Air is seen in the nondistended stomach. NG tube in distribution of distal gastric body.", "output": "Nonspecific but favor ileus. NG tube in distribution of distal gastric body."}
{"instruction": "Generate impression based on findings.", "input": "Female; 67 years old. Reason: usg of liver, hcc screen for cirrhosis History: same LIVER: The liver measures 13.0 cm in length. The liver surface is nodular, the parenchyma is diffusely echogenic and coarsened in echotexture. No focal hepatic lesion is evident. There is no ascites.The main portal vein is patent and demonstrates a hepatopetal flow with a peak velocity of 0.2 m/sec. Portal vein diameter is 1.6 cm in diameter on the current study, previously 2.3 cm.BILIARY TRACT: Status post cholecystectomy. The common duct measures 9 mm in diameter, unchanged. There is no intrahepatic biliary duct dilatation.PANCREAS: The pancreas is not well visualized due to overlying bowel gas.SPLEEN: The spleen measures 14.4 cm in length.KIDNEYS: The right kidney measures 11.0 cm in length, the left measures 11.5 cm in length. The renal parenchyma is normal in echogenicity bilaterally. There is no hydronephrosis or shadowing renal stone. OTHER: No significant abnormalities noted.", "output": "1.Cirrhotic liver morphology. No focal hepatic lesion.2.Splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Female; 81 years old. Reason: hx of renal mass, please evaluate History: see above RIGHT KIDNEY: The right kidney measures 9.9 cm in length. Moderate hydronephrosis appears slightly worse when compared to the prior ultrasound. No shadowing renal stone or worrisome renal mass is identified.LEFT KIDNEY: The left kidney measures 8.1 cm in length. The renal cortex is increased in echogenicity. There is no hydronephrosis, shadowing renal stone, or worrisome renal mass is identified. There is a 3.1-cm simple cysts in the upper pole renal sinus.URINARY BLADDER: The bladder is nondistended.OTHER: No significant abnormalities noted.", "output": "1.Moderate right hydronephrosis slightly worse when compared to the prior ultrasound.2.3.1 cm simple cyst in the right upper pole renal sinus.3.Echogenic kidneys compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Normal echogenicity without worrisome mass. Multiple liver cysts. The largest within the right lobe measuring 3.5 x 3.7 x 2.6 cm. Liver length 13 cmGALLBLADDER, BILIARY TRACT: Nonmobile subcentimeter soft tissue focus within the gallbladder measuring 0.3 x 0.4 x 0.3 cm. No acute inflammation. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.9 cm in lengthOTHER: Left kidney 11.3 cm in length. Spleen 8.9 cm in length. No ascites.", "output": "Multiple liver cysts. No worrisome hepatic mass or ductal dilatation. No acute inflammatory process. Probable subcentimeter gallbladder polyp. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female patient with rising direct and indirect bilirubin, ascites. Evaluate etiology of liver and gallbladder disorder. LIVER: The liver measures 15.9 cm in length. A segment IV hyperechoic lesion corresponds to focal fat as seen on prior MRI. Additional hyperechoic lesions are similar to the prior ultrasound. The liver is mildly nodular in contour. Main portal vein flow is hepatopetal and measures 0.1 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. An echogenic focus in the gallbladder which likely represents a polyp measures 0.3 x 0.3 x 0.4 cm. There is no intrahepatic biliary ductal dilatation. The common duct measures 8 mm in diameter.PANCREAS: The pancreas is poorly visualized on this examination.RIGHT KIDNEY: The right kidney measures 13.9 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 15.7 cm in length. No evidence of hydronephrosis.The spleen measures 18.7 cm in length.There is mild ascites.", "output": "1. Cirrhotic morphology of the liver with scattered hyperechoic lesions, one of which demonstrated to be fat on prior MRI.2. Mild ascites and splenomegaly.3. Subcentimeter gallbladder polyp."}
{"instruction": "Generate impression based on findings.", "input": "Reason: worsening renal function RIGHT KIDNEY: The right kidney measures 12.8 cm in length. No evidence of hydronephrosis or stones.LEFT KIDNEY: Non-visualized.OTHER: Poorly distended urinary bladder. Small volume of ascites.", "output": "Normal appearing right kidney without hydronephrosis. Left kidney not visualized."}
{"instruction": "Generate impression based on findings.", "input": "55 year old female with ascites. Assess patency of TIPS. LIMITED ABDOMENLIVER: Cirrhotic liver morphology measuring 13.6 cm in length. No focal hepatic lesions. BILIARY TRACT: Status post cholecystectomy. Common bile duct measures 3 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of pancreas are unremarkable.SPLEEN: Normal echogenicity of the spleen measuring 11.3 cm in length. RIGHT KIDNEY: Measures 10.0 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 10.5 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "Cirrhotic liver morphology. Patent TIPS."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic small cell carcinoma with liver abnormalities LIVER: Diffusely heterogeneous liver with multiple bilobar confluent hypoechoic mass lesions. Liver length 27.2 cmDoppler interrogation of hepatic vessels demonstrate a possible filling defect in the main portal vein. Main portal vein flow remains pedal with a velocity 15.8 cm/s. Hepatic artery and hepatic veins appear patent.GALLBLADDER, BILIARY TRACT: No significant abnormality noted.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. 8.1 cm in length KIDNEYS: Right kidney 12 cm in length Left kidney 11.6 cm in length ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Porta hepatis adenopathy. No ascites. Right pleural effusion.", "output": "Diffusely heterogeneous liver with bilobar confluent mass lesions worrisome for metastatic disease. No ductal dilatation. While the hepatic vessels appear patent with normal directional flow, there may be a nonobstructing filling defect within the main portal vein. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Male 57 years old; Reason: Patient w/ history of NASH cirrhosis w/fever, RUQ ultrasound to eval for biliary tract pathology History: Patient with NASH cirrhosis, fever LIVER: The liver measures 16.4 cm in length. There is coarse increased echogenicity of the liver parenchyma with a nodular appearance, unchanged from prior CT. No focal hepatic lesions. The main portal vein is patent with normal hepatopetal flow measured at 53.8 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is surgically absent. The common hepatic duct measures 5.3 mm. The common bile duct was not well visualized and difficult to measure. No intrahepatic ductal dilation is seen.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 14.9 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 8.3 cm in length and appears atrophic. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 8.3 cm in length and appears atrophic. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No ascites is visualized.", "output": "1. The liver has coarse increased echogenicity and nodular appearance compatible with chronic liver disease. This appears stable from prior CT. No worrisome masses or ascites are seen.2. The gallbladder is surgically absent. There is no intra or extrahepatic ductal dilation seen.3. Splenomegaly.4. Bilaterally the kidneys appear echogenic and atrophic compatible with medical renal disease, as seen on prior CT."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female with renal insufficiency. Ultrasound guidance was provided for biopsy of patient's native right kidney.", "output": "Ultrasound guidance."}
{"instruction": "Generate impression based on findings.", "input": "24 years old, Male, Reason: evaluate for cholelithiasis History: post prandial abdominal pain, nausea LIVER: The liver measures 16.4 cm in length. The liver parenchyma 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 0.2 m/s. Small subcentimeter calcification within the left lobe of the liver is indeterminate and may represent a granuloma.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 11.5 cm in length. RIGHT KIDNEY: Kidney measures 11.1 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 12.5 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis.2.Subcentimeter calcification in the left hepatic lobe is indeterminate and may represent a granuloma."}
{"instruction": "Generate impression based on findings.", "input": "Postprandial right upper quadrant pain LIVER: Normal parenchymal echogenicity without mass. Liver length 16.6 cm.GALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or duct dilatation. Possible adenomyomatosisPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.8 cm in length.OTHER: Left kidney 10.9 cm in length. Upper pole left renal cyst. Spleen 11.3 cm in length. No ascites", "output": "Gallbladder sludge without acute inflammation or ductal dilatation. Possible adenomyomatosis. Unremarkable liver. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Ms. McClintock is a 26 year old female presenting with physician-detected right breast fullness. Patient herself complains of focal pain in the right upper inner breast. On physical exam of the right breast, no discrete masses are appreciated. Right breast ultrasound was performed.No suspicious cystic or solid mass is identified in the right breast, including at her site of pain.", "output": "No sonographic evidence of malignancy. Patient's focal breast pain should be managed clinically. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Obstructive jaundice of unknown etiology. LIVER: Diffusely heterogeneous echogenic liver. Normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: Intrahepatic biliary ductal dilatation is better appreciated on MRCP from same date. Dilated proximal common hepatic duct, measuring 12 mm. Borderline enlarged distal common bile duct, measuring 6 mm. Numerous hyperechoic stones are noted in the gallbladder body and neck, with single stone in the gallbladder neck measuring 1.5 cm. The gallbladder is distended and partially filled with sludge, however there is no evidence of wall thickening or pericholecystic fluid.PANCREAS: No significant abnormalities noted. Not well visualized.RIGHT KIDNEY: Numerous bilateral hypoechoic renal lesions likely represent benign cysts, measuring up to 3.3 cm.OTHER: No significant abnormalities noted.", "output": "1. Intra and extrahepatic biliary ductal dilation, raising concern for distal obstructive process. When correlated with MRCP, again no stones within the common bile duct are identified.2. Cholelithiasis with gallbladder distention, without evidence of cholecystitis.2. Diffusely echogenic liver, consistent with hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "74 years old, Female, Reason: 74 y/o F with therapy realated MPS now R lateral thigh cellulitis with induration. Please evaluate for drainable fluid collection/abscess History: pain, R thigh cellulitis Skin thickening with increased echogenicity and edema within the soft tissues consistent with cellulitis. No focal fluid collections to suggest abscess.", "output": "Cellulitis without evidence of abscess."}
{"instruction": "Generate impression based on findings.", "input": "Female 48 years old Reason: epigastric pain/ RUQ pain, loss of appetite History: as above LIVER: Echogenic liver parenchyma, which is nonspecific but may be seen in the setting of fatty infiltration or diffuse hepatic dysfunction. No focal hepatic mass. Main portal vein is patent with normal directional flow.BILIARY TRACT: Common bile duct is dilated measuring approximately 10 mm near the porta hepatis and distally tapering to 8 mm. No common bile duct stone is visualized. Gallbladder is normal in appearance. No gallstones. No intrahepatic biliary ductal dilatation.PANCREAS: Partially visualized portions of the pancreas are unremarkable.SPLEEN: Spleen is normal in appearance measuring 8.3 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass.. Right kidney measures 10.8 cm. Left kidney measures 10.9 cmOTHER: There is a multilobulated, predominantly anechoic collection, which appears peripherally calcified with septations. This does not definitely connect to the spleen or to the kidney.", "output": "1.Dilated common bile duct without ductal stone identified. Recommend MRCP for further evaluation of possible intraductal pathology and/or stone.2.Nonspecific multilobulated fluid collection in the left upper quadrant, which may originate from the adrenal gland or retroperitoneum. MRI of the abdomen will also help further evaluate this lesion.Discussed with ordering physician Dr. Veskovic. "}
{"instruction": "Generate impression based on findings.", "input": "34 years Female with history of thyroid cancer status post thyroidectomy now with elevated thyroglobulin. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Status post thyroidectomy. No suspicious nodules in the thyroidectomy bed.LEFT LOBE: Status post thyroidectomy. Inferior to the left thyroidectomy bed, there is a heterogeneous, predominantly solid mass with somewhat indistinct margins which measures 3.7 x 1.7 x 2.2 cm. The lesion does not appear to demonstrate internal vascularity.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormalities.LYMPH NODES: No significant abnormalities. OTHER: No significant abnormalities.", "output": "Heterogeneous predominantly solid mass inferior to the left thyroidectomy bed measuring up to 3.7 cm which could represent recurrence and would be amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Urinary retention RIGHT KIDNEY: Normal parenchymal echogenicity without worrisome mass or hydronephrosis. Multiple subcentimeter punctate nonobstructing renal stones. Benign renal cysts. Right kidney 9.8 cm in lengthLEFT KIDNEY: Normal parenchymal echogenicity without worrisome mass or obstruction. Multiple subcentimeter punctate nonobstructing renal stones. Benign renal cyst. Left kidney 8 cm in lengthOTHER: Bladder nondistended", "output": "Multiple bilateral punctate nonobstructing renal stones without worrisome mass or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old male with a history of heart failure and lower extremity edema. Evaluate for cirrhosis. LIVER: The liver is mildly coarse and increased in echogenicity. It is normal in size, measuring 16.4 cm. The liver morphology is normal. No focal hepatic lesion or intrahepatic biliary ductal dilatation. Normal hepatopetal portal venous blood flow at 30 cm/sec.GALLBLADDER, BILIARY TRACT: Normally distended gallbladder without gallstones, wall thickening, focal tenderness or pericholecystic fluid. No extrahepatic biliary ductal dilatation with the common duct measuring 6 mm.PANCREAS: The pancreas is obscured by overlying bowel gas shadowing.RIGHT KIDNEY: The right kidney is normal in size, measuring 10 cm without hydronephrosis, shadowing nephrolithiasis or discrete lesion evident. Increased cortical echogenicity.OTHER: The left kidney is normal in size, measuring 12.9 cm without hydronephrosis, shadowing nephrolithiasis or discrete lesion evident. Increased cortical echogenicity.The spleen is normal in size, measuring 11.2 cm.", "output": "Coarsened and increased hepatic echogenicity likely related to diffuse fatty infiltration. No focal hepatic lesion or specific findings of cirrhosis.Medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Enlarging right neck mass over 10 years RIGHT LOBE MEASUREMENTS: 10.6 x 5.8 x 4.4 cmLEFT LOBE MEASUREMENTS: 6.6 x 3.4 x 3.1 cm ISTHMUS MEASUREMENTS: 0.6 cm RIGHT LOBE: Conglomerate nodular mass replaces the right thyroid lobe and demonstrates solid and cystic components.LEFT LOBE: Multinodular mass in left thyroid lobe measures 2.8 x 2.9 x 2.7 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional lymphadenopathy.", "output": "Enlarged multinodular thyroid, likely benign in etiology."}
{"instruction": "Generate impression based on findings.", "input": "Female, 41 years old. Right flank pain. History of nephrolithiasis and prior chronic right pyelonephritis. RIGHT KIDNEY: The right kidney measures 8.4 cm in length, with mildly increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.9 cm in length, with normal cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The bladder is decompressed.", "output": "No shadowing urinary stones or hydronephrosis. Mildly atrophic/echogenic right kidney likely relates to a given history of prior chronic pyelonephritis."}
{"instruction": "Generate impression based on findings.", "input": "Female 72 years old; Reason: Change in nodules History: Multinodular goiter childhood radiation RIGHT LOBE MEASUREMENTS: 5 x 1.5 x 1.2 cmLEFT LOBE MEASUREMENTS: 4 x 1.7 x 1.0 cmISTHMUS MEASUREMENT: 1.5 cmRIGHT LOBE: Heterogenous echotexture with multiple hypoechoic nodules, with the dominant predominantly solid nodule in the lower pole measuring 1.5 x 1.2 x 0.6 cm, compared to 1.7 x 1.1 x 0.7 cm on the prior exam, essentially unchanged considering differences in technique.LEFT LOBE: Heterogenous echotexture with predominantly solid nodule at the upper pole measuring 1.6 x 1.4 x 1.3 cm compared to 1.4 x 1.4 x 1.3 cm, essentially unchanged.ISTHMUS: No significant abnormality noted.LYMPH NODES: Right level 2 benign-appearing lymph node measuring 1.1 x 0.6 x 2.0 cm, slightly decreased as compared to prior exam. Left level 3 benign-appearing left lobe measures 0.8 x 0.3 x 1.3 cm, unchanged from the prior exam.OTHER: No significant abnormality noted.", "output": "Bilateral thyroid nodules as described above, unchanged as compared to the prior exam."}
{"instruction": "Generate impression based on findings.", "input": "62 year-old male with right upper quadrant abdominal pain. Evaluate for cholecystitis. LIVER: Normal echogenicity of the liver measuring 16.7 cm in length. No focal hepatic lesion. Portal vein is patent with appropriate directional flow; peak velocity measures 0.4 m/sec.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. Gallbladder wall thickening measuring 6 mm in thickness. No pericholecystic fluid. Common bile duct measures 4 mm in caliber. No intra-or extrahepatic delayed ductal dilatation.PANCREAS: Visualized portions of the pancreas are normal in echogenicity.RIGHT KIDNEY: The visualized portions of the right kidney unremarkable.OTHER: No significant abnormalities noted.", "output": "Nonspecific Gallbladder wall thickening. No peri-cholecystic fluid, no cholelithiasis or sludge. No intra or extrahepatic biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Hepatic fibrosis. Evaluate for hepatocellular carcinoma. LIVER: Non-cirrhotic liver morphology. Unremarkable parenchymal echogenicity. 13 cm in length. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Cholelithiasis and biliary sludge noted in the gallbladder. No gallbladder wall thickening, pericholecystic fluid, or sonographic Murphy's sign elicited.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 10.6 cm in length. The left kidney is 9.6 cm in length. The previously seen left hepatic cyst is not evident on the current exam, possibly due to technical factors. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.5 cm in length, without focal lesions evident. Splenule noted.OTHER: No significant abnormalities noted. No ascites.", "output": "Cholelithiasis without specific evidence of cholecystitis. No suspicious hepatic lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female patient with fever, distended abdomen, critical illness. Evaluate for acalculus cholecystitis. LIVER: The liver measures 17.6 cm in length and demonstrates increased hepatic parenchymal echogenicity. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.4 m/sec.GALLBLADDER, BILIARY TRACT: There are gallstones. The gallbladder is mildly dilated. There is no significant gallbladder wall thickening or pericholecystic fluid.. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 6 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 10.5 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.6 cm in length. No evidence of hydronephrosis.The spleen measures 8.9 cm in length.Bilateral pleural effusions are noted.", "output": "1. Cholelithiasis with mildly dilated gallbladder but no sonographic findings of acute cholecystitis.2. Increased hepatic parenchymal echogenicity which can be seen with hepatic steatosis/hepatic parenchymal dysfunction.3. Bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Gaevskiy is a 44-year-old female with history of palpable right breast lesions, previously worked up with mammogram and ultrasound at an outside hospital. A targeted right ultrasound was performed for the palpable area of concern. In the right breast at the 10:00 position, approximately 1 cm from the nipple, are several scattered simple cysts, the largest of which measures 6 x 3 x 6 mm, without internal vascularity. In the right breast at the 5:00 position, approximately 1 cm from the nipple, is a cluster of cysts and microcysts, with the largest individual cyst measuring 4 x 4 mm, and the entire cluster measuring approximately 13 x 6 x 9 mm; there is no associated internal vascularity within the cysts themselves.", "output": "Scattered cysts and a cluster of microcysts in the right breast correlating to the patient's palpable areas of concern. Please note, diagnostic mammogram is recommended for palpable breast lesions, however her referring provider Dr. Jacobson declined that test. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram and right breast ultrasound are recommended in 6 months. Results and recommendation 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": "Female 33 years old . Query anterior abdominal wall hernia? Focused ultrasound performed over the site of patient's clinical concern superior to the umbilical area. An approximately a 1.3-cm defect in the ventral abdominal wall musculature was identified with herniated abdominal content which reduced during the examination.", "output": "Reducible ventral wall hernia."}
{"instruction": "Generate impression based on findings.", "input": "Male; 64 years old. Reason: new AKI on CKD, recent clots, portable exam History: AKI RIGHT KIDNEY: The right kidney measures 9.5 cm in length. The renal parenchyma is echogenic. Again seen is a simple appearing cyst in the upper pole of the kidney which measures 2.7 x 2.4 x 2.7 cm on the current study. There is no hydronephrosis or shadowing renal stone.LEFT KIDNEY: The left kidney measures 9.6 in length. The renal parenchyma is echogenic. There is no hydronephrosis or shadowing renal stone.URINARY BLADDER: The bladder is not distended.", "output": "1.Echogenic kidneys consistent with medical renal disease.2.Simple appearing renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "Severe hypertension. Evaluate kidneys. RIGHT KIDNEY: The right kidney is normal in morphology, echogenicity and size measuring 10.2 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.LEFT KIDNEY: The left kidney is normal in morphology, echogenicity and size measuring 10.4 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion evident. Color Doppler demonstrates hilar blood flow.OTHER: Contracted urinary bladder.", "output": "The right and left kidneys measure 10.2 and 10.4 cm in length, respectively without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old male with abnormal liver function. LIVER: Liver is upper normal in size. Echotexture appears normal. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder again appears unremarkable without cholelithiasis, wall thickening or pericholecystic fluid.PANCREAS: Pancreas not adequately visualized due to bowel gas.RIGHT KIDNEY: Right kidney appears mildly echogenic when compared to prior exam of uncertain etiology given normal renal function.OTHER: Spleen appears unremarkable. Left kidney also appears mildly echogenic.", "output": "Normal liver parenchyma. Interval development of mildly echogenic kidneys."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis. Evaluate for HCC. LIVER: Cirrhotic liver morphology. 15.8 cm in length. Coarsened parenchymal echogenicity. No focal hepatic lesions. No discernible portal venous blood flow. Enlarged hepatic artery.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Cholelithiasis and biliary sludge, without specific evidence of 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 12.6 cm in length. The left kidney is 14.1 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 14.7 cm in length, without focal lesions evident.OTHER: Minimal perihepatic ascites.", "output": "1. Cirrhosis without detectable portal venous flow, consistent with thrombosis.2. No suspicious hepatic lesions identified.3. Splenomegaly and minimal ascites."}
{"instruction": "Generate impression based on findings.", "input": "40 year old who is status post left mastectomy for malignancy, presents for ultrasound evaluation of a palpable abnormality in the left axilla. Focused ultrasound was performed for the marked area in the left axilla. There is a tube-like foreign body, measuring 17 x 5 mm. This could be a part of a drainage tube.", "output": "A tube-like foreign body was identified in the left axilla. Results were discussed with Dr. Chhablani. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Reason: r/o enlarging nodules, adenopathy History: multiple thyroid nodules. 10 month follow up study. RIGHT LOBE MEASUREMENTS: 5 x 2 x 1.9 cm, previously 6.5 x 2.2 x 2.8 cm.LEFT LOBE MEASUREMENTS: 5.4 x 1.8 x 1.7 cm, previously 4.8 x 1.6 x 2.1 cm.ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: Previously seen predominantly cystic lesion in the right inferior lobe with reported biopsy results of colloid nodule has decreased in size, predominantly in its cystic component, now demonstrating mixed solid and cystic appearance, measuring 1.8 x 1.6 x 1.2 cm, previously 2 x 2.6 x 2.7 cm.LEFT LOBE: Previously seen predominantly solid nodule with cystic components in the left inferior lobe measures 1.6 x 1.3 x 1.4 cm, previously 1.2 x 1.1 x 1.3 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Interval decrease in size and cystic component of right nodule with reported biopsy results of colloid nodule. Stable left thyroid nodule allowing for differences in measuring technique. No new nodule. "}
{"instruction": "Generate impression based on findings.", "input": "Female 41 years old; Reason: RUQ pain, eval stones History: above LIVER: The liver measures 16.9 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 20.0 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 4.0 mm. No stones or sludge are seen. No pericholecystic fluid. Negative sonographic Murphy sign. The common bile duct measures 1.7 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.2 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 13.7 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. No evidence of cholelithiasis or acute cholecystitis are seen. No intra or extrahepatic ductal dilation.2. Coarse increased echogenicity of the liver parenchyma compatible with fatty infiltration/hepatocellular dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Male 61 years old Reason: Assess for cholecystitis, cholelithiasis History: RUQ abdominal pain, nausea, vomiting LIVER: Liver echogenicity is increased. Hepatic veins and IVC are dilated. There is small amount of perihepatic ascites. Common bile duct measures 6 mm, normal.BILIARY TRACT: No evidence of intra or extrahepatic biliary dilatation. Gallbladder is distended with sludge and stones. There is gallbladder wall thickening and small amount of pericholecystic fluid. These findings can be compatible with acute cholecystitis despite the lack of sonographic Murphy's sign.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 11.5 cm.RIGHT KIDNEY: Right kidney measures 10.4 cm. Left kidney measures 12 cm. No evidence of hydronephrosis. OTHER: No significant abnormalities noted.", "output": "Cholelithiasis with distended gallbladder and gallbladder wall thickening. These findings may be compatible with acute cholecystitis.Heterogeneous echotexture of the liver. Correlate with clinical liver function tests. Dilated IVC and hepatic veins and small amount of hepatic ascites. These may be secondary to congestive heart failure."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Nodules or abnormal nodes? History: Germline ret mutation (MEN2) RIGHT LOBE MEASUREMENTS: 4.6 x 0.9 x 2.0 cm.LEFT LOBE MEASUREMENTS: 3.9 x 1.1 x 1.5 cm.ISTHMUS MEASUREMENTS: Up to 14 mm in thickness.RIGHT LOBE: Background parenchymal echotexture within normal limits without suspicious nodules.LEFT LOBE: Background parenchymal echotexture within normal limits without suspicious nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No lymphadenopathy identified.OTHER: No significant abnormality noted.", "output": "Unremarkable appearance of the thyroid gland without suspicious nodule or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Likely lipoma. Need evaluation of soft tissue mass noted in left upper quadrant of the abdomen. At the site of the palpable abnormality left upper quadrant, there is well marginated a 3.7 x 2.7 x 1.0 cm soft tissue nodule with internal vascularity. This is nonspecific on ultrasound although a lipoma would be most likely. This is not a cyst.", "output": "Soft tissue nodule at the site of the palpable abnormality. This is nonspecific by ultrasound although a lipoma is favored."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male with history of angiomyolipoma and renal cysts. RIGHT KIDNEY: The right kidney measures approximately 12 cm in length, and demonstrates an approximately 7.6 x 6 x 5.2 cm simple cyst in the lower pole. Additional smaller cysts are seen.LEFT KIDNEY: The left kidney measures approximately 14 cm in length, and has an approximately 5 x 7.6 x 5.8 cm lower pole simple cyst with a single septation. The previously seen hyperechoic area in the superior pole, consistent with angiomyolipoma, is unchanged in size measuring approximately 2.6 x 3 x 2 cm.URINARY BLADDER: The bladder is with normal limits, with a small amount of adjacent free fluid.OTHER: No significant abnormalities noted.", "output": "1.Left renal angiomyolipoma is not significantly changed.2.Multiple bilateral renal cysts.3.Small amount of pelvic free fluid."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old 20 week pregnant female presents for follow-up of left breast finding from outside institution. History of left lumpectomy in February 20, 2014. Per the patient this was done for premalignant findings. A targeted left ultrasound was performed for the patient\u2019s area of concern. In the upper outer quadrant of the left breast, there is no solid or cystic mass identified.", "output": "Comparison with prior examinations is necessary for complete evaluation. Results and recommendations were discussed with the patient.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: O - Old Study For Comparison."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female undergoing renal biopsy. Ultrasound demonstrates 2 passes of a renal biopsy.", "output": "1. Ultrasound guidance for renal biopsy."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with hepatitis B. Evaluate for hepatic mass. LIVER: Liver parenchyma is mildly and heterogeneously echogenic. Overall hepatic size is within normal limits. There is no gross cirrhotic morphology of the liver. There is no evidence for hepatic mass. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: The gallbladder is normal without cholelithiasis, 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": "No interval change. No evidence for hepatic mass."}
{"instruction": "Generate impression based on findings.", "input": "Male; 69 years old. Reason: RUQ discomfort History: HBV LIVER: The liver measures 15.0 cm in length. The liver contour is smooth. The parenchyma is coarse 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 0.15 m/sec. BILIARY TRACT: The gallbladder is normal in appearance. There is no cholelithiasis or gallbladder wall thickening. The common duct measures 2 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head of the pancreas is unremarkable. The body and tail are obscured by overlying bowel gas.SPLEEN: The spleen measures 11.0 cm in length.RIGHT KIDNEY: Status post right nephrectomy. OTHER: The left kidney measures 10.7 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone. Previously seen hyperechoic, non-shadowing lesion in the interpolar region of the left kidney currently measures 6 x 5 x 5 mm, stable since November 2013.", "output": "1.Coarse liver echotexture. No focal mass is identified.2.Stable size and appearance of hyperechoic left renal lesion."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for whole breast ultrasound for dense breast screening. Personal history of benign right breast biopsy 1995. 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.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"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": "Microhematuria RIGHT KIDNEY: 10.2 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 1.9 cm in length. Unremarkable renal parenchymal echogenicity. Two 1-2 cm minimally complex cysts noted. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: Collapsed and not well visualized.OTHER: No significant abnormality noted.", "output": "No specific findings to account for the patient's hematuria."}
{"instruction": "Generate impression based on findings.", "input": "32 years old, Female, Reason: 32 y/o lady w/ a hx of renal transplant and w/ AKI History: AKI RENAL TRANSPLANT: The renal transplant is increased in echogenicity consistent with medical renal disease. No evidence of hydronephrosis, shadowing calculus, or mass. The renal transplant measures 11.6 cm in length and is similar in appearance to CT dated 6/20/14.LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: Trace peritransplant fluid.COLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: The bladder is incompletely distended.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels. No significant abnormality noted. Peak velocity at the anastomosis is 0.7 m/sec with resistive index of 0.7. Peak systolic velocity in the proximal renal artery is 0.5 m/sec. Peak systolic velocity in the mid renal artery 0.5 m/sec and in the distal renal arteries are 0.7 m/sec. Resistive indices in the renal artery ranges from 0.7 to 0.67. Peak velocities and resistive indices within the segmental and arcuate arteries are within normal limits.OTHER: No significant abnormality noted", "output": "Increased echogenicity of the transplanted kidney consistent with medical renal disease without evidence of hydronephrosis, shadowing calculus, or mass. No evidence of vascular complication of the transplanted kidney."}
{"instruction": "Generate impression based on findings.", "input": "Bilateral breast tenderness. A whole breast ultrasound was performed bilaterally for the patient\u2019s areas of concern. The breast parenchyma and subcutaneous soft tissues are sonographically normal. No solid or cystic mass is identified.", "output": "No sonographic abnormality evident. Breast pain should managed clinically.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Female 48 years old Reason: Please assess for cirrhosis and r/o portal venous clot History: acute hepatitis NYD LIVER: Coarse appearance of the liver with increased echogenicity. No focal mass. Main portal vein is patent with normal directional flow and a peak velocity of 23.6 cm/s. No thrombus.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Common bile duct measures 4 mm.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: Spleen measures 8.5 cm and is normal in appearance.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 9.5 cm. Left kidney measures 11.0 cm. OTHER: No significant abnormalities noted.", "output": "Coarse appearance of the liver without focal mass. Main portal vein is patent and has normal directional flow. No portal venous thrombus as clinically questioned."}
{"instruction": "Generate impression based on findings.", "input": "78-year-old male with alcoholic cirrhosis, screening for hepatocellular carcinoma. LIVER: Measures 14.7 in length. Cirrhotic liver morphology and increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Cholelithiasis and gallbladder wall thickening, most likely due to sequela of chronic liver disease in this setting. 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: Moderate ascites with loculations.", "output": "1. Cirrhosis and increased hepatic echogenicity consistent with chronic liver disease, without discrete focal lesion. 2. Moderate ascites with loculations. "}
{"instruction": "Generate impression based on findings.", "input": "Male; 69 years old. Reason: hematuria History: hematuria history of prostate cancer RIGHT KIDNEY: The right kidney measures 9.2 cm in length. The renal cortex is normal in echogenicity. No shadowing stone, hydronephrosis or worrisome renal mass is identified. LEFT KIDNEY: The left kidney measures 9.5 cm in length. The renal cortex is normal in echogenicity. There is a 1.5 x 1.3 x 1.8 cm simple renal cyst. No shadowing stone, hydronephrosis or worrisome renal mass is identified. URINARY BLADDER: Bladder is nondistended.", "output": "1.Left simple renal cyst. 2.No nephrolithiasis or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "22-year-old female with an enlarged neck lymph node. Along the right level 2A region of the neck is a heterogeneous complex solid cystic lesion measuring 2.4 x 1.6 x 2.6 cm which is suspicious for a necrotic lymph node. Additional multiple smaller lymph nodes are noted adjacent to this lesion.", "output": "Findings suspicious for a necrotic lymph node in the right level 2A region of the neck. Follow-up CT or MRI is suggested."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodule RIGHT LOBE MEASUREMENTS: 3.7 x 1.4 x 1.9 cmLEFT LOBE MEASUREMENTS: 3.7 x 1 x 1.3 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Multiple benign-appearing spongiform nodules. The largest within the lower pole measures 1.4 x 1.2 x 1.2 cm.LEFT LOBE: Benign-appearing spongiform nodule lower pole measuring 0.9 x 0.4 x 0.6 cmISTHMUS: Spongiform nodule measuring 1.1 x 0.8 x 0.4 cmPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Benign-appearing spongiform thyroid nodules bilaterally. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "History lymphoma with fever of unknown origin history of ampullary Arceneaux, status post Whipple LIVER: Mildly coarse echogenic liver echotexture without worrisome mass. Stable hepatic cyst. Liver length 16.3 cmBILIARY TRACT: Pneumobilia again noted. No ductal dilatation. Gallbladder absent.PANCREAS: Obscured by overlying gasSPLEEN: No significant abnormalities noted. 12.5 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 12.9 cm in lengthOTHER: Left kidney 12.9 cm in length. No ascites.", "output": "Mildly coarse echogenic liver echotexture raises the possibility of fatty infiltration/parenchymal dysfunction without worrisome mass or ductal dilatation. Stable expected pneumobilia. No ascites"}
{"instruction": "Generate impression based on findings.", "input": "Patient with known malignancy of the left breast from outside hospital presents for a left unilateral diagnostic mammogram to confirm clip placement and repeat left breast ultrasound to evaluate additional SPECT relate mass identified on the mammogram. Mammogram: Three standard views of the left breast and 2 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. Clip identified within the left upper-outer quadrant with a confluent hematoma measuring 3 cm around it. Spiculated mass measuring 14 mm is identified immediately posterior to it. Probably the clip has migrated anterolateral to the mass x 6 mm.A 15 mm focal asymmetry is identified in the left central posterior breast best seen on the ML view with a possible correlate in the lateral cc view. It is located 2.7 cm posterior to the previously biopsied mass. Multiple scattered oil cysts identified in the left breast.Ultrasound: Targeted left breast ultrasound was performed. Previously biopsied suspicious mass now with probably organizing hematoma adjacent to it measures 1.2 x 0.9 x 1.6 cm with peripheral blood flow. A clip is identified within a hematoma located slightly lateral to it. The hematoma approximately measures 1.6 x 1.8 cm.Sonographic correlate to the focal asymmetry seen on the mammogram is identified at 4:30 o'clock position, 9 cm from the nipple that measures 1.1 x 1.2 x 0.9 cm with apical blood flow. This appears suspicious and ultrasound-guided core biopsy is recommended.", "output": "Biopsy-proven cancer in the left breast 4:00 position with clip located within it hematoma adjacent to it.New spiculated mass identified on the mammogram and ultrasound of the left breast 4:30 o'clock position, 9 cm from the nipple that needs ultrasound-guided core biopsy.Given the multifocality of the mass, breast MRI can be considered for further evaluation. BIRADS: 6 - Known cancer.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Increasing LFTs LIVER: Coarse echogenic liver echotexture without mass. Liver length 16.4 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.8 cm in lengthOTHER: Left kidney 11 cm in length. Spleen 11.4 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Male 56 years old Reason: history of alcoholic/HCV cirrhosis r/o lesions History: as above LIVER: Liver measures 15.3 cm. Coarse echotexture of the liver. There is a new 1.9 x 1.6 cm hypoechoic lesion in the right lobe of the liver.BILIARY TRACT: No evidence of cholelithiasis. No evidence of intra or extra hepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 9.4 cm.RIGHT KIDNEY: No significant abnormalities noted. Right kidney measures 10.6 cm. Left kidney measures 10.9 cm. No evidence of hydronephrosis or focal lesions.OTHER: No significant abnormalities noted.", "output": "Findings suggestive of chronic liver disease. There is a new hypoechoic lesion in the liver suspicious for hepatocellular carcinoma. Further evaluation with liver MRI is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess for HCC History: hx of HCV with sustained viral response; cirrhosis. LIVER: The liver measures 17.3 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, though sensitivity somewhat limited. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.3 m/s.BILIARY TRACT: Gallbladder mildly decompressed which limits evaluation. Possible gallstone. No gallbladder wall thickening or pericholecystic fluid. No intrahepatic biliary ductal dilatation is present. The common bile duct measures 8 mm in diameter, not significantly changed.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 12.5 cm in length. RIGHT KIDNEY: Kidney measures 10.3 cm in length. Increased cortical echogenicity. No hydronephrosis.LEFT KIDNEY: Kidney measures 9.5 cm in length. Increased cortical echogenicity. No hydronephrosis.OTHER: No ascites.", "output": "1.Cirrhotic liver morphology without focal masses identified.2.Echogenic kidneys compatible with medical renal disease.3.Possible gallstone without evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Male; 52 years old. Reason: r/o adenopathy, recurrence History: h/o thyroid cancer. 1 year follow up study RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: No suspicious mass in the right thyroid bed.LEFT LOBE: Redemonstrated 3 x 3 x 6 mm hyperechoic focus in the left thyroid bed (previously 4 x 3 x 5 cm), unchanged. A new 4 x 3 x 5 mm hypoechoic lesion with flow on color Doppler is seen in the left thyroid bed.ISTHMUS: No suspicious mass in the isthmus bed.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level 6 lymph node measures 3 x 3 x 4 mm. A normal fatty hilum is not identified and there is increased vascularity.Two new abnormal left level 4 lymph nodes are identified. They measure 6 x 3 x 7 and 5 x 3 x 4 cm they demonstrate increased vascularity and have lost their normal fatty hilum. OTHER: No significant abnormality noted.", "output": "Abnormal lymph nodes and a new lesion in the left thyroid bed suspicious for recurrence. The thyroid bed lesions are small and may not be amenable to biopsy. The lymph nodes are amenable to biopsy.Findings discussed with Dr. Cohen at 11:43 on 2/13/2015."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Sierra Rush is a 17 years old female who presents with a palpable concern in the upper inner right breast. ULTRASOUND:On physical examination, a mobile mass is palpated in the upper inner right breast.A targeted right ultrasound was performed for the palpable area of concern. In the right breast, 1:00 position, 5 cm from the nipple, there is a homogeneously hypoechoic, well-circumscribed mass measuring 1.6 x 0.9 x 1.7 cm. There is internal flow to this mass.", "output": "1.7 cm palpable mass in the right breast most consistent with a fibroadenoma. Surgical consultation is recommended. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "70 year old female with left scalp/neck lump and headache. Additional patient noted a palpable mass in the left back. In the left scalp region there is a relatively hypoechoic solid nodule measuring 1.0 x 0.7-cm x 1.1-cm with no internal vascularity or definite microcalcifications. Additionally, patient noted a palpable mass in the left back. Limited ultrasound showed an echogenic heterogeneous solid mass measuring 3.6 cm x 0.9 cm 3.1 cm with no increased internal vascularity or definite microcalcifications.", "output": "1. In the left scalp findings may represent a small lymph node, although other considerations include a sebaceous cyst or small lipoma. 2. In the left back findings favor a lipoma. If definite characterization is needed, MRI can be obtained. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess fluid collection on left anterior lower leg. History: swelling, pain Soft tissue edema is noted within the left lower leg and ankle, with no evidence of distinct fluid collection.", "output": "Soft tissue edema of the left lower leg and ankle, with no evidence of distinct fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "Left leg wound revealed the left many years Mild left leg skin thickening with edema noted. No underlying abscess or fluid collection noted.", "output": "Left leg focal cellulitis adjacent to the wound. No underlying abscess or fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "History of Crohn's disease with portal vein thrombosis LIVER: Diffusely heterogeneous coarse and echogenic liver parenchyma without mass. Liver length 17.5 cm Limited Doppler interrogation of the portal vein again demonstrates cavernous transformation of the portal veinGALLBLADDER, BILIARY TRACT: Status post cholecystectomy.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.7 cm in length OTHER: Left kidney 11.4 cm in length. Spleen 12.7 cm in length. No ascites.", "output": "Diffusely heterogeneous coarse and echogenic liver parenchyma consistent with parenchymal dysfunction/chronic liver disease without mass or ductal dilatation. Cavernous transformation of the portal vein again noted."}
{"instruction": "Generate impression based on findings.", "input": "Primary hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 1.8 x 1.9 x 3.3 cmLEFT LOBE MEASUREMENTS: 1.2 x 1.1 x 3.3 cmISTHMUS MEASUREMENT: 0.4 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No lesion corresponding to a parathyroid adenoma.", "output": "1.No visible parathyroid adenoma by ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "Cholelithiasis LIVER: Coarse echogenic liver echotexture without mass. Liver length 17.3 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation. Negative Murphy's.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 8.3 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.4 cm in lengthOTHER: Left kidney 11.8 cm in length. No ascites.", "output": "Cholelithiasis without acute inflammation or ductal dilatation. Coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female with history of follicular thyroid cancer status post thyroidectomy. Evaluate for interval change. RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: Benign-appearing lymph node in the inferior margin of the thyroidectomy bed measures 4 mm x 4 mm x 8 mm unchanged.LEFT LOBE: No discrete nodules or masses in the thyroidectomy bed.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right neck benign-appearing level 3 lymph node measures 1.1 cm x 0.8 cm x 0.3 cm. Left neck level 2 lymph node measures 2.2 cm x 1.0 cm x 0.6 cm. Additional smaller nodules are seen. No pathology lymphadenopathy. OTHER: No significant abnormality noted.", "output": "Right thyroidectomy bed benign appearing lymph node unchanged. No regional lymphadenopathy. "}
{"instruction": "Generate impression based on findings.", "input": "Female; 69 years old. Reason: nephrotic syndrome of unclear etiology, elevated liver enzymes. please eval for pathology History: BLE, weakness LIVER: The liver measures 14.9 cm in length. The liver has a smooth contour. The parenchyma is normal in echotexture. Within the left lobe of the liver there is a cluster of mildly complex cystic structures. The largest the cyst measures 2.4 x 1.9 x 1.9 cm. There is ascites. The portal vein is patent but and demonstrates hepatopetal flow with a peak velocity of 0.17 m/sec.BILIARY TRACT: The gallbladder has an anechoic lumen. There is no gallbladder wall thickening or pericholecystic fluid. Common duct measures 0.4 cm. There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreas is obscured due to bowel gas.KIDNEYS: The right kidney measures 10.2 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 10.6 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 9.8 cm. in length. ABDOMINAL AORTA: Proximal: 2.0 x 1.7 x 2.4 cmMid: Obscured by overlying bowel gasDistal: 1.6 x 1.5 x 1.6 cmINFERIOR VENA CAVA: No significant abnormality noted.OTHER: There are bilateral pleural effusions.The urinary bladder is unremarkable.", "output": "1.A cluster of mildly complex cystic structures in the left liver may simply be related to a complex cyst/hamartoma however biliary cystadenoma remains a possibility.2.Ascites and bilateral pleural effusions.3.Echogenic kidneys bilaterally compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Leukocytosis. Status post ERCP with stent placement. LIVER: Diffusely heterogeneous parenchymal echogenicity. 17 cm in length. The previously seen focal lesions on CT are not evident by ultrasound. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Cholelithiasis. No gallbladder wall thickening or sonographic Murphy's sign.PANCREAS: No sonographic abnormality evident in the visualized pancreatic body. The head and and tail are obscured by bowel gas, including the patient's known pancreatic head mass.KIDNEYS: The right kidney is 5.7 cm in length, with an inferior pole cyst. The left kidney is not fully visualized. The renal parenchyma is markedly echogenic. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 7.6 cm in length, without focal lesions evident.OTHER: Mild to moderate ascites is again seen.", "output": "1. No biliary ductal dilation.2. Heterogeneous hepatic echogenicity compatible with parenchymal dysfunction and/or metastatic disease, similar to prior.3. Cholelithiasis without specific evidence of cholecystitis.4. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "History of goiter. Evaluate thyroid nodules. RIGHT LOBE MEASUREMENTS: 4.2 x 1.6 x 2.6 cmLEFT LOBE MEASUREMENTS: 3.7 x 1.8 x 1.7 cmISTHMUS MEASUREMENTS: 8 mmRIGHT LOBE: Multiple predominantly cystic nodules are again noted in the right thyroid lobe with the largest measuring 8 x 8 x 6 mm, not significantly changed from 7 x 7 x 5 mm previously. Many are anechoic with posterior through enhancement compatible with colloid cysts. No nodule with suspicious sonographic features.LEFT LOBE: Multiple predominantly cystic nodules are again noted in the left thyroid lobe with the largest measuring 1.2 x 1.0 x 1.3 cm, not significantly changed from 1.3 x 1.1 x 1.0 cm previously. Again many of these are compatible with colloid cyst. No nodule with suspicious sonographic features.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal size and morphologically benign appearing cervical lymph nodes are noted.OTHER: No significant abnormality noted.", "output": "No significant interval change in bilateral thyroid cystic/colloid nodules. No nodule with suspicious sonographic features."}
{"instruction": "Generate impression based on findings.", "input": "21-year-old female with history of left breast mass, presenting for short interval sonographic follow-up. No family history of breast cancer. Patient reporting interim enlargement of palpable left breast lump. Targeted ultrasound of the left breast 4:00 position 3 cm from the nipple reveals a macrolobulated slightly heterogeneous hypoechoic mass measuring 3.0 x 2.6 cm, previously 1.9 cm in longest dimension. There is redemonstrated posterior acoustic enhancement and internal vascularity.", "output": "Enlarging left lower outer breast mass for which surgical consult is recommended, especially given the interval increase in size to 3 cm. The patient will see Dr. Jaskowiak later today.  BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old female with mildly enlarged right axillary lymph node on prior mammogram of 4/27/2016. Positive family history for breast cancer in maternal great grandmother and mother. Targeted ultrasound of the right axilla demonstrates multiple benign-appearing lymph nodes largest measuring up to 1.3 cm in size, with no significant cortical thickening. Normal fatty hila and normal hilar blood flow are maintained.", "output": "No sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended next year, to ensure stability. If the exam is stable, she may subsequently return to routine screening. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Hypothyroidism RIGHT LOBE MEASUREMENTS: 1.9 x 1.9 x 5 cmLEFT LOBE MEASUREMENTS: 1.9 x 1.9 x 4.8 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Atrophic gland with diffusely heterogeneous echotexture with multiple regions of hypoechogenicity surrounded by increased echogenicity without discrete mass. No increased vascularityLEFT LOBE: Atrophic gland with diffusely heterogeneous echotexture with multiple regions of hypoechogenicity surrounded by increased echogenicity without discrete mass. No increased vascularityISTHMUS: Atrophic gland with diffusely heterogeneous echotexture with multiple regions of hypoechogenicity surrounded by increased echogenicity without discrete mass. No increased vascularityPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Atrophic gland with diffusely heterogeneous echotexture with multiple regions of hypoechogenicity surrounded by increased echogenicity without discrete mass. No increased vascularity. Findings suggestive for chronic thyroiditis. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old male with right upper quadrant pain. LIVER:Measures 14.6 cm. Normal 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. Gallbladder wall measures 1.7 mm. No pericholecystic fluid, sludge, or stones. Common bile duct measures 2.2 mm. Negative sonographic Murphy's sign.PANCREAS: Evaluation the pancreas limited due to overlying bowel gas.SPLEEN: Measures 13.5 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 10.8 cm. Left kidney measures 10.6 cm. Normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "1. Normal ultrasound of the abdomen without signs of cholelithiasis or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Right-sided flank pain RIGHT KIDNEY: 9.6 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 9.9 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "History of hepatitis C, evaluate liver function. LIVER: The liver measures 19.3 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 0.21 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 5 mm in diameter.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.The spleen measures 8.9 cm in length. RIGHT KIDNEY: Kidney measures 14.2 cm in length. Normal echotexture. No hydronephrosis or shadowing calculus. Lower pole renal cyst.LEFT KIDNEY: Kidney measures 12.1 cm in length. Normal echotexture. No hydronephrosis or shadowing calculus. Upper pole renal cyst.OTHER: No significant abnormalities noted.", "output": "Echogenic liver compatible with fatty infiltration/parenchymal dysfunction without focal liver lesions identified."}
{"instruction": "Generate impression based on findings.", "input": "48 male with history of focal gallbladder wall thickening. LIVER: The liver is normal in morphology, echogenicity and size measuring 18 cm in craniocaudal dimension. No intrahepatic biliary ductal dilatation or focal hepatic lesion is evident. The liver capsule is smooth. Normal hepatopetal portal venous blood flow at 15 cm/sec is present. BILIARY TRACT: There is a normally distended gallbladder with normal wall thickness of 2 mm. Note is made of a focal thickening of the gallbladder fundus of approximately 8 mm. There is cholelithiasis but no pericholecystic fluid or focal tenderness. The common bile duct at the level of the pancreatic head is normal in caliber, measuring 4 mm. More proximally it measures 2 mm at the porta hepatis.PANCREAS: The visualized portions of the pancreatic body and head are unremarkable. SPLEEN: The spleen is normal in morphology, echogenicity, and size, measuring 11.5 cm in length.RIGHT KIDNEY: The right kidney measures 9.9 cm without hydronephrosis and contains subcentimeter simple appearing cysts. There are small collecting system foci with twinkle artifact on color Doppler compatible with nonobstructive non-shadowing calculi. OTHER: The left kidney measures 10.6 cm in length without hydronephrosis. Note is made of a 1.3-cm simple appearing parapelvic cyst. Small foci of twinkle artifact on color Doppler are compatible with nonobstructive non-shadowing calculi.Trace ascites.", "output": "1. Cholelithiasis without focal tenderness, pericholecystic fluid or diffuse wall thickening.2. Nonspecific gallbladder fundus focal thickening. Re-evaluation in 6 months is recommended to assure stability.3. Probable bilateral nonobstructive non-shadowing calculi.4. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "34-year-old female with transaminitis after stem cell transplant. Evaluate for abnormal blood flow. LIMITED ABDOMENLIVER: Increased echogenicity of the liver measuring 17.8 cm in length. No focal hepatic lesions.BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. Common duct measures 4 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are unremarkable.SPLEEN: Not well visualized. RIGHT KIDNEY: Increased echogenicity of kidney measuring 12.1 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Increased echogenicity of the left kidney measuring 11.6 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "1. Increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. Patent hepatic inflow and outflow vasculature.2. Increased echogenicity of the kidney suggestive of parenchymal dysfunction. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal LFTs LIVER: Coarse echogenic liver without mass. Liver length 13.9 cmGALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.4 cm in lengthOTHER: Left kidney 10.4 cm in length. Spleen 10.3 cm in length. No ascites.", "output": "Coarse echogenic liver consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Gallbladder sludge without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal failure RIGHT KIDNEY: Mildly echogenic renal parenchyma without mass, stone, or hydronephrosis. 9.9 cm in lengthLEFT KIDNEY: Mildly echogenic renal parenchyma without mass, stone, or hydronephrosis. 9.5 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": "70-year-old male with elevated ammonia level LIVER: Measures 17.0 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: Multicystic kidneys with increased echogenicity but no hydronephrosis. None of the visualized cysts demonstrate septations or solid components. The largest cyst on the left measures up to 7.3 cm in diameter.OTHER: No significant abnormalities noted.", "output": "1.Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease.2.Multicystic echogenic kidneys consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old female with thyroidectomy for thyroid cancer. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massLEFT LOBE: No massISTHMUS: No massPARATHYROID 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": "44 years old, Female, Reason: 44 year-old female with low albumin for 20 years, RUQ u/s requested to evaluate for imaging findings of liver disease LIVER: The liver measures 18.5 cm in length. The parenchyma of the liver is within normal limits.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 4 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 8.8 cm in length. RIGHT KIDNEY: Kidney measures 11.8 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.1 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.The liver parenchyma and contours are normal in appearance. 2.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain LIVER: No significant abnormalities noted. 17.1 cm in lengthGALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.1 cm in lengthOTHER: Left kidney 11.1 cm in length. Spleen 10.9 cm in length. Right pleural effusion.", "output": "Gallbladder sludge without acute inflammation or ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Elevated liver enzymes. LIVER: The liver is mildly coarse in echotexture. It is normal in size and morphology measuring 13 cm in craniocaudal dimension. No intrahepatic biliary ductal dilatation or focal lesion. Normal hepatopedal portal venous blood flow at 0.2 m/s.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring up to 7 mm at the pancreatic head. The patient is status post cholecystectomy.PANCREAS: Limited evaluation of the visualized pancreatic head and neck demonstrates no significant abnormality.SPLEEN: The spleen is normal in size measuring 8.6 cm without a discrete lesion.RIGHT KIDNEY: The right kidney is diminutive measuring 9.4 cm without hydronephrosis. Mildly echogenic renal cortices. OTHER: The left kidney is diminutive 9.3 cm in length without hydronephrosis. Mildly echogenic renal cortices.", "output": "1. Mildly coarse liver echotexture may be seen in the setting of parenchymal dysfunction, differential including but not limited to steatosis. 2. Status post cholecystectomy without significant biliary ductal dilatation. 3. Diminutive kidneys which appear mildly echogenic, suggesting medical renal disease, correlate with renal function."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old male with hypercalcemia, evaluate for primary hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 3.4 x 1.7 x 1.6 cmLEFT LOBE MEASUREMENTS: 3.5 x 1.3 x 1.3 cmISTHMUS MEASUREMENTS: No significant abnormality noted.RIGHT LOBE: Solid predominantly isoechoic to slightly hyperechoic nodule with a thin hypoechoic halo in the right lobe measures 1.4 x 1.1 x 1.0 cm.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Extrathyroidal hypoechoic cystic focus with increased through transmission inferior to the right thyroid measures 0.7 x 0.6 x 0.5 cm.LYMPH NODES: Scattered cervical lymph nodes with benign morphologic features.OTHER: No significant abnormality noted.", "output": "1. Homogeneously cystic extrathyroidal lesion inferior to the right thyroid measuring 0.7 cm. Cystic parathyroid nodules have been described but generally have an identifiable solid component. This lesion may represent a cystic parathyroid adenoma but would be atypical. 2. Solitary right thyroid nodule as described above. "}
{"instruction": "Generate impression based on findings.", "input": "Acute obstructive renal failure, evaluate for hydronephrosis RIGHT KIDNEY: Echogenic kidney measures 10.9 cm. No hydronephrosis or mass. LEFT KIDNEY: Echogenic kidney measures 12.3 cm. No hydronephrosis or mass. OTHER: The bladder is not distended. Foley catheter in the bladder.", "output": "No hydronephrosis. Medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Female; 44 years old. Reason: 44 yo female with enlarged left inguinal area; please evaluate for hernia History: left inguinal pain Imaging of the left inguinal area in the area of the patient's pain demonstrates a small, 3 mm defect in the fascia. No bowl or fat is seen protruding despite provocative maneuvers.", "output": "3 mm left inguinal fascial defect without evidence of fat or bowel herniation."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old female with abnormal liver function. The exam is limited by patient's combativeness and motion.LIVER: Normal in size and echotexture. No focal hepatic abnormality.BILIARY TRACT: Dependent sludge in the gallbladder without shadowing stones. There are likely one or 2 very small polyps arising from the wall. No gross wall thickening. Visualized biliary tract is normal in caliber. PANCREAS: No significant abnormalities noted.SPLEEN: Cannot be imaged due to patient positioning.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Gallbladder sludge and likely small polyps. Otherwise, normal liver and biliary tract."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury. RIGHT KIDNEY: 10.3 cm in length. Mildly echogenic renal parenchyma. No suspicious lesions, stones, or hydronephrosis.LEFT KIDNEY: 12.8 cm in length. 1.4 cm medullary cyst with noted. Mildly echogenic renal parenchyma. No suspicious lesions, stones, or hydronephrosis.BLADDER: Collapsed with Foley catheter in place.OTHER: No significant abnormalities noted.", "output": "Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Thyromegaly RIGHT LOBE MEASUREMENTS: 4.3 x 3.8 x 8.1 cmLEFT LOBE MEASUREMENTS: 4.8 x 4.7 x 7.6 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Enlarged diffusely heterogeneous gland. 5.6 x 3.6 x 5.8 cm dominant mixed cystic and solid nodule LEFT LOBE: Enlarged diffusely heterogeneous gland. 4.4 x 3.7 x 4.5 cm dominant mixed cystic and solid noduleISTHMUS: Enlarged diffusely heterogeneous gland. 2.2 x 2.4 x 2.7 cm predominantly solid nodule arising from the isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Thyromegaly with diffusely heterogeneous gland. Bilateral mixed cystic and solid nodules as described. Predominantly solid isthmic nodule."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female with history of nephrolithiasis, status post bilateral ureteral stent removal. Evaluate for hydronephrosis. RIGHT KIDNEY: Measures 10.4 cm in length. Extensive nephrolithiasis without hydronephrosis.LEFT KIDNEY: Measures 9.7 cm in length. Extensive nephrolithiasis without hydronephrosis.URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.", "output": "Nephrolithiasis without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old female with increase in creatinine and potassium. Limited examination secondary to patient body habitus and surgical bandages.RIGHT KIDNEY: Measures 9.1 cm in length. No hydronephrosis. No nephrolithiasis identified.LEFT KIDNEY: Measures 9.6 cm in length. No hydronephrosis. No nephrolithiasis identified.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Limited study as detailed above. No hydronephrosis or evidence of nephrolithiasis. "}
{"instruction": "Generate impression based on findings.", "input": "60year old female who was recalled from screening mammogram for new asymmetry left breast. MAMMOGRAM: An ML view 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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Additional views demonstrate a 6 mm asymmetry in the left breast central depth upper outer quadrant which partially disperses on spot compression views. Ultrasound is recommended for further evaluation. ULTRASOUND: On physical exam, there is no visible or palpable abnormality.Targeted ultrasound of the left breast was performed for the mammographic area of concern. In the left breast 4:00 position 4 cm from nipple middle to posterior depth, correlating to the abnormality on mammogram, there is a 5 x 2 x 7 mm oval cyst. No suspicious masses are identified.", "output": "Left 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": "50 female with right upper quadrant pain. LIVER: Hepatomegaly. Liver is coarsely echogenic which is non-specific. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Mild hepatomegaly with echogenic liver. Normal gallbladder and biliary tract."}
{"instruction": "Generate impression based on findings.", "input": "30 year-old female presents for short-term follow up of high probability benign mass, likely fibroadenoma. Family history breast carcinoma in her mother at age 32, as well as maternal and paternal grandmothers. On physical examination, no palpable masses were present within the left breast. Patient states she no longer feels any palpable abnormality at the previous site of concern.A targeted left ultrasound was performed for the area of previously demonstrated abnormality. At the two o'clock position of the left breast, 4 cm from the nipple, there is redemonstration of a parallel, hypoechoic mass measuring 0.4 x 0.1 x 0.2 cm (previously 0.4 x 0.2 x 0.3 cm).", "output": "Slight decrease in size of the previously demonstrated mass of the left upper outer quadrant. Follow-up should be directed by Dr. Jaskowiak. Given her family history and breast density, consideration should be given to bilateral screening breast MRI.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old female with HCV. Evaluate for chronic liver disease. LIVER: Coarse echotexture of the liver measuring 15.7 cm in length. No focal hepatic lesions are identified.GALLBLADDER, BILIARY TRACT: There is sludge in the gallbladder. No pericholecystic fluid. Gallbladder wall measures 2 mm in thickness. Common bile measures 6 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: The visualized portions of the pancreas are normal in echogenicity with no pancreatic ductal dilatation.RIGHT KIDNEY: Right kidney measures 10.3 cm in length with increased echogenicity of the renal cortex. A cyst in the upper full measures 2.4 cm x 1.7 cm x 2.0 cm.OTHER: Left kidney measures 10.6 cm in length with increased echogenicity of the renal cortex.Spleen is normal in echogenicity measuring 7.2 cm in length.", "output": "1. Findings suggestive of hepatic steatosis but no focal hepatic lesions. 2. Increased bilateral renal echogenicity raises the possibility of parenchymal dysfunction. There is a benign appearing cyst in the upper pole of the right kidney. 3. Sludge in the gallbladder with no evidence of cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for obstruction, AKi, needs to be done at bedside RIGHT KIDNEY: The right kidney measures 8.8 cm in length. Markedly increased renal parenchymal echogenicity. Minimal to mild hydronephrosis without evidence of obstructive lesion. Anechoic simple cyst in the right lower pole measures 1.4 x 1.1 x 1.4 cm. The right ureter is not visualized. No shadowing calculi.LEFT KIDNEY: The left kidney measures 8.5 cm in length. Markedly increased renal parenchymal echogenicity. No hydronephrosis or shadowing calculi.OTHER: The urinary bladder is decompressed by Foley catheter, precluding its evaluation. Ureteral jets not visualized.", "output": "1. Minimal to mild right hydronephrosis without evidence of obstruction.2. Markedly increased renal parenchymal echogenicity, consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate left pleural effusion Large left pleural effusion without significant complexity or loculation", "output": "Large left pleural effusion without significant complexity or loculation"}
{"instruction": "Generate impression based on findings.", "input": "20 year old female patient with history of thyroid cancer status post thyroidectomy and RAI. RIGHT LOBE: Status post thyroidectomy without recurrent or residual parenchymal tissue identified.LEFT LOBE: Status post thyroidectomy without recurrent or residual parenchymal tissue identified.ISTHMUS: Status post thyroidectomy without recurrent or residual parenchymal tissue identified.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A heterogeneous right submandibular lymph node measures 2.7 x 1.1 x 2.2 cm with punctate internal echogenic foci, not significantly changed in size. A heterogeneous left submandibular lymph node with punctate internal echogenic foci measures 1.8 x 1.1 x 2.6 cm, previously 1.7 x 0.9 x 2.2 cm.OTHER: No significant abnormality noted.", "output": "1. No recurrent tissue identified in the thyroid bed.2. Redemonstration of submandibular lymph nodes; the left lymph node is slightly larger in size. "}
{"instruction": "Generate impression based on findings.", "input": "Pancreatitis. Evaluate for cholelithiasis. LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Minimal biliary sludge noted. Otherwise unremarkable appearance of the gallbladder. No gallstones identified, per clinical query.OTHER: No significant abnormalities noted.", "output": "No gallstones or biliary ductal dilation."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal wall defect associated with area of previous hernia repair. Please evaluate for disruption of mesh. No acute abnormalities. No fluid collections or evidence of ventral hernia. The hernia repair mesh is not visualized.", "output": "No acute abnormality. The hernia repair mesh is not visualized."}
{"instruction": "Generate impression based on findings.", "input": "Left thyroid nodule RIGHT LOBE MEASUREMENTS: 2.6 x 2.2 x 5.1 cmLEFT LOBE MEASUREMENTS: 2.3 x 2.1 x 5.7 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Diffusely heterogeneous gland with increased vascularity. Multiple predominantly solid nodules. A representative mid pole nodule measures 1.2 x 0.9 x 1.3 cm. A lower pole nodule measures 1.3 x 1.1 x 1.3 cm.LEFT LOBE: Diffusely heterogeneous gland with increased vascularity. Multiple predominantly solid nodules. The largest within the upper pole measures 2.1 x 0.9 x 2.8 cm.ISTHMUS: Diffusely heterogeneous gland with increased vascularityPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland with increased vascularity raises the possibility of Graves disease or thyroiditis. Multiple bilateral predominantly solid thyroid nodules, the largest within the left thyroid gland. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: needs US guidance for renal biopsy History: AKI Ultrasound guidance and technical assistance was provided for a left kidney biopsy by the nephrology service. Four passes were performed.", "output": "Ultrasound guidance and technical assistance for left kidney biopsy. "}
{"instruction": "Generate impression based on findings.", "input": "Female; 57 years old. Reason: r/o recurrence History: h/o thyroid cancer, s/p thyroidectomy RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: 4 x 4 x 7 mm hypoechoic nodular focus in the inferior thyroid bed is redemonstrated and unchanged in appearance. This previously measured 3 x 4 x 8 mm. A second hypoechoic focus is seen in the mid thyroid bed. This measures 6 x 8 x 8 mm and was not definitely seen on the recent prior ultrasounds, but was measured and reported on a more remote thyroid ultrasound from 7/27/2011. It is stable in appearance compared to that study when it measured 8 x 6 x 7 mm.LEFT LOBE: Soft tissue echogenicity in the left thyroid bed measures 1.1 x 0.6 x 1.0 cm (previously 1.0 x 0.5 x 0.5 cm).ISTHMUS: No significant abnormality noted.LYMPH NODES: 0.8 to 0.4 x 2.1 cm right mid neck lymph node has a fatty hilum.", "output": "1. Stable exam with no change in hypoechoic lesions in the right thyroid bed.2. Hyperechoic structure in the left thyroid bed may represent residual thyroid tissue given its appearance and stability over time."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old woman presents for further evaluation of a bumpy area in the left upper-outer quadrant breast. Patient said she first noticed this 2 months ago and that it has smaller in size since then. On physical exam, there is focal discoloration of the skin in the upper outer quadrant at the site of patient's concern.A targeted gray scale and color Doppler left ultrasound was performed for the patient\u2019s area of concern. In the left breast 1:00 position 4 cm from the nipple, within the epidermis, there is a mixed echogenicity lesion measuring 1.7 x 0.1 x 0.9 cm, consistent with an epidermal inclusion cyst. No internal vascularity is appreciated. No suspicious solid or cystic masses are identified in the breast parenchyma deep to this lesion.", "output": "Left breast 1:00 position epidermal inclusion cyst, correlating to the area of clinical concern. No sonographic evidence for malignancy. Clinical follow-up is recommended. Results and recommendations were discussed with the patient at the time of exam.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Reason: rule out hepatic abnormality. Pt with elevated liver enzymes, history of hepatitis B. LIVER: The liver measures 17.6 cm in length. The liver demonstrates mildly 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 0.22 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 3 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 9.2 cm in length. RIGHT KIDNEY: Kidney measures 12.0 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": "Mildly increased hepatic echogenicity suggestive of parenchymal dysfunction/fatty infiltration. No evidence of acute cholecystitis or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "24 year old female with neurofibromatosis Type I with abdominal pain and nausea. LIVER: The liver is normal in morphology, echogenicity and size, measuring 15.6 cm in craniocaudal dimension. No intrahepatic biliary ductal dilatation or focal hepatic lesion is identified. There is normal hepatopetal portal venous blood flow at 30 cm/sec.BILIARY TRACT: A normally distended gallbladder is present without gallstones, wall thickening, pericholecystic fluid, or focal tenderness. No extrahepatic biliary ductal dilatation with the common hepatic duct measuring 4 mm.PANCREAS: The pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 11.4 cm.RIGHT KIDNEY: The right kidney measures 11.2 cm in length without hydronephrosis or shadowing calculus. OTHER: The left kidney measures 12.6 cm in length without hydronephrosis or shadowing calculus.", "output": "No specific findings to account for the patient's right upper quadrant pain. Please note that the pancreas is obscured by overlying bowel gas."}
{"instruction": "Generate impression based on findings.", "input": "Nontoxic multinodular goiter, rule out growth of nodules, adenopathy RIGHT LOBE MEASUREMENTS: 5.1 x 1.8 x 1.9 cm, mostly stableLEFT LOBE MEASUREMENTS: 7.5 x 3 x 2.7 cm, minimal increase in sizeISTHMUS MEASUREMENTS: 8 mmRIGHT LOBE: Multiple nodules identified mostly solid in appearance mostly unchanged from prior examination.Superior pole nodule: 2.1 x 1 x 1.8 cm, previously 1.8 x 1.3 x 1 cm.Midpole nodule: 1.1 x 0.8 x 0.6 cm, previously measured 1.1 x 0.9 x 0.6 cm.Lower pole nodule: Not well seen on today's imaging, previously measured 0.7 x 0.7 x 0.5 cm. No new suspicious nodules identified.LEFT LOBE: Multiple heterogenous nodules identified, mostly unchanged from prior examSuperior pole nodule: 1.5 x 0.9 x 1.4 cm, previously measured 1.2 x 0.7 x 0.7 cm. Mid pole nodule: 1.9 x 1.3 x 1.8 cm, previously measured 1.9 x 2 x 2.1 cm mostly unchanged.Inferior pole nodule: 3.8 x 3.1 x 2.8 cm, previously measured 3.6 x 2.5 x 2.9 cm, unchanged.No new suspicious nodules identified.ISTHMUS: Heterogenous thyroid nodule involving the isthmus measures 2 x 1.3 x 1.4 cm, previously measured 1.4 x 1.7 x 1.3 cm, mostly unchanged.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal morphology lymph nodes are notedOTHER: No significant abnormality noted.", "output": "Multinodular goiter mostly stable from prior examinations."}
{"instruction": "Generate impression based on findings.", "input": "Low back pain RIGHT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 10.3 cm in lengthLEFT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 10.8 cm in lengthOTHER: Bladder nondistended. Incidental note made of 1 x 1.1 x 1 cm well-circumscribed hyperechoic focus within the right lobe of the liver.", "output": "Normal renal parenchyma without mass, stone, or hydronephrosis. Incidental note made of well-circumscribed hyperechoic focus within the right lobe of the liver; statistically most probably represents a benign hemangioma."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old male with soft tissue swelling in the subcutaneous tissues of the left lower quadrant after heparin injection. No focal mass is identified within the soft tissues. There is edematous change.OTHER: Limited evaluation of the abdomen demonstrates mild to moderate ascites and bilateral pleural effusions.", "output": "1. No focal collection within the abdominal wall.2. Ascites with pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for cirrhosis vs hcc, eval for renal disease worsening Cr History: hcv cirrhosis, acute renal failure Examination mildly limited by constraints positioning patient.LIVER: The liver measures 14.3 cm in length. The liver parenchymal echotexture is coarse. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.17 m/s.BILIARY TRACT: Sludge/debris is present within the gallbladder. No significant gallbladder wall thickening. Common tail artifact associated with the gallbladder wall suggesting adenomyomatosis. 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: Pancreas poorly visualized.SPLEEN: No significant abnormalities noted. The spleen measures 8.5 cm in length. RIGHT KIDNEY: Kidney measures 7.3 cm in length. Increased parenchymal echogenicity. No frank hydronephrosis.LEFT KIDNEY: Left kidney is not well-visualized.ABDOMINAL AORTA: The proximal aorta measures 1.0 cm AP x 0.7 cm transverse. The middle aorta measures 1.1 cm in AP dimension. The distal aorta is not well-visualized.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Large amount of ascites, increased from prior. Foley catheter in collapsed bladder.", "output": "1.Limited exam.2.Cirrhotic liver morphology without focal lesions identified. Large amount of ascites, increased.3.Increased echogenicity of right kidney compatible with medical renal disease. Left kidney not well visualized. No frank hydronephrosis on the right."}
{"instruction": "Generate impression based on findings.", "input": "Weight loss abnormal liver enzymes LIVER: Mildly heterogeneous liver echotexture without mass. Liver length 13.2 cmGALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Benign-appearing cyst. Right kidney 10.6 cm in lengthOTHER: Minimally complex left renal cyst. Left kidney 10.5 cm in length. Spleen 8.6 cm in length. No ascites.", "output": "Mildly heterogeneous liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 61 years old; Reason: eval for signs of cirrhosis, portal HTN History: chronic hep c LIVER: The liver measures 15.6 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 18.6 cm/s. No ascites is seen.GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.8 mm. No stones are seen. No pericholecystic fluid. 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 measures 9.7 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 9.4 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 9.2 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "The liver has coarse increased echogenicity compatible with fatty infiltration/hepatocellular dysfunction. No new worrisome masses or ascites are seen."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old male with elevated creatinine and BUN. Evaluate for chronic kidney disease. RIGHT KIDNEY: The right kidney measures 12.5 cm in length. No hydronephrosis. Mildly increased echogenicity of the renal parenchyma. No shadowing calculi or suspicious masses.LEFT KIDNEY: The left kidney measures 12.1 cm in length. No hydronephrosis. Mildly increased echogenicity of the renal parenchyma. No shadowing calculi or suspicious lesions. In the left upper renal pole, there is a stable exophytic 2.7 x 2.4 x 2.2 cm simple cyst.URINARY BLADDER: The urinary bladder is distended without acute abnormality. OTHER: Enlarged prostate is partially visualized.", "output": "Mild increased echogenicity of the renal parenchyma suggestive of chronic medical renal disease. No hydronephrosis, shadowing stone, or suspicious mass."}
{"instruction": "Generate impression based on findings.", "input": "Small palpable left breast nodule. Targeted grayscale and color Doppler ultrasound was performed of the palpable abnormality of the left breast near the nipple. No discrete solid or cystic lesion is identified. Shadowing from the nipple is noted. The breast parenchyma is symmetric when compared to the right.", "output": "No sonographic abnormality corresponding to the patient's left breast palpable nodule."}
{"instruction": "Generate impression based on findings.", "input": "19-year-old female with family history of breast cancer in maternal and paternal grandmother. Patient has a history of left upper outer benign appearing, compatible with fibroadenoma. Targeted ultrasound of the left breast 11:00 6 cm from the nipple, redemonstrates a 1.2 x 0.7 x 1.3 cm oval circumscribed parallel predominately hypoechoic mass with posterior acoustic enhancement and mild internal vascularity.There is no suspicious solid or cystic mass.", "output": "Stable benign-appearing left upper inner breast mass, with imaging characteristics compatible with fibroadenoma.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": "62-year-old female with multinodular goiter for evaluation prior to fine-needle aspirate. RIGHT LOBE MEASUREMENTS: 5.7 x 2.8 x 3.9 cmLEFT LOBE MEASUREMENTS: 6.5 x 2.7 x 1.8 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Predominantly solid and heterogeneous nodule involving much of the right thyroid lobe with some internal cystic area and increased echogenicity measures 2.4 x 3 x 4.8 cm.LEFT LOBE: Large solid but heterogeneous nodule with areas of increased echogenicity in the midportion of the left lobe measures 1.3 x 1.8 x 2.0 cm.ISTHMUS: Within the right isthmus there is a complex cystic nodule measuring 0.6 x 1.2 x 1.3 cm with a spongiform appearance and comet tail artifact consistent with colloid nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No abnormal lymph nodes.OTHER: No significant abnormality noted.", "output": "Bilateral solid or predominantly solid thyroid nodules. Colloid nodule right isthmus."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female with known thyroid cancer presents for evaluation of adenopathy. RIGHT LOBE MEASUREMENTS: 1.5 x 1.6 x 4.4 cm.LEFT LOBE MEASUREMENTS: 1.5 x 1.6 x 3.4 cm.ISTHMUS MEASUREMENTS: 0.6 cm.RIGHT LOBE: The right lobe appears normal with homogeneous parenchyma.LEFT LOBE: There are 2 nodules in the left mid pole of the thyroid. The larger nodule measures approximately 0.7 x 0.6 x 0.8 cm, is solid, round and has a mixed echogenicity. There is a hypoechoic rim. The other nodule is similar in appearance and has dimensions approximately 0.5 x 0.4 x 0.4 cm.ISTHMUS: There is an approximately 0.7 x 0.4 x 0.6 cm round hypoechoic solid nodule in the isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional adenopathy.OTHER: No significant abnormality noted.", "output": "1. Multinodular thyroid as above consistent with patient's known thyroid cancer. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C with congestive heart failure and acute renal insufficiency LIVER:Coarse echogenic liver echotexture again noted without mass. Liver length 18.6 cmGALLBLADDER, BILIARY TRACT: No significant abnormality noted.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. 11.1 cm in lengthKIDNEYS: Echogenic renal parenchyma again noted without mass or hydronephrosis. Right kidney 10 cm in length; left kidney 8.9 cm in length. ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Mild ascites", "output": "Coarse echogenic liver again noted consistent with chronic liver disease without mass or ductal dilatation. Mild ascites.Echogenic renal parenchyma again noted consistent with medical renal disease/parenchymal dysfunction without mass or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old female presents for evaluation of thyroid nodule. RIGHT LOBE MEASUREMENTS: 5.7 x 1.3 x 1.3 cm.LEFT LOBE MEASUREMENTS: 4.4 x 1.5 x 1.4 centers.ISTHMUS MEASUREMENTS: 0.4 centers.RIGHT LOBE: Unremarkable parenchyma. One nodule in the superior aspect measuring approximately 1.0 x 0.6 x 0.7 cm; well-defined, mixed cystic-solid although predominantly solid.LEFT LOBE: Unremarkable parenchyma. One nodule in the left thyroid measuring approximately 1.3 x 1.2 x 0.9 cm; well-defined, mixed echogenicity, solid, no calcifications or internal vascularity.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. Dominant left sided nodule amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Whirity is a 39-year-old woman with right breast IDC diagnosed at age 39. She presents today for right breast mammogram and sonographic evaluation of the right breast and axilla. She is taking xgeva, zoladex, letrozole, and ibrance. She has a surgical history of bilateral oophorectomy performed on 9/1/2016. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Again seen is a spiculated mass at the right 1:00 position, mid depth , which measures 2.4 x 2.0 x 1.8 cm, and is again noted to contain a few pleomorphic calcifications. This mass previously measured up to 3.3 cm in greatest dimension. ULTRASOUND", "output": "Interval decrease in size of a right breast mass and right axillary lymph node. Findings were discussed with the patient.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B. Evaluate for hepatocellular carcinoma. LIVER: Non-cirrhotic liver morphology. 21 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 12.3 cm in length. The left kidney is 11.2 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 13.0 cm in length at the upper limits of normal, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites.", "output": "Mild hepatomegaly with mildly coarsened hepatic echogenicity compatible with parenchymal dysfunction, without suspicious hepatic lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male with myeloma-related kidney disease and increasing creatinine. Ultrasound guidance was provided for renal biopsy.", "output": "Ultrasound guidance."}
{"instruction": "Generate impression based on findings.", "input": "Intraoperative guidance for suprapubic bladder catheter placement A distended bladder was identified pre-procedure. The bladder catheter and balloon are identified within the bladder post-procedure.", "output": "Guidance for suprapubic bladder catheter placement."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old female with a history of thyroid cancer status post thyroidectomy presents with palpable lymph nodes. 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 noted on the study.Right level 1 node: Measures approximately 1.5 x 1.2 x 0.7 cm. Has benign morphology.Right level 3 node: Measures approximately 2.1 x 1.6 x 0.7. Has benign morphology.Left level 3 node: Measures approximately 1.4 x 1.4 x 0.4 centers. Has benign morphology.OTHER: No significant abnormality noted.", "output": "1. Surgical changes of a thyroidectomy without evidence of recurrence.2. Reactive lymph nodes as described above; favor benign etiology."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old male with prior inguinal hernia repair with an episode of discomfort and bulging. Evaluate for recurrent hernia. Fascial planes appear intact. There is no evidence for recurrent hernia in the inguinal region. No fluid collections are seen.", "output": "No evidence for recurrent hernia."}
{"instruction": "Generate impression based on findings.", "input": "Female 66 years old; Reason: assess for thrombosis/duct dilation History: assess for thrombosis/ duct dilation The study was very limited due to patient's intubated status.LIVER: The liver appears coarse, echogenic, nodular and shrunken. The known mass of the hepatic dome is not visualized due to incomplete inspiration. No intrahepatic ductal dilation is seen. The main portal vein is patent with decreased hepatopetal flow measured at 9.7 cm/s. Large volume ascites is noted.GALLBLADDER/BILIARY TRACT: The gallbladder is surgically absent. The common bile duct measures 6.6 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen is enlarged measuring 14.2 cm and no acute abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.3 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen. There is suboptimal visualization due to incomplete inspiration.LEFT KIDNEY: The left kidney measures 12.2 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.Dopplers:MAIN PORTAL VEIN: The portal vein is not well-visualized but appears to be patent with hepatopetal flow measuring 9.7 cm/s, which is decreased.HEPATIC ARTERIES: The common hepatic artery is patent with hepatopetal flow and peak systolic velocity measured at 136.2 cm/s and RI of 0.7. The left hepatic artery is patent with hepatopetal flow and peak systolic velocity of 84.1 cm/s and RI of 0.7. Normal spectral Doppler wave forms are noted. The right hepatic artery was difficult to evaluate, and a normal spectral Doppler waveform was obtained.The right hepatic vein, main hepatic vein, left hepatic vein were unable to be evaluated with spectral Doppler interrogation.SPLENIC ARTERY: The splenic artery is patent with anterior grade flow to the spleen measured at peak systolic velocity of 125.7 cm/s and RI of 0.7.SPLENIC VEIN: The splenic vein is patent with hepatopedal flow.IVC: The inferior vena cava is patent.", "output": "1. The known mass at the hepatic dome was not visualized due to incomplete inspiration. Cirrhotic contour is noted. Large volume ascites, splenomegaly, and decreased velocity of the main portal vein are compatible with portal hypertension.2. Incomplete visualization and interrogation of the hepatic veins due to technical limitations. The hepatic arteries, splenic artery, splenic vein, and IVC are patent.3. No evidence for intrahepatic ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Leftwich is a 42-year-old woman with a personal history of right breast DCIS and left breast IDC status post bilateral mastectomy and breast reconstruction in 2009. She presents today from surgery clinic with new palpable abnormality (fullness) in left axilla. Upon physical exam, the clinical area of concern is marked in the left axillary region. There is an area of nodularity identified, however, no discrete mass is palpated.A targeted left axillary ultrasound was performed for the palpable area of concern. Sonographic images identified prominent scar tissue. No suspicious cystic or solid mass is identified.", "output": "Prominent left axillary scar tissue. No sonographic evidence for malignancy. The patient should follow up with her primary care team as clinically warranted for the palpable area of abnormality, presuming these results are concordant with the physical exam findings. All results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female patient with thyroid nodule seen on MRI. RIGHT LOBE MEASUREMENTS: 6.2 x 3.5 x 1.9 cm.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: The remaining isthmus measures 6 mm in thickness.RIGHT LOBE: The right thyroid lobe is heterogeneous in echogenicity and contains multiple thyroid nodules. The largest within the right inferior thyroid lobe measures 2.3 x 1.7 x 1.8 cm and is mostly solid with cystic spaces. An additional peripherally calcified hypoechoic solid nodule is noted within the right upper pole measuring 1.1 x 0.9 x 1.3 cm. Additional subcentimeter mostly cystic nodules are present.LEFT LOBE: Status post thyroidectomy without residual or recurrent tissue identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A benign morphology lymph node is noted in the left neck.OTHER: No significant abnormality noted.", "output": "1. Dominant right solid and complex cystic thyroid nodules.2. Status post left thyroid lobectomy."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old female with history of metastatic papillary carcinoma with recurrent disease resected in June, 2015. RIGHT LOBE MEASUREMENTS: Post thyroidectomy LEFT 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 or metastatic disease in the neck."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 79 yo male with CHF and new hyperbilirubinemia Examination somewhat limited by postsurgical changes in anterior abdominal wall.LIVER: The liver measures 14.2 cm in length. The liver parenchymal echotexture is coarse. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating biphasic hepatopetal flow with a velocity of 0.21 m/s. The hepatic veins appear prominent.BILIARY TRACT: The gallbladder is not visualized, and surgical clips in the right upper quadrant on prior chest radiograph suggests that the gallbladder is surgically absent. No intrahepatic biliary ductal dilatation is present. The common bile duct is mildly prominent measuring 8.9 mm in diameter which would not be unexpected status post cholecystectomy.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 9.7 cm in length. RIGHT KIDNEY: Kidney measures 9.8 cm in length. Increased parenchymal echogenicity and cortical thinning. No hydronephrosis.LEFT KIDNEY: Kidney measures 9.7 cm in length. Increased parenchymal echogenicity and cortical thinning. No hydronephrosis.OTHER: Large ascites.", "output": "1.Findings suggestive of elevated right heart pressures.2.Increased hepatic echogenicity suggestive of parenchymal dysfunction which may be due to congestive hepatopathy.3.Large ascites.4.Increased renal echogenicity compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain LIVER: Bilobar benign-appearing hepatic cysts. No worrisome mass. Liver length 12.9 cm.BILIARY TRACT: Status post cholecystectomy. Mildly prominent extra hepatic bile duct with maximal diameter 1 cm. No significant intrahepatic ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9.3 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 9.3 cm in lengthOTHER: Left kidney 10.4 cm in length. No ascites.", "output": "Bilobar benign-appearing hepatic cysts. No worrisome hepatic mass. Status post cholecystectomy with mildly prominent extrahepatic bile duct without significant intrahepatic ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old female with a right parotid mass for follow-up. In the superior aspect of the right parotid gland there is an ovoid, hypoechoic mass with a more echogenic center. This measures approximately 0.5 x 0.7 x 0.7 cm. The appearance is consistent with an intraparotid lymph node. No other abnormality identified.", "output": "Right intraparotid lymph node."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain. Pancreatic mass. Status post ERCP. LIVER: Diffusely heterogeneous parenchymal echogenicity with focal lesions suggestive of metastatic disease. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: The biliary ductal dilation is markedly decreased status post stent placement. Cholelithiasis. No gallbladder wall thickening or sonographic Murphy's sign.PANCREAS: Pancreatic head prominence compatible with the patient's known pancreatic head mass is partially visualized due to overlying bowel gas. KIDNEYS: The right kidney is 6.0 cm in length. The left kidney is 5.8 cm in length. The renal parenchyma is markedly echogenic. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.3 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.", "output": "1. Decreased biliary ductal dilation status post stent placement.2. Cholelithiasis without specific evidence of cholecystitis.3. Diffusely heterogeneous liver lesions suggestive of metastatic disease.4. Diminutive kidneys with echogenic renal parenchyma, compatible with chronic renal disease."}
{"instruction": "Generate impression based on findings.", "input": "NASH cirrhosis LIVER: Cirrhotic morphology again noted without mass. Liver length 22.3 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted..RIGHT KIDNEY: No significant abnormalities noted. 14.1 cm in lengthOTHER: Left kidney 16.6 cm in length. Spleen 19 cm in length. Recannulized umbilical vein again observed. No ascites.", "output": "Cirrhotic morphology without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid carcinoma status post resection RIGHT LOBE: Status post thyroidectomy without worrisome mass. Stable postoperative echogenic focus within the right thyroidectomy bed measuring 1.3 x 0.4 x 0.4 cm.LEFT LOBE: Status post thyroidectomy without worrisome massISTHMUS: Status post thyroidectomy without worrisome massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable examination post thyroidectomy without worrisome mass or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Coarse echogenic liver parenchyma without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 18.2 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 12.8 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.8 cm in lengthOTHER: Left kidney 11.9 cm in length. No ascites.", "output": "Coarse echogenic liver parenchyma suggestive for fatty infiltration without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Li Fraumeni syndrome. AKI. RIGHT KIDNEY: 11.9 cm in length. Unremarkable renal parenchymal echogenicity. A 4 mm hyperechoic focus at the inferior pole corresponds to a nonenhancing hypoattenuating lesion on the prior CT, likely representing a angiomyolipoma. No suspicious lesions are evident. No renal stones or hydronephrosis. No perinephric fluid collection.LEFT KIDNEY: 12.7 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis. No perinephric fluid collection.BLADDER: No significant abnormality noted.OTHER: A 2.6 cm homogeneously hyperechoic lesion is noted in the inferior right hepatic lobe, corresponding to a hypoattenuating lesion on the prior CT, likely representing a lipoma or angiomyolipoma. No ascites identified.", "output": "1. No hydronephrosis.2. 4 mm hypoechoic focus in the right kidney, likely representing an angiomyolipoma.3. 2.6 cm lesion in the inferior right hepatic lobe, seen on the prior CT and MRI, likely representing a lipoma or angiomyolipoma given apparent fat content."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female with acute kidney injury. Evaluate for hydronephrosis. Suboptimal examination due to patient body habitus. RIGHT KIDNEY: Measures 10.5 cm in length. Increased echogenicity without hydronephrosis.LEFT KIDNEY: Measures 10.3 cm in length. Increased echogenicity without hydronephrosis.URINARY BLADDER: Collapsed with a Foley catheter in place.OTHER: Bilateral pleural effusions.", "output": "1. Suboptimal examination with increased renal echogenicity consistent with medical renal disease. No hydronephrosis.2. Bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old with right breast swelling Right nipple areolar area is swollen. With focused ultrasound, there is a 2.5 x 2.2 cm abscess formation with increased blood flow associated with skin thickening at retroareolar region.", "output": "Imaging findings consistent with right breast abscess. Results were relayed to Dr. Shakhsheer. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "75-year-old female with multinodular goiter. Follow-up imaging to ensure stability of nodules. Prior ultrasound at Northwestern. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 5 x 2 x 1.7 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.6 x 1.4 x 1.7 cm.ISTHMUS MEASUREMENTS: The isthmus measures 0.3 cm in thickness.RIGHT LOBE: In the right anterior thyroid lobe, there is a spongiform nodule measuring 0.7 x 0.6 x 0.5 cm.LEFT LOBE: A small spongiform nodule of the left upper thyroid pole is noted. In the left mid gland, there is an isoechoic nodule with a hypoechoic rim measuring 1.4 x 1.2 x 1.1 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A left lateral neck level 3 lymph node measuring 0.6 x 0.3 x 1.3 cm does not show a normal fatty hilum.OTHER: No significant abnormality noted.", "output": "1. Bilateral thyroid nodules as described above. No prior outside imaging was uploaded to for comparison.2. Nonspecific subcentimeter left level 3 lymph node does not contain a normal fatty hilum. Attention on follow-up imaging is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain with elevated lipase LIVER: Cirrhotic morphology again noted without mass. Liver length 16.1 cmGALLBLADDER, BILIARY TRACT: Gallbladder wall thickening and pericholecystic fluid with biliary sludge and possible stones again noted.PANCREAS: Obscuration of peripancreatic fat planes; no obvious peripancreatic loculated fluid collection or pancreatic ductal dilatationRIGHT KIDNEY: No significant abnormalities noted. 13.6 cm in lengthOTHER: Spleen 18.4 cm in length. Moderate ascites", "output": "Obscuration of peripancreatic fat planes; no obvious peripancreatic loculated fluid collection or pancreatic ductal dilatation. Cannot assess for pancreatic necrosis; would recommend correlation with contrast CT if the presence of necrosis is clinically suspected. Cirrhotic morphology again noted without mass or ductal dilatation. Gallbladder abnormalities again noted and unchanged. Moderate ascites."}
{"instruction": "Generate impression based on findings.", "input": "16 year old female with a palpable lump in the right breast for about an year. With physical exam, a mobile mass is palpated at 10 o'clock position in the right breast. With focused ultrasound, a lobulated hypoechoic mass, measuring 28 x 16 mm, with increased blood flow at 10 o'clock position in the right breast, consistent with fibroadenoma.", "output": "Benign appearing mass in the left breast, consistent with fibroadenoma. Clinical follow-up is recommended. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female patient with epigastric and right upper quadrant pain. Question of cholecystitis. GALLBLADDER, BILIARY TRACT: There is biliary sludge, appearing less than the prior study. No gallstones, pericholecystic fluid, or gallbladder wall thickening is identified. There is no extrahepatic biliary ductal dilatation. The common bile duct measures 4 mm in diameter.", "output": "Biliary sludge without sonographic evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old female with history of myelofibrosis. Evaluate for hepatosplenomegaly. LIVER: Liver is mildly coarse in echotexture and measures 19.6 cm in length. Mean portal vein is patent with peak systolic velocity measuring 0.4 m/s.GALLBLADDER, BILIARY TRACT: Cholelithiasis. Gallbladder wall measures 0.2 cm and the common hepatic duct measures 0.2 cm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Kidneys are normal in echotexture with the right kidney measuring 10.6 cm and left kidney measuring 12.3 cm in lengthOTHER: Spleen measures 20.6 cm in length and is homogeneous in echotexture.", "output": "Findings consistent with hepatosplenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Allen submitted outside examinations:-Bilateral screening mammogram: 12/23/2009-Bilateral breast ultrasound: 12/23/2009-Ultrasound-guided biopsy of right breast: 2/12/2010All examinations were performed at Mercy Hospital. Submitted outside studies were compared to the current mammogram dated 4/7/2016. The breast parenchyma is heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. Multiple circumscribed masses identified in both breasts (right upper outer and left upper outer quadrants) are stable when compared to prior examinations and compatible with cysts (as seen on prior ultrasound examinations). In addition, a cluster of calcifications in the left upper outer breast are faintly seen on prior ML view from 2009. There is no significant change between these studies.", "output": "Multiple benign cysts of both breasts. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually, due next in April 2017. BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Skeletalization of the Right ureter during surgery, eval for hydronephrosis RIGHT KIDNEY: The right kidney measures 10.2 cm in length. No hydronephrosis, masses, or shadowing stones.LEFT KIDNEY: The left kidney measures 11.4 cm in length. No hydronephrosis, masses, or shadowing stones.OTHER: The bladder is poorly distended, limiting evaluation.", "output": "No acute renal abnormality. No evidence of hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Goodman is a 20-year-old female presenting with bilateral palpable breast masses for the past 6 years. According to the electronic medical record, patient has had multiple prior ultrasounds, a biopsy revealing fibroadenoma in 2013 and recommendations to see a breast surgeon. This history was gathered after the exam was done, as at the time of examination today the patient did not provide any of this history. Upon physical exam of the right breast, at least 3 palpable masses are identified, the largest of which is in the right lower inner breast.Targeted right breast ultrasound is performed for the patient's areas of concerns.- 5 o'clock location: 3.1 x 1.6 x 2.2 cm, compared to 3.3 x 1.8 x 2.6 cm.- 9 o'clock location: 1.6 x 1 .0 x 1.7 cm, compared to 1.8 x 1.1 x 1.8 cm- 10 o'clock location: 1.0 by 0.4 x 1.2 cmUpon physical exam of left breast, at least for palpable masses are identified, the largest of which is in the left lower inner breast.Targeted left breast ultrasound is performed for the patient's area of concerns.- 7 o'clock location: 3.2 x 1.2 x 3.6 cm, compared to 3.7 x 2.0 x 3.5 cm.- 3 o'clock location: 1.1 x 0.7 x 1.2 cm- 12 o'clock location: 0.9 x 0.8 cm, compared to 0.9 x 1.2 cm.- 12 o'clock location: 1.1 x 0.6 cm", "output": "Multiple bilateral hypoechoic masses, likely representing fibroadenomata. Surgical consultation is recommended for this patient. All results and recommendations were thoroughly discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female with thyroid nodules on prior ultrasound RIGHT LOBE MEASUREMENTS: 5.3 by 1.6 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.2 x 1.9 x 1.3 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Scattered, small hypoechoic nodules identified with at least one with a comet tail artifact suggestive colloid nodule.LEFT LOBE: Spongiform -- appearing nodule in the midportion of the left lobe, also demonstrating comet tail artifact and measuring 0.4 x 0.7 x 0.9 cm.In the inferior left lobe there is an ovoid, mildly hypoechoic nodule with a complete hypoechoic rim measuring 0.7 x 0.7 x 1.2 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 thyroid nodules. Majority appear benign. Non-descript nodule left lower pole."}
{"instruction": "Generate impression based on findings.", "input": "Reassess perihepatic fluid. Elevating total bilirubin. LIVER: Noncirrhotic liver morphology. Mildly coarse parenchymal echogenicity. No focal lesion. Normal hepatopedal portal venous blood flow at 29 cm/s. No intrahepatic biliary ductal dilatation. Complex fluid collection posterior to the left hepatic lobe now measures 8.7 x 5.4 x 5.6 cm, increased from the prior, appearing to communicate with the adjacent complex fluid as seen on CT.Septated perihepatic ascites.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 3 mm. Normally distended gallbladder without gallbladder wall thickening, pericholecystic fluid or focal tenderness. No gallstones.PANCREAS: Obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 13.2 cm in length.RIGHT KIDNEY: The right kidney measures 9.1 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. The cortex is echogenic. Color Doppler demonstrates hilar blood flow. OTHER: In the left upper quadrant there is a 14.4 x 11.2 x 12.6 cm complex heterogeneous presumed collection. The left kidney is not visualized. Moderate volume of complex septated ascites..", "output": "1. Normally distended gallbladder without wall thickening or focal tenderness.2. Increasing size of the complex collection posterior to the left hepatic lobe which appears to communicate with complex abdominal fluid. Left upper quadrant complex collection is new from the prior ultrasound but may correspond to increasing complex ascites. At least moderate volume of complex septated ascites.3. Echogenic renal parenchyma compatible with medical renal disease. Coarse hepatic echogenicity compatible with parenchymal dysfunction without biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Biliary obstruction, infection History: Elevated LFTs, concern for stones. LIVER: The liver measures 18 cm in craniocaudal dimension. The liver is heterogeneous in echotexture likely due to fatty infiltration. In the left lobe of the liver, there is a 1.4 x 1 x 1.3 cm hepatic cyst.GALLBLADDER, BILIARY TRACT: Cholelithiasis. No pericholecystic fluid or gallbladder wall thickening. No intrahepatic or extra hepatic biliary ductal dilatation. The common hepatic duct measures 2 mm.PANCREAS: The visualized pancreas is within normal limits. The distal tail is predominantly obscured by overlying bowel gas.KIDNEYS: The right kidney measures 8.3 cm. The left kidney measures 9.3 cm. Corticomedullary differentiation is normal. No hydronephrosis.SPLEEN: The spleen measures 8.5 cm. No focal splenic lesion.OTHER: No significant abnormalities noted.", "output": "1.Heterogeneous liver likely due to fatty infiltration.2.Cholelithiasis without evidence of acute cholecystitis.3.No biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with possible ascites. Elevated alkaline phosphatase. LIVER: The liver is normal in size and echotexture. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder appears unremarkable without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber. PANCREAS: Pancreatic duct is mildly prominent without obvious pancreatic abnormalityRIGHT KIDNEY: No significant abnormalities noted.OTHER: Trace ascites.", "output": "Trace ascites.Mildly prominent pancreatic duct."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female with right axillary mass, negative mammography. A targeted right axillary ultrasound was performed for the palpable area of concern. There is a 1.0 x 0.7 x 0.5 cm sebaceous cyst in the right axilla correlating with the patient's palpable abnormality. Benign morphology lymph nodes are also present.", "output": "Right axillary sebaceous cyst correlates with the patient's palpable complaint. No evidence of malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old male complains of fatigue and dyspnea. There is clinical concern for a multinodular thyroid. RIGHT LOBE MEASUREMENTS: 5.2 x 1.8 x 1.3 cm.LEFT LOBE MEASUREMENTS: 0.4 x 2.2 x 1.6 cm.ISTHMUS MEASUREMENTS: 0.4 cm.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.", "output": "Normal ultrasound of the thyroid without mass or adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "86-year-old female with hematuria RIGHT KIDNEY: Measures 9.9 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 11.1 cm in length. 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": "Right upper quadrant ultrasound post cholecystectomy pain LIVER: Liver measures 17 cm with increased echogenicity suggestive of hepatic steatosis. No focal lesions noted within the liver. Main portal vein is patent with normal flow directionality. No intrahepatic biliary ductal dilatation. BILIARY TRACT: Status post cholecystectomy. Common bile duct measures up to 6 mm within normal limits without any stones or sludge within it.PANCREAS: Head and body of pancreas appears unremarkable, tail of pancreas not visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 8.8 cmRIGHT KIDNEY: Right kidney measures 9.6 cm left kidney measures 8.2 cm. Mild increased echogenicity noted in both kidneys. No hydronephrosis or focal lesions. OTHER: No ascites", "output": "Mild increased echogenicity of the liver suggestive of hepatic steatosis.Status post cholecystectomy without intrahepatic or extra biliary ductal dilatation.Mild increased echogenicity of both kidneys suggestive of chronic medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B. Evaluate for hepatocellular carcinoma. LIVER: 14.3 cm in length. 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. 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 9.5 cm in length in length. The left kidney is 9.4 cm in length in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9.0 cm in length in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites identified.", "output": "Mildly increased hepatic echogenicity, compatible with parenchymal dysfunction. No suspicious lesions identified."}
{"instruction": "Generate impression based on findings.", "input": "Male 27 years old; Reason: 27 yo M with ? History PSC presenting with RUQ pain, elevated alk phos History: RUQ abdominal pain LIVER: The liver measures 17 cm in length. There are patchy areas of increased and course echogenicity of the liver parenchyma in particular around the periphery. No focal hepatic lesions. Mild patchy areas of Intra hepatic ductal dilation is seen predominantly on the right than the left side. The main portal vein is patent with normal hepatopetal flow. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 3.7 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 10.3 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 13.3 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 10.8 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.", "output": "1. Heterogenous echotexture of the liver with cirrhotic morphology. No ascites.2. Intra- and extra- biliary dilation may be indirect sequale of PSC. Recommend further evaluation with MRCP.3. Mild splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Medullary thyroid cancer status post surgery RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE surgical bed: Unchanged 7 x 5 x 7 mm hypoechoic focus in the right lobe surgical bed.LEFT LOBE surgical bed: No significant abnormality noted.ISTHMUS surgical bed: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes are identified and are unchanged.OTHER: No significant abnormality noted.", "output": "Unchanged subcentimeter hypoechoic focus in the right thyroid bed."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Lara is a 33-year-old woman with a 0.5 cm palpable nodule within the outer left breast who presents for additional evaluation. Physical examination demonstrates a subcentimeter palpable nodule within the upper outer left breast.A targeted left ultrasound was performed for the palpable area of concern. Within the left breast at the 2:00 position approximately 6 cm from the nipple, no solid or cystic masses are identified.", "output": "No sonographic evidence for malignancy. Palpable concern should be managed clinically. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually beginning at the age of 40.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Female 33 years old; Reason: r/o thyroid cysts History: none RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 6.2 x 1.5 x 1.1 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 6.1 x 1.8 x 1.1 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.15 cm.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: There are 2 nodules noted in the left lobe of the thyroid.Nodule 1: There is a round 0.7 x 0.4 x 0.6 predominantly cystic nodule in the superior aspect of the left lobe without microcalcifications or internal vascularity.Nodule 2: There is a complex round 0.8 x 0.4 x 0.3 predominately cystic nodule in the inferior aspect of the left lobe without microcalcifications or internal vascularity.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted. OTHER: No significant abnormality noted.", "output": "1.Multinodular thyroid as above. Follow with serial ultrasounds."}
{"instruction": "Generate impression based on findings.", "input": "72 years old, Female, Reason: hyperparathyroidism, adenoma in left inferior position on sestamibi please correlate History: hyperpara RIGHT LOBE MEASUREMENTS: 4.5 x 1.6 x 1.8 cmLEFT LOBE MEASUREMENTS: 3.9 x 1.4 x 1.3 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: The right thyroid lobe is diffusely heterogeneous without evidence of nodule, parathyroid hyperplasia or parathyroid adenoma.LEFT LOBE: The left lobe is also diffusely heterogeneous. No discrete nodules or masses. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Inferior to left lower pole of the thyroid there is a hypoechoic oval shaped mass medially located and partially overlapping the trachea consistent with parathyroid tissue measuring 1.0 by 0.4 x 0.7 cm. This is consistent with recent nuclear medicine study findings suspicious for parathyroid adenoma inferior to the left lower pole of the thyroid.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Inferior to the left lower pole of the thyroid there is a oval hypoechoic mass consistent with a parathyroid adenoma which is medially located and partially overlapping the trachea."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Left Inguinal Ultrasound. History: Rule Out Left Inguinal Hernia. In the patient's palpable area of concern, there is a 1.1 x 0.7 x 2.1 cm lymph node. No suspicious mass. No evidence of inguinal hernia.", "output": "No evidence of inguinal hernia. Reactive lymph node in the patient's palpable area of concern."}
{"instruction": "Generate impression based on findings.", "input": "Male; 60 years old. Reason: history of AML s/p allogeneic transplant with mid-epigastric pain since November 2014 but normal liver enzymes. Evaluate for gallbladder process History: mid-epigastric pain LIVER: The liver measures 13.3 cm in length. The liver surface is smooth, the parenchyma is increased in echogenicity. No focal mass is identified. There is no ascites.The main portal vein is patent and demonstrates a 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 head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 7.9 cm in length.KIDNEYS: The right kidney measures 10.4 centimeters in length, the left kidney measures 10.4 cm in length. The renal cortex is normal in echogenicity bilaterally. There is no hydronephrosis or shadowing renal stone.", "output": "1.Echogenic liver compatible with hepatic steatosis/parenchymal dysfunction.2.No cholelithiasis or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Female 44 years old with right upper quadrant pain. LIVER: The liver has a smooth contour and is normal in echogenicity. It measures 13.2 cm in length. There is no focal liver lesion or ascites. The portal vein is patent with a velocity of 20.0 cm/s.BILIARY TRACT: The gallbladder has an anechoic lumen and a wall thickness of 2 mm. There is no pericholecystic fluid. Common duct measures 3 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and proximal body of the pancreas are unremarkable. The distal body and tail are obscured by overlying bowel gas.SPLEEN: The spleen measures 8.3 cm in length. RIGHT KIDNEY: The right kidney measures 9.3 cm and has normal parenchymal echogenicity. There is no shadowing stone, suspicious mass or hydronephrosis. OTHER: The left kidney measures 9.0 cm in length with normal parenchymal echogenicity. There is no shadowing stone, suspicious mass or hydronephrosis", "output": "Unremarkable right upper quadrant ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old female patient with small thyroid nodule. Family history of thyroid cancer. One year follow-up study. Evaluate for growth of nodule, adenopathy. RIGHT LOBE MEASUREMENTS: 4.7 x 1.6 x 1.4 cm.LEFT LOBE MEASUREMENTS: 4.4 x 1.4 x 1.4 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: The right thyroid lobe is homogeneous in echogenicity and contains a single subcentimeter cystic nodule with colloid in the upper pole, unchanged in size.LEFT LOBE: The left thyroid lobe is homogeneous in echogenicity and contains a single heterogeneous, solid nodule measuring 0.5 x 0.4 x 0.6 cm, unchanged.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology lymph nodes are noted bilaterally.OTHER: No significant abnormality noted.", "output": "Stable appearance of subcentimeter bilateral thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodularity RIGHT LOBE MEASUREMENTS: 4.9 x 1.8 x 2 cmLEFT LOBE MEASUREMENTS: 4.4 x 1.6 x 2 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Diffusely heterogeneous gland without discrete nodule or increased vascularityLEFT LOBE: Diffusely heterogeneous gland without discrete nodule or increased vascularityISTHMUS: Diffusely heterogeneous gland without discrete nodule or increased vascularityPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous thyroid gland without discrete nodule or increased vascularity. Findings consistent with chronic thyroiditis. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "15-year-old male with right neck lymphangioma Several prominent submandibular cervical lymph nodes are noted with normal morphology. In the right submandibular region inferior to the parotid gland is a small, 1.8-cm simple fluid collection without vascularity or soft tissue component corresponding to the region of abnormality seen on prior CT.", "output": "Small residual fluid collection at the site of questioned lymphangioma."}
{"instruction": "Generate impression based on findings.", "input": "38 year-old female with goiter, fatigue. Family history of thyroid disease RIGHT LOBE MEASUREMENTS: 2.1 cm x 1.5 cm x 6.3-cmLEFT LOBE MEASUREMENTS: 2.1 cm x 1.7 cm x 7.3-cmISTHMUS MEASUREMENTS: 2 mm in thicknessRIGHT LOBE: Mildly heterogeneous echotexture. Subcentimeter heterogeneous nodule in the upper pole. LEFT LOBE: Mildly heterogeneous echotexture. Dominant heterogeneous nodule at the lower pole measures 2.2 cm x 1.5 cm x 1.4 cm. Additional subcentimeter heterogeneous nodules are seen.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious lymph nodes.OTHER: No significant abnormality noted.", "output": "Mildly heterogeneous thyroid gland with bilateral thyroid nodules as above, dominant 2.2 cm mixed solid/cystic nodule in the left lobe would be amenable to FNA if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Male, 77 years old. Evaluate renal stones. RIGHT KIDNEY: The right kidney measures 11.3 cm in length, with normal echotexture. No hydronephrosis. Multiple echogenic shadowing foci compatible with stones are again seen. An inferior pole stone measures 0.5 x 0.4 cm. A mid pole stone measures 0.5 x 0.2 cm. A midpole exophytic simple cyst measures 1.5 x 1.5 x 1.2 cm.LEFT KIDNEY: Left kidney measures 11.4 cm in length, with normal echotexture. No hydronephrosis. A midpole echogenic shadowing focus compatible with a stone measures 0.4 x 0.3 x 0.4 cm. A midpole exophytic cyst measures 5.1 x 3.5 x 5.1 cm, unchanged. URINARY BLADDER: The bladder is incompletely distended.OTHER: Enlarged prostate again noted.", "output": "Bilateral nonobstructing renal stones and exophytic renal cysts are not significantly changed from prior."}
{"instruction": "Generate impression based on findings.", "input": "23-year-old female with a large right thyroid goiter. RIGHT LOBE MEASUREMENTS: 5.3 x 3.2 x 4.2 cmLEFT LOBE MEASUREMENTS: 4.8 x 1.3 x 1.5 cmISTHMUS MEASUREMENTS: 6 mmRIGHT LOBE: The right thyroid lobe is replaced by a 2.8 x 4.6 x 4.3 cm isoechoic solid nodule with small cystic components. The nodule is vascular without any associated calcifications. The visualized margins are well defined.LEFT LOBE: The left thyroid lobe is heterogeneous and contains numerous sub-5 mm predominately hypoechoic nodules without a single dominant nodule.ISTHMUS: The isthmus is heterogeneous with numerous sub-5 mm nodules.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Morphologically unremarkable and normal sized cervical lymph nodes are noted.OTHER: No significant abnormality noted.", "output": "1. 4.6-cm right thyroid lobe solid nodule is amenable to FNA if clinically warranted. 2. Numerous sub-5 mm hypoechoic left thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Andrews is a 32-year-old female with history of right breast cancer. Right axillary ultrasound requested for fullness in the right axilla. On physical examination, no palpable mass was identified.A targeted right axillary ultrasound was performed for the palpable area of concern. Two abnormal morphology lymph nodes were identified in the right axilla, labeled #1 and #2 on the ultrasound images with the following measurements: -Lymph node #1: Measures 1.6 cm x 0.9 cm x 0.9 cm and demonstrates cortical thickening and lobular contour. Minimal hilar flow is present on Doppler imaging. -Lymph node #2: Measures 1.7 cm x 0.6 cm x 2.6 cm and demonstrates cortical thickening and lobular contour. Minimal hilar flow is present on Doppler imaging.", "output": "Two abnormal morphology lymph nodes in the right axilla, which in setting of known breast cancer are suspicious for metastatic disease. Ultrasound-guided biopsy is recommended for the larger lymph node (labeled #2 above). Plan is to perform the ultrasound-guided biopsy later today. Findings discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old female with biopsy-proven multifocal right breast invasive ductal carcinoma with metastatic axillary lymph node presents for reevaluation after neoadjuvant therapy. A targeted right ultrasound was performed for the previously identified right breast masses and abnormal right axillary lymph node. In the right breast, 8:00, 3 cm from the nipple, there is a 1.4 x 1.6 x 0.9 cm irregular hypoechoic mass with biopsy clip, previously 1.5 x 1.7 x 2 cm.In the right breast, 9:00, 5 cm from the nipple, there is a 1.1 x 0.5 cm hypoechoic mass. This finding may be a correlate for the previously described 9:00 mass, but is only well seen on one in the transverse dimension. The 9:00 mass previously measured 1.1 x 0.8 x 1 cm.In the right breast, 10:00, 5 cm from the nipple, no sonographic correlates for the two previously described masses are identified.In the right axilla, there is a 1.1 x 0.9 x 1.4 cm abnormal right axillary lymph node with biopsy clip, previously 2 x 1.7 x 1.9 cm.", "output": "Interval decrease in size of biopsied right breast 8:00 mass and biopsied right axillary lymph node. Possible correlate for the right breast 9:00 mass is mildly decreased as well. Two previously described masses at the 10:00 position are not visualized.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "59 year old female who was recalled from screening mammogram for left breast asymmetry. No family history of breast cancer. MAMMOGRAM: An 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 asymmetry within the upper slightly inner left breast, which partially resolves on spot compression imaging. This area is further evaluated with ultrasound.ULTRASOUND: On physical examination, no palpable abnormality is appreciated in the upper inner left breast. A targeted left ultrasound was performed for the mammographic area of concern. There is no solid or cystic mass identified.", "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": "62 years Male with history of bilateral hydronephrosis, evaluate for change. RIGHT KIDNEY: Kidney measures 16.2 cm in length. The renal cortex demonstrates normal echogenicity. Again seen is severe hydroureteronephrosis to the vesicoureteral junction appearing similar to prior. No obstructing stones are seen.LEFT KIDNEY: Kidney measures 17.5 cm in length. The renal cortex is somewhat thinned and demonstrates normal echogenicity appearing similar to prior. Again seen is severe hydronephrosis appearing similar to prior.URINARY BLADDER: No significant abnormality noted", "output": "Severe bilateral hydroureteronephrosis suspicious for etiology of vesicoureteral reflux appearing similar to the prior study."}
{"instruction": "Generate impression based on findings.", "input": "Female 52 years old Reason: left upper back mass - evaluate for lipoma versus other History: mass Within the left upper pelvic area, there is a well-circumscribed palpable mass measuring 2.5 x 4.4 x 1.3 cm. This mass has internal echogenicity isoechoic to surrounding fat and soft tissue. No abnormal internal vascularity. Within this mass there is a focal nodular area which is more hypoechoic compared to the mass.", "output": "Well-circumscribed left upper back mass isoechoic to surrounding subcutaneous fat most likely represents a lipoma or fibroma. If there is continued clinical concern regarding this nodule, consider cross-sectional imaging for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for mass in epigastric, upper abdomen History: palpable firmness, possible mass in epigastric/upper abdominal area appreciated on physical exam At the site of palpable concern in the anterior superficial abdominal wall, no abnormal focal masses are identified.", "output": "No focal mass identified on ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male status post liver transplant, evaluate for lesions. LIMITED ABDOMENLIVER: The transplanted liver measures 15.3 cm in length. The liver is of normal echogenicity. There are no masses seen within the liver and no intrahepatic ductal dilation. The portal vein is patent with hepatopedal flow measuring 15.7 cm/sBILIARY TRACT: The common bile duct measures 5.1 mm. The gallbladder is surgically absent.PANCREAS: No significant abnormalities noted. RIGHT KIDNEY: The right kidney measures 10.1 cm in length. The cortex is of normal echogenicity. There is no hydronephrosis, stones, or worrisome masses seen.LEFT KIDNEY: The left kidney measures 10.8 cm in length. The cortex appears normal, no stones or hydronephrosis is seen. No worrisome masses are noted.", "output": "1. Negative liver transplant ultrasound, no new worrisome masses are noted within the liver."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Morton is a 53-year-old female with a personal history of bilateral mastectomy for breast cancer (right - IDC, left - prophylactic) status post radiation and chemotherapy, followed by DIEP flap reconstruction on the right. She now presents with two palpable lesions in the right reconstructed breast. A targeted right ultrasound was performed for the palpable area of concern. In the right breast at the 2:00 position, approximately 3 cm from the nipple, is an oval, circumscribed, anechoic cyst measuring 10 x 6 x 12 mm, without internal vascularity, compatible with an oil cyst. In the right breast at the 8:00 position, approximately 6 cm from the nipple, is a mixed echogenic lesion measuring 6 x 6 mm, compatible with fat necrosis.", "output": "Benign oil cyst and fat necrosis in the right reconstructed breast, corresponding to the palpable areas of concern. 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: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Male 69 years old; Reason: abd pain, worse with eating, r/o gallstones and liver pathology History: abd pain LIVER: The liver measures 11.9 cm in length. There is mildly increased echogenicity of the liver parenchyma consistent with fatty liver. 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 wall measures 10.21 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 0.53 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.3 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.5 cm in length. The cortex has increased echogenicity. Mild hydronephrosis is seen but no stones or worrisome masses.LEFT KIDNEY: The left kidney measures 11.9 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.", "output": "1. Slightly increased echogenicity of the liver consistent with fatty liver.2. Slightly increased echogenicity of the kidneys bilaterally with mild hydronephrosis on the left.3. No gallstones or biliary pathology to explain patient's abdominal pain."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain, pancreatitis. LIVER: The liver measures 20.7 cm in length. The liver parenchymal echotexture is heterogeneous with increased echogenicity. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.25 m/s.BILIARY TRACT: Numerous shadowing gallstones are present within the gallbladder. There is no definite gallbladder wall thickening or pericholecystic fluid. There is a shadowing stone within the common hepatic duct with upstream dilatation of the common duct measuring up to 2 cm. There is also mild intrahepatic biliary ductal dilatation.PANCREAS: The pancreas is largely obscured by overlying bowel gas, however, the imaged pancreatic parenchyma is somewhat hypoechoic and heterogeneous suggestive of pancreatitis. The pancreatic duct is mildly prominent measuring up to 4 mm.SPLEEN: No significant abnormalities noted. The spleen measures 9.9 cm in length. RIGHT KIDNEY: Kidney measures 12.4 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 13.5 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Choledocholithiasis with associated biliary ductal dilatation.2.Findings suggestive of pancreatitis. Mild prominence of pancreatic duct.3.Cholelithiasis without sonographic evidence of cholecystitis.4.Hepatomegaly and probable hepatic steatosis.Findings were relayed by on call radiology resident to emergency department staff via stat consult system at 10:54 AM on 11/29/2015."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old male with chronic kidney disease and proteinuria. Ultrasound guidance was provided for biopsy of right kidney.", "output": "Ultrasound guidance."}
{"instruction": "Generate impression based on findings.", "input": "Male, 82 years old. Reason: eval for hydronephrosis History: renal failure RIGHT KIDNEY: The right kidney measures 11.1 cm in length with increased cortical echogenicity. Multiple cystic lesions are identified. An upper pole simple cyst measures 4.3 x 4.5 x 4.5 cm. An additional upper pole simple cyst measures 5.0 x 6.2 x 5.1 cm. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 14.9 cm in length with increased cortical echogenicity. Multiple cystic lesions are identified. A midpole simple cyst measures 4.0 x 4.1 x 3.6 cm. A lower pole simple cyst measures 4.6 x 3.3 x 4.5 cm. An upper pole simple cyst measures 3.4 x 4.0 x 3.7 cm. No shadowing stones or hydronephrosis.OTHER: The bladder is distended, without significant wall thickening. The prostate is enlarged.", "output": "1.Increased renal cortical echogenicity compatible with medical renal disease. Multiple bilateral renal cysts. No hydronephrosis.2.Enlarged prostate."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain and increased LFTs LIVER: Normal echogenicity without mass. Liver length 14.6 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.2 cm in lengthOTHER: Left kidney 12 cm in length. Spleen 10.3 cm in length. No ascites.", "output": "Negative right upper quadrant ultrasound. No hepatobiliary abnormality."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male with transaminitis. Evaluate for liver pathology or portal vein thrombosis. Limited study due to patient body habitus.LIVER: Increased echogenicity of the liver measuring 15.9 cm in length. No focal hepatic lesions. The main portal vein is patent with appropriate directional flow: Peak velocity measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: Sludge within the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. Cannot assess for sonographic Murphy's sign. Common duct is obscured due however there is no intrahepatic biliary ductal dilatation noted. PANCREAS: Obscured by overlying bowel gas.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 11.0 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the spleen measuring 14.2 cm in length.Normal echogenicity of the left kidney measuring 10.6 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "Increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. Portal vein is patent.Sludge within the gallbladder with no sonographic evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "47 year old female who has a complaint of palpable left breast cyst. Personal history of right mastectomy for malignant phylloides tumor, left implant exchange, and left breast cysts. A targeted left ultrasound was performed for the palpable area of concern. Multiple simple cysts were identified in the left breast, the largest of which measures 3.9 x 3.8 x 1.7 cm and is located in the retroareolar region. No discrete solid mass identified.", "output": "Multiple benign simple cysts in the left breast along the palpable area of concern along the areola. Consider cyst aspiration if patient experiences worsening pain. 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: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Bilateral nephrolithiasis RIGHT KIDNEY: Parenchymal echogenic focus again noted. No renal stone. No worrisome mass or hydronephrosis. Right kidney 10.3 cm in lengthLEFT KIDNEY: No change in subcentimeter nonobstructing lower pole left renal calculus measuring 0.7 cm in diameter. No hydronephrosis. Stable renal cyst. Left kidney 11.2 cm in lengthOTHER: Bladder nondistended", "output": "Stable subcentimeter nonobstructing lower pole left renal calculus. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Male 55 years old Reason: cirrhosis abn mass? History: hep B carrier LIVER: Liver is coarsened with increased echogenicity measuring 14.4 cm in length. Main portal vein flow is hepatopedal with a peak velocity of 16.0 cm/s. No focal hepatic masses. No definite sonographic evidence of cirrhosis.BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. No gallbladder wall thickening. Multiple polyps are identified, similar to the prior exam. The largest polyp measures approximately 0.6 x 0.5 cm x 0.5 cm, previously measuring 1.0 x 0.6 x 0.8 cm. Spondylosis smaller or unchanged over multiple prior exams. No internal flow is identified gallbladder polyps.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 9.9 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 10.6 cm. Left kidney measures 11.4 cm. OTHER: No significant abnormalities noted.", "output": "1.Multiple gallbladder polyps, not significantly changed from prior exam. 2.Coarsened echogenicity of the liver without sonographic evidence of focal hepatic lesions."}
{"instruction": "Generate impression based on findings.", "input": "Precardiac transplant evaluation LIVER: Echogenic liver parenchyma without mass. Liver length 19.6 cmGALLBLADDER, BILIARY TRACT: No significant abnormality noted.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted.KIDNEYS: No significant abnormality noted. Right renal cyst. Right kidney 11.8 cm in length. Left kidney 11.2 cm in length.ABDOMINAL AORTA: Proximal aorta unremarkable. The mid and distal aorta not visualized due to overlying gas.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No ascites", "output": "Echogenic liver parenchyma with mild hepatomegaly suggestive for chronic liver disease/congestion without mass or ductal dilatation. No ascites.Mid and distal aorta not visualized due to overlying gas."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C. Cirrhosis. Evaluate for hepatocellular carcinoma. LIVER: Cirrhotic liver morphology. Coarsened parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Gallbladder sludge noted. No evidence of 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 6.5 cm in length with a benign-appearing cyst in the midpole. The left kidney is 6.7 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.", "output": "1. Cirrhotic liver morphology without suspicious lesion identified.2. Mild ascites.3. Echogenic renal parenchyma, without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B. Evaluate for hepatocellular carcinoma. LIVER: Non-cirrhotic liver morphology. Increased and coarsened 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.KIDNEYS: The right kidney is 10.4 cm in length. The left kidney is 10.8 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.6 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites is identified.", "output": "Coarsened hepatic echogenicity, compatible with diffuse liver disease. No suspicious liver lesion is identified."}
{"instruction": "Generate impression based on findings.", "input": "Renal stones RIGHT KIDNEY: No significant abnormalities noted. 11.2 cm in lengthLEFT KIDNEY: At least 2 lower pole left renal stones noted. The largest measures 1.1 x 0.5 cm. Minimal hydronephrosis appreciated. Left kidney 11.8 cm in lengthOTHER: 1.4 cm bladder stone present.", "output": "At least 2 lower pole left renal stones noted as described. Minimal left hydronephrosis. 1.4 cm bladder stone."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are digital mammographic images (9/24/15), ultrasound images of both breasts (9/24/15), images from ultrasound guided biopsy of left breast with specimen radiograph and postprocedural left mammographic images, and images from ultrasound guided right breast aspiration (9/24/15) performed at Rush University Medical Center. For comparison, digital mammographic images (9/11/14, 9/11/13, 3/1/10), ultrasound images (9/11/14, 1/27/14, 9/11/13) are available. DIGITAL MAMMOGRAPHIC IMAGES (9/24/15):The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Multiple circumscribed masses are present in both breasts. Many of those masses are stable and benign. An oval mass at lower outer quadrant in the left breast shows interval increase in size. Multiple calcifications in both breast are unchanged. There are no suspicious findings in either breast on mammogram.ULTRASOUND IMAGES OF BOTH BREASTS (9/24/15):There are multiple simple cysts in the right breast. In the left breast, there is an irregularly shaped hypoechoic mass with angular margins at 6:30 position measuring 6 x 6 mm. A complicated cyst measuring 6 mm is seen at 4:00 position. In addition, there are multiple simple cysts in the left breast. A simple cyst at left 4:30 position likely corresponds to the developing circumscribed mass on left mammogram.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF LEFT BREAST WITH SPECIMEN RADIOGRAPH AND POSTPROCEDURAL LEFT MAMMOGRAPHIC IMAGES, AND IMAGES FROM ULTRASOUND GUIDED RIGHT BREAST ASPIRATION (9/24/15):An aspiration for the complicated cyst at 4:00 position in the right breast was performed. Complete resolution of the cyst was achieved. Core needle biopsy for the hypoechoic mass at 6:30 in the left breast was performed with appropriate needle placement. Radiograph of the specimen shows several pieces of solid tissue without calcifications. Postprocedural mammographic images show a marker clip located at lower inner quadrant in the left breast.Per outside pathology report, the result of the core biopsy of left breast was DCIS grade 3.", "output": "Biopsy proven DCIS in the left breast. The lesion was occult on mammogram and was detected on ultrasound. Given complicated appearance of mammogram and dense breast tissue, breast MRI would be helpful to rule out any other occult disease.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Renal transplant with elevated creatinine and unilateral leg swelling RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: 2 separate complex perinephric fluid collections. A superior lateral collection measures 9.4 x 3 cm. An inferior medial collection measures 2.8 x 4.3 x 5.9 cm. KIDNEY: No significant abnormality notedCOLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vesselsPatent vasculature without evidence for inflow or outflow compromise.OTHER: No significant abnormality noted", "output": "Status post en bloc renal transplant. Patent vasculature without evidence for inflow or outflow compromise. No hydronephrosis. Complex perinephric collections as described; favor benign postoperative collection."}
{"instruction": "Generate impression based on findings.", "input": "HCV LIVER: Mildly coarse echogenic liver echotexture without mass. Liver length 20.4 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flowBILIARY TRACT: Adenomyomatosis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 7.8 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 12.2 cm in lengthOTHER: Left kidney 11.9 cm in length. Left renal cysts. No ascites.", "output": "Mild hepatomegaly associated with mildly coarse echogenic liver liver echotexture consistent with chronic liver disease without mass or ductal dilatation. No ascites. Gallbladder adenomyomatosis without acute inflammation."}
{"instruction": "Generate impression based on findings.", "input": "Type 2 diabetes without complications, history of pain and fullness in the left abdomen. LIVER: Liver measures 12.7 cm, normal echotexture. Limited evaluation. No focal lesions. Gallbladder is visualized without gallbladder wall thickness.Main portal vein is patent with normal flow directionality and patency.BILIARY TRACT: No intrahepatic biliary ductal dilatation. Common hepatic duct measures up to 4 mm within normal limits.PANCREAS: Not visualized due to limited evaluation, position and overlying bowel gas.SPLEEN: Spleen could not be visualized due to patient positioning.RIGHT KIDNEY: Right kidney measures 9 cm and left kidney measures 10.1 cm. No hydronephrosis. Mild increased echogenicity noted consistent with chronic medical renal disease. OTHER: No ascites or significant abnormality in the right lower quadrant.", "output": "Limited evaluation due to patient positioning.Incomplete visualization of the spleen due to patient positioning.Mild increased echogenicity of the kidneys consistent with chronic medical renal disease.Normal echotexture of the liver. Gallbladder appears unremarkable. Main portal vein is patent."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male with left renal lesion on CT. RIGHT KIDNEY: The right kidney measures 9.4 cm in length. The renal cortex is echogenic. Subcentimeter midpole cyst measures 0.9 x 0.6 x 0.7 cm.LEFT KIDNEY: The left kidney measures 9 cm in length. The renal cortex is echogenic. Previously described mid pole lesion on CT is anechoic and demonstrates posterior through transmission, most likely a cyst. This lesion measures 2.0 x 2.0 x 2.3 cm.URINARY BLADDER: The bladder is collapsed with a thickened wall.OTHER: No significant abnormalities noted.", "output": "1.Left midpole lesion seen on prior CT most likely represents a cyst given sonographic features.2.Echogenic cortices are compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Female 40 years old; Reason: r/o cholecystitis History: RUQ pain worse w food intake LIVER: The liver measures 18.3 cm in length. There is normal 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 15.1 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.2 mm. No stones are seen. No pericholecystic fluid. Negative sonographic Murphy sign. The common bile duct measures 1.9 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 8.0 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.1 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.", "output": "1. No evidence of cholelithiasis or acute cholecystitis.2. Mild hepatomegaly, no worrisome masses or intrahepatic ductal dilation are seen."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old female with history of chronic kidney disease. RIGHT KIDNEY: Echogenic renal parenchyma without hydronephrosis, nephrolithiasis, or suspicious mass lesion.LEFT KIDNEY: Echogenic renal parenchyma without hydronephrosis, nephrolithiasis, or suspicious mass lesion.OTHER: No significant abnormalities noted.", "output": "Increased renal echogenicity consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for hematoma of the Left Lower Extremity Sonographic images of the anterior superficial soft tissues of the left leg demonstrate a discrete area of soft tissue echogenicity measuring up to 4.8 cm which lacks internal vascularity and is associated with edema in the surrounding superficial soft tissues. The appearance is somewhat atypical for an abscess or hematoma, and is favored to represent a neoplastic process such as a lipoma.", "output": "Discrete soft tissue focus within the anterior superficial soft tissues of the leg with associated surrounding soft tissue edema. Appearance is somewhat atypical for a hematoma or abscess, and a neoplastic etiology such as a lipoma is favored. MRI may be considered for additional evaluation as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Reason: ultrasound thyroid/neck History: Hyperthyroidism RIGHT LOBE MEASUREMENTS: Measures 4.7 x 1.9 x 2.4 cm.LEFT LOBE MEASUREMENTS: Measures 5.0 x 1.9 x 2.0 cm.ISTHMUS MEASUREMENTS: Measures up to 0.5 cm in thickness.RIGHT LOBE: Heterogeneous background parenchymal echotexture without discrete nodules.LEFT LOBE: Heterogeneous background parenchymal echotexture. Discrete nodule in the midpole measuring 1.1 x 0.8 x 1.0 cm with heterogeneous echotexture, minimal internal vascularity, and several echogenic reflectors which may reflect inspissated colloid. No definite microcalcifications. Overall, nodule is low suspicion for neoplasm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Heterogeneous thyroid gland with dominant 1.1 cm nodule in the left lobe. No parathyroid adenoma candidates are identified."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female patient with known history of hepatic abscesses. Evaluate for etiology of hepatic failure. Assess for portal vein thrombosis or Budd-Chiari. LIMITED ABDOMENLIVER: The liver measures 13.4 cm in length and is nodular in contour.BILIARY TRACT: The gallbladder is not visualized. There is moderate intrahepatic biliary ductal dilatation. The common bile duct is poorly visualized on this examination.PANCREAS: The pancreas is poorly visualized on this examination.SPLEEN: The spleen measures 12.6 cm in length. RIGHT KIDNEY: The right kidney measures 9.4 cm in length. No evidence of hydronephrosis.OTHER: The left kidney measures 10.5 cm in length. No evidence of hydronephrosis.There is mild to moderate ascites.", "output": "1. Moderate intrahepatic biliary ductal dilatation; contrast enhanced CT is recommended to further evaluate the etiology of biliary ductal dilatation.2. Cirrhotic morphology of the liver with mild to moderate ascites.3. Portal veins are not visualized on this examination."}
{"instruction": "Generate impression based on findings.", "input": "Female 53 years old; Reason: previously diagnosed left lower pole thyroid nodule- s/p aspiration in 2014 History: query changes or residua RIGHT LOBE MEASUREMENTS: 5.1 x 1.5 x 1.3 cmLEFT LOBE MEASUREMENTS: 4.9 x 1.7 x 1.5 cmISTHMUS MEASUREMENT: 0.21 cmRIGHT LOBE: 0.8 x 0.6 x 0.6 cm hypoechoic nodule in the posterior inferior right thyroid. No calcifications or increased vascularity. LEFT LOBE: In the mid thyroid is a 1.5 x 1.0 x 1.3 cm hypoechoic nodule that is predominantly solid with cystic components. No definite calcifications or increased vascularity. In the inferior pole is a 1.6 x 1.1 x 1.3 cm hyperechoic nodule that is predominantly solid with cystic spaces and small hyperechoic foci suggestive of colloid.ISTHMUS: There is a small microcalcification in the isthmus. This is nonspecific.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.1.6-cm inferior pole nodule is amenable to ultrasound guided biopsy. However, correlation with previous pathology is recommended to determine if this is clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "Reason: cardiac history, sharp abdominal pain radiating to back for 3 weeks, please r/o abdominal aortic aneurysm. Examination is somewhat limited due to patient body habitus and overlying bowel gas.ABDOMINAL AORTA: The visualized portions of the aorta are normal in caliber. The proximal aorta measures 2.8 x 2.1 cm. The mid aorta measures 2.4 x 1.9 cm. The distal aorta measures 2.3 x 1.9 cm. The iliac arteries are not visualized.OTHER: The proximal IVC appears patent. Increased echogenicity of the partially visualized liver.", "output": "1.Limited exam. 2.No abdominal aortic aneurysm identified.3.Increased hepatic echogenicity suggestive of fatty infiltration/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old female patient with history of thyroid cancer. Evaluate for adenopathy. RIGHT LOBE: Status post thyroidectomy. A hypoechoic nodule with an echogenic center within the right thyroid bed measures 5 x 4 mm, not significantly changed in size.LEFT LOBE: Status post thyroidectomy without residual or recurrent tissue identified.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology lymph nodes are noted within the left neck.OTHER: No significant abnormality noted.", "output": "Hypoechoic nodule within the right thyroid bed region has imaging characteristics of a lymph node with a fatty hilum. No specific evidence of disease recurrence or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old male with hypercalcemia, evaluate for kidney stones. RIGHT KIDNEY: Measures 10.6 cm in length. 0.9 cm right inferior pole cyst too small to completely characterize. No hydronephrosis or nephrolithiasis.LEFT KIDNEY: Measures 12.0 cm in length. 6.1 cm inferior pole renal cyst and 1.9 cm superior pole renal cyst without septation or solid component. Left nephrolithiasis with a calculus in the inferior pole measuring up to 0.9 cm. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Left nephrolithiasis without hydronephrosis. Renal cysts as detailed above. "}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant tenderness LIVER: Mildly coarse liver parenchyma without mass. Liver length 15.8 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.9 cm in lengthOTHER: Left kidney 9.6 cm in length. Spleen 10.6 in meters in length. No ascites.", "output": "Mildly coarse liver parenchyma raises the possibility of fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites. Unremarkable gallbladder "}
{"instruction": "Generate impression based on findings.", "input": "65-year-old male with PET positive low, midline nodule in the neck on PET. Metastatic renal cell carcinoma to pancreas. RIGHT LOBE MEASUREMENTS: 4.3 x 1.7 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.8 x 1.5 x 1.8 cm.ISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: In the upper pole of the right lobe of the thyroid there is a 0.3 x 0.4 x 0.5 nodule which is likely complex cystic.LEFT LOBE: Inseparable from the lower pole of the left lobe is a 1.5 x 1.1 x 1.7 cm rounded, vague and hypoechoic but mildly heterogeneous mass. This may be exophytic, arising from the lower pole or even potentially extra thyroidal. Two small cystic nodules are present within the left lobe as well.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Prominent, morphologically normal level 3 lymph node on the right measuring 0.8 x 1.6 x 1.5 cm.OTHER: At midline in the suprasternal region there is a hypoechoic mass with some central increased echogenicity. This measures 1.5 x 1.9 cm corresponding to the PET positive abnormality. This appears separate from thyroid.", "output": "PET positive abnormality corresponds to a suprasternal, solid mass.Vague, hypoechoic mass lower pole left lobe of the thyroid."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old female patient with liver lesion noted on CT. LIVER: The liver measures 14.9 cm in length and demonstrates increased parenchymal echogenicity. Previously demonstrated liver lesions on CT are not visualized on this examination. Main portal vein flow is hepatopetal and measures 0.24 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 9.1 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.2 cm in length. No evidence of hydronephrosis.The spleen measures 7.6 cm in length.", "output": "1. Previously seen liver lesions on CT are not adequately visualized on this examination.2. Increased hepatic echogenicity which can be seen in the setting of hepatic steatosis. "}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female with history of kidney stones. Patient underwent right ureteroscopic stone removal x2 for partial staghorn calculus in February and March. RIGHT KIDNEY: The right kidney measures 11.6 cm in length. Staghorn calculus is redemonstrated in the right renal collecting system, filling the pelvis and several calyces. No evidence of hydronephrosis. No renal masses identified.LEFT KIDNEY: The left kidney measures 12.3 cm in length. No renal mass, stone, or hydronephrosis is present.OTHER: Urinary bladder is unremarkable.", "output": "Extensive stone burden of the right renal collecting system."}
{"instruction": "Generate impression based on findings.", "input": "57 year old female with history of complex cystic and solid left breast mass with pathology revealing LCIS and ALH here for follow-up. Three standard 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. The previously noted complex cystic and solid left mass in the medial left breast is not well visualized. There is a hydromark clip in the left central breast. There are scattered benign calcifications bilaterally. ULTRASOUND", "output": "A biopsy clip is present in the 10:00 position without associated discrete mass identified. Consider further evaluation with MRI given history of LCIS and ALH.Annual diagnostic mammogram is recommended in 6 months. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Status post right partial nephrectomy for renal cell carcinoma RIGHT KIDNEY: Status post right partial nephrectomy and resection of previously noted posterior mass. No worrisome mass, stone, or hydronephrosis. Stable renal cyst. Right kidney 11.5 cm in lengthLEFT KIDNEY: Stable minimally complex lower pole cysts. Stable upper/mid pole hypoechogenic focus measuring 1.7 cm in length not significantly changed from the prior CT study. No stone or hydronephrosis. Left kidney 11 cm in lengthOTHER: Bladder nondistended", "output": "Status post resection of right posterior renal mass. Stable left complex lower pole cysts. Stable upper/mid pole hypoechogenic focus unchanged from right prior CT. Would recommend continued surveillance monitoring of this lesion on future scans."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter RIGHT LOBE MEASUREMENTS: 6.9 x 3.8 x 3.9 cmLEFT LOBE MEASUREMENTS: 5.5 x 2.4 x 2.4 cmISTHMUS MEASUREMENTS: 1.3 cmRIGHT LOBE: Interval increase in size of several of the previous noted multiple spongiform appearing nodules. An upper pole nodule now measures 3.7 x 3.1 x 2.7 cm; this is in comparison to 1.1 x 1.6 x 2.2 cm in 2011. A lower pole nodule now measures 2 x 1 x 2.5 cm; this is in comparison to 1.1 x 1.1 x 1.2 cm 2011.LEFT LOBE: Interval increase in size of several of the previous noted mixed cystic and solid nodules. A mid pole nodule now measures 2.3 x 1.6 x 1.8 cm; this compares to 1.2 x 1.5 x 1.9 cm in 2011. A lower pole nodule now measures 1.8 x 1.2 x 1.5 cm; this is in comparison to 0.7 x 0.9 x 1 cm in 2011.ISTHMUS: Slight interval increase in size of the previous noted spongiform isthmic nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Interval increase in size of several of the previous noted thyroid nodules. Multinodular goiter is favored."}
{"instruction": "Generate impression based on findings.", "input": "Right testicular hypoechoic focus RIGHT TESTIS: 2.2 x 1.9 x 4 cm. No significant change in focal hypoechoic peripheral lesion within the right testicle measuring 0.3 x 0.9 x 0.6 cm. Additional heterogeneity involving the right testis also noted and unchanged. Bilaterally symmetric Doppler flow characteristicsLEFT TESTIS: 2.8 x 2 x 3.8 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristicsRIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Stable peripheral hypoechoic focus within the right testicle; given the temporal stability of this lesion, a benign etiology is favored. Other right testicular heterogeneity also unchanged and also suggestive of a benign chronic etiology."}
{"instruction": "Generate impression based on findings.", "input": "History of hyperthyroidism. RIGHT LOBE MEASUREMENTS: 5.9 x 2.6 x 2.6 cmLEFT LOBE MEASUREMENTS: 6.1 x 2.4 x 3.6 cmISTHMUS MEASUREMENTS: 1 mmRIGHT LOBE: Multiple thyroid nodules with the largest being a complex predominantly solid isoechoic nodule measuring 2.0 x 1.0 x 2.2 cm with a coarse 4 mm calcification and punctate echogenic foci (several of which show comet tail or reverberation artifact supportive of colloid, many too small to adequately characterize) and vascularity. It is well-defined.Dorsally there is a 0.9 x 1.0 x 1.0 cm hypoechoic well-defined solid nodule, most likely colloid.LEFT LOBE: Complex solid/cystic isoechoic nodule measuring 2.1 x 3.5 x 3.7 cm with punctate echogenic foci (again some demonstrating comet tail artifact suggestive of colloid) and vascularity. It is well-defined.ISTHMUS: Hypoechoic 0.9 x 0.8 cm left isthmus nodule without significant vascularity or suspicious sonographic features.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multinodular thyroid with heterogeneous mixed cystic/solid nodules seen bilaterally, see discussion above. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Siwak is a 26 year old female presenting with a palpable tender lump in the right axilla for one month. A targeted right breast ultrasound is performed for the patient's area of concern.In the right breast 10:00 location, approximately 6 cm from the nipple, no suspicious cystic or solid mass is identified.Seen just slightly superolateral to this is a normal right axillary lymph node measuring approximately 1.8 x 1.1 cm with normal hilar flow.", "output": "Patient's palpable tender lump may correspond to a low-lying normal right axillary lymph node. No sonographic evidence of 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": "Male 31 years old Reason: R posterior cervical lymph node enlargement, ultrasound to quantify size and shape History: see above There are a few benign-appearing cervical lymph nodes. Largest measures 1.6 x 0.4 cm.", "output": "Benign-appearing cervical lymph nodes at the site where the patient feels the lump."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female presents for MR-directed ultrasound for the left breast. History of bilateral mastectomies for left breast cancer in 2015. Focused ultrasound was performed for the left medial breast. There is a hypoechoic mass with irregular margins with increased blood flow at 9:00 position measuring 9 x 4 x 6 mm (prior measurement: 5 x 3 x 5 mm). This lesion corresponds to MR findings.", "output": "MR directed ultrasound detected a suspicious lesion at 9:00 position in the left breast, correlating to the MR findings. Ultrasound-guided biopsy is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old male with palpable mass right scrotum RIGHT TESTIS: Normal in size, echotexture and vascularity. No focal mass.LEFT TESTIS: Normal in size, echotexture and vascularity. No focal mass.RIGHT EPIDIDYMIS: The palpable abnormality corresponds to a 4 mm cyst in the epididymal head. Smaller epididymal cysts are present as well.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Trace of fluid in the scrotum bilaterally", "output": "Pelvic wall abnormality corresponding to epididymal cyst. Further follow-up not needed."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Brockway is a 28 year old female presenting with a palpable left axillary mass for the past 12 weeks. Although the mass has been getting smaller, patient can still palpate it. Patient recently gave birth in February 2015. Upon physical exam at the patient's area of concern, a soft mobile mass is appreciated. Targeted left axillary ultrasound is performed for further evaluation.In the high left axillary region, there is an ovoid hypoechoic mass measuring 2.2 x 0.4 x 2.3 cm. There is minimal associated vascularity. This mass is located in the superficial dermis and is compatible with a benign epidermal inclusion cyst.", "output": "Benign epidermal inclusion cyst in high left axillary region. No sonographic evidence of malignancy. Patient should follow up with her primary care physician as clinically warranted.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for HCC History: HCV cirrhosis LIVER: The liver measures 14.3 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 0.2 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 5 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: The spleen measures 14.7 cm in length. Coarse calcification within the spleen.RIGHT KIDNEY: Kidney measures 11.0 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 11.3 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No ascites.", "output": "Cirrhotic liver morphology without focal lesions identified. Mild splenomegaly. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for hydronephrosis. Acute kidney injury. History of renal infarct. Evaluate for pancreatitis, gallstones and cirrhosis. LIVER: The liver measures 16.3 cm in length. Its mildly echogenic and nodular in contour compatible with cirrhosis. No focal liver lesions are evident. Mild intrahepatic biliary ductal prominence; correlate with bilirubin. The portal vein is patent with flow toward the liver on color Doppler imaging. Small probable portal lymph node noted measuring 2 cm in length.GALLBLADDER, BILIARY TRACT: Small non-shadowing gallstone or gallbladder polyp. No pericholecystic fluid. Common duct measures 4 mm which is within normal limits.PANCREAS: No significant abnormality noted. Body and tail obscured by overlying bowel gas.SPLEEN: No significant abnormality noted.KIDNEYS: No hydronephrosis of either kidney although both kidneys are mildly echogenic. The right kidney measures 11.5 cm in length and the left kidney measures 10.4cm in length. Left kidney was difficult to visualize, probably secondary to the known infarct. This complex area measured approximately 2.7 x 2.2 x 2.3 cm.ABDOMINAL AORTA: No significant abnormality. The proximal aorta measured 2.3 x 2.9 x 3.4 cm. The mid aorta measured 2.1 cm. The distal aorta was obscured by overlying bowel gas.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted. Spleen measures 10.5 cm in length.", "output": "1. Cirrhotic appearing liver with questionable intrahepatic biliary ductal dilatation but no evidence of extrahepatic biliary ductal dilatation; correlate with bilirubin.2. Presumed evolving left renal infarct. No hydronephrosis.3. Nonshadowing gallstone versus polyp. No evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Male; 38 years old. Reason: cholecystitis? History: ct evidence pericholecystic fluid, abd pain LIVER: The liver measures 16.1 cm in length. The liver surface is smooth, the parenchyma is diffusely heterogeneous. In the right lobe of the liver is a 2.1 x 2.2 x 1.9 cm hyperechoic lesion without vascularity on color Doppler. This correlates with the lesion seen on same day CT. There is a moderate amount of ascites.The portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.3 m/sec.BILIARY TRACT: There is no cholelithiasis. The gallbladder wall is thickened measuring up to 7 mm. The common duct measures 3 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head of the pancreas has a lobulated appearance correlating with the appearance on the two prior CTs from February 2015. The body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: The spleen measures 14.1 cm in length.KIDNEYS: The right kidney measures 11.9 cm in length, the left kidney measures 12.1 cm in length. The cortex is normal in echogenicity bilaterally. There is no hydronephrosis or shadowing renal stone.OTHER: Note is made of bilateral pleural effusions.", "output": "1.Thickened gallbladder wall is likely secondary to ascites. There is no cholelithiasis or other evidence of acute cholecystitis.2.2.2-cm hyperechoic lesion in the right lobe of the liver is indeterminate. Continued follow-up is recommended. Alternatively, correlation with MRI may be considered if clinically warranted.3.Splenomegaly.4.Moderate amount of ascites.5.Bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old female with history of right breast abscess status post drainage in June 2016 presents with palpable right breast lump. A targeted right ultrasound was performed for the palpable area of concern. At 6:00, 3 cm from the nipple, there is a 2 x 1.2 x 1.5 cm irregular hypoechoic mass with internal echoes. Immediately adjacent, at 7:00, 5 cm from the nipple, there is a 1.4 x 1.2 x 1.4 cm irregular hypoechoic mass with internal echoes. These 2 masses appear contiguous with one another. At 9:00, 5 cm from the nipple, there is a 1.4 x 1.3 x 1.6 cm irregular hypoechoic mass with internal echoes.", "output": "Multiple hypoechoic masses in the lower outer right breast, suggestive of multiloculated abscesses. These do not appear amenable to ultrasound-guided drainage. No sonographic evidence for malignancy. The results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "History of ascites, right upper quadrant evaluation of the liver for echogenicity LIVER: Liver demonstrates diffuse coarse echotexture, measures 19.3 cm. Prominent hepatic veins are noted. Portal vein demonstrates normal flow directionality and patency. No hepatic focal lesions noted. Perihepatic fluid noted.BILIARY TRACT: No intra or extra hepatic delivery ductal dilatation noted. Status post cholecystectomy.PANCREAS: Visualized pancreas appears unremarkable. Tail and body of pancreas is not seen due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 13.8 cmRIGHT KIDNEY: Right kidney measures 8.4 cm and left measures 8.4 cm. No hydronephrosis or focal lesions. Normal echotexture noted. OTHER: Moderate amount of ascites", "output": "Diffuse coarse echotexture of the liver suggestive of chronic liver disease.Moderate ascites."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Progressive CKD, assess kidney size, echogenecity History: Progressive CKD RIGHT KIDNEY: The right kidney measures 12.6 cm in length. Echogenic renal parenchyma is again noted. Hyperechoic focus in the midpole of the right kidney with twinkling artifact may represent a nonobstructive stone. Numerous anechoic simple cysts are seen throughout the lower, mid, and upper pole. Reference upper pole cyst measures 2.3 x 2.1 x 2.9 cm and is minimally complex with a thin septation. No hydronephrosis.LEFT KIDNEY: The left kidney measures 9.6 cm in length. Echogenic renal parenchyma is again noted. Numerous anechoic simple cysts are seen throughout the lower, mid, and upper pole. Reference complex cystic lesion in the midpole with multiple thin septations and peripheral calcification appears similar to prior exam, measuring 2.7 x 2.6 x 2.8 cm. No definite shadowing calculi or hydronephrosis.OTHER: Unremarkable bladder.", "output": "1. Echogenic renal parenchyma, consistent with medical renal disease.2. Stable bilateral simple to complex renal cystic lesions as described above.3. Questionable nonobstructive right renal stone. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Graves' disease 25 years prior with recurrence. RIGHT LOBE MEASUREMENTS: 6.3 x 1.9 x 2.4 cm. Normal parenchymal vascularity.LEFT LOBE MEASUREMENTS: 5.8 x 1.9 x 2.1 cm. Normal parenchymal vascularity.ISTHMUS MEASUREMENTS: 0.3 cm in AP dimension.RIGHT LOBE: 4 mm nodule with dystrophic calcifications in the midpole.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not identified.LYMPH NODES: Normal-appearing lymph nodes, with a normal 6 mm level II left cervical lymph node noted.OTHER: No significant abnormality noted.", "output": "Mildly prominent thyroid gland. Subcentimeter right thyroid lobe nodule with dystrophic appearing calcifications."}
{"instruction": "Generate impression based on findings.", "input": "Reason: acute pancreatitis, evaluate for gallstones LIVER: The liver measures 14 cm in length. There are multiple well-defined, round hypoechoic-to-isoechoic solid hepatic lesions. Two representative lesions in the right lobe measure 4.5 x 3.9 x 4.6 cm and 3.8 x 3.4 x 2.8 cm. The portal vein is patent with normal directional hepatopedal portal venous blood flow, peak velocity 28 cm/s.GALLBLADDER, BILIARY TRACT: Multiple shadowing gallstones in the dependent aspect of the gallbladder and gallbladder neck. No pericholecystic fluid or evidence of acute inflammation. The gallbladder wall measures 0.2 cm. The common bile duct measures 0.4 cm. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 11 cm in length. No hydronephrosis or stones.LEFT KIDNEY: The left kidney measures 11.2 cm in length. No hydronephrosis or stones.OTHER: Left pleural effusion.", "output": "1. Multiple solid hepatic lesions as described above, suspicious for metastases. MRI of the liver is recommended for further evaluation.2. Cholelithiasis without evidence of acute inflammation."}
{"instruction": "Generate impression based on findings.", "input": "Male 54 years old Reason: ruq pain, eval gallbladder History: abd pain LIVER: Partially visualized liver is normal in appearance. Main portal vein is patent with normal directional flow.BILIARY TRACT: Gallstones are present within the gallbladder. Gallbladder wall measures 2 mm. No significant pericholecystic fluid. Negative sonographic Murphy's sign. No intra or extrahepatic biliary ductal dilatation. Common bile duct measures 2 mm.OTHER: No significant abnormalities noted.", "output": "Cholelithiasis without evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Chronic kidney disease RIGHT KIDNEY: 7.6 cm in length. Mildly increased renal parenchymal echogenicity. No renal stones or hydronephrosis.LEFT KIDNEY: 8.0 cm in length. Mildly increased renal parenchymal echogenicity. No renal stones or hydronephrosis.BLADDER: No significant abnormality noted.OTHER: Cholelithiasis without evidence of cholecystitis. Heterogeneous uterus, likely related to underlying leiomyomatous disease.", "output": "Mildly echogenic, relatively small kidneys without hydronephrosis, compatible with chronic renal disease.Heterogeneous uterus, likely related to underlying leiomyomatous disease.Cholelithiasis."}
{"instruction": "Generate impression based on findings.", "input": "23-year-old with multiple tender palpable areas of concern. Per the patient, her physician notes a palpable area of concern in the left breast. A targeted bilateral ultrasound was performed for the patient\u2019s areas of concern. There is no solid or cystic mass identified in either breast, including at the area where the patient states her physician had a palpable concern in her left upper inner quadrant.", "output": "No sonographic evidence for malignancy. Clinical correlation for causes of pain is recommended. Please also correlate with physical examination to ensure concordance between these benign results and physical exam findings.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female with palpable left lump, 2 sites previously biopsied showing PASH, here for follow-up A targeted left breast ultrasound was performed at the 2:00 position at the site of previously biopsied masses. An irregular hypoechoic mass with no associated vascularity 10 cm from the nipple corresponding to patient's palpable abnormality is not significantly changed size measuring 2.9 x 1.4 cm, previously 3.5 x 1.6 cm. A smaller irregular hypoechoic mass 7 cm from the nipple is also unchanged measuring 0.6 x 0.6 cm, previously 0.9 x 0.4 cm.", "output": "Two left breast masses corresponding to PASH on biopsy are not significantly changed in size. Annual diagnostic mammogram is recommended. The next mammogram is due in January 2016. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "As per discussion of the interdisciplinary conference, patient presents for right axillary ultrasound. History of right lumpectomy for breast cancer in 2013, now with new biopsy-proven cancer in the right central breast. A targeted right axillary ultrasound was performed. Patient has a history of prior sentinel lymph node biopsy. A bilobed hypoechoic lesion in the right lower axilla measures 8 x 4 x 4 mm with minimal to no blood flow. This could represent an abnormal lymph node. Another smaller lymph node measures 4 x 2 x 4 mm. A large lymph node with fatty hilum is identified in the right higher axilla that measures 12 x 7 mm.", "output": "Two suspicious subcentimeter lymph nodes in the right axilla one of them amenable to ultrasound-guided biopsy. Patient is on Coumadin. Findings discussed with Dr. Barrera and Donna Christian at the time of dictation.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old man with transaminitis. LIVER: Echogenicity of the hepatic parenchyma is normal. The liver measures 16.3 centimeters in length. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts.There is marked dilatation of the hepatic veins.The main portal vein is patent with normal hepatopedal flow and velocity of 20.4 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is collapsed. There is no pericholecystic fluid, gallbladder wall thickening or cholelithiasis. The common bile duct measures 0.2 cm in diameter. PANCREAS: The head and proximal body of the pancreas are normal. The tail is obscured by bowel gas.SPLEEN: The spleen is normal in echogenicity and measures 11 cm in length. RIGHT KIDNEY: The right kidney measures 12.0 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 12.4 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.OTHER: Mild ascites. Large right pleural effusion.", "output": "Mild ascites and dilatation of the hepatic veins. Large right pleural effusion. Findings can all be seen in the setting of heart failure."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old male patient with chronic HCV. Evaluate for any suspicious lesions/findings. LIVER: The liver measures 13.8 cm in length. Hepatic parenchymal echotexture is slightly coarsened. 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 10.5 cm in length. No evidence of hydronephrosis.The spleen measures 8.9 cm in length.", "output": "No hepatic mass is identified."}
{"instruction": "Generate impression based on findings.", "input": "HCV LIVER: Coarse echogenic liver parenchyma without mass. Liver length 15.5 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.7 cm in lengthOTHER: Left kidney 12.5 cm in length. Spleen 9.6 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": "History of probable hematoma presents for follow-up. Per patient the area has become smaller. A targeted left ultrasound was performed for the palpable area of concern. There has been interval decrease in size of the hematoma, which now measures 3.5 x 0.4 x 4.5 cm.", "output": "Decreased volume of left breast hematoma. As long as the palpable finding continues to resolve clinically, no further targeted follow-up would be necessary. An annual mammogram will be due for this patient in January 2017.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Segment 5 hepatic lesion concerning for abscess versus pancreatic cancer metastasis LIVER: Mildly heterogeneous background parenchymal echogenicity. The segment 5 lesion seen on prior CT and MRI is not evident by ultrasound.OTHER: The peripancreatic cystic collection is again visualized.", "output": "Segment 5 lesion not evident by ultrasound for percutaneous biopsy."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old male with acute renal failure. RIGHT KIDNEY: The right kidney measures approximately 9.3 cm in length. Echotexture is within normal limits. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures approximately 9.1 cm in length. Echotexture is within normal limits. No hydronephrosis, shadowing calculus or mass.URINARY BLADDER: Incompletely distended without gross abnormality.OTHER: Liver appears somewhat echogenic which is nonspecific but could be due to fatty infiltration.", "output": "Normal-appearing kidneys.Echogenic liver."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old male with cirrhosis and hepatitis C. Evaluate for hepatocellular carcinoma. LIVER: Liver is relatively small and coarsely echogenic consistent with parenchymal disease. No focal mass identified. Color and spectral Doppler demonstrates patency and for direction in the main portal vein with low velocities.BILIARY TRACT: Gallbladder is collapsed with stones. The biliary tract is normal in caliber.PANCREAS: Limited due to bowel gasSPLEEN: Marked splenomegaly.RIGHT KIDNEY: No significant abnormalities noted. OTHER: Small left renal cyst.", "output": "Stable examination without evidence for solid hepatic mass."}
{"instruction": "Generate impression based on findings.", "input": "60 year-old female for follow-up of thyroid nodule. RIGHT LOBE MEASUREMENTS: 4.5 x 1.6 x 1.9 cmLEFT LOBE MEASUREMENTS: 3.9 x 1.5 x 1.5 cmISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: In the mid portion of the right lobe there is a mildly heterogeneous and hyperechoic solid nodule with a partial hypo-echoic rim measuring 0.8 x 0.8 x 1.3 cm without change. Right lobe is diffusely heterogeneous.LEFT LOBE: Diffusely heterogeneous without mass.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 lobe thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "Low TSH RIGHT LOBE MEASUREMENTS: 7.2 x 5.2 x 2.2 cm. Enlarged.LEFT LOBE MEASUREMENTS: 8.8 x 5.1 x 3.6 cm. Enlarged ISTHMUS MEASUREMENTS: 11 mm in AP dimension, enlarged.RIGHT LOBE: Multiple subcentimeter hypoechoic nodules with features suggestive of colloid. A 4.1 x 2.4 x 2.6 cm heterogeneously solid nodule is noted at the inferior pole though incompletely visualized due to subclavicular extension. This lesion was seen on the prior chest CT in 2009.LEFT LOBE: Multiple subcentimeter hypoechoic nodules with features suggestive of colloid. 5.2 x 5.1 cm heterogeneously solid nodule is noted at the inferior pole though incompletely visualized due to subclavicular extension. This lesion was seen on the prior chest CT in 2009.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "Multiple nodules with substernal ext6ension bilaterally, also seen on the prior CT in 2009."}
{"instruction": "Generate impression based on findings.", "input": "7-year-old female with pancreatic cancer and recent ERCP with stent placement, right upper quadrant pain LIVER: No significant abnormalities noted.BILIARY TRACT: Air in the gallbladder lumen partially limits evaluation. The visualized portions of the gallbladder are not significantly distended. There is sludge in the gallbladder lumen. The gallbladder wall measures 3 mm in thickness. There is no discrete pericholecystic fluid. A biliary stent is visualized.PANCREAS: Redemonstration of a pancreatic head mass measuring 4.0 x 2.1 x 2.3 cm consistent with the patient's known neoplasm. Mild pancreatic ductal dilation. SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "1. Limited evaluation of the gallbladder as described above demonstrates no specific evidence of acute cholecystitis.2. Pancreatic head mass consistent with the patient's known neoplasm3. Interval placement of a common bile duct stent."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female with history of right breast palpable lump at the periphery of the inferior right breast. Family history of breast cancer in paternal aunt. No palpable mass at 5:00-6:00 of the right breast on physical examination.A targeted right ultrasound was performed for the palpable area of concern. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy at the site of palpable concern.As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually starting at age 40. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old female a history of left lumpectomy for IDC and DCIS in April of 2008, status post chemotherapy and radiation. Mammogram: Three standard views of both breasts and two left breast 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, unchanged in pattern and distribution. Post surgical scar with surgical clips is re-demonstrated at upper outer quadrant in the left breast without significant change. Focal asymmetry in the left lower inner breast disperses on spot compression views, however, ultrasound was subsequently performed for confirmation.No suspicious mass or suspicious microcalcifications in either breast. Ultrasound: Targeted left lower, inner quadrant ultrasound was performed. Normal glandular tissue is noted. No suspicious cystic or solid mass noted.", "output": "No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Elevated bilirubin LIVER: Mildly coarse and echogenic liver echotexture without mass. Liver length 17.8 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 11.8 cm in length. Spleen 11.2 cm in length. No ascites.", "output": "Mildly coarse and echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old woman presents with self palpated left axillary lymph node. No family history of cancer. DIAGNOSTIC MAMMOGRAM", "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": "50-year-old female presents with soft tissue prominence superior to the left clavicle that comes and goes. There is clinical concern for lymphadenopathy. The soft tissues appear normal without lymphadenopathy, mass, or fascial defect. No focal fluid collection.", "output": "1. Normal ultrasound of the area superior to the clavicle without lymphadenopathy. If symptoms persist, consider CT or MR."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male with single renal cyst. Evaluate renal cyst. RIGHT KIDNEY: The right kidney measures 12.1 cm in length. No hydronephrosis or shadowing calculi. A right lower pole simple cyst measures 4.2 x 5.2 x 4.8 cm (prior 3.9 x 3.8 x 3.5 cm). Mild cortical thinning of the renal parenchyma.LEFT KIDNEY: The left kidney measures 12.2 cm in length. No hydronephrosis or shadowing calculi. No suspicious lesions. Mild cortical thinning of the renal parenchyma.URINARY BLADDER: No acute abnormality of the urinary bladder.OTHER: Increased echogenicity of the partially visualized hepatic parenchyma suggestive of fatty infiltration.", "output": "1. Right lower pole simple renal cyst has slightly increased in size since the 2013 abdominal ultrasound exam. Measurements listed above.2. Mild cortical thinning of the bilateral kidneys, unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Papillary thyroid carcinoma RIGHT LOBE MEASUREMENTS: 5.1 x 1.8 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.5 x 1.3 x 1.2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: 0.9 x 0.8 x 1.2 cm hypoechoic mid gland nodule with indistinct borders.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": "Hypoechoic mid right gland nodule with indistinct borders presumably representing the clinically known appendectomy thyroid carcinoma. No other thyroid nodules appreciated. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Status post gastric bypass with new transaminitis LIVER: Mildly coarse liver echotexture without mass. Liver length 16.4 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: Gallbladder absent. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Benign-appearing cyst. Right kidney 9.9 cm in lengthOTHER: Left kidney 10.8 cm in length. Spleen 11.5 cm in length. No ascites.", "output": "Mildly coarse liver echotexture raises the possibility of parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with hepatitis C presents for evaluation of portal hypertension and cirrhosis. LIVER:Measures 14.1 cm. Mildly coarse echogenicity. No intrahepatic biliary dilation or ascites. No suspicious lesion is seen. Main portal vein is patent with hepatopedal flow. An approximately 1.3 x 1.2 x 1.0 cm anechoic areas consistent with a simple hepatic cyst.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. The wall is 0.2 cm. No pericholecystic fluid, stones, or sludge. Common bile duct measures 0.1 cm.PANCREAS: Evaluation the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 7.7 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 10.9 cm. Left kidney measures 11.1 cm. Normal echogenicity. No hydronephrosis or shadowing calculi. OTHER: No significant abnormality noted.", "output": "1. Mildly coarse echogenicity of liver consistent with fatty infiltration and chronic liver disease/parenchymal dysfunction. No ascites.2. Benign simple hepatic cyst appears unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury. Right thigh swelling; evaluate for bleeding into right thigh. RIGHT KIDNEY: 12.0 cm in length. Echogenic parenchyma, without hydronephrosis. No focal renal lesions or shadowing stones noted.LEFT KIDNEY: 10.2 cm in length. Echogenic parenchyma, without hydronephrosis. No focal renal lesions or shadowing stones noted.RIGHT THIGH", "output": "1. Echogenic renal parenchyma without hydronephrosis, compatible with medial renal disease.2. 5.7 cm hematoma in the right thigh, which does not appear to directly involve the external iliac/femoral artery and vein."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old male patient with right upper quadrant pain. Assess for gallstones. LIVER: The liver measures 15.2 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.1 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. 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 pancreas is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 10.5 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.3 cm in length. No evidence of hydronephrosis.The spleen measures 10.6 cm in length.", "output": "No cholelithiasis or other specific findings to account for the patient's symptoms. "}
{"instruction": "Generate impression based on findings.", "input": "Left renal mass RIGHT KIDNEY: Multiple benign cysts again noted. No worrisome mass, stone, or hydronephrosis. Right kidney 11.7 cm in lengthLEFT KIDNEY: 1.9 x 1.6 x 2.1 cm mildly echogenic solid lesion corresponding to the enhancing focus seen on the MR within the midportion of the left kidney. Stable benign left renal cysts. No stone or hydronephrosis. Left kidney 11.9 cm in length.OTHER: Bladder nondistended", "output": "Previous seen MR enhancing lesion within the left renal interpolar region can be identified on ultrasound as an mildly echogenic solid lesion on ultrasound which does not fulfill the criteria for a simple cyst; a malignant etiology such as papillary renal cell carcinoma is suspected."}
{"instruction": "Generate impression based on findings.", "input": "History of renal transplant approximately 8 weeks prior. Assess for hydronephrosis. The right iliac fossa transplanted kidney measures 11.6 cm in length with moderate hydronephrosis. The ureter also appears slightly prominent. Along the inferomedial aspect of the kidney there is a new 7.8 x 3.4 cm hypoechoic fluid collection which appears distinct from the ureter and may represent a urinoma.Anterior to the kidney fossa is a 4.5 x 6.7 x 3.3 cm complex collection with regions which are nearly anechoic and peripherally hypoechoic which may represent a hematoma.The inflow and outflow vessels were not assessed.", "output": "Moderate hydronephrosis of the right iliac fossa transplanted kidney.7.8 cm hypoechoic collection along the inferomedial aspect of the kidney appears distinct from the ureter and may represent a urinoma. This may be contributing to or be the source of hydronephrosis.Anterior to the kidney is a 6.7 cm complex collection which may represent a hematoma."}
{"instruction": "Generate impression based on findings.", "input": "Goiter, 5 year follow-up study RIGHT LOBE MEASUREMENTS: 7.2 x 2.7 x 3.3 cm.LEFT LOBE MEASUREMENTS: 7.3 x 2.5 x 3.5 cm.ISTHMUS MEASUREMENTS: 1.8 cm.RIGHT LOBE: Diffusely enlarged and heterogeneous echotexture without discrete mass or nodule.LEFT LOBE: Diffusely enlarged and heterogeneous echotexture without discrete mass or nodule.ISTHMUS: Diffusely enlarged and heterogeneous echotexture without discrete mass or nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely enlarged heterogeneous thyroid gland without discrete mass or nodule, similar in appearance to the prior exam."}
{"instruction": "Generate impression based on findings.", "input": "78-year-old male with elevated creatinine. Evaluate RIGHT KIDNEY: The right kidney measures 10.9 cm in length. Normal cortical echogenicity of the right kidney. No evidence of hydronephrosis.LEFT KIDNEY: Left kidney measures 12.4 cm in length with normal cortical echogenicity. No evidence of hydronephrosis.BLADDER: The bladder is nondistended.", "output": "No specific sonographic findings to suggest medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Hoarseness and right vocal cord paralysis RIGHT LOBE MEASUREMENTS: 2 x 1.7 x 5.7 cmLEFT LOBE MEASUREMENTS: 2.6 x 1.9 x 5.6 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Diffusely heterogeneous gland. Possible discrete predominant solid nodule measuring 3.3 x 2.2 x 1.9 cm.LEFT LOBE: Diffusely heterogeneous gland. Mid pole predominantly solid nodule measuring 2 x 1 x 2.4 cm.ISTHMUS: Diffusely heterogeneous glandPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland. Bilateral predominant solid nodules; favor benign etiology. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Taylor is a 23-year-old female presenting with a palpable abnormality left axilla. She states that she initially felt this abnormality for the past one month, but has progressively gotten smaller in size. Last week, she noted some yellowish discharge from the area. Upon physical exam at the patient's area of concern, a small pimple-like area is noted in the central left axillary region. No discharge is able to be extruded.A targeted left ultrasound was performed for the patient\u2019s area of concern. In the central left axillary region, there is a superficial hypoechoic lesion measuring 0.9 x 0.4 x 1.3 cm. There is no suspicious solid or cystic mass identified.", "output": "Benign epidermal inclusion cyst in the left axillary region. No sonographic evidence for malignancy. Patient should follow-up with her primary care physician as clinically warranted. All results and recommendations were relayed to the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "54 year old female. Left thyroid nodule. RIGHT LOBE MEASUREMENTS: 5.9 x 2.3 x 2.4 cm.LEFT LOBE MEASUREMENTS: 6.1 x 1.7 x 1.8 cm.ISTHMUS MEASUREMENTS: 0.4 cm in AP dimension.RIGHT LOBE: Nodule 1: Upper pole, mixed solid and cystic, 1.5 x 0.8 x 1 cm (previously 1.5 x 0.8 x 1.1 cm), punctate echogenic foci with ringdown artifact, most suggestive of a colloid nodule.Nodule 2: Mid/inferior pole, solid, 2.4 x 1.6 x 1.2 cm (previously 2.3 x 1.6 x 1.1 cm), previously biopsied to be a colloid nodule.LEFT LOBE: Small cystic, benign appearing focus. No suspicious nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Complex cystic lesion with a solid mural nodule just to the left of midline at the level of the hyoid bone measures 1.3 x 1.9 x 2.1 cm, previously 1.6 x 1.8 x 2.5 cm, consistent with biopsy proven papillary thyroid carcinoma.", "output": "Complex cystic solid lesion inferomedial to the left submandibular gland consistent with biopsy prove papillary thyroid carcinoma, suspected to be within a thyroglossal duct cyst, not significantly changed. Two right thyroid nodules, unchanged."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old woman with family history of breast cancer presents with right breast mass detected on ultrasound and presents for biopsy. On MRI performed on the same day, an additional suspicious masses were identified in bilateral retroareolar region. Patient presents for second look ultrasound. ULTRASOUND", "output": "Successful ultrasound-guided core biopsy and clip placement of the right breast, 2 sites as described. The mass in the right breast 2:00 position is most likely a fibroadenoma. The mass in the right retroareolar region is most likely a papilloma. Pathology is pending at this time.No MRI correlate was identified to the enhancing lesion in the left breast. 6 month follow up MRI is recommended to confirm stability of the enhancing foci. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "History of renal transplant. RIGHT ILIAC FOSSA TRANSPLANT KIDNEY: The ureteral stent is noted in a partially distended bladder. Interval resolution of upper moiety hydronephrosis. The kidney measures 11.2 cm in length. No peri-transplant fluid collection.", "output": "Interval resolution of right iliac fossa transplant kidney upper moiety hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female with hyperbilirubinemia status post chemotherapy who presents for evaluation of the liver. LIVER: The hepatic parenchyma is coarse in echotexture, not significantly changed compared to the previous examination. The liver measures 23 cm in length. No suspicious hepatic lesions. The main portal vein is patent with peak systolic velocity of 0.3 m/s.BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. The gallbladder is not distended. Gallbladder wall measures 3 mm. The common bile duct measures 4 mm.PANCREAS: No significant abnormalities noted.SPLEEN: Spleen is normal in echogenicity and measures 12 cm in lengthKIDNEYS: The kidneys are normal in echogenicity with the right kidney measuring 13.7 and left kidney measuring 12.2 cm in length. No hydronephrosis. OTHER: No significant abnormalities noted.", "output": "1.Findings suggestive of fatty infiltration of the liver with hepatomegaly.2.Nondistended gallbladder without intra or extrahepatic biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Recalled from screening mammography for a focal asymmetry with calcifications in the left breast. An ML view and two spot magnification 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. The focal asymmetry with calcifications measuring about 5 mm persists on spot magnification views. The calcifications have a benign appearance, suggestive of milk of calcium.ULTRASOUND", "output": "Ultrasound finding is low suspicion, more likely a cluster of microcysts or a papilloma, less likely malignancy. Management options were discussed with the patient, and biopsy for definitive diagnosis is preferred.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old female with acute kidney injury. Evaluate for obstruction or other cause of AKI. Limited evaluation due to patient's body habitus and condition. Postoperative state with multiple drains and bandages along the abdomen. Patient is on ventilator and unable to be repositioned.RIGHT KIDNEY: The right kidney measures 10.3 cm in length. No hydronephrosis. Echogenic parenchyma.LEFT KIDNEY: Suboptimal visualization of the left kidney, particularly the left upper pole. No definite hydronephrosis.URINARY BLADDER: The urinary bladder is decompressed with a Foley catheter.OTHER: No significant abnormalities noted.", "output": "Exam limitations are described above. Very limited evaluation of the left kidney. No hydronephrosis on the right."}
{"instruction": "Generate impression based on findings.", "input": "75-year-old female with a right-sided thyroid nodule incidentally seen on a PET/CT. RIGHT LOBE MEASUREMENTS: 4.0 x 0.9 x 1.2 cmLEFT LOBE MEASUREMENTS: 2.7 x 0.8 x 0.9 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: There is a 5 x 5 x 8 mm isoechoic solid nodule in the interpolar region with a thin hypoechoic rim and mild vascularity. No associated calcifications. Additional subcentimeter nodules are noted. Otherwise, the right lobe is normal in morphology, echogenicity, and size.LEFT LOBE: The left thyroid lobe is normal morphology, echogenicity, and size without a dominant nodule evident.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Morphologically unremarkable and normal-sized cervical lymph nodes are noted.OTHER: No significant abnormality noted.", "output": "8mm right thyroid solid nodule without specific suspicious sonographic features."}
{"instruction": "Generate impression based on findings.", "input": "Reason: cholecystitis History: RUQ pain, tenderness, large stone seen on bedside u/s, +U/S murphy LIVER: The liver measures 16.1 cm in length. The portal vein is patent with normal directional hepatopetal flow, peak velocity 36.9 cm/s. No focal masses.GALLBLADDER, BILIARY TRACT: There is a single echogenic stone in the gallbladder at the junction of the body and neck within a collapsed gallbladder. No pericholecystic fluid or inflammation. The gallbladder wall measures less than 3 mm. The common bile duct measures 4 mm proximally. No intrahepatic or extrahepatic biliary ductal dilatation. Positive sonographic Murphy's sign.PANCREAS: No significant abnormalities noted.KIDNEYS: The right kidney measures 9.1 cm. The left kidney measures 9.2 cm. Echogenic renal parenchyma bilaterally. No shadowing stones or hydronephrosis.OTHER: No ascites. The spleen measures 9.1 cm.", "output": "1. Cholelithiasis without visualized evidence of acute cholecystitis, however positive sonographic Murphy's sign raises the question of acute inflammation. HIDA scan could be obtained for further evaluation if clinically indicated.2. Echogenic renal parenchyma, consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "18-year-old female with constipation and vomiting.VIEW: Abdomen AP (one view) 7/28/2016 Normal bowel gas pattern is present. There is average fecal burden. No intraperitoneal free air. Lung bases are normal.", "output": "Average fecal burden."}
{"instruction": "Generate impression based on findings.", "input": "Status post cell transplant with elevated liver enzymes LIVER: Mildly coarse and echogenic liver echotexture again noted without worrisome mass. Small cysts again noted. Liver length 13.7 cm.GALLBLADDER, BILIARY TRACT: Gallbladder absent. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Status post right nephrectomyOTHER: Spleen 12 cm in length. Left kidney 12.2 cm in length. No ascites. Limited evaluation of the portal vein demonstrates a patent main portal vein with normal directional flow.", "output": "Stable examination. Mildly coarse and echogenic liver echotexture again noted suggestive for parenchymal dysfunction/fatty infiltration without worrisome mass or ductal dilatation. No ascites. Patent main portal vein with normal directional flow."}
{"instruction": "Generate impression based on findings.", "input": "Female 44 years old Reason: 44 yof with h/o hydronephrosis and ureteral stents, now with acute kidney injury, evaluate for worsening hydronephrosis History: acute kidney injury RIGHT KIDNEY: Mild increased echogenicity. Cortical thinning. 7.4 cm in length. No hydronephrosis. Stent seen on the plain film is not visible by ultrasound.LEFT KIDNEY: 14.8 cm in length. Moderate to marked hydronephrosis unchanged. Stent appears to be in place.URINARY BLADDER: Partially collapsed.OTHER: No significant abnormalities noted.", "output": "Persistent moderate to marked left-sided hydronephrosis despite stent apparently in place. The degree of hydronephrosis is unchanged from the 11/3/2015 ultrasound.Atrophic right kidney."}
{"instruction": "Generate impression based on findings.", "input": "History of hepatitis C. Evaluate for hepatocellular carcinoma. LIVER: The liver is mildly coarse and echogenic in echotexture. No focal suspicious lesion. No intrahepatic biliary ductal dilatation. The liver is normal in size measuring 15.9 cm in craniocaudal dimension. Normal hepatopedal portal venous blood flow at 0.3 m/s.BILIARY TRACT: Cholecystectomy. Stable mild extrahepatic biliary ductal dilatation measuring 10 mm.PANCREAS: The visualized portions of the pancreas are unremarkable.SPLEEN: The spleen is enlarged measuring 14.5 cm.RIGHT KIDNEY: The right kidney measures 12 cm in length without hydronephrosis or focal suspicious lesion. OTHER: The left kidney measures 12.3 cm in length without hydronephrosis. Stable 1.3 cm simple cyst.", "output": "1. Mildly coarsened echogenic hepatic parenchyma compatible with chronic liver disease. No focal hepatic lesion. 2. Mild splenomegaly. 3. Stable mild common bile duct dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Female 40 years old Reason: eval liver, hx ETOH abuse x 10-15 years with elevated LFT and lipase History: N/V, abd pain LIVER: Enlarged 26 cm in length. Heterogeneous texture and echogenic consistent with fatty infiltration. Correlate for underlying liver disease. No definite focal lesions. Flow in the portal vein is hepatopedal peak velocity 20.6 cm/sGALLBLADDER, BILIARY TRACT: Cholelithiasis. Negative sonographic Murphy sign. No gallbladder wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary dilatation.PANCREAS: Limited visualization.RIGHT KIDNEY: 11.9 cm in length.OTHER: Left kidney 12.1 cm in length.Spleen 8.2 cm in length.No evidence of ascites.", "output": "Cholelithiasis with no evidence of biliary dilatation or signs of cholecystitis. Hepatomegaly. Fatty liver."}
{"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 new no solid or cystic mass identified. Known right breast fibroadenoma is present. However, due to a technical error, a single column of images located just lateral to the left nipple was not saved. Therefore the patient will need to return for repeat ultrasound. Exam was double read by two attending breast radiologists.", "output": "Technical repeat is needed due to missing automated images of the left breast. The patient has been informed of this and is coming in today for the additional images.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: R - Technical Repeat Views."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old male with elevated LFTs LIVER: Measures 14.9 in length. Mildly 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": "Mildly increased hepatic echogenicity may represent hepatic steatosis or parenchymal disease."}
{"instruction": "Generate impression based on findings.", "input": "Liver transplant with increased LFTs and abdominal pain LIVER: Status post liver transplant. Liver length 16.6 cm. No mass. Limited Doppler interrogation of the main portal vein demonstrates a patent portal vein with normal directional flow. Main portal vein velocity 23 cm/s.GALLBLADDER, BILIARY TRACT: Gallbladder absent. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.1 cm in length. OTHER: Left kidney 10.4 cm in length. Spleen 14.6 cm in length. Trace ascites.", "output": "Status post liver transplant. No worrisome mass or ductal dilatation. Trace ascites. Limited Doppler interrogation of main portal vein demonstrates a patent portal vein with normal directional flow."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female complains of flatus and abdominal distention. Limited 4 quadrant ultrasound demonstrates no free fluid or ascites.", "output": "Normal four quadrant ultrasound. No free fluid or ascites."}
{"instruction": "Generate impression based on findings.", "input": "Amiodarone induced hyperthyroidism RIGHT LOBE MEASUREMENTS: 4.3 x 2.4 x 1.9 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.8 x 1.8 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Diffusely heterogeneous gland without mass. No increased vascularityLEFT LOBE: Diffusely heterogeneous gland without increased vascularity. 1.4 x 1 x 1.1 cystic lesion lower pole left thyroid glandISTHMUS: Diffusely heterogeneous gland without mass. No increased vascularityPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland without worrisome mass or increased vascularity. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Gallbladder wall thickening and right-sided colitis/enteritis seen on CT LIVER: Non-cirrhotic liver morphology. 16.2 cm in length. Normal parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilation. The gallbladder is nondistended without wall thickening, though with mild pericholecystic edema. No gallstones identified. 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 12.0 cm in length. The left kidney is 12.1 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 8.2 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No significant ascites identified.", "output": "Mild pericholecystic edema without gallbladder wall thickening or specific signs of cholecystitis. The differential diagnosis for this includes hypoproteinemia versus aggressive IV fluid hydration."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male with known left inguinal hernia. Scrotal swelling. Evaluate for hydrocele. RIGHT TESTIS: Right testis appears normal in size, contour and echogenicity. No focal abnormality.LEFT TESTIS: Left testis appears normal in size, contour and echogenicity. No focal abnormality.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: There is a large, loculated right hydrocele which has mild mass effect upon the testicle and epididymis on the right and a certain degree the left, scrotum. This is simple appearing.", "output": "Loculated right hydrocele."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female presents for evaluation of thyroid. She status post lobectomy. RIGHT LOBE MEASUREMENTS: The right side of the thyroid is absent.LEFT LOBE MEASUREMENTS: 1.0 x 1.0 x 3.4 cm.ISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: The right lobe is absent.LEFT LOBE: The parenchyma is homogenous without a nodule.ISTHMUS: The parenchyma is homogenous without a nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: There is a partly-calcified approximately 8 mm echogenic focus in level 2 of the left neck that could represent partial calcification of a lymph node. Given the absence of abnormality on the left, this may represent a postinflammatory lymph node.", "output": "1. Surgical changes of a right-sided thyroid lobectomy. Otherwise, normal ultrasound of the isthmus and left thyroid without nodule.2. Partly calcified lymph node in level 2 of the left neck may represent postinflammatory lymph node."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old female with recurrent UTI, dysuria. RIGHT KIDNEY: Measures 9.0 cm in length. Normal echogenicity without hydronephrosis, nephrolithiasis, or mass lesion. LEFT KIDNEY: Measures 10.1 cm in length. Normal echogenicity without hydronephrosis, nephrolithiasis, or mass lesion. A left renal stent is in place.URINARY BLADDER: Partially collapsed with distal stent partially imaged. Necrotic lymph node conglomerate abutting the left ureterovesical junction better seen on recent CT examination. OTHER: No significant abnormalities noted.", "output": "1. Left ureteral stent in place without hydronephrosis. 2. Partially collapsed bladder with distal stent partially imaged. Necrotic lymph node conglomerate abutting the left ureterovesical junction better seen on recent CT examination. "}
{"instruction": "Generate impression based on findings.", "input": "75 years old, Female, Reason: Renal Failure History: AS CAD LOW EF Rising Creatinine RIGHT KIDNEY: Kidney measures 10.0 cm in length. Right kidney is echogenic consistent with medical renal disease. No hydronephrosis or shadowing calculus. Multiple anechoic foci in the right kidney most likely represent cysts, however some which are too small to characterize. The largest cyst measures 2.0 x 1.8 x 1.6 cm.LEFT KIDNEY: The left kidney is difficult to visualize. Kidney measures 9.7 cm in length. The left kidney is slightly echogenic consistent with medical renal disease. No definite hydronephrosis or shadowing calculus. Anechoic foci consistent with renal cysts are noted.Bladder: Not well visualized on this exam.", "output": "1.Bilateral echogenic kidneys consistent with medical renal disease.2.No evidence of hydronephrosis.3.Bilateral anechoic lesions are favored to represent cysts, however some are too small to characterize."}
{"instruction": "Generate impression based on findings.", "input": "Reason: h/o liver cyst s/p drainage please evaluate for cyst History: rare RUQ pain LIVER: The liver measures 15.8 cm in length, decreased from previously. The liver demonstrates increased parenchymal echogenicity with coarsened echotexture. Multiple hepatic cysts are again noted, some of which demonstrate minimal internal complexity such as thin septations. The previously described largest right lobe cyst is no longer visualized. The largest currently is in the right lobe measuring up to 12.4 x 11.8 x 10.6 cm, similar to prior. Additional smaller cysts are present in the right and left hepatic lobes. The previously seen left hepatic lobe cystic lesion with internal complex contents is no longer visualized. 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. 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 9.6 cm in length. RIGHT KIDNEY: Kidney measures 11.2 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.9 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Decrease in number of hepatic cysts following drainage as described above. The largest cyst currently is in the right hepatic lobe measuring up to 12.4 cm.2.Increased hepatic echogenicity suggestive of fatty infiltration/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female with generalized abdominal pain and increased abdominal girth. LIVER: Liver is normal in size and echotexture. 1.3 cm right lobe cyst. No other focal hepatic abnormality.GALLBLADDER, BILIARY TRACT: Gallbladder appears unremarkable without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No ascites.", "output": "Normal examination."}
{"instruction": "Generate impression based on findings.", "input": "59 years old, Female, Reason: Please evaluate for cirrhosis, splenomegaly, ascites or masses History: 59 yo F with hepatitis C, elevated fibrospect. LIVER: The liver measures 16.3 cm in length. Hepatic parenchyma is within normal limits. No nodularity of the liver to suggest cirrhosis. 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 5 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 9.3 cm in length. RIGHT KIDNEY: Kidney measures 11.3 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 11.1 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass. In the inferior pole of the left kidney there is a round anechoic structure favored to be a simple cyst. Adjacent to this cyst there is a smaller anechoic structure which also likely represents a cyst.OTHER: No evidence of ascites.", "output": "1.No evidence of nodularity or widening of the fissures to suggest cirrhosis.2.Left kidney cysts."}
{"instruction": "Generate impression based on findings.", "input": "23 year old male with collection near gallbladder on prior CT. Complains of recurrent abdominal pain. LIVER: The liver measures 16.6 cm in length. It demonstrates normal echotexture without focal lesions or biliary ductal dilatation. The main portal vein is patent and demonstrates hepatopedal flow with velocity of 0.2 m/s.GALLBLADDER, BILIARY TRACT: There is wall thickening of the gallbladder fundus, with numerous associated echogenic foci along the gallbladder wall. The region of abnormality measures 5.1 x 1.5 x 2.5 cm. Findings likely represent fundal adenomyomatosis. No evidence of fluid collection/abscess. No shadowing gallstones. No sonographic Murphy sign.PANCREAS: No significant abnormalities noted.OTHER: No ascites.", "output": "Findings compatible with focal fundal adenomyomatosis as described above."}
{"instruction": "Generate impression based on findings.", "input": "Ms.Shavonne Lundy is a 28 year old female who presents for follow-up of a nonpalpable right breast fibroadenoma. ULTRASOUND:A targeted right ultrasound was performed for the patient\u2019s area of concern. In the right breast, 3:00 position, 4 cm from the nipple, there is an 8 x 5 x 9 mm circumscribed hypoechoic mass, which is not significantly changed in size from the prior (measuring 9 x 7 x 6 mm). There is no significant internal vascularity associated with this mass. This sonographic appearance is compatible with a fibroadenoma.", "output": "No significant change in right breast fibroadenoma. Follow-up ultrasound can be performed at the discretion of the ordering physician or as clinically indicated. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "73 year old male with history of cholelithiasis, choledocholithiasis, isolated gastric varices. Evaluate liver vasculature. LIMITED ABDOMENLIVER: Slightly coarse echogenicity of the liver measuring 16.9-cm in length. No focal hepatic lesions.BILIARY TRACT: Gallbladder is contracted containing stones and sludge with mild gallbladder wall thickening. No pericholecystic fluid. Sonographic Murphy's sign is negative. Common bile duct is not well visualized in its entirety, however there is no evidence of biliary ductal dilatation or choledocholithiasis of the visualized portion.PANCREAS: Visualized portions of the pancreas are normal in echogenicity. No pancreatic ductal dilatation.SPLEEN: Normal echogenicity of the spleen measuring 11.47 m in length. RIGHT KIDNEY: Right kidney measures 12.9 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 14.6 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "1. Slight coarse echogenicity of the liver suggestive of parenchymal distortion/fatty infiltration.2. Common bile duct not well visualized in its entirety, however no evidence of choledocholithiasis or ductal dilatation is noted. 3. Contracted gallbladder containing stones and sludge with mild gallbladder wall thickening. Sonographic Murphy's sign is negative. 4. Patent inflow and outflow hepatic vasculature. "}
{"instruction": "Generate impression based on findings.", "input": "Female 59 years old; Reason: thyroid nodules. RIGHT LOBE MEASUREMENTS: 4.8 x 2.0 x 1.8 cm.LEFT LOBE MEASUREMENTS: 4.2 x 2.0 x 1.6 cm.ISTHMUS MEASUREMENT: 0.2 cm.RIGHT LOBE: Normal echogenicity of the right lobe without mass. The previously noted nodule is not visualized on the current study.LEFT LOBE: There are 2 nodules noted in the left thyroid.Nodule 1: measures approximately 0.6 x 0.5 x 0.2 cm and is in the superior, anterior aspect of the left thyroid. This is an oval, well-defined, and hypoechoic lesion. No calcifications or internal vascularity. It appears similar in appearance to the prior study.Nodule 2: Measures approximately 0.9 x 0.7 x 0.5 cm in size in the middle left thyroid lobe. It is round, well-defined, heterogenous and spongiform. Appears similar to the prior study.ISTHMUS: No significant abnormality noted.LYMPH NODES: Lymph node is again noted in the right level 3 neck, measuring approximately 0.5 x 0.2 cm in a similar appearance to the prior study; favor benign etiology.OTHER: There is a round hypoechoic echogenicity anterior and posterior to the left thyroid favored to be a parathyroid gland.", "output": "1.Multinodular thyroid as described above similar in appearance to the prior study."}
{"instruction": "Generate impression based on findings.", "input": "75-year-old male with history of HCV cirrhosis. Evaluate for HCC. LIVER: Measures 16.5 cm in length. Mildly nodular contour with increased echogenicity. A 1.7 x 1.4 x 2.1 cm avascular hypoechoic mass is identified in the left hepatic lobe, no associated posterior acoustic enhancement seen to suggest a cyst.BILIARY TRACT: No significant abnormalities noted.PANCREAS: The pancreas is partially imaged due to bowel gas. Imaged portions of the pancreas appear unremarkable.SPLEEN: No significant abnormalities noted.KIDNEY: No significant abnormalities noted. OTHER: No ascites.", "output": "1. 2 cm mass in the left hepatic lobe indeterminate but worrisome for hepatocellular carcinoma. Recommend dedicated hepatic contrast enhanced MRI or CT for further characterization. 2. Cirrhotic liver morphology and increased echogenicity consistent with chronic liver disease."}
{"instruction": "Generate impression based on findings.", "input": "Recurrent UTIs RIGHT KIDNEY: Echogenic parenchyma again noted without mass, stone, or hydronephrosis. Right kidney 10.7 cm in lengthLEFT KIDNEY: Echogenic parenchyma again noted without mass, stone, or hydronephrosis. 10.6 cm in lengthOTHER: Bladder nondistended", "output": "Echogenic renal parenchyma again noted consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for routine screening mammography. Sister diagnosed with breast cancer at age 74. Two standard digital views of both breasts and additional left MLO view were performed 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 a new focal symmetry in the left central inferior breast for which additional spot compression views and possibly ultrasound are recommended. Extensive vascular calcifications and scattered benign calcifications are redemonstrated.", "output": "New focal asymmetry in the left central inferior breast for which spot compression views and possibly ultrasound are recommended for further evaluation.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female patient with right upper quadrant abdominal pain. LIVER: The liver measures 13.3 in length and demonstrates heterogeneous, coarsened echotexture. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.15 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones or pericholecystic fluid. The gallbladder wall is slightly irregular near the fundus and borderline thickened measuring approximately 4 mm. 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 11 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 12.5 cm in length. No evidence of hydronephrosis. Two subcentimeter hyperechoic foci noted within the lower pole likely represent nonobstructing renal calculi.The spleen measures 16 cm in length.Foley catheter is noted within the bladder.", "output": "1. Coarsened hepatic echotexture which can be seen with hepatic parenchymal dysfunction.2. Non-specific slightly irregular, thickened gallbladder wall near the fundus; differential diagnosis includes both benign and malignant conditions including adenomyomatosis and neoplasm. 3. Subcentimeter nonobstructing left nephrolithiasis.Findings communicated via telephone to R. Young at 0928 hrs on 11/6/2015. "}
{"instruction": "Generate impression based on findings.", "input": "44-year-old with self palpated left breast mass. Difficult to appreciate on physician physical exam. History of left breast cancer status post mastectomy and reconstruction. A targeted left ultrasound was performed for the patient\u2019s area of concern. There is no solid or cystic mass identified. No finding to suggest fat necrosis.", "output": "No sonographic evidence for malignancy. Clinical follow-up for the palpable area of concern and routine diagnostic mammography of the right breast are recommended.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Rule out growth of nodules and adenopathy, 3 year follow-up study patient with multiple thyroid nodules RIGHT LOBE MEASUREMENTS: 5.3 x 1.8 x 1.7 cmLEFT LOBE MEASUREMENTS: 5.5 x 2.3 x 1.8 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: Multiple hypoechoic heterogenous solid thyroid nodules noted, mostly unchanged from prior study. Nodule 1 In the upper pole measures 0.9 x 0.6 x 0.5 cm, nodule 2 In the mid to lower pole measures 0.4 x 0.3 x 0.3 cm and nodule 3 in the inferior pole measures 1 x 0.7 x 0.5 cm which appears slightly more cystic than before.LEFT LOBE: Previously described partly cystic partly solid nodule in the inferior pole appears more solid on today's imaging and measures 2.3 x 1.6 x 1.5 cm, mostly unchanged from prior study.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 nodules mostly unchanged in size.Altered morphology of the inferior pole left thyroid nodule, now appears less cystic than before."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain. LIVER: The liver measures 24.6 cm in length. The background liver parenchymal echotexture is normal. There are several focal hypoechoic lesions within the liver some of which demonstrate a targetoid appearance. An example lesion within the left lobe measures 2.1 x 1.9 x 1.6 cm. There are also multiple cystic structures primarily in the right lobe of the liver several of which contain fine internal septations. The largest cystic structure is in the right lobe measuring 7.9 x 9.0 x 12.0 cm. The portal vein is patent demonstrating normal hepatopetal flow with an elevated velocity of 0.64 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. There is a non-shadowing, nonmobile structure along the body of the gallbladder wall measuring up to 8 mm which lacks internal vascularity and is compatible with a polyp. 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 11.5 cm in length. RIGHT KIDNEY: Kidney measures 12.0 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 11.2 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Several hypoechoic hepatic lesions, which are nonspecific but could reflect metastases. Dedicated cross-sectional imaging of the abdomen and pelvis with intravenous contrast is recommended for further characterization.2.Mildly increased flow velocity in the main portal vein which is nonspecific but which could suggest narrowing.3.Several hepatic cysts.4.No evidence of acute cholecystitis or biliary ductal dilatation.5.8 mm gallbladder polyp, continued surveillance is recommended.Findings discussed with ordering ER physician at 2:14 PM on 11/21/2016. "}
{"instruction": "Generate impression based on findings.", "input": "31-year-old female with ascites on CT. Evaluate for cirrhosis. LIVER: Liver is normal in echotexture and is upper limits of normal in size. There is not gross cirrhotic morphology. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein with normal velocity. No focal mass.BILIARY TRACT: Nondependent 4 mm echogenic focus in the gallbladder likely small polyp. No shadowing gallstones.PANCREAS: Not adequately visualized due to bowel gas.SPLEEN: Normal in size.RIGHT KIDNEY: Poorly visualized and highly atrophic. OTHER: Left kidney poorly visualized and highly atrophic.Extensive ascites throughout the abdomen and pelvis. This contains mildly echogenic debris diffusely. This may be seen with ascites complicated by hemorrhage, infection or early may be due to complex fluid associated with mucinous neoplasm.", "output": "No gross morphology of the liver to suggest cirrhosis.Extensive, complex ascites, presumably due to hemorrhage.Atrophic kidneys without hydronephrosis.Small gallbladder polyp."}
{"instruction": "Generate impression based on findings.", "input": "22-year-old female looking for a shunt related pseudocyst /CSF-oma. History of prior pseudocyst. Presents with abdominal pain. Targeted ultrasound of the right and left upper and lower quadrants was performed. There is no discrete fluid collection identified to suggest pseudocyst formation.Note is made of the gastrojejunostomy tube balloon.", "output": "No fluid collection to suggest pseudocyst formation."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Dogan is a 36 year old female with a personal history of bilateral breast cancer (left breast IDC x2, right breast DCIS). Patient is currently on Femara therapy and Herceptin. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. In the right breast, extensive pleomorphic calcifications are not significantly changed, spanning approximately 11 x 5 cm (AP x SI), and continue to extend to within 1 cm from the right nipple base. In the left breast, the biopsy proven retroareolar mass as well as the inferior left breast mass appear similar to the prior mammogram. There continue to be calcifications at the site of the inferior left breast mass, which span approximately 3.5 cm in the AP dimension and approach to within 1 cm of the inferior skin surface. Stable benign morphology mass seen in the left upper outer breast, compatible with biopsy proven fibroadenoma. LEFT BREAST ULTRASOUND", "output": "Bilateral breast malignancies with unchanged appearance on mammogram. The left breast masses and axillary lymphadenopathy appear improved on ultrasound. Continued surgical consultation is recommended. Results and recommendations were discussed with the patient.BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for gallstones History: RUQ pain LIVER: The liver measures 18.87 m in length, enlarged. Unremarkable hepatic parenchymal echogenicity and echotexture. The portal vein is patent with normal directional hepatopedal flow, peak velocity 49.0 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: No shadowing stones or gallbladder sludge. The gallbladder wall measures 0.3 cm. The common bile duct measures 0.4 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 7.7 cm in length. Markedly echogenic renal parenchyma with numerous anechoic, cystic lesions, consistent with end-stage renal disease. No shadowing renal calculi or hydronephrosis.OTHER: The spleen is enlarged, measuring 10.5 cm in length. No ascites.", "output": "1. Hepatosplenomegaly. No evidence of cholelithiasis or acute pericholecystic inflammation.2. Bilateral echogenic, multicystic kidneys, consistent with end-stage renal disease."}
{"instruction": "Generate impression based on findings.", "input": "History of NASH and hepatitis C cirrhosis, evaluate liver and biliary system. Exam limited due to body habitus. LIVER: The liver measures 16 cm in length. Coarse echotexture and nodular capsule consistent with cirrhosis. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.1 m/s.BILIARY TRACT: Status post cholecystectomy. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 2 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: The spleen measures 15.2 cm in length. RIGHT KIDNEY: Kidney measures 9.4 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 11.8 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "Limited study due to patient's body habitus. Cirrhotic liver. Splenomegaly. "}
{"instruction": "Generate impression based on findings.", "input": "55 -Year-old female with history of hepatitis C. Evaluate for hepatocellular carcinoma. Limited evaluation due to poor penetration of ultrasound.LIVER: The patient is status post cholecystectomy. Normal appearing liver parenchyma, without focal masses or significant intrahepatic biliary dilatation.BILIARY TRACT: No significant biliary dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "No focal masses or significant intrahepatic biliary dilatation."}
{"instruction": "Generate impression based on findings.", "input": "History of papillary thyroid cancer status post thyroidectomy. RIGHT LOBE THYROIDECTOMY BED: No specific sonographic findings to suggest tumor recurrence.LEFT LOBE THYROIDECTOMY BED: No specific sonographic findings to suggest tumor recurrence.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A morphologically benign-appearing left level 3 lymph node is noted.OTHER: No significant abnormality noted.", "output": "Stable examination with no evidence of recurrent disease or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female status post gastric sleeve now with portal vein, SMV thrombosis. LIVER: Measures 13.3 cm in length. Patent hepatic artery with normal waveforms. The right portal vein is apparently patent and diminutive in caliber, with flow measuring 0.2 m/s. The left portal vein is patent, with flow measuring 0.3 m/s. The hepatic veins are patent.GALLBLADDER, BILIARY TRACT: No significant abnormality noted.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted.KIDNEYS: No significant abnormality noted. OTHER: The superior mesenteric vein is not visualized.", "output": "1. Patent left and right portal vein branches as detailed above. 2. Nonvisualization of the superior mesenteric vein. "}
{"instruction": "Generate impression based on findings.", "input": "35 year old female with a history of mild transaminitis and concern for NASH. LIVER: The liver parenchyma is coarsened and increased in echogenicity. Normal hepatic contour and morphology. Increased echogenicity limits evaluation for a small focal lesion. Given this limitation, no focal hepatic lesion is evident. The liver is normal in size, measuring 20 cm in craniocaudal dimension. There is 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 3 mm. There are small layering gallstones without wall thickening, pericholecystic fluid, or focal tenderness.PANCREAS: The visualized portions of the pancreatic body and head are normal.RIGHT KIDNEY: The right kidney measures 13.3 cm in length without hydronephrosis, shadowing nephrolithiasis, or focal lesion evident.OTHER: The left kidney is normal in size, measuring 13.2 cm without hydronephrosis or focal lesion evident. There is an approximately 8mm collecting system shadowing calculus. The spleen is normal in size, measuring 11.4 cm.", "output": "1. Coarsened and increased hepatic echogenicity compatible with diffuse fatty infiltration/NASH. No focal hepatic lesion is identified.2. Cholelithiasis without evidence of acute cholecystitis. 3. Nonobstructive left renal collecting system 8-mm calculus."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for cholecystitis/docholithiasis History: Abdominal pain. Pancreatic and cbd dilation on ct. Possible ampullary cancer vs impacted gallstone. 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. No shadowing choledocholithiasis identified.PANCREAS: Pancreas is largely obscured. There appears to be mild prominence of the proximal pancreatic duct as seen on recent CT.", "output": "No evidence of acute cholecystitis or significant biliary ductal dilatation. Mildly prominent proximal pancreatic duct as seen on same-day CT. If there is continued clinical concern for an ampullary process or choledocholithiasis, MRCP can be considered as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Female; 60 years old. Reason: pain at r femoral vein site, evaluate for hematoma History: pain No evidence of fluid collection or hematoma at the site of the right femoral line. There is perhaps mild skin thickening at the line site, correlation with physical exam is recommended.", "output": "No fluid collection or hematoma at the right femoral line site."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with right upper quadrant pain. History of Crohn's disease. LIVER: Normal in size and echotexture. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. Visualized biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.SPLEEN: Poorly visualized due to high position.RIGHT KIDNEY: There is a shadowing, echogenic focus in the midportion of the right kidney likely representing a nonobstructing calyceal calculus.OTHER: Limited views of left kidney demonstrate no abnormality.", "output": "Normal gallbladder and biliary tract.Nonobstructing right renal stone."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury evaluate for evidence of urinary obstruction. ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures 11.3 cm in length. The cortex has normal echogenicity. No hydronephrosis is seen. No significant abnormalities are seen.LEFT KIDNEY: The left kidney measures 9.6 cm in length. The cortex is normal echogenicity. No hydronephrosis is seen. No significant abnormalities are seen. The left kidney is not well-visualized in this exam as patient was not able to turn.LIVER: Portions of the liver visualized on this exam, the parenchyma appears to have increased echogenicity. BLADDER: The bladder is not well-visualized on this exam.OTHER:There is large volume free fluid seen within the pelvis.", "output": "1. Bilaterally negative renal ultrasound. No hydronephrosis is seen.2. Large volume free fluid is seen within the abdomen and pelvis.3. Portions of the liver were visualized on this exam and are concerning for increased echogenicity compatible with fatty liver/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid cancer follow-up RIGHT LOBE MEASUREMENTS: 3.2 x 1.2 x 1.1 cm.LEFT LOBE MEASUREMENTS: Resected.ISTHMUS MEASUREMENTS: No significant abnormality noted.RIGHT LOBE: Hypoechoic nodule in the superior right lobe measures 0.9 x 0.5 x 0 .5 cm, similar in appearance to the prior exam.LEFT LOBE: Resected. A large lipoma is present in the left thyroid bed measuring greater than 4 cm in greatest dimension.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional adenopathy.OTHER: No significant abnormality noted.", "output": "1.Postsurgical changes with stable nonspecific right thyroid nodule. 2.No regional adenopathy. 3.Left neck lipoma."}
{"instruction": "Generate impression based on findings.", "input": "34 year old male with right anterior cervical enlarged lymph node. A targeted ultrasound exam was performed of the patient's right anterior neck, at the site of palpable abnormality. In the right neck, at level 1, there is a corresponding 2.0 x 1.5 x 0.6 cm lymph node with a normal oval morphology and a fatty hilum. No cystic component or associated calcifications. Additional morphologically unremarkable and normal sized cervical lymph nodes are noted. Limited evaluation of the thyroid is normal.", "output": "Slightly prominent but morphologically normal appearing right level 1 lymph node. Benign etiology is favored as lymph nodes at this level may normally be prominent. Alternatively, node may be reactive in etiology."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old female with history of right upper quadrant pain, abnormal liver enzymes. Evaluate for biliary obstruction. LIVER: Measures 24.0 cm in length. Innumerable hypoechoic lesions throughout the liver. Patent portal vein with antegrade flow. BILIARY TRACT: No cholelithiasis. Partially collapsed gallbladder without 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: Incompletely visualized due to bowel gas. KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "Innumerable hepatic lesions highly suspicious for metastatic disease given the clinical history, please see separately dictated MRI examination for further characterization. No evidence of biliary obstruction as clinically questioned."}
{"instruction": "Generate impression based on findings.", "input": "60 years old, Female, Reason: Abnormal nodules History: thyroid cancer MEASUREMENTS: Patient status post thyroidectomyRIGHT LOBE AREA: No significant abnormality noted.LEFT LOBE AREA: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No evidence of lymphadenopathy.OTHER: No significant abnormality noted.", "output": "No evidence of local recurrence or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "39 year old female with low TSH. RIGHT LOBE MEASUREMENTS: 4.9 cm x 2.0 cm x 1.6 cmLEFT LOBE MEASUREMENTS: 5.5 cm x 1.8 cm x 1.4 cmISTHMUS MEASUREMENTS: No significant abnormality noted.RIGHT LOBE: Heterogeneous echotexture with two nodules noted, dominant nodule in the lower pole is is predominately cystic measuring 2.5 cm x 1.4 cm x 1.1 cm. The second smaller nodule is mixed solid cystic and appears spongiform in appearance. LEFT LOBE: Heterogeneous echotexture containing multiple nodules which are mixed solid cystic in appearance and containing echogenic foci with comet tail artifact most consistent with colloid nodules. Reference nodule in the lower pole measures 1.1 cm x 0.9 cm x 1.2 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right neck level 3 benign appearing lymph node measuring 0.5 cm x 0.3 cm x 1.3 cm.Additional left level 2 lymph node not containing a prominent fatty hilum measures 1.1 cm x 0.9 cm x 0.5 cm. OTHER: No significant abnormality noted.", "output": "1. Heterogeneous thyroid gland suggestive of thyroiditis. Bilateral thyroid nodules as described above for which continued surveillance is recommended. 2. Bilateral neck lymph nodes with lymph node in the left neck not containing a prominent fatty hilum and is likely reactive. Continued surveillance is recommended. "}
{"instruction": "Generate impression based on findings.", "input": "76 year-old female with primary hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 5.2 x 1.5 x 1.9 cmLEFT LOBE MEASUREMENTS: 4.4 x 2.1 x 1.4 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: The right thyroid lobe is heterogeneous in appearance with several spongiform nodules and sub-centimeter hypoechoic nodules. In the superior pole of the right thyroid lobe is a coarsely calcified .9 x .8 x 1.1 cm nodule whose visualized margins are well-defined. LEFT LOBE: The right thyroid lobe is heterogeneous in appearance with several spongiform nodules and sub-centimeter hypoechoic nodules. The largest nodule measures 1.3 x 0.9 x 1.1 cm in the inferior pole with a spongiform appearance, compatible with a colloid nodule. ISTHMUS: The isthmus is heterogeneous in appearance with no discrete dominant nodule. PARATHYROID GLANDS: Immediately caudal to the right thyroid lobe is a 0.9 x 0.8 x 1.1 cm hyperechoic mildly vascular focus. Similarly, there is a 1.1 x 0.6 x 0.8 cm hyperechoic avascular focus immediately caudal to the left thyroid lobe.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Hyperechogenic foci immediately caudal to the right and left thyroid lobes are non-specific and can represent focal fat; the appearance would be atypical for parathyroid adenomas. Correlation with a nuclear medicine parathyroid scan is suggested.2. Coarsely calcified 1.1-cm right superior pole nodule. Fine needle aspiration should be considered. 3. Multiple bilateral subcentimeter nodules, many of which have a characteristic spongiform appearance of colloid nodules."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old male with history of acute kidney injury. RIGHT KIDNEY: Measures 11.3 cm in length. Mildly increased echogenicity with prominent pyramids. Focal increased echogenicity along the lateral margin of the right kidney most likely represents adjacent mesenteric fat along a focally lobulated contour. 1.2 cm right renal cyst without septation or solid component. No nephrolithiasis, hydronephrosis, or suspicious masses.LEFT KIDNEY: Measures 11.7 cm in length. Mildly increased echogenicity with prominent pyramids. No nephrolithiasis, hydronephrosis, or solid mass.URINARY BLADDER: Incompletely distended.OTHER: No significant abnormalities noted.", "output": "Increased echogenicity consistent with medical renal disease. No hydronephrosis, nephrolithiasis, or suspicious mass lesion. "}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status, acute renal failure ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures 10.9 cm in length. There is marked hydronephrosis seen with significant internal debris within the collecting system. The cortex has increased echogenicity and is thinned. There is a proximal ureteral calculus seen that appears to be obstructing. This measures 1.2 cm x 0.5 cm.LEFT KIDNEY: The left kidney measures 8.3 cm in length. There is moderate degree hydronephrosis seen. There is a hypoechoic area redemonstrated in the upper pole measuring 3.4 cm x 3.1 cm x 3.7 cm, however this is poorly assessed. There is increased echogenicity of the cortex.OTHER: Echogenic structure(s) seen within the bladder which may represent ureteral stent placement.", "output": "1. There is right greater than left moderate to marked hydronephrosis with a significant amount of debris, concerning for pyonephrosis or superimposed infection. There is also a proximal right ureteral calculus measuring 1.2 cm x 0.5 cm, suspected to be obstructing.2. Bilaterally there is increased renal cortical echogenicity consistent with medical renal disease.3. Ureteral stent placement questioned, see above; if so correlate clinically for appropriate functioning due to presence of bilateral hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old male with fullness, discomfort the testicles left greater than right. RIGHT TESTIS: Measures 3.8 cm x 1.8 cm x 2.6 cm. normal homogeneous echotexture.Normal arterial and venous flow is visualized on Doppler exam.LEFT TESTIS: Measures 4.8 cm x 2.3 cm x 2.9 cm. Normal homogeneous echotexture.Normal arterial and venous flow is visualized on Doppler exam.RIGHT EPIDIDYMIS: Measures 2.8 cm x 1.0 cm x 0.8 cm and is normal in echogenicity. LEFT EPIDIDYMIS: Measures 3.5 cm x 0.9 cm x 0.8 cm and is normal in echogenicity. OTHER: No significant abnormalities noted.", "output": "No testicular masses are noted. No evidence of testicular torsion."}
{"instruction": "Generate impression based on findings.", "input": "18-year-old female with familial hypophosphatemia. Evaluate for renal stone. RIGHT KIDNEY: The right kidney measures 9.7 cm in length. Echotexture is normal. There is a 2.4 cm upper pole parapelvic cyst. No hydronephrosis, shadowing calculus or solid mass.LEFT KIDNEY: The left kidney measures 10 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "Right parapelvic renal cyst. Otherwise normal exam."}
{"instruction": "Generate impression based on findings.", "input": "Ms. KATHERINE GADALINSKI is a 40 years old female with a personal history of a focal asymmetry noted on screening mammography in the right lower inner breast. MAMMOGRAM: Three standard views of the right breast as well as two 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. 4 mm circumscribed benign morphology mass persist on spot compression views.ULTRASOUND:A targeted right ultrasound was performed for the mammographic area of concern. There is no solid or cystic mass identified. Normal glandular tissue is noted.", "output": "High probability benign morphology mass in the right breast lower inner quadrant without sonographic correlate. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended in 6 months. Results and recommendation 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": "67-year-old female with nontoxic single thyroid nodule. RIGHT LOBE MEASUREMENTS: 6.1 x 3.4 x 2 cmLEFT LOBE MEASUREMENTS: 5.7 x 2.4 x 1.5 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Parenchyma is heterogeneous with hyperechoic and hypoechoic areas. This may be seen with thyroiditis. Large solid nodule which is mildly hypoechoic with internal cystic component in the midportion of the gland measuring 1.3 x 2.7 x 2.9 cm. This corresponds to the CT abnormality. In the inferior right lobe is a minimally hypoechoic, rounded solid mass measuring 1 x 1.2 x 1.6 cm with a partial halo. Smaller hypoechoic nodules are present as well.LEFT LOBE: Parenchyma is heterogeneous with hyperechoic and hypoechoic areas. In the anterior, midportion of the left lobe is a hypoechoic and mildly heterogeneous mass, measuring 0.6 x 1.3 x 1.5 cm. Very hypoechoic but heterogeneous, posterior mass in the inferior left lobe is believed to be extrathyroidal, measuring 1 x 0.9 x 1.3 cm alternately this could represent a somewhat pedunculated or exophytic left thyroid nodule. There are also other slightly hypoechoic nodules that are not adequately defined for measurement. Small cystic nodules are present as well. ISTHMUS: Heterogeneous. Small cystic areas with comet tail consistent with colloid.PARATHYROID GLANDS: See above. Potential parathyroid adenoma on the left.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple, bilateral thyroid nodules with a background heterogeneous parenchyma.Probable extrathyroidal mass on the left."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Normal echogenicity without mass. Liver length 14.6 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.3 cm in lengthOTHER: Left kidney 10.4 cm in length. Spleen 9.3 cm in length. No ascites", "output": "Negative right upper quadrant ultrasound. No hepatobiliary abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Meeks is a 23 year old female presenting with a self palpated lump in the right medial breast for the past one week. She denies any tenderness, history of trauma, overlying skin changes, or fevers. Upon physical exam at the palpable area of abnormality, a vague soft, nontender mass was appreciated.Targeted right breast ultrasound was performed at the patient's area of concern. No suspicious cystic or solid mass was identified. However, a slightly prominent fat lobule was noted, which may correlate to the palpable area of abnormality.", "output": "No sonographic evidence of malignancy. Patient should follow up with her primary care physician as clinically warranted.BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Normal echogenicity without mass. Liver length 16 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.3 cm in lengthOTHER: Left kidney 11.3 cm in length. Spleen 8 cm in length. No ascites.", "output": "Cholelithiasis without acute inflammation or ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "The patient submitted outside ultrasound dated 4/9/2009. Submitted outside study was compared to the more recent ultrasound dated 12/12/14. The right outer breast mass measures up to 2.2 x 1.5 cm in 2009. This is larger than the more recent measurements from 2014 (1.4 x 0.8 x 1.4 cm).", "output": "Biopsy proven benign mass in the right breast measures slightly smaller on the more recent ultrasound from 2014. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Female 28 years old Reason: please evaluate right flank for hematoma formation History: anemia, firm mass under incision on right flank/abdomen Soft tissue edema along the right flank. Heterogeneous well-circumscribed collection in the deep subcutaneous tissues along the site of the incision concerning for hematoma. Estimated measurements 12 x 10 x 4 cm.", "output": "Probable hematoma as measured."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old male with conjugated hyperbilirubinemia, abdominal discomfort. LIVER: Mildly coarsened hepatic echotexture suggests hepatic steatosis.GALLBLADDER, BILIARY TRACT: Sludge in the gallbladder lumen. No gallbladder wall thickening or pericholecystic fluid. No sonographic Murphy's sign was elicited.No evidence of intrahepatic or extrahepatic biliary ductal dilation.PANCREAS: The pancreas is not well-visualized due to bowel gas.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "1.Gallbladder sludge without evidence of cholecystitis or biliary obstruction.2.Increased hepatic echogenicity suggestive of hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "Female 68 years old; Reason: Abnormal masses? History: thyroid cancer s/p surgery only RIGHT LOBE, LEFT LOBE, ISTHMUS MEASUREMENTS: The thyroid has been surgically removed.RIGHT LOBE: Has been surgically removed.LEFT LOBE: Has been surgically removed.ISTHMUS: Has been surgically removed.LYMPH NODES: No suspicious adenopathy noted. OTHER: Approximately 0.6 x 0.4 cm oval hypoechoic area in the bed of the left aspect of the isthmus may represent scar tissue.", "output": "1.Surgical changes of a prior thyroidectomy.2.Attention to area of possible scarring vs nodule in the left isthmus area on subsequent exams."}
{"instruction": "Generate impression based on findings.", "input": "Male, 69 years old. Reason: kidney stone History: stone RIGHT KIDNEY: The right kidney measures 11.0 cm in length, with mildly increased cortical echogenicity. A lower pole septated cyst measures 4.6 x 4.4 x 4.0 cm, unchanged from prior imaging dated 12/2010. Compared to the CT exam from 10/29/2015, there is redemonstration of mild to moderate hydronephrosis with proximal hydroureter. The remainder of the ureter is not visualized. No obvious stones are seen on today's exam, and no additional radiodense stones were seen on prior CT. LEFT KIDNEY: The left kidney measures 13.0 cm in length, with mildly increased cortical echogenicity. A midpole renal stone measures 1.0 x 0.6 x 0.8 cm. No hydronephrosis.OTHER: The bladder is not well visualized, likely decompressed.", "output": "1.Redemonstration of right hydronephrosis and proximal hydroureter, without right renal stone identified.2.Nonobstructing left renal stone, without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "History of thyroid nodule, assess for changes. RIGHT LOBE MEASUREMENTS: 4.8 x 1.4 x 1.2 cmLEFT LOBE MEASUREMENTS: 5.0 x 1.4 x 1.5 cmISTHMUS MEASUREMENTS: Up to 3 mm RIGHT LOBE: Normal echotexture.LEFT LOBE: Normal echotexture.ISTHMUS: There is a part cystic, part solid heterogeneous nodule in the thyroidal isthmus measuring approximately 1.5 x 0.9 x 1.2 cm, previously 1.8 x 1.0 x 1.8 cm. The cystic component has decreased in size.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Mixed solid/cystic isthmus nodule, with interval decrease in size of the cystic component."}
{"instruction": "Generate impression based on findings.", "input": "Septic shock with history UTI RIGHT KIDNEY: Unremarkable echogenicity without mass, stone, or hydronephrosis. Right kidney 13.7 cm in lengthLEFT KIDNEY: Unremarkable echogenicity without mass or stone. Minimal hydronephrosis. 12.7 cm in lengthOTHER: Bladder collapsed around Foley catheter", "output": "Minimal left hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for routine screening mammography. Mother and aunt diagnosed with breast cancer. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Best seen on the left MLO view is focal asymmetry in the upper outer breast for which further evaluation with spot compression views and possibly ultrasound is recommended. Small tight cluster of calcifications in the right upper outer breast for which further evaluation with spot magnification views is recommended. A few loosely scattered calcifications in the left breast.", "output": "1. Focal asymmetry in the left upper outer breast for which further evaluation with spot compression views and possibly ultrasound is recommended. 2. Small tight cluster of calcifications in the right upper outer breast for which further evaluation with spot magnification views is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "Preoperative planning. Based on ultrasound examination from yesterday the patient has a left arm mass. There is tenting of the anterolateral skin of the upper arm presumably represents the subcutaneous lesion seen on yesterday's ultrasound. I see no soft tissue calcification. The underlying bone appears normal.", "output": "Left arm mass better depicted on yesterday's ultrasound examination."}
{"instruction": "Generate impression based on findings.", "input": "Female 54 years old with palpable left breast lumps and thickening. History of left breast calcifications status post biopsy showing radial scar in outside hospital. A targeted left ultrasound was performed for the patient\u2019s area of concern. On physical examination, no discrete palpable mass noted. No discrete solid or cystic mass identified. Normal glandular tissue noted.", "output": "No sonographic evidence for malignancy corresponding to palpable area of concern in the left upper-outer quadrant.Annual diagnostic mammogram due, in August 2017 is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Pregnant patient with right upper quadrant pain. The study is slightly limited due to poor soft tissue penetration.LIVER: The liver is normal in size measuring 15.2 cm in length. It is mildly coarse and increased in echogenicity. Normal hepatopedal portal venous blood flow at 0.3 m/s.Shadowing gallstones in a contracted gallbladder. No wall thickening, pericholecystic fluid or focal tenderness.BILIARY TRACT: No biliary ductal dilatation with the common duct measuring 3 mm. Shadowing gallstones in a contracted gallbladder. No wall thickening, pericholecystic fluid or focal tenderness.PANCREAS: The very poorly seen pancreas shows no significant abnormality.SPLEEN: The spleen is normal in size and appearance measuring 10.7 cm.RIGHT KIDNEY: The right kidney is normal in size measuring 12 cm in length. There is mild pelviectasis which persists after the patient voided. OTHER: The left kidney is normal in size measuring 11 cm in length without hydronephrosis or shadowing of lithiasis.", "output": "1. Mild right-sided renal pelviectasis which persisted after the patient voided. This may be physiologic in the gravid state. 2. Cholelithiasis without evidence of acute gallbladder inflammation.3. Mildly coarse and echogenic liver parenchyma may reflect fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "42 year-old female with elevated alkaline phosphatase, evaluate for hepatobiliary etiology LIVER: Measures 14.3 cm. No focal hepatic lesions. No biliary ductal dilation. The portal vein is patent.GALLBLADDER, BILIARY TRACT: The gallbladder is normal in appearance without wall thickening or pericholecystic fluid. The common bile duct is normal in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Measures 9.4 centers. No hydronephrosis or mass.OTHER: The left kidney measures 10.8 cm. The spleen measures 8.5 cm.", "output": "Normal ultrasound of the right upper quadrant."}
{"instruction": "Generate impression based on findings.", "input": "17 year old woman presents for follow up of left breast mass. On physical exam, there is a mobile mass in the upper outer quadrant of the left breast.A targeted left grayscale and color Doppler ultrasound was performed for the palpable/clinical area of concern. In the left breast 2:00 position 4 cm from nipple at the site of palpable concern is a well circumscribe heterogeneous lobulated mass measuring in 3.6 x 2.0 x 2.7 cm, not significantly changed in size since the prior ultrasound when measured 3.9 x 1.8 cm. Internal vascularity is present. Sonographic features favor a fibroadenoma. Continued surgical clinic follow-up is recommended.", "output": "No enlargement in size of left breast mass.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Reason: r/o growth of nodule, adenopathy History: h/o nodule with coarse calcifications RIGHT LOBE MEASUREMENTS: 4.3 x 1.3 x 1.3 cm.LEFT LOBE MEASUREMENTS: 5.0 x 1.2 x 1.4 cm.ISTHMUS MEASUREMENTS: Up to 0.1 cm in thickness.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: Predominantly hypoechoic nodule with peripheral calcifications measures 1.4 x 0.8 x 0.9 cm, unchanged.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy seen.OTHER: No significant abnormality noted.", "output": "No significant change in left lower pole thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old male patient status post DDRT now with increased JP output and dropping hemoglobin. RENAL TRANSPLANT: LOCATION: Left iliac fossa.PERITRANSPLANT TISSUES: There is a 10.1 x 15.0 cm heterogeneous collection superior and lateral to the transplant kidney suggestive of a hematoma.KIDNEY: The transplant kidney measures 10.6 cm in length.COLLECTING SYSTEM/URETER: No evidence of hydronephrosis.URINARY BLADDER: The bladder is decompressed with a Foley catheter.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vesselsTransplant renal artery anastomosis: 54 cm/s with RI of 0.77Transplant renal artery proximal: 51 cm/s with RI of 0.79Transplant renal artery mid: 56 cm/s with RI of 0.80Transplant renal artery distal: 46 cm/s with RI of 0.74Transplant renal artery hilum: 37 cm/s with RI of 0.72Segmental arteries RI range: 0.61 to 0.70Arcuate arteries RI range: 0.55 to 0.67OTHER: No significant abnormality noted", "output": "Heterogeneous collection superolateral to the transplant kidney which is suggestive of a perinephric hematoma; correlation with non-contrast CT is recommended. "}
{"instruction": "Generate impression based on findings.", "input": "Two focal asymmetries seen in the right breast and two focal asymmetries seen in the left breast on screening mammogram. Family history of breast cancer in paternal grandmother and two maternal great aunts. Three standard views of both breasts 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. The two circumscribed masses in the right lateral and retroareolar breast persist on spot compression images. The two focal asymmetries in the left upper outer breast partially disperse on spot compression images.ULTRASOUND", "output": "1. 9 mm indeterminate left lateral breast mass. Ultrasound guided biopsy is recommended.2. Bilateral simple breast cystsBIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old male with abdominal mesothelioma. Evaluate for hydronephrosis. UTI, febrile after removal of percutaneous nephrostomy tubes. RIGHT KIDNEY: The right kidney measures 13.3 cm in length. Right ureteral stent partially visualized. No hydronephrosis. Echogenic renal parenchyma.LEFT KIDNEY: The left kidney measures 11.9 cm in length. Mild hydronephrosis on the left. A left ureteral stent partially visualized. Echogenic renal parenchyma.URINARY BLADDER: Partially distended urinary bladder, and ureteral stents are partially visualized.OTHER: No significant abnormalities noted.", "output": "Mild hydronephrosis on the left. Bilateral ureteral stents in place."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for abdominal abscess. 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. Contracted gallbladder with minimal wall thickening, decreased compared to prior. No gallstones 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 7.9 cm in length. The left kidney is 10.0 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 8.3 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites is identified.", "output": "1. No specific findings to account for the patient's symptoms. Specifically no evidence of acute cholecystitis or abdominal fluid collection, per clinical query.2. Decreased size of the kidneys, reflecting some degree of atrophy."}
{"instruction": "Generate impression based on findings.", "input": "Ms. MacQueen is a 28-year-old female presenting with a physician palpated lump in the left inferior breast. Per patient, she herself does not palpate any discrete mass. She denies any history of trauma, fever or chills Upon physical exam at the physician palpated area of concern, no discrete mass is appreciated. There is subtle nodularity to the breast parenchyma at this area.A targeted left breast ultrasound was performed for the palpable area of concern. In the left inferior breast 6 o'clock location, approximately 1 cm from the nipple, no suspicious cystic or solid mass is identified.", "output": "No sonographic evidence for malignancy. Patient should follow up with her primary care physician as clinically warranted. 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": "Six month old male with history of hydronephrosis on outside ultrasound. KIDNEYS  Cortical Echogenicity: Normal on right, left kidney not visualized.  Medullary Echogenicity: Normal on right, left kidney not visualized.  Pelvicaliceal System -- SFU Grade*  Right: 0 Left: Not visualized  Length*** Right: 6.2 cm Left: Not visualized  Mean for age: 6 cm  Range for age: 4.5 - 7.5 cmADDITIONAL OBSERVATIONS: Patient family reports left kidney was seen in a low position on ultrasound from Kuwait when patient was one month of age. Now, no left kidney is visualized in any of the 4 abdominal quadrants or pelvis.", "output": "Normal solitary right kidney. Nonvisualized left kidney likely secondary to involution of a multicystic dysplastic kidney.*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 calyces are seen. Grade 4: Grade 3 and parenchymal thinning.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": "5-year-old male with VOD and ascites ABDOMENLIVER: The liver measures 13.1 cm in length. Increased echogenicity of the liver, unchanged. No focal hepatic lesions or masses are identified.GALLBLADDER, BILIARY TRACT: Mild pericholecystic edema, likely related to ascites. No intrahepatic or extrahepatic biliary ductal dilatation is present. Sludge is present within the gallbladder, unchanged.PANCREAS: No significant abnormalities are noted in the visualized head of the pancreas. The body and tail of the pancreas are obscured by bowel gasOTHER: Moderate to large amount of ascites, unchanged. DOPPLER: Color and spectral Doppler were performed on inflow and outflow vessels.PORTAL VENOUS: Patent with hepatofugal flow. Hepatofugal flow is identified in the right, left, and main portal veins. Velocities of main, right, and left portal veins measure 0.2, 0.2, 0.1 m/sec, respectively.HEPATIC ARTERIES: Patent with normal arterial waveform. Common hepatic artery: Peak systolic velocity of 1.5 m/sec. Resistive index 0.9. Right hepatic artery: Peak systolic velocity of 0.6 m/sec. Resistive index 0.8.Left hepatic artery: Peak systolic velocity of 0.4 m/sec. Resistive index 0.8.HEPATIC VEINS: Hepatic veins are patent with normal phasic waveform.INFERIOR VENA CAVA: Non-dilated with no significant abnormalities noted.", "output": "Persistent hepatofugal flow throughout the portal venous system. Mildly increased resistive indices in hepatic arterial system. Moderate to large amount of ascites, unchanged. Gallbladder sludge."}
{"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": "49 year old female with history of right upper quadrant pain. Evaluate for gallbladder stone. LIVER: No significant abnormalities noted. Liver measures 18.6 cm.GALLBLADDER, BILIARY TRACT: Cholelithiasis and gallbladder sludge are noted. The gallstone measures approximately 2.1 x 1.6 x 0.9 cm. No biliary dilatation, gallbladder wall thickening or pericholecystic fluid.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. The right kidney measures 10.6 cmOTHER: No significant abnormalities noted. The left kidney measures 11.3 cm. No sonographic Murphy sign.", "output": "Cholelithiasis and gallbladder sludge without findings of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Right thyroid nodule RIGHT LOBE MEASUREMENTS: 5.9 x 1.9 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.3 x 1.3 x 1.7 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Diffusely heterogeneous gland. Predominantly solid lower pole nodule measuring 2 x 1.5 x 1.5 cm.LEFT LOBE: Diffusely heterogeneous gland without nodule.ISTHMUS: Diffusely heterogeneous gland without nodulePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous thyroid gland. Predominantly solid right lower lobe thyroid nodule as described. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Linda Weber is a 68 years old female with right mastectomy for IDC 23 years ago followed by left prophylactic mastectomy in 2010 with a reconstruction presents for follow-up for a palpable mass in the right axilla. Patient states that the palpable area in her right axilla is not painful anymore. A targeted right axillary ultrasound was performed for the palpable area of concern. There is redemonstration of the possibly encapsulated heterogeneous mass with mixed echogenicity, which has slightly decreased in size from the prior study and now measures 2.5 x 0.7 x 2.1 cm (previously 2.9 x 0.7 x 2.6 cm). This again likely represents a benign pathology, such as fat necrosis. No suspicious mass is noted.", "output": "No sonographic evidence for malignancy. Interval slight decrease in size of the previously described benign heterogeneous mass. Further imaging follow up should be dictated by any changes on physical exam. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female with history of proteinuria and hematuria. RIGHT KIDNEY: Measures 10.8 cm in length. Unremarkable echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 9.7 cm in length. Unremarkable echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: Increased hepatic echogenicity is incompletely imaged.", "output": "1. No hydronephrosis, nephrolithiasis, or suspicious renal mass.2. Increased hepatic echogenicity partially imaged consistent with hepatic steatosis or parenchymal disease."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney failure. Evaluate for obstructive or renal parenchymal disease. RIGHT KIDNEY: The right kidney measures 9.0 cm. Minimal increased echogenicity of the right kidney. No renal calculus, hydronephrosis or suspicious lesion identified.LEFT KIDNEY: The left kidney measures 9.9 cm. Minimal increased echogenicity of the left kidney. No renal calculus, hydronephrosis or suspicious lesion identified.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Minimal increased echogenicity of the kidneys, may represent medical renal disease. No renal calculus, hydronephrosis or suspicious renal lesion."}
{"instruction": "Generate impression based on findings.", "input": "66 year old male with history of tachycardia, altered metal status, immunosuppression. Evaluate for infection source. LIVER: Heterogeneous liver parenchyma echogenicity. The liver measures 21 cm. No focal masses are seen.BILIARY TRACT: Cholelithiasis and gallbladder sludge, without gallbladder wall thickening or pericholecystic fluid.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. The spleen measures 10.4 cm.RIGHT KIDNEY: No significant abnormalities noted. The right kidney measures 13 cm.OTHER: No significant abnormalities noted. The left kidney is within normal limits, and the measures 12 cm.", "output": "Hepatomegaly and findings of fatty liver infiltration. Gallbladder cholelithiasis without findings of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules RIGHT LOBE MEASUREMENTS: 2.4 x 2.8 x 7.0 cm.LEFT LOBE MEASUREMENTS: 2.4 x 2.6 x 7.1 cmISTHMUS MEASUREMENTS: 6 mm in AP dimensionRIGHT LOBE: Multiple heterogeneous nodules noted, some of which are spongiform. The largest of these measures 14 mm. No suspicious calcifications or vascularity are identified.LEFT LOBE: Spongiform 19 mm nodule noted in the inferior pole.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not identifiedLYMPH NODES: Normal morphology cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "Multiple bilateral thyroid nodules, the largest of which measures 19 mm in the left lobe."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female with history of bilateral breast cysts from 2014. Bilateral breast ultrasound examination was performed.LEFT BREAST:Targeted ultrasound of the left breast at the 12:00 position approximately 2 cm from the nipple reveals an oval avascular circumscribed anechoic 5 mm mass with posterior acoustic enhancement compatible with simple cyst. A similar 4 mm cyst was identified in the left breast at the 3:00 position 2 cm from the nipple.6 mm simple cyst within the left breast at 4:00 position 2 cm from the nipple. 5 mm simple cyst within the left breast at the 10:00 position 2 cm from the nipple.RIGHT BREAST:3 mm simple cyst within the right breastTargeted ultrasound of the right breast at the 6:00 position 2 cm from the nipple reveals another oval avascular circumscribed anechoic 3 mm mass with posterior acoustic enhancement compatible with simple cyst. Another similar finding is present at the 9:00 position 2 cm from the nipple, measuring 9 mm.There is no solid mass identified.", "output": "Bilateral simple mammary cysts. No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Kompare is a 67 year old female with a personal history of bilateral mastectomies with reconstruction in 1994 treated with tamoxifen therapy. Patient also has a history of excision of right shoulder melanoma with sentinel lymph node biopsy performed in July 2011. She now presents with a palpable lump in the right axilla since July 2016. A targeted right breast ultrasound was performed for the patient's area of concern.In the right axilla, at site of palpable area of concern, there is a reniform shaped hypoechoic mass identified measuring 0.7 x 0.3 x 0.6 cm. Sonographic findings are compatible with a normal axillary lymph node.", "output": "Normal axillary lymph node at site of palpable concern in the right axilla. No sonographic evidence of malignancy. Patient should follow up with her breast surgeon as clinically warranted. All results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old female with history of bilateral palpable breast lumps. Patient denies any breast lump at the time of this diagnostic ultrasound evaluation. Bilateral breast ultrasound was performed for the areas of previous palpable concern as indicated by the patient. Patient denies any breast lump at the time of this diagnostic study.Targeted ultrasound of the medial and lateral breasts reveals no cystic or solid mass.", "output": "Normal targeted diagnostic ultrasound evaluation of both breasts. No sonographic evidence for malignancy. Clinical follow up is recommended. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old female with enlarged thyroid. RIGHT LOBE MEASUREMENTS: 4.8 x 1.5 x 1.8 cm.LEFT LOBE MEASUREMENTS: 4.9 x 1.2 x 1.7 cm.ISTHMUS MEASUREMENTS: 0.3 cm.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: Scattered small cervical lymph nodesOTHER: No significant abnormality noted.", "output": "No thyroid nodules"}
{"instruction": "Generate impression based on findings.", "input": "Female 73 years old Reason: soft tissue superior aspect of the left kidney 1.4cm, R/o neoplasm History: renal mass RIGHT KIDNEY: Right kidney measures 8.7 cm. No focal lesions or hydronephrosis.LEFT KIDNEY: Left kidney measures 9 cm. No focal lesions or hydronephrosis.OTHER: No significant abnormalities noted.BLADDER: Unremarkable", "output": "Unremarkable ultrasound of the kidneys."}
{"instruction": "Generate impression based on findings.", "input": "23 year old with right breast pain. Clinical suspicion of abscess Ultrasound study is performed for the right breast. No cystic lesion suggesting abscess is present. No solid lesions or skin thickening are seen.", "output": "Negative for abscess in the right breast. Results were relayed to Dr. Adjei-Twum. BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "64 year old female with thyroid nodules, evaluate progression RIGHT LOBE MEASUREMENTS: 5.8 x 1.9 x 2.4 cmLEFT LOBE MEASUREMENTS: 5.6 x 1.6 x 1.7 cmISTHMUS MEASUREMENTS: 0.3 centimetersRIGHT LOBE: Mild diffuse heterogeneity. Right inferior pole hypoechoic nodule is stable measuring 0.6 x 0.4 x 0 .4 cm, previously 0.8 x 0.7 x 0.6 cm. Right midpole mixed solid and cystic nodule measures 0.6 x 0.4 x 0 .5 cm, previously 0.8 x 0.7 x 0.5 cm.LEFT LOBE: Mild diffuse heterogeneity. Left superior cystic nodule measures 0.5 x 0.6 x 0 .4 cm, previously 0.5 x 0.3 x 0.3 cm. Cystic nodule in the left inferior pole with a focus of colloid is minimally decreased measuring 0.8 x 0.7 x 0 .4 cm, previously 1.1 x 1.0 x 0.8 cm.ISTHMUS: Hypoechoic indeterminate nodule within the isthmus is unchanged measuring 0.9 by 0.8 x 0 .6 cm, previously 0.8 x 0.7 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multinodular thyroid, not significantly changed."}
{"instruction": "Generate impression based on findings.", "input": "55 years old, Female, Reason: 55F with abdominal pain that awakes her at night History: abdominal pain LIVER: The liver measures 15.2 cm in length. Diffusely increased echogenicity of the liver is consistent with 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. Per ultrasound technologist, the sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common 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 12.6 cm in length. Normal echotexture. No hydronephrosis or shadowing calculus. LEFT KIDNEY: Kidney measures 12.2 cm in length. Normal echotexture. No evidence of hydronephrosis or shadowing calculus. Left mid pole renal cyst measures 1.6 x 1.6 x 1.9 cm.OTHER: No significant abnormalities noted.", "output": "1. Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis.2. Diffusely increased echogenicity of the hepatic parenchyma is consistent with fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "Female 57 years old; Reason: thyroid nodules History: as above RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.1 x 1.6 x 1.2 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.1 x 1.6 x 1.3 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.24 cm.RIGHT LOBE: There are two lesions noted in the right thyroid as below.Lesion #1: There is an approximately 9mm x 6 mm round hypoechoic lesion in the right superior thyroid without posterior acoustic enhancement, microcalcifications, or internal vascularity.Lesions #2: There is an approximately a 5mm x 4mm oval hypoechoic and spongiform lesion in the right mid thyroid without definite posterior acoustic enhancement, microcalcifications, or internal vascularity. LEFT LOBE: There is one lesion noted in the left thyroid as below.Lesion #1: There is an approximately 7mm x 5mm hypoechoic lesion in the left superior thyroid without definite posterior acoustic enhancement, microcalcifications, or internal vascularity. This lesion appears similar to the lesion in the right superior thyroid.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted. OTHER: No significant abnormality noted.", "output": "1.Thyroid lesions as above without definite suspicious features."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Male 70 years old Reason: Pt w/ CHF p/w ADHF. Want to assess for significant ascites. LIVER: The liver measures 18.5 cm in length. The liver parenchymal echotexture is normal. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating pulsatile hepatopetal flow with a velocity of 0.19 m/s. The hepatic veins appear mildly prominent and are patent.BILIARY TRACT: No cholelithiasis. Mild gallbladder wall thickening nonspecific in the setting of ascites. 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 10.9 cm in length. RIGHT KIDNEY: Not well visualized.LEFT KIDNEY: Kidney measures 11.5 cm in length. Increased cortical echogenicity. No hydronephrosis.OTHER: Mild ascites.", "output": "1.Mild hepatomegaly. Mild ascites.2.Mild non-specific gallbladder wall thickening without cholelithiasis or biliary ductal dilatation.3.Increased left renal echogenicity suggestive of medical renal disease.4.Findings suggestive of elevated right heart pressures."}
{"instruction": "Generate impression based on findings.", "input": "26 year old male with lower abdominal pain extending into inguinal area and extending into testicles. RIGHT TESTIS: Normal homogeneous echotexture measuring 4.7-cm x 2.5 cm x 3.3 cm. Few foci of microcalcifications are noted. Arterial and venous blood flow was visualized upon Doppler exam.LEFT TESTIS: Normal homogeneous echotexture measuring 4.6 cm x 2.6 cm x 3.1 cm. Few foci of microcalcifications are noted. Arterial and venous blood flow was visualized upon Doppler exam.RIGHT EPIDIDYMIS: 3.9 cm x 1.0 cm x 1.2 cm. No significant abnormality noted. LEFT EPIDIDYMIS: 2.6 cm x 1.0 cm x 1.0 cm. No significant abnormality noted. OTHER: Right inguinal lymph node measures 1.6 cm x 0.4 cm x 1.0 cm. An additional lymph node measures 1.5 cm x 0.4 cm x 2.5 cm.Bilateral mild to moderate hydroceles.", "output": "1. Bilateral mild to moderate hydroceles. 2. Few foci of testicular microcalcification bilaterally. 3. Right sided inguinal lymph nodes are noted. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Zhang is a 22-year-old female presenting with a left breast mass and pain for three days. On physical examination, no palpable abnormality was identified in the left breast. Targeted ultrasound of the left lateral breast demonstrates a circumscribed hypoechoic mass in the 3:00 position 1 cm from the nipple measuring 4 x 4 x 6 mm with peripheral vascularity.", "output": "High probability benign morphology mass in the left breast, likely representing a fibroadenoma. A short-term 6 month ultrasound is recommended in 6 months in order to confirm stability of these findings. These findings were discussed with the patient at the time of examination.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female with decreased urine output, hematuria RIGHT KIDNEY: Measures 10.5 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 11.3 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Incompletely distended with a Foley catheter in place.OTHER: No significant abnormalities noted.", "output": "1. Increased renal echogenicity consistent with medical renal disease. 2. No nephrolithiasis, hydronephrosis, or suspicious mass. "}
{"instruction": "Generate impression based on findings.", "input": "54 years old, Female, Reason: hx pancreatis/ abdominal pain. per pt previuos u/s OSH stones History: abdominal pain LIVER: The liver measures 16.4 cm in length. Coarse echogenicity of the liver. 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. 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: Pancreas is not fully evaluated on this ultrasound examination to overlying bowel gas. The visualized portion of the pancreas is heterogeneous without ductal dilatation and may be a sequela of known pancreatitis. SPLEEN: No significant abnormalities noted. The spleen measures 12.8 cm in length. RIGHT KIDNEY: Kidney measures 12.2 cm in length. Normal echotexture. Nohydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 11.5 cm in length. Normal echotexture. Nohydronephrosis or shadowing calculus.OTHER: No significant abnormalities noted.", "output": "1.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis. Coarse liver parenchyma suggestive of chronic liver disease/fatty infiltration without mass.2.Pancreas is not fully evaluated on this ultrasound examination due to overlying bowel gas. The visualized portion of the pancreas is heterogeneous without ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "82-year-old female patient with history of hyperthyroidism, multinodular goiter. Upon review of prior imaging reports, status post radioactive iodine ablation for Graves' disease. RIGHT LOBE MEASUREMENTS: Status post ablation.LEFT LOBE MEASUREMENTS: Status post ablation.ISTHMUS MEASUREMENTS: Status post ablation.RIGHT LOBE: Patient is status post ablation. There is a 1.0 x 1.2 x 0.8 cm slightly heterogeneous hypoechoic nodule within the right thyroid bed which demonstrates internal vascularity. This appears similar to the prior exam, previously measuring 1 x 1 x 0.9 cm, and has not significantly changed in appearance since the ultrasound dated from 5/7/2007.LEFT LOBE: Status post ablation.ISTHMUS: Status post ablation.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Status post thyroid ablation with stable appearing hypoechoic nodule within the right thyroid bed."}
{"instruction": "Generate impression based on findings.", "input": "EtOH use LIVER: Heterogeneous coarse liver echotexture without mass. Liver length 14.4 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.3 cm in lengthOTHER: Left kidney 11.4 cm in length. Spleen 8.3 cm in length. No ascites.", "output": "Heterogeneous coarse liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 82 years old Reason: concern for toxic multinodular goier History: hyperthyroidism on labs RIGHT LOBE MEASUREMENTS: 6 x 5.0 x 3.4 cm.LEFT LOBE MEASUREMENTS: 5.2 x 1.4 x 1.5 cm.ISTHMUS MEASUREMENTS: 4 mm.RIGHT LOBE: Right lobe of the thyroid is very heterogeneous. There is a dominant nodule measuring 4.7 x 4.5 cm. This nodule contains solid and cystic components and microcalcifications an amenable for biopsy.LEFT LOBE: There are subcentimeter nodules in the left lobe of the thyroid.ISTHMUS: There is a 1.2 x 1 cm nodule in the isthmus towards the right. The second complex nodule with possible solid and cystic components.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Bilateral nonenlarged lymph nodes. A level 2/3 noted on the right side measures 9 x 9 mm. Level 2 node on the left side measures 8 x 8 mm.OTHER: No significant abnormality noted.", "output": "Large dominant nodule in the right lobe of the thyroid. Multiple other nodules are also visualized as described above. Bilateral nonenlarged, lymph nodes."}
{"instruction": "Generate impression based on findings.", "input": "Male 57 years old Reason: evaluate renal cysts History: hx of renal cell carcinoma, sp partial nephrectomy Exam is somewhat limited secondary to patient body habitus and increased renal cortical echogenicity.RIGHT KIDNEY: Right kidney measures 1.7 x 1.8 x 1.5 cm. Markedly echogenic renal cortex. No hydronephrosis. Evaluation for parenchymal mass is somewhat limited secondary to patient body habitus and echogenicity of the kidneys. Anechoic exophytic right renal cyst measures 1.8 x 1.5 x 1.7 cm. No hydronephrosis.LEFT KIDNEY: Left kidney measures 12.7 cm. Left renal cortex is also markedly echogenic. Anechoic left renal cyst measures 2.6 x 2.8 x 2.5 cm. Solid, complex-appearing left renal nodule measures 2.3 x 2.2 x 2.4 cm. The previously identified exophytic hyperdense cyst is not definitely visualized on this exam. No hydronephrosis.OTHER: Bladder is distended and unremarkable.", "output": "1.Multiple indeterminate renal nodules as detailed above. Evaluation for renal masses by ultrasound is limited secondary to patient body habitus and increased echogenicity of the renal cortex. Recommend follow-up with CT to exclude recurrent or metastatic disease.2.Bilateral markedly increased echogenicity of the renal cortex, which may be secondary to medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Papillary thyroid carcinoma status post resection with enlarged bilateral level 5 lymph nodes. 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: Slight interval decrease in size of enlarged bilateral level 5 lymph nodes. The largest on the right now measures 1.9 x 1.3 x 0.6 cm; this is in comparison to 2.5 x 1.6 x 1 cm on 9/30/2015. The enlarged left level 5 lymph node has remained stable measuring 1.5 x 1.2 x 0.6 cm.No new adenopathy.OTHER: No significant abnormality noted.", "output": "Stable to slightly decreased in size of enlarged bilateral level 5 lymph nodes; favor benign reactive adenopathy. No new adenopathy or worrisome mass lesion appreciated."}
{"instruction": "Generate impression based on findings.", "input": "82-year-old male with right inguinal hernia, pain in right lower quadrant. Evaluate for interval change. During Valsalva maneuver, there is redemonstration of a right inguinal hernial sac containing loop of bowel which is reducible and appears similar to prior study.", "output": "Right reducible inguinal hernia containing loop of bowel not significantly changed. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: AKI RIGHT KIDNEY: The right kidney measures 11.2 cm in length. There is a small anechoic simple cyst in the superior pole of the right kidney measuring 2.5 x 2.5 x 2.3 cm. The renal cortical echogenicity is normal. There is no hydronephrosis.LEFT KIDNEY: The right kidney measures 11.2 cm in length. The renal cortical echogenicity is normal. There is no hydronephrosis.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Unremarkable renal ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "34-year-old female with history of thyroid cancer status post resection and radioablation. RIGHT LOBE MEASUREMENTS: Surgically absentLEFT LOBE MEASUREMENTS: Surgically absentISTHMUS MEASUREMENTS: Surgically absentRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small cervical lymph nodes with overall benign morphologic features. No regional lymphadenopathy.OTHER: No significant abnormality noted.", "output": "No evidence of recurrent or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Female 39 years old Reason: patient with flank pain and RUQ pain; hx stone at UPJ; as well has elevated liver enzymes History: RUQ pain and hx kidney stone as well as elevated liver enzymes LIVER:15.7 cm in length. Normal echogenicity. No focal lesions.Flow in the main portal vein is hepatopedal peak velocity 21 cm/sGALLBLADDER, BILIARY TRACT: Gallbladder surgically absent. No intrahepatic or extra hepatic biliary dilatation. Common bile duct measures 0.3 cm in diameter.PANCREAS: No significant abnormality noted.SPLEEN: Morphologically normal 11.8 cm in length.KIDNEYS: Right kidney 10.4 cm length. Left kidney 10 cm in length. Normal echogenicity isoechoic to liver. No focal lesions. No hydronephrosis. ABDOMINAL AORTA: Proximal 1.8 x 2 x 1.7 cm.Mid 1.6 x 1.8 x 1.8 cm.Distal 1.7 x 1.7 x 1.6 cm.Right common iliac artery 1.3 x 1.2 x 1.1 cm.Left common iliac artery 0.9 x 0.9 x 1 cm.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Small pericardial effusion.", "output": "Gallbladder surgically absent. No biliary dilatation. Small pericardial effusion. No evidence of aneurysm. No evidence of hydronephrosis no evidence of nephrolithiasis by ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male being evaluated for heart transplant. The study was limited by the patient's body habitus and inability to hold his breath.LIVER: The liver is normal in morphology, echogenicity and size, measuring 15.2 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: Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid, or focal tenderness. No extrahepatic biliary ductal dilatation with the common duct measuring 3 mm.PANCREAS: Overlying bowel gas obscures the pancreas.SPLEEN: The spleen is normal in size, measuring 11.3 cm.KIDNEYS: The right kidney is normal in size measuring 11.6 cm in length without hydronephrosis, shadowing calculus, or discrete lesion evident. The left kidney measures 10.9 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident.ABDOMINAL AORTA: The proximal aorta is normal in caliber, measuring 2 cm in AP dimension. The remaining aorta is obscured by overlying bowel gas shadowing.INFERIOR VENA CAVA: The inferior vena cava is patent.OTHER: Left pleural effusion.", "output": "Left pleural effusion. Otherwise, limited examination without significant abnormality evident."}
{"instruction": "Generate impression based on findings.", "input": "Transaminitis. LIVER: The liver parenchyma is mildly heterogeneous. No focal lesion is evident. The hepatic veins are dilated. Pulsatile hepatopedal portal venous blood flow.BILIARY TRACT: The common bile duct measures up to 10 mm. Normally distended gallbladder containing sludge. Significant gallbladder wall thickening up to 10 mm. Trace pericholecystic fluid. No focal tenderness.PANCREAS: The visualized portions of the pancreatic head and body are unremarkable. The remainder is obscured by overlying bowel gas.SPLEEN: The spleen measures 13 cm in length without a focal lesion.RIGHT KIDNEY: The right kidney measures 10 cm in length without hydronephrosis or shadowing nephrolithiasis. OTHER: The left kidney is partially imaged measuring approximately 8 cm. Mild ascites. Pleural effusions.", "output": "Findings suggestive of right sided heart failure with associated hepatic congestion.Gallbladder sludge. Significant gallbladder wall thickening is nonspecific in the setting of fluid overload. No focal tenderness to suggest acute cholecystitis.Mild ascites and pleural effusions.Extrahepatic biliary ductal dilatation without apparent etiology. Consider MRCP as clinically indicated. "}
{"instruction": "Generate impression based on findings.", "input": "54-year-old male with history of kidney stones. RIGHT KIDNEY: The right kidney measures 12.2 cm in length. Normal parenchymal echogenicity. No evidence of renal stone, hydronephrosis, or renal mass.LEFT KIDNEY: The left kidney measures 12.9 cm in length. Normal parenchymal echogenicity. A 1.3 x 1.0 cm stone is identified in the lower pole, similar to that seen on previous CT. No evidence of hydronephrosis or renal mass.BLADDER: No significant abnormality noted.OTHER: Hyperechoic, coarse liver echotexture suggestive of hepatic steatosis.", "output": "1.Nonobstructing 1.3 cm left inferior pole renal stone.2.Hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "Male 66 years old Reason: evaluate urinary retention/hydronephrosis History: urinary retention Technologist note: Limited exam patient confused.RIGHT KIDNEY: 9.5 cm in length. Echogenic suggestive medical renal disease.LEFT KIDNEY: 11.8 cm in length. Upper pole cyst. No hydronephrosis.Urinary bladder is collapsed.", "output": "Echogenic kidneys suggestive medical renal disease. No hydronephrosis. Left upper pole renal cyst. Urinary bladder is collapsed."}
{"instruction": "Generate impression based on findings.", "input": "Patient is a 27-year-old pregnant female who presented with a palpable lump in her right axilla. On physical exam, a small mobile mass is appreciated in the right axilla.Targeted grayscale and color ultrasound was performed at the area of palpable concern in the right axilla. There is a 4 x 3 mm oval, well-circumscribed mass in the right axilla, which demonstrates fatty hilum and central flow, most compatible with a lymph node.", "output": "No sonographic evidence for malignancy. A small right axillary lymph node corresponding to the palpable concern. Annual screening mammogram at age 40 is recommended. Results and recommendations were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "70 year-old male with history of transaminitis. Evaluate for mass or other abnormality. LIVER: Slightly increased echogenicity of the liver parenchyma. The liver measures 22 cm. No biliary dilatation or focal masses.BILIARY TRACT: Cholelithiasis. No biliary dilatation or significant abnormality otherwise.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen is enlarged, measuring 14.5 cm.RIGHT KIDNEY: No significant abnormalities noted. Right kidney measures 11.8 cm.OTHER: No significant abnormalities noted. Left kidney measures 13.7 cm.", "output": "1.Hepatosplenomegaly, with slightly increased echogenicity of the liver parenchyma, may reflect hepatic steatosis/parenchymal dysfunction.2.Cholelithiasis without biliary dilatation or significant abnormality otherwise."}
{"instruction": "Generate impression based on findings.", "input": "Male 68 years old Reason: Concern for cyst History: Asx Focused ultrasound performed over the patient's palpable lump in the left upper back demonstrated 9.5 x 8.9 x 2.7 cm well-circumscribed, solid lesion, hypoechoic with linear undulating hyperechoic foci. The lesion is larger in length than width and demonstrates posterior acoustic enhancement.", "output": "Superficial mass in the left back which does not have the appearance of cyst. Lipoma is a differential consideration."}
{"instruction": "Generate impression based on findings.", "input": "Hyper bilirubinemia LIVER: Mildly coarse heterogeneous liver echotexture without mass. Liver length 19 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.7 cm in length.OTHER: Left kidney 10 cm in length. Spleen 15 cm in length. Trace ascites.", "output": "Mildly coarse heterogeneous liver echotexture suggestive for parenchymal dysfunction/fatty infiltration without mass or ductal dilatation. Mild hepatomegaly. Cholelithiasis without acute inflammation. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female, 59 years old. AKI RIGHT KIDNEY: The right kidney measures 12.9 cm in length with increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.5 cm in length with increased cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The bladder is decompressed.", "output": "Increased renal cortical echogenicity compatible with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "79 year old female with history of kidney stones. The kidneys are difficult to visualize bilaterally due to low signal to noise ratio.RIGHT KIDNEY: The right kidney measures 9.8 cm. No significant hydronephrosis.LEFT KIDNEY: The left kidney measures approximately 9.9 cm, and has no significant hydronephrosis. There is a small left lower pole calculus which measures approximately 1 cm in greatest diameter.OTHER: No significant abnormalities noted.", "output": "Small left renal calculus, without significant hydronephrosis as above."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female patient with hepatitis B. HCC screening. LIVER: The liver measures 12.8 cm in length and coarsened in echotexture. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.1 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 10.9 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.7 cm in length. No evidence of hydronephrosis.The spleen measures 8.6 cm in length.", "output": "Coarsened hepatic echotexture which can be seen with hepatic parenchymal dysfunction, but no focal hepatic lesion identified. "}
{"instruction": "Generate impression based on findings.", "input": "Hyperparathyroidism RIGHT LOBE MEASUREMENTS: 4.6 x 3.7 x 7.7 cmLEFT LOBE MEASUREMENTS: 3.8 x 3.8 x 8.6 cmISTHMUS MEASUREMENTS: 1.7 cmRIGHT LOBE: Enlarged heterogeneous gland without discrete mass. Diffuse increased vascularityLEFT LOBE: Enlarged heterogeneous gland without discrete mass. Diffuse increased vascularityISTHMUS: Enlarged heterogeneous gland without discrete mass. Diffuse increased vascularityPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Enlarged heterogeneous gland without discrete mass associated with diffuse increased vascularity. Findings suggestive for Graves' disease. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Bishop is a 15 year old female presenting follow-up of left breast mass, likely fibroadenoma. She denies overlying skin changes and nipple discharge. Family history of breast cancer in maternal grandmother. A targeted left ultrasound was performed. In the left breast 10:00 location, approximately 4 cm from the nipple there is redemonstration of a lobulated hypoechoic mass measuring 1.6 x 0.5 x 1.7 cm, previously 2.4 x 1.2 x 2.2 cm . There is mild associated vascularity.", "output": "1.7 cm lobulated mass in the left upper inner breast, likely representing a fibroadenoma, decreased in size from previous exam. Given patient's age and palpability of mass, a surgical consultation is recommended for further evaluation. All results and recommendations were discussed with the patient and her mother. Findings also discussed with patient's breast surgeon, Dr. Bao. BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old female patient with right upper quadrant pain. Evaluate for stones or gallbladder inflammation. LIVER: The liver measures 16.2 cm in length. Hepatic parenchymal echogenicity is increased. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: There is a shadowing gallstone near the neck of the gallbladder. There is no significant pericholecystic fluid or gallbladder wall thickening. The patient is mildly tender with palpation, however, is noted to be medicated. 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 9.7 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.9 cm in length. No evidence of hydronephrosis.The spleen measures 8 cm in length.", "output": "1. Cholelithiasis with equivocal sonographic Murphy's sign, however, no compelling evidence of gallbladder inflammation to suggest acute cholecystitis. 2. Hepatic steatosis. "}
{"instruction": "Generate impression based on findings.", "input": "Epigastric pain and nausea LIVER: Unremarkable parenchymal echogenicity without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 15.6 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 7.2 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 9.9 cm in lengthOTHER: Left kidney 10.6 cm in length. No ascites.", "output": "Negative right upper quadrant ultrasound. No acute hepatobiliary abnormality. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "4-year-old male pretransplant workup LIMITED ABDOMENLIVER: The liver measures 11.8 cm in length. Increased echogenicity of the liver is consistent with fat infiltration. No focal hepatic lesions or masses are identified.GALLBLADDER, 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 two mm in diameter.PANCREAS: The visualized head and body of the pancreas are normal in appearance. RIGHT KIDNEY: Kidney measures 8.6 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 9.0 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.SPLEEN: Spleen normal in size and contour, measuring 8.9 cm.OTHER: Free lymphatic fluid in the loculated lymphatic fluid is present within the right upper quadrant and throughout the abdomen.", "output": "1.Increased echogenicity of the liver is consistent with hepatic steatosis.2.Free and loculated lymphatic fluid is present in the abdomen.3.Normal Doppler examination inflow and outflow vessels of the liver."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with noncirrhotic portal hypertension. HCC screening. Evaluate for cirrhosis. LIVER: The liver measures 23.2 cm in craniocaudal diameter, indicating hepatomegaly. Coarse echogenic liver parenchyma without focal lesion or mass. Portal vein with normal hepatopedal flow, peak velocity of 25.1 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. The common bile duct measures 0.2 cm in diameter. Partially distended gallbladder containing shadowing intraluminal stones and no wall thickening (0.3 cm). Negative sonographic Murphy's sign.PANCREAS: The visualized portion of the pancreas are within normal limits. Limited visualization of the pancreatic body and tail due to overlying bowel gas.SPLEEN: The spleen measures 7 cm in length.RIGHT KIDNEY: The right kidney measures 10.6 cm in length. No hydronephrosis, masses, or shadowing calculi. OTHER: The left kidney measures 11.3 cm in length. No hydronephrosis, masses, or shadowing calculi.", "output": "1. Coarse echogenic liver parenchyma, consistent with chronic liver disease or parenchymal dysfunction. No discrete masses.2. Cholelithiasis without sonographic evidence for acute cystitis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess liver and gallbladder History: N/V, elevated liver enzymes Exam is limited by patient's body habitus.LIVER: The liver measures 15.3 cm in length. Echogenic liver parenchyma. The portal vein is patent with normal directional hepatopedal portal venous blood flow, peak velocity 16.2 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. Small echogenic stone in the dependent aspect of the gallbladder. No pericholecystic inflammation or fluid. The gallbladder wall measures 0.4 cm. The common bile duct measures 0.3 cm. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 12.1 cm in length. No hydronephrosis or shadowing stones.LEFT KIDNEY: The left kidney measures 11.47 m in length. No hydronephrosis or shadowing stones.OTHER: The spleen measures 12.1 cm in length.", "output": "1. Echogenic hepatic parenchyma, consistent with hepatic steatosis or hepatic parenchymal dysfunction.2. Cholelithiasis without evidence of acute inflammation. No biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal failure, leukocytosis, and abnormal LFTs LIVER:Mildly coarse heterogeneous liver echotexture without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 15.2 cmGALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. 9.8 cm in lengthKIDNEYS: Probable subcentimeter right renal angiomyolipoma. Right renal cyst. Right kidney 9.1 cm in length; left kidney 8.6 cm in length. ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No ascites", "output": "Mildly coarse and heterogeneous liver echotexture suggestive for chronic liver disease without mass or ductal dilatation. No ascites. Unremarkable renal parenchymal echogenicity without worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old female with new palpable right breast mass, currently breast feeding, presenting for diagnostic sonographic evaluation. No family history of breast cancer. Targeted ultrasound of the left lower inner breast, 7:00 7 cm from the nipple, in patient's area of palpable concern reveals a solid or cystic mass.", "output": "No sonographic evidence of 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: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Male; 41 years old. Reason: abdominal fullness, early satiety, h/o EtOH LIVER: The liver measures 17.8 cm in length. The parenchyma demonstrates a mildly coarsened echotexture. No worrisome hepatic mass is identified. The 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 cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. There is no intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: Head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 7.6 cm in length.RIGHT KIDNEY: The right kidney measures 11.5 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone.LEFT KIDNEY: The left kidney measures 11.3 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone.", "output": "Hepatomegaly and mildly coarsened echotexture of liver parenchyma compatible with fatty infiltration/parenchymal dysfunction. No worrisome hepatic mass is identified."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old with known right breast fibroadenoma presents for follow-up. A targeted right ultrasound was performed for the known fibroadenoma. An oval circumscribed mass compatible with a fibroadenoma in the right breast 1:00 position today measures 1.7 x 1.0 x 1.7 cm, slightly increased from prior measurements of 1.5 x 0.8 x 1.5 cm.", "output": "Slight interval increase in size of known fibroadenoma. The patient will be seen in surgical clinic for additional follow-up today.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with goiter, history of Graves' disease and nodules. RIGHT LOBE MEASUREMENTS: 6.4 x 2.9 x 2.4 cmLEFT LOBE MEASUREMENTS: 6.2 x 2.4 x 2.8 cmISTHMUS MEASUREMENTS: 0.8 cmRIGHT LOBE: Mildly and diffusely heterogeneous. In the upper pole there is a hypoechoic and somewhat spongiform nodule measuring 0.6 x 0.9 x 0.9 cm review of the prior study demonstrates this is unchanged. There may be a spongiform nodule in the posterior upper pole measuring 1 x 0.9 x 1.2 cm. It is likely that this was present on the prior study. Other, smaller complex cystic nodules are present as well.LEFT LOBE: Mildly and diffusely heterogeneous. Isoechoic but mildly heterogeneous nodule in the midportion of the left lobe with a somewhat spongiform appearance measures 0.9 x 1.3 x 1.3 cm. Review of the prior study demonstrates that this is likely unchanged in the interim although with certainly less well-visualized on the prior exam. Previously noted left upper pole nodule is not visualized. ISTHMUS: Mildly and diffusely heterogeneous in echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral thyroid nodules. Although at least 3 nodules were not previously measured but appear unchanged. "}
{"instruction": "Generate impression based on findings.", "input": "Chronic renal disease RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. Right kidney 13.5 cm in lengthLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. Left kidney 13 cm in lengthOTHER: Bladder collapsed around Foley catheter", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Status post total thyroidectomy, evaluate for parathyroid adenoma, history of hypercalcemia RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomy ISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: No focal lesion suggestive of recurrence.LEFT LOBE: Ill-defined hypodensity in the thyroidectomy bed with increased blood flow, does not hold up its morphology in the orthogonal plane most likely represents scar tissue over recurrence.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal morphology left little1. The right neck lymph node measures 1.6 x 0.5 x 0.3 cm. Level 2 left neck lymph node measures 1.1 x 0.5 x 0.3 cm.OTHER: No significant abnormality noted.", "output": "Ill-defined hypodensity in the thyroidectomy bed, favor scar tissue over recurrence"}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female. Follow-up thyroid nodules. RIGHT LOBE MEASUREMENTS: 5.5 x 2.9 x 2 cmLEFT LOBE MEASUREMENTS: 5.7 x 3.2 x 1.8 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: In the inferior pole of the right lobe is a spongiform nodule measuring 0.6 x 1.2 x 1.2 cm without change.LEFT LOBE: In the left lobe, 2 nodules are identified. There is a spongiform nodule in the mid to lower pole of the left lobe measuring 0.6 x 0.9 x 1.1 cm without significant change. In the lower pole there is a small and mildly complex cystic nodule without changeISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable, bilateral thyroid nodules. The appearance is consistent with benign colloid nodules."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate abdominal abscess site for fluid collection History: worsening abdominal abscess Ultrasound evaluation of the superficial soft tissues of the anterior abdominal wall at the site of the patient's previously treated abdominal wall abscess demonstrates no discrete fluid collections to suggest recurrent abscess. There is mild heterogeneity within the surrounding soft tissues which is nonspecific but may reflect edema/inflammation.", "output": "No discrete fluid collections identified at site of clinical concern in anterior abdominal wall."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female with hepatitis B. Elevated liver function. LIVER: Liver is relatively small and echogenic, without interval change. There is no focal hepatic abnormality except for a stable cyst in the left lobe.GALLBLADDER, BILIARY TRACT: No biliary tract dilatation. The gallbladder appears unremarkable.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Stable examination. Echogenic liver without mass or biliary tract dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for NASH, pt with persistent transaminitis History: asymptomatic LIVER: The liver measures 12.0 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 0.24 m/s.BILIARY TRACT: Cholelithiasis including large gallstone in the gallbladder neck without associated gallbladder wall thickening or pericholecystic fluid. 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 7.5 cm in length. RIGHT KIDNEY: Kidney measures 8.5 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 8.8 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Sonographic appearance of the liver within normal limits. Cholelithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Mildly coarsened heterogeneous liver echotexture without mass.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No change in mild to moderate right hydronephrosis. Right kidney 13.9 cm in lengthOTHER: No change in mild to moderate left hydronephrosis. Left kidney 12.6 cm in length. No ascites. Bladder nondistended.", "output": "Mildly coarsened heterogeneous liver echotexture suggestive of chronic liver disease/fatty infiltration without mass or ductal dilatation. Unremarkable gallbladder. No ascites.No change in bilateral mild to moderate hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Connor is a 62 year old female presenting for six-month follow-up of left breast mass, compatible with fat necrosis, seen on ultrasound. Patient states today she can no longer feel the mass. She has a family history of breast cancer in a maternal niece, diagnosed at age of 43. A targeted left ultrasound was performed for the previously palpable area of concern. Patient states today that she can no longer feel the mass. Previously identified findings compatible with fat necrosis are no longer present. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy. Fat necrosis likely resolved over the course of 6 months.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Miller is a 70 year old female presenting for a repeat ultrasound of the left breast due to technical error from whole breast ultrasound performed on 8/29/2016. Targeted left breast ultrasound was performed, specifically just lateral to the left nipple where images from a whole breast ultrasound were inadvertently not saved.No suspicious cystic or solid mass is identified.", "output": "No sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually, due next in Aug 2017. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "46 year old woman with history of cysts and fibroadenomas seen in left breast on prior ultrasound. A targeted left ultrasound was performed for the previously seen masses on ultrasound. Left breast implant is noted.In the left breast, 8'o clock position 2 cm from the nipple, 2 contiguous anechoic masses with posterior acoustic enhancement are seen measuring 8 x 5 x 5 mm, unchanged in size and appearance from the prior examination.In the left breast, 8'o clock position 4 cm from the nipple, 3 contiguous hypoechoic circumscribed masses are seen measuring 3 x 3mm, 3 x 3mm, and 2 x 2mm, unchanged in size and appearance from the prior examination.", "output": "Stable cysts and fibroadenomas of the left breast. No evidence of malignancy. Followup with annual diagnostic mammogram and possible ultrasound is recommended and due in about 6 months. Results and recommendations discussed with patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Female 63 years old Reason: r/o obstruction / hydronephrosis History: AKI RIGHT KIDNEY: Increased echogenicity of the right kidney suggestive of medical renal disease. No hydronephrosis or shadowing calculus.LEFT KIDNEY: Increased cortical echogenicity of the left kidney suggestive of medical renal disease. Mild left pelvicaliceal fullness without frank hydronephrosis.URINARY BLADDER: Bladder is not well-visualizedOTHER: Again seen are numerous very large loculated cystic lesions throughout the abdomen consistent with known metastatic disease.", "output": "1.Numerous very large complex loculated cystic lesions throughout the abdomen compatible with known metastatic disease.2.Increased cortical echogenicity bilaterally suggestive of medical renal disease. Mild left pelvicaliceal fullness without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "53 year old female who was recalled from screening mammogram for 2 focal asymmetries in the left upper-outer quadrant. Mammogram: An ML view and four 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. Total of 3 subcentimeter asymmetries are noted in the anterior, mid and posterior depth in the lateral left breast. All 3 symmetries have benign morphology and a definite correlate is identified to the most anterior asymmetry. Ultrasound: Clustered cyst in the left breast 12:00 position measures 6 x 3 mm most likely corresponding to the anterior-most focal asymmetry. The other 2 mid and posterior depth asymmetries do not have an ultrasound correlate.", "output": "Clustered cyst identified in the left breast 12:00 position corresponding to the anterior most focal asymmetry. Benign morphology asymmetries in the lateral left breast without sonographic correlate for which six-month follow-up left unilateral diagnostic mammogram is recommended. No mammographic evidence of malignancy. Results and recommendation 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": "History multiple thyroid nodules RIGHT LOBE MEASUREMENTS: 5.6 x 1.7 x 2.0 cmLEFT LOBE MEASUREMENTS: 5.2 x 1.9 x 1.8 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Diffusely heterogeneous gland without worrisome or dominant noduleLEFT LOBE: Diffusely heterogeneous gland without worrisome or dominant noduleISTHMUS: Diffusely heterogeneous gland without worrisome or dominant nodulePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous thyroid gland without worrisome or dominant nodule. No increased vascularity. Findings suggestive for chronic thyroiditis. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter. Fine-needle aspiration proven colloid nodules. RIGHT LOBE MEASUREMENTS: 5.7 x 2.1 x 2.5 cm, similar to prior. Normal background echotexture and vascularity.LEFT LOBE MEASUREMENTS: 5.5 x 1.9 and 1.9 cm, similar to prior. Normal background echotexture and vascularity.ISTHMUS MEASUREMENTS: 2 mm in AP dimension.RIGHT LOBE: There is a 2.3 cm mixed solid and cystic nodule in the inferior pole, unchanged in size. The solid components of this nodule demonstrate prominent vascularity, though this is similar to prior. LEFT LOBE: There is a 1.7 cm predominantly solid nodule in the inferior pole, unchanged in size. There is mild internal vascularity, which is similar to prior. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "Bilateral thyroid nodules, unchanged in size and vascularity."}
{"instruction": "Generate impression based on findings.", "input": "Male 33 years old Reason: eval for liver masses, bile duct stones, portal blood flow History: acute liver failure w/ ascites, significant alcohol abuse LIVER: There demonstrates significantly increased echogenicity consistent with fatty infiltration. Liver measures 20.5 cm. Main portal vein and left portal vein demonstrate hepatofugal flow. Flow in the right portal vein is hepatopedal.BILIARY TRACT: Gallbladder is distended with sludge and possible stones. Mild gallbladder wall thickening. No evidence of intra or extrahepatic biliary dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: Spleen measures 8.1 cm.RIGHT KIDNEY: Right kidney measures 10.5 cm. No evidence of hydronephrosis. OTHER: Small amount of ascites.Doppler findings:Hepatic artery is patent. Flow in the main portal vein and left portal vein is reversed. Flow in the right portal vein is hepatopedal. Splenic vein is patent.", "output": "Hepatomegaly with severely echogenic liver. Reversed flow direction the main portal vein and left portal vein consistent with portal hypertension. Small amount of ascites."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old female patient with history of thyroid cancer. One year follow-up study. Evaluate for adenopathy or recurrence. RIGHT LOBE: Status post thyroidectomy without evidence of residual or recurrent tissue within the thyroidectomy bed.LEFT LOBE: Status post thyroidectomy without evidence of residual or recurrent tissue within the thyroidectomy bed.ISTHMUS: Status post thyroidectomy without evidence of residual or recurrent tissue within the thyroidectomy bed.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No specific evidence of disease recurrence or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Epigastric pain. LIVER: Non-cirrhotic liver morphology. 12 cm in length. Mildly increased and 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 gallbladder. No gallstones identified. Negative 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 9 cm in length. The left kidney is 10 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 7.4 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No significant free fluid identified.", "output": "1. Minimally coarsened liver echogenicity, which is nonspecific, though may reflect hepatic steatosis.2. No specific findings to account for the patient's epigastric pain."}
{"instruction": "Generate impression based on findings.", "input": "Preheart transplant evaluation LIVER:Mildly echogenic hepatic parenchyma without mass. Liver length 16.9 cmGALLBLADDER, BILIARY TRACT: No significant abnormality noted.PANCREAS: No significant abnormality noted.SPLEEN: Mild splenomegaly. Spleen length 16.3 cmKIDNEYS: No significant abnormality noted. Right kidney 10.6 cm in length; left kidney 11.7 cm in lengthABDOMINAL AORTA: Abdominal aorta obscured by gasINFERIOR VENA CAVA: Distal vena cava obscured by gasOTHER: Trace ascites", "output": "Mildly echogenic hepatic parenchyma suggestive for chronic liver disease/parenchymal dysfunction without mass or ductal dilatation. Mild splenomegaly. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "67 year old female, evaluate thyroid nodules. RIGHT LOBE MEASUREMENTS: 4.2 cm x 1.7 cm x 1.7-cm. LEFT LOBE MEASUREMENTS: 3.0 cm x 1.6 cm x 1.4 cmISTHMUS MEASUREMENTS: 4 mm in thickness. RIGHT LOBE: Heterogeneous parenchyma with no discrete nodules. LEFT LOBE: Heterogeneous parenchyma. There is a fluid collection containing internal septations and questionable solid components that courses along the left thyroid lobe posteriorly and continues along the lateral anterior aspect of the thyroid lobe. This was not seen on outside hospital CT neck dated 11/8/2014. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Indeterminant predominately cystic fluid collection along the left thyroid lobe. Correlation with recent nuclear medicine parathyroid SPECT/CT scan is recommended. "}
{"instruction": "Generate impression based on findings.", "input": "32-year-old male with history of testicle pain and swelling. Evaluate for hemorrhage versus torsion versus cellulitis. RIGHT TESTIS: The right testicle measures 3 x 2.6 x 3 cm, and is normal in morphology and vascularity.LEFT TESTIS: Left testicle measures 3.4 x 3.5 x 2 .7 cm, and is normal in morphology. Subtle increased vascularity.RIGHT EPIDIDYMIS: Right epididymis measures 1 x 0.4 x 0.4 cm, and is normal in morphology and vascularity.LEFT EPIDIDYMIS: Left epididymis measures 0.6 x 0.9 x 0.7 cm, and demonstrates subtle increased vascularity.OTHER: Small amount of bilateral scrotal fluid is seen. Small left inguinal lymph nodes are seen, one measuring up to 1.3 x 0 .6 cm, likely reactive.", "output": "Findings suggestive of left epididymitis/orchitis and mild bilateral hydrocele."}
{"instruction": "Generate impression based on findings.", "input": "4-month-old female patient with intermittent hypertension. Evaluate for renal vein thrombosis. KIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 4.9 cm Left: 4.6 cm   Mean for age: 6.2 cm  Range for age: 4.8 - 7.5 cmADDITIONAL OBSERVATIONS: The right renal vein is patent and there is Doppler color flow throughout the right kidney. The left renal vein is patent with Doppler color flow throughout the kidney. There is a trace amount of perihepatic ascites.", "output": "Patent renal veins bilaterally without evidence of hydronephrosis.*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.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": "44-year-old female with mass posterior to the left shoulder. In the region of the mass in the left posterior subcutaneous tissues, there is an ovoid and septated -- appearing mass measuring 9.7 cm in greatest diameter with a thickness of approximately 2.3 cm. The appearance is consistent with lipoma.", "output": "Large lipoma involving subcutaneous fat of the left posterior shoulder."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female patient with elevated LFTs. Question of cholelithiasis or hepatic congestion. LIVER: The liver measures 19.9 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There is a single gallstone, but no gallbladder wall thickening or pericholecystic fluid. Sonographic Murphy's sign is negative. 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 12.6 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 13.1 cm in length. No evidence of hydronephrosis.The spleen measures 17 cm in length. A splenic calcification is present.", "output": "1. Mild hepatosplenomegaly.2. Cholelithiasis without sonographic evidence of acute cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "53-year-old female with tertiary hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 5.5 x 2.2 x 1.5 cmLEFT LOBE MEASUREMENTS: 5.4 x 1.7 x 2.1 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: 0.5 x 0.3 x 0.3 cm cystic nodule with peripheral hyperechoic focus most likely colloid.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Hypoechoic solid nodule posterior and inferior to the left thyroid lobe measures 1.2 x 1.2 x 0.9 cm.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Hypoechoic solid nodule posterior and inferior to the left thyroid is suspicious for parathyroid adenoma. Correlate with same day nuclear medicine examination."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Buziecki is 29-year-old female presenting for a follow-up right breast ultrasound of palpable area in the right outer breast. She has no current breast related complaints. Upon physical exam at the palpable area of concern, nodular tissue is identified.A targeted right ultrasound was performed for the palpable area of concern. In the right outer breast at the 9:00 position 2 cm from the nipple, there is revisualization of a hypoechoic area with biopsy clip now measuring 0.8 cm x 0.5 cm x 1.6 cm, previously 1.0 cm x 0.8 cm x 1.8 cm. No new solid or cystic lesion is identified in this region.", "output": "Stable to slight decrease in size of the palpable area of concern in the right breast, previously biopsied with benign results. A short-term 6 month follow-up ultrasound exam can be performed in July 2016. If sonographically stable at that time, a 1 year stability will have been documented and patient can then continue to follow-up with her primary care physician with clinical breast exams. All results and recommendations were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (6 Months)."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old male with hyperparathyroidism. Evaluate for kidney stones. RIGHT KIDNEY: The right kidney measures 10.4 cm in length. No hydronephrosis, shadowing calculus or mass. Echotexture is normal.LEFT KIDNEY: The left kidney measures 11.1 cm in length. No hydronephrosis, shadowing calculus or mass. Echotexture is normal.OTHER: Bladder unremarkable.", "output": "Normal kidneys."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for ascites. Hep C cirrhosis. Minimal ascites, markedly less than prior, located predominantly in the upper abdomen. Cirrhotic liver noted incidentally.", "output": "Minimal ascites, predominantly in the upper abdomen."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male with transaminitis. History of cystectomy. LIVER: Normal in size but moderately echogenic which may be due to fatty infiltration although not specific. There is a 1.4 cm mildly complex cyst in the region of the caudate with smaller cyst as well as.GALLBLADDER, BILIARY TRACT: Gallbladder is not visualized on this exam. Visualized portions of the intra and extrahepatic biliary tract are normal in caliber.PANCREAS: Pancreas is not visualized. Patient has a dense, midline scar with obscuration of underlying structures.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Echogenic liver, presumably related to fatty infiltration.Hepatic cysts."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old with multicentric left breast cancer with metastatic left axillary lymph node, status post neoadjuvant chemotherapy. Repeat mammogram and ultrasound for left axilla to look for a marker clip. MLO, exaggerated CC, and spot compression views of the left breast (axilla) were performed digitally. Previously seen enlarged lymph node in the left axilla has become smaller, measuring 7 mm. Hydromark clip is again identified within this lymph node.Focused ultrasound was performed for the left axilla with 12-5 MHz transducer. Within a normal appearing lymph node, there is a hyperechoic material, likely a metallic clip. There is no hypoechoic portion, which is usually seen for Hydromark clip, surrounding this metallic clip. A BB marker was placed on the skin over the metallic clip, and MLO view of mammogram was performed. BB marker is the same level of the lymph node with Hydromark clip, confirming the metallic clip seen on the ultrasound study is a metallic component of the Hydromark clip.", "output": "Successful visualization of the Hydromark clip by ultrasound within the left axillary lymph node, which has become smaller after neoadjuvant chemotherapy. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Male, 48 years old. Assess native kidneys for tumors or mass. S/p kidney transplant RIGHT KIDNEY: The right kidney is atrophic with markedly increased cortical echogenicity. Margination is difficult, but the kidney measures approximately 5.9 cm in length. No gross hydronephrosis, obstructing urinary stone, or focal lesion is identified.LEFT KIDNEY: The left kidney is atrophic with markedly increased cortical echogenicity. Margination is difficult, but the kidney measures approximately 6.8 cm in length. No gross hydronephrosis, obstructing urinary stone, or focal lesion is identified.OTHER: The bladder is not well visualized.", "output": "Bilateral atrophic and echogenic kidneys. No gross hydronephrosis or focal renal lesions."}
{"instruction": "Generate impression based on findings.", "input": "female presents with swelling around the right areolar area. Evaluate for abscess. An approximately 3.8 x 2.4 cm well-defined hypoechoic lesion with internal echoes and posterior acoustic enhancement is present in the subareolar area. No internal septations. There is internal complexity.", "output": "Findings consistent with breast abscess."}
{"instruction": "Generate impression based on findings.", "input": "Female 53 years old; Reason: patient with multinodular goiter. Please assess for change in morphology History: feeling of enlargement of goiter RIGHT LOBE MEASUREMENTS: 5.9 x 2.7 x 2.2 cm.LEFT LOBE MEASUREMENTS: 8.0 x 3.4 x 4.1 cm.ISTHMUS MEASUREMENT: The isthmus measures 1.2 cm in the AP dimension.RIGHT LOBE: Enlarged heterogenous gland with stable multiple subcentimeter nodules. Of note, there is a mixed cystic-solid nodule measuring approximately 2.3 x 2.3 x 1.5 cm that appears similar to the prior exam as well as a 0.9 x 0.9 x 0.8 cm cm mixed cystic-solid nodule that appears similar to the prior exam.LEFT LOBE: Multiple mixed cystic-solid nodules are noted in the left lobe of the thyroid are again noted and are stable in appearance. The largest of these measures approximately 1.4 x 0.9 X 2.0 cm.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted. OTHER: No significant abnormality noted.", "output": "1.Stable mixed cystic solid bilateral thyroid nodules.2.No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Measures 13.1 cm in length. No focal mass.GALLBLADDER, BILIARY TRACT: Gallbladder is sonographically normal in appearance without wall thickening or biliary dilation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Measures 8.8 cm in length. Bilateral subcentimeter renal cysts.OTHER: Spleen measures 8.4 cm in length. Left kidney measures 9.4 cm in length.", "output": "No focal hepatic lesions."}
{"instruction": "Generate impression based on findings.", "input": "Male; 62 years old. Reason: hydronephrosis History: hydronephrosis RIGHT KIDNEY: The right kidney measures 10.3 cm in length. The renal cortex is echogenic. There is no hydronephrosis or shadowing renal stone. There is a 0.6 x 0.5 x 0.4 cm anechoic lesion in the midpole of the kidney.LEFT KIDNEY: Left kidney measures 10.6 cm in length. The renal cortex is echogenic. There is no hydronephrosis or shadowing renal stone. There is a 1.2 x 1.3 x 1.3 cm mildly complex left renal cyst with no vascular flow.BLADDER: The bladder is decompressed by a Foley catheter.", "output": "1.1.3 cm mildly complex left renal cyst would be better evaluated with contrast enhanced CT or MRI.2.No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant tenderness. Evaluate liver in the setting of congestive heart failure. LIVER: The liver measures 16.8 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 0.25 m/s. The hepatic veins are prominent which can be seen with elevated right heart pressures.BILIARY TRACT: The gallbladder appears contracted and contains gallstones. No 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: There is an ovoid soft tissue echogenicity structure adjacent to the pancreas measuring 3.0 x 1.5 x 2.1 cm which appears to have a fatty hilum and thus is favored to reflect a reactive lymph node, however this could be better evaluated with contrast-enhanced CT or MRI if clinically indicated.SPLEEN: No significant abnormalities noted.The spleen measures 10.0 cm in length. RIGHT KIDNEY: Kidney measures 12.2 cm in length. Increased parenchymal echogenicity is suggestive of medical renal disease/parenchymal dysfunction. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 11.7 cm in length. Increased parenchymal echogenicity is suggestive of medical renal disease/parenchymal dysfunction. There is an ovoid structure interposed between the left kidney and spleen which may be a splenule as seen on prior CT.ABDOMINAL AORTA: The abdominal aorta appears patent and is normal in caliber measuring 2.1 x 1.7 cm, 1.7 x 1.6 cm, and 1.9 x 1.8 cm in the proximal, middle, and distal portions.INFERIOR VENA CAVA: Slightly dilated but patent.BLADDER: Not well distended.OTHER: No significant abnormality noted.", "output": "1.Cholelithiasis without sonographic evidence of acute cholecystitis.2.Echogenic kidneys suggestive of medical renal disease.3.Findings suggestive of elevated right heart pressures.4.Probable peripancreatic prominent lymph node, favor reactive, although could be further evaluated with dedicated cross-sectional imaging as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Chronic pancreatitis. LIVER: The liver is normal in morphology, echogenicity and size measuring 15 cm in craniocaudal dimension. There is normal hepatopedal portal venous blood flow at 0.2 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Normally distended gallbladder.PANCREAS: The visualized pancreatic head demonstrates possible echogenic foci which may represent changes from chronic pancreatitis as clinically reported. No pancreatic duct dilatation. No significant adjacent inflammatory changes.SPLEEN: The spleen is normal in morphology and size measuring 9.3 cm.RIGHT KIDNEY: The right kidney measures 11.7 cm in length without hydronephrosis or shadowing nephrolithiasis.OTHER: The left kidney measures 11.7 cm in length without hydronephrosis or shadowing nephrolithiasis.", "output": "Patent and normal directional flow of the portal vein."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male patient with ischemic cardiomyopathy, history of mitral valve replacement, and advanced heart failure with recent gram-positive rod bacteria. Evaluate for LVAD. LIVER:The liver measures 18.2 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal measures 0.3 m/s.GALLBLADDER, BILIARY TRACT: There are gallstones but no gallbladder wall thickening or pericholecystic fluid. There is no intra or extra hepatic biliary ductal dilatation. 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.SPLEEN: The spleen measures 11.2 cm in length.KIDNEYS: The right kidney measures 11 cm and the left kidney measures 11.9 cm in length. No evidence of hydronephrosis. ABDOMINAL AORTA: The proximal aorta measures 4.2 x 3.1 cm and the mid portion of the abdominal aorta measures 3.2 x 3.9 cm, however, there appears to focal aneurysmal dilatation measuring up to 4.5 cm. The distal aorta is not visualized secondary to overlying anatomy.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Cholelithiasis without sonographic evidence of acute cholecystitis.2. Aneurysmal dilatation of infrarenal abdominal aorta which is inadequately evaluated on this examination; CTA can be obtained for further evaluation. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: abdominal pain LIVER: The liver measures 15.9 cm in length. Coarse, echogenic hepatic parenchyma. The portal vein is patent with normal hepatopetal directional flow, peak velocity 21.3 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. The common bile duct measures 0.3 cm. No biliary ductal dilatation.PANCREAS: No significant abnormalities noted. The body and tail of the pancreas are obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 10.3 cm in length. No hydronephrosis, shadowing stones, or mass.LEFT KIDNEY: The left kidney measures 11.2 cm in length. There is a complex cystic lesion in the left lower pole measuring 2.0 x 1.6 x 1.6 cm with internal septation. No hydronephrosis or shadowing stones.OTHER: No ascites.", "output": "1. Cystic lesion in the lower pole of the left kidney is of indeterminate complexity. Follow-up evaluation with dedicated contrast-enhanced CT scan is recommended.2. Coarse, echogenic liver, consistent with hepatic steatosis or parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old male with chronic HCV and cirrhosis. Screen for HCC. LIVER: The liver measures approximately 16 cm in length. No focal hepatic lesion is identified. Stable findings of a subtle nodular contour and coarse parenchymal echotexture. The main portal vein flow is hepatopedal and measures 21 cm/s.BILIARY TRACT: The common bile duct measures 2.3 mm in diameter. Shadowing gallstones are again noted. No gallbladder wall thickening or pericholecystic fluid.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 10.5 cm in length.RIGHT KIDNEY: The right kidney measures 11.4 cm in length. No hydronephrosis. OTHER: The left kidney measures 11.8 cm in length. No hydronephrosis. Stable 1.5 x 1.7 cm cyst of the left mid/lower renal pole.", "output": "1. No focal hepatic lesion identified. Stable findings of chronic liver disease.2. Cholelithiasis without sonographic evidence of acute cholecystitis.3. Stable left renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "73 year-old female with right lower quadrant pain. Evaluate for fluid. The study was limited by the patient's body habitus. Targeted evaluation of the 4 abdominal quadrants demonstrates no significant fluid.", "output": "No significant peritoneal fluid."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female with history of right breast asymmetry on screening mammography. No current breast complaints. 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(BiRads Density Category B), unchanged in pattern and distribution. Again seen are two asymmetries in the right breast, one in the outer breast mid depth on the CC view, and one on the MLO view posterior depth. The asymmetry in the outer breast mid depth persists with spot compression views, possibly a benign intramammary lymph node. The asymmetry in the posterior breast disperses with spot compression.ULTRASOUND", "output": "Benign appearing intramammary lymph node correlates with the outer breast asymmetry seen on the CC view on the prior screening study. The more posterior asymmetry disperses with spot compression and does not demonstrate a sonographic correlate, most likely representing superimposed glandular tissue. 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": "Reason: please assess for liver pathology History: 64M with CAD, inferior MI, PVD p/w DOE, scleral icterus with recent very high transaminitis and hyperbilirubinemia LIVER: The liver measures 13.5 cm in length. Coarse, echogenic hepatic parenchyma. The portal vein is patent with normal directional hepatopedal portal venous blood flow, peak velocity 31.5 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. No shadowing stones or sludge. The gallbladder wall measures 0.2 cm. The common bile duct measures 0.3 cm. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 11.5 cm in length. No hydronephrosis or shadowing stones.LEFT KIDNEY: The left kidney measures 10.2 cm in length. No hydronephrosis or shadowing stones.OTHER: The spleen measures 10.7 cm in length. Trace perisplenic fluid.", "output": "1. Echogenic hepatic parenchyma, consistent with hepatic steatosis or parenchymal dysfunction. No biliary ductal dilatation.2. Trace perisplenic fluid, which is nonspecific."}
{"instruction": "Generate impression based on findings.", "input": "50 old male with abdominal discomfort. Aorta is normal in caliber with no evidence for aneurysm. Both common iliac arteries are normal in caliber as well. There is not significant atherosclerotic change.", "output": "No evidence for AAA."}
{"instruction": "Generate impression based on findings.", "input": "Male 31 years old Reason: HCC screening History: HCC screening LIVER: Liver measures 16.2 cm in length. No focal hepatic mass. Liver parenchyma is mildly coarse. No evidence of cirrhosis. Main portal vein is patent with normal directional flow and a peak velocity of 22.7 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Gallbladder is normal. No gallstones. No evidence of acute inflammation of the gallbladder.PANCREAS: Pancreas is not well-visualized secondary to overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 9.2 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 10.6 cm. Left kidney measures 10.9 cm. OTHER: No significant abnormalities noted.", "output": "Liver is mildly coarse without focal mass."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Li Fraumeni Syndrome, screening exam, please evaluate abdomen for malignancy. LIVER: The liver measures 14.1 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 0.25 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 4.5 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 10.2 cm in length. RIGHT KIDNEY: Kidney measures 8.9 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 9.3 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "No sonographic evidence of malignancy."}
{"instruction": "Generate impression based on findings.", "input": "Chronic kidney disease status post right nephrectomy RIGHT KIDNEY: AbsentLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 9.5 cm in length.OTHER: Bladder nondistended", "output": "Echogenic left renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs with acute renal insufficiency LIVER:Coarse echogenic liver echotexture without mass. Liver length 11.7 cmGALLBLADDER, BILIARY TRACT: No significant abnormality noted.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. 8.6 cm in lengthKIDNEYS: Echogenic renal parenchyma again noted without worrisome mass, stone, or hydronephrosis. Right kidney 9.5 cm in length; left kidney 9.8 cm in length. ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No ascites", "output": "Coarse echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites. Echogenic renal parenchyma again noted consistent with medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Known metastatic right axillary lymph node, status post biopsy and clip placement prior to her neoadjuvant chemotherapy. Evaluate for residual lymph node and biopsy clip. A targeted right ultrasound was performed for the axillary region. Two subcentimeter adjacent lymph nodes are seen in the right axilla. These are normalized in morphology compared to prior exams. There is an echogenic focus which has a morphology suggestive of the metallic portion of the Hydromark clip. This is located just medial to the adjacent lymph nodes.", "output": "Subcentimeter right axillary lymph nodes with an adjacent hyperechoic focus suggestive of the biopsy clip.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old female with epigastric pain. Evaluate gallbladder for stones, infection. LIVER: Normal echogenicity of the liver measuring 14.8 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: Nonmobile echogenic focus with no acoustic shadowing along the gallbladder wall measures 4 mm x 3 mm consistent with a polyp. No gallbladder wall thickening. No pericholecystic fluid. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Tail of the pancreas obscured by overlying bowel gas. The remaining visualized portions are unremarkable.RIGHT KIDNEY: Measures 12.1 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Spleen measures 11.1 cm in length and is normal in echogenicity. Left kidney measures 12.3 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "Subcentimeter gallbladder polyp. "}
{"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": "Successful ultrasound-guided core biopsy of the right breast lesion and clip placement, 2 sites as described. Both masses are suspicious for recurrence. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter RIGHT LOBE MEASUREMENTS: 3.5 x 1.9 x 1.6 cm.LEFT LOBE MEASUREMENTS: 5.1 x 2.6 x 1.6 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Dominant solid nodule within the right thyroid gland/isthmus measuring 3.9 x 3.8 x 2.9 cmLEFT LOBE: Dominant solid nodule within the left lobe measuring 2.6 x 1.6 x 1.4 cmISTHMUS: Dominant solid nodule within the right thyroid gland/Isthmus measuring 3.9 x 3.8 x 2.9 cmPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral solid dominant thryoid nodules as described. Both nodules are amenable to ultrasound-guided percutaneous biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Neck pain over thyroid RIGHT LOBE MEASUREMENTS: 5.4 x 1.6 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.3 x 1.9 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: Multiple nodules identified in the right lobe, measuring less than 1 cm.Nodule 1 appears complex measures 0.6 x 0.5 x 0.6 cm, previously measured 0.5 x 0.3 x 0.5 cm.Nodule 2 appears partly cystic partly solid, measures 0.6 x 0.3 0.5 cm, previously measured 0.7 x 0.4 x 0.5 cm.LEFT LOBE: Subcentimeter nodules identified. A new nodule is also identified in the inferior pole which appears partly cystic partly solid, measuring 0.6 x 0.3 x 0.5 cm.Nodule 1 in the liver lower pole predominantly cystic with ringdown artifact measures 0.4 x 0.3 x 0.4 cm, previously measured 0.4 x 0.2 x 0.4 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal morphology lymph nodes especially level 2 and on the right lateral neck and level 2 and level 3 in the left neck are unchanged.OTHER: No significant abnormality noted.", "output": "No increase in size of measured subcentimeter thyroid nodules. A new subcentimeter nodule identified in the left gland inferior pole. Continued surveillance is recommended. No dominant nodule noted."}
{"instruction": "Generate impression based on findings.", "input": "Nasopharyngeal carcinoma with left thyroid nodule RIGHT LOBE MEASUREMENTS: 4.9 x 2.0 x 1.8 cmLEFT LOBE MEASUREMENTS: 6.7 x 2.3 x 1.4 cmISTHMUS MEASUREMENTS: 0.1-cmRIGHT LOBE: Diffusely heterogeneous gland. Subcentimeter calcified nodule within the midpole measuring 0.5 x 0.6 x 0.5 cm.LEFT LOBE: Diffusely heterogeneous gland. 2.3 x 2 x 1.3 cm predominantly solid left thyroid nodule.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 thyroid gland. Dominant predominantly solid left thyroid nodule corresponding to the lesion seen on the recent chest CT. This lesion will be biopsied today."}
{"instruction": "Generate impression based on findings.", "input": "RUQ postprandial pain LIVER: Non-cirrhotic liver morphology. Mildly increased parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Several moderate-sized gallstones identified. Mild wall thickening, measuring 4 mm. 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 9.7 cm in length. The left kidney is 9.7 in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 8.4 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.", "output": "1. Cholelithiasis with mild wall thickening. This may represent a mild or early cholecystitis in the appropriate clinical setting. 2. Mildly increased hepatic parenchymal echogenicity suggestive of steatosis."}
{"instruction": "Generate impression based on findings.", "input": "Male 65 years old Reason: assess for cholecystitis History: rising lft, septic shock now in ards LIVER: The liver measures 17.5 cm in length. There is mildly coarsened echogenicity. The main portal vein is patent, demonstrating hepatopetal flow at 0.2 m/sec. The hepatic artery is patent.BILIARY TRACT: There is a small amount of sludge/non-shadowing stones within the gallbladder neck. There is no evidence of gallbladder wall thickening. The common duct measures 5 mm in maximal diameter and there is no evidence of choledocholithiasis.PANCREAS: No significant abnormality noted. Mild prominence of pancreatic duct again seen.SPLEEN: The spleen measures 7.4 cm in length.RIGHT KIDNEY: The right kidney measures 11.6 cm in length without hydronephrosis., shadowing calculus or discrete lesion evident.OTHER: The left kidney measures 11.9 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Bilateral pleural effusions unchanged. New moderate volume ascites.", "output": "1. Biliary sludge and possible non-shadowing gallstones within the gallbladder neck, without evidence of cholecystitis.2. Stable bilateral pleural effusions and new moderate volume ascites."}
{"instruction": "Generate impression based on findings.", "input": "57 years old, Female, Reason: eval for parathyroid adenomas/hyperplasia, plan for possible parathyroidectomy History: primary hyperparathyroidism (hypercalemia, hyperparathyroidism), fatigue, renal stones, nausea RIGHT LOBE MEASUREMENTS: 5.4 x 2.9 x 3.4 cmLEFT LOBE MEASUREMENTS: The inferior aspect of the left thyroid lobe is below the field of view and appears to extend retrosternally. Measurements are approximately 9.5 x 2.4 x 2.8 cm.ISTHMUS MEASUREMENTS: 1.5 cmRIGHT LOBE: Right spongiform nodule, most consistent with a colloid nodule measuring 2.6 x 1.8 x 2.4 cm.LEFT LOBE: Left lower lobe spongiform nodule measures 3.1 x 2.7 by 3.4 cm. and likely represents a colloid nodule. Inferior portion of the left lower lobe appears nodular and extends retrosternally and is therefore incompletely visualized. We cannot exclude an extrathyroidal mass.ISTHMUS: Spongiform thyroid nodule likely representing a colloid nodule measuring 1.7 x 1.1 x 1.7 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Inferior portion of the left thyroid lobe appears nodular and extends retrosternally beyond the field-of-view on this ultrasound examination. We cannot exclude an extrathyroidal mass or adenoma.2.Multiple bilateral thyroid nodules the largest of which is on the left measuring up to 3.4 cm."}
{"instruction": "Generate impression based on findings.", "input": "Female 66 years old Reason: 66 F with left gluteal cellulitis s/p bedside I\\T\\D; please ultrasound left buttock and hip for possible fluid collection History: please ultrasound left buttock and hip for possible residual fluid collection Soft tissues adequately visualized no evidence of any loculated fluid collections.", "output": "No fluid collections to suggest abscess."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Mildly echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Minimally complex renal cyst. Right kidney 12.5 cm in lengthLEFT KIDNEY: Mildly echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Minimally complex renal cyst. Left kidney 11.5 cm in lengthOTHER: Bladder nondistended", "output": "Mildly echogenic parenchyma suggestive for parenchymal dysfunction/medical renal disease without worrisome mass, stone, or obstruction"}
{"instruction": "Generate impression based on findings.", "input": "Transaminitis and sarcoidosis, evaluate liver LIVER: Liver measures 17.4 cm with mild increased echogenicity compatible with hepatic steatosis. Main portal vein demonstrates normal directionality and patency. No focal lesions noted.BILIARY TRACT: Gallbladder appears well-distended with normal gallbladder wall thickness. No evidence of gallstones. Common Hepatic duct slightly prominent measuring up to 4 mm.Common bile duct at the porta hepatis measures 6 mm, slightly dilated.PANCREAS: Head of the pancreas visualized appears unremarkable. Body and tail of pancreas not visualized due to overlying bowel gas. Pancreatic duct is not visualized.Peripancreatic lymph node measures 2.2 x 1.9 x 1 cm.SPLEEN: Spleen measures 9.9 cm with normal echotexture.KIDNEY: Right kidney measures 12.5 and left kidney measures 11.7 cm. The kidneys demonstrate normal echotexture without any focal lesions. No hydronephrosis. OTHER: No ascites", "output": "Mild hepatic steatosis.Mildly dilated common bile duct without any stones or debris within it. "}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with history of thyroid cancer. No abnormal tracer accumulation is seen in the neck or elsewhere in the body. 48hr uptake was 0.08%.", "output": "No evidence of residual thyroid tissue or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "35 year old female with right upper quadrant pain. The examination is limited and suboptimal due to the patient's body habitus.LIVER: The liver parenchyma is moderately coarse. The liver measures 20 cm in the craniocaudal length. No focal hepatic lesion or intrahepatic biliary ductal dilatation is evident. Normal hepatopetal portal venous blood flow at 30 cm/sec.BILIARY TRACT: A normally distended gallbladder is identified without gallstones, wall thickening, pericholecystic fluid, or focal tenderness. No extrahepatic biliary ductal dilatation with the common bile duct measuring 4 mm.PANCREAS: Limited evaluation of the pancreatic head and body is grossly unremarkable.SPLEEN: The spleen measures 11 cm in length without a discrete focal abnormality.RIGHT KIDNEY: The right kidney measures 12.6 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow.OTHER: The left kidney measures 13 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow.", "output": "Slightly limited study with no specific findings to account for the patient's right upper quadrant pain. Coarsened hepatic parenchyma may represent diffuse fatty infiltration/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "History renal stones RIGHT KIDNEY: Normal echogenicity without mass or hydronephrosis. 0.8 x 0.8 x 0.7 cm nonobstructing lower pole renal stone. Right kidney 9.7 cm in lengthLEFT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 10.1 cm in lengthOTHER: Bladder nondistended", "output": "Nonobstructing subcentimeter lower pole right renal stone."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old female with palpable painful right breast lump. The patient reports a history of recurrent cysts. Three standard views of both breasts 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 new round circumscribed masses are identified in both breasts, including the area of the patient's palpable complaint.ULTRASOUND", "output": "Multiple simple cysts in both breasts. The largest symptomatic cyst(s) in the right breast are amenable to ultrasound-guided aspiration, which was discussed with the patient and will be considered. Otherwise, she may return for routine annual screening mammogram. In view of dense breast tissue, tomosynthesis would be useful at the time of next screening mammogram. 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": "Reason: Right Hip Ultrasound to assess for previously seen fluid collection on bone scan. History: 16 yo M paraplegia with history of recent right leg adductor surgery and hx of left hip osteomyelitis Patient's right hip was contracted and unable to position properly for the exam. Assessment for right hip effusion cannot be done.", "output": "Assessment for right hip effusion cannot be done due to difficulty in patient positioning. "}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules RIGHT LOBE MEASUREMENTS: 4.3 x 1.9 x 2 cmLEFT LOBE MEASUREMENTS: 4.9 x 1.9 x 2.3 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Multiple subcentimeter benign-appearing hypoechoic probably cystic nodules. A benign-appearing spongiform nodule within the lower pole measures 0.7 x 0.5 x 0.6 cm.LEFT LOBE: Multiple subcentimeter benign-appearing cystic and spongiform nodules. A representative upper pole spongiform nodule measures 1.3 x 0.9 x 1.1 cm.ISTHMUS: 1.1 x 1.3 x 0.9 hypoechoic nodule with internal echogenic focus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple bilateral subcentimeter benign-appearing thyroid nodules. Benign-appearing left upper pole spongiform nodule.Hypoechoic nodule with internal echogenic focus within the isthmus. While this may represent an intrathyroid lymph node, it is best considered indeterminate in nature. This nodule is amenable to ultrasound-guided biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Male 66 years old Reason: assess for liver lesions/fibrosis History: Hx of HCV LIVER: Coarsened appearance of the liver consistent with fatty infiltration or diffuse hepatic disease. Liver measures 17.1 cm in length. No focal hepatic mass. Main portal vein is patent with normal directional flow and a peak velocity of 12 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Patient is status post cholecystectomy. Common bile duct measures 2 mm.PANCREAS: Pancreas is not well-visualized secondary to overlying bowel gas.SPLEEN: Spleen is not well visualized secondary to body habitus, however a portion of the spleen is normal in appearance measuring 6.9 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 11.6 cm. Left kidney measures 11.0 cm.OTHER: No significant abnormalities noted.", "output": "Coarsened liver consistent with fatty infiltration or diffuse hepatic dysfunction. No focal hepatic mass."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for cholecystitis History: Abdominal pain, nausea, vomiting. Also history of pancreatitis. LIVER: The liver measures 12.9 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 0.27 m/s.BILIARY TRACT: Cholelithiasis without associated 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: Within the proximal pancreatic body, there is a well-defined hypoechoic mass measuring 3.4 x 3.0 x 3.5 cm which appears solid but lacks visible internal vascularity. The more distal pancreas is obscured by bowel gas. The more proximal pancreatic duct does not appear dilated.SPLEEN: No significant abnormalities noted. The spleen measures 9.2 cm in length. RIGHT KIDNEY: Kidney measures 11.1 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 11.9 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Cholelithiasis without sonographic evidence of acute cholecystitis.2.Pancreatic lesion measuring up to 3.5 cm which is incompletely characterized. Differential considerations include pancreatic cancer or pseudocyst. MRCP is recommended for additional evaluation.3.Increased hepatic echogenicity suggestive of parenchymal dysfunction/fatty infiltration.Discussed with Dr. JACOBS, JEFFREY. "}
{"instruction": "Generate impression based on findings.", "input": "71 years old, Female, Reason: 71F with history of thyroid nodule History: no symptoms RIGHT LOBE MEASUREMENTS: 3.6 by 0.7 x 1.3 cmLEFT LOBE MEASUREMENTS: 3.7 x 1.2 x 0.8 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Heterogeneous right thyroid lobe with multiple subcentimeter hypoechoic foci. No dominant lesion is identified.LEFT LOBE: Heterogeneous left thyroid lobe. No focal nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Heterogeneous thyroid bilaterally with multiple subcentimeter hypoechoic foci in the right thyroid lobe which are indeterminate on this exam but are favored to represent benign colloid cysts. No dominant lesion is identified."}
{"instruction": "Generate impression based on findings.", "input": "Leukocytosis, right upper quadrant pain, evaluate for cholecystitis LIVER: Liver measures 16.7 cm with heterogenous echotexture. No focal lesions noted within the liver. No intrahepatic biliary duct dilatation.Main portal vein demonstrates normal flow directionality and patency.BILIARY TRACT: Gallbladder is distended with multiple gall stones in the neck, body and fundus region. Gallbladder wall thickening is predominantly noted in the region of the fundus measuring up to 5 mm. The fundal wall thickening with multiple small hyperechoic areas, few of which demonstrate shadowing suggesting stones and few demonstrate ringdown artifact suggestive of underlying fundal adenomyomatosis.No evidence of pericholecystic fluid noted. Sonographic Murphy sign is positive.Common bile duct is nondilated measures up to 4 mmPANCREAS: Part of the head of the pancreas as visualized appears unremarkable. Body and tail of pancreas not visualized.SPLEEN: Spleen is not visualized due to overlying bowel gas.RIGHT KIDNEY: Right kidney measures 11.7 cm and left kidney measures 10.9 cm. Both kidneys are mildly echogenic suggesting underlying parenchymal disease. Multiple small septated cyst identified in the lower pole of the right kidney, largest measuring 5 x 4 x 3.1 cm. OTHER: No ascites", "output": "Cholelithiasis with gallbladder wall thickening and sonographic Murphy's sign positive suggestive of acute cholecystitis. Focal fundal findings suggestive of fundal adenomyomatosis.Spleen is not visualized due to overlying bowel gas.No ascitesRight lower pole septated cyst."}
{"instruction": "Generate impression based on findings.", "input": "Rule out cholelithiasis. Abdominal pain in 40+-year-old woman who is overweight. LIVER: The liver is markedly echogenic compatible with fatty infiltration. It measures 20.1 cm in length. No focal lesions are evident. Portal vein is patent with flow toward the liver on color Doppler imaging.BILIARY TRACT: No gallstones. The common duct measures 3 mm which is within normal limits.PANCREAS: Limited evaluation secondary to overlying bowel gas.SPLEEN: No focal lesions. The spleen measures 9.9 cm in length.RIGHT KIDNEY: No hydronephrosis of either kidney. The right kidney measures 11.1 cm in length and the left kidney measures 11.6 cm in length OTHER: No significant abnormalities noted.", "output": "Echogenic liver compatible fatty infiltration. No gallstones identified."}
{"instruction": "Generate impression based on findings.", "input": "Female 51 years old Reason: eval for gall stones History: ruq pain LIVER: Liver measures 16 cm. Normal echogenicity. No focal lesions.BILIARY TRACT: Gallbladder is unremarkable. No evidence of intra or extra hepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 6 cm.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Unremarkable study."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for hydronephrosis. Acute kidney injury. RIGHT KIDNEY: The right renal cortex is echogenic. The right kidney measures 11.6 cm. No hydronephrosis, renal calculi or suspicious lesion identified.LEFT KIDNEY: The left renal cortex is echogenic. The left kidney measures 11.4 cm. A left upper pole simple cyst measures 2.2 x 1.9 x 2.3 cm, unchanged. No hydronephrosis, renal calculi or suspicious lesion identified.URINARY BLADDER: Incompletely distended urinary bladder, containing debris.OTHER: Large right pleural effusion.", "output": "1.Echogenic kidneys, compatible with medical renal disease. Unchanged left upper pole simple cyst. No hydronephrosis, renal calculi or suspicious lesion.2.Large right pleural effusion.3.Debris noted within the bladder."}
{"instruction": "Generate impression based on findings.", "input": "Female, 54 years old. Flank pain, rising creatinine. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 12.3 cm in length, with normal cortical echogenicity. Moderate hydronephrosis and dilation of the imaged proximal ureter. No shadowing stones identified.LEFT KIDNEY: The left kidney measures 11.9 cm in length, with normal cortical echogenicity. Moderate hydronephrosis and dilation of the imaged proximal ureter. No shadowing stones identified.OTHER: The bladder is incompletely distended.", "output": "Moderate bilateral hydronephroureter, left slightly greater than right."}
{"instruction": "Generate impression based on findings.", "input": "51 years old, Female, Reason: evaluate hydronephrosis History: h/o cervical cancer, h/o hydronephrosis, back pain RIGHT KIDNEY: Kidney measures 10.5 cm in length. Normal echotexture. No evidence of hydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 10.8 cm in length. Normal echotexture. No evidence of hydronephrosis or shadowing calculus.BLADDER: The bladder is not completely distended.", "output": "No evidence of hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Chronic kidney disease. RIGHT KIDNEY: The right kidney measures 8.4 cm without hydronephrosis, shadowing nephrolithiasis or focal lesion.LEFT KIDNEY: The left kidney measures 8.7 cm without hydronephrosis, shadowing nephrolithiasis or focal lesion.OTHER: Unremarkable partially distended urinary bladder.", "output": "Small kidneys without hydronephrosis or discrete lesion."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old female with history of thyroidectomy. Completion thyroidectomy in November 2015 for small thyroid cancer. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massesLEFT LOBE: No massesISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Morphologically normal lymph nodes bilaterally.OTHER: No significant abnormality noted.", "output": "No evidence for recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "Reason: s/p renal transplant admitted with UTI with bacteremia, eval for polynephritis or perinephric abscess History: fever, GNB bacteremia LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: Kidney measures 12.7 cm in length. Normal cortical echogenicity. No hydronephrosis. No perfusion defects are seen on the color Doppler images.COLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: The bladder is collapsed.OTHER: No significant abnormality noted", "output": "No evidence of hydronephrosis or perinephric collections. Please note that pyelonephritis is not excluded; if there is continued clinical concern, contrast-enhanced CT recommended for evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Female 52 years old Reason: colicky right upper quadrant pain, please asses for gallbladder disease History: abdominal pain LIVER: Mildly heterogeneous appearance of the liver is nonspecific but can be seen in setting of fatty infiltration. No focal hepatic mass. Main portal vein is patent with normal directional flow and a peak velocity of 22 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Common bile duct measures 2 mm. Gallbladder is normal in appearance with a non thickened wall measuring 2 mm. Sludge is present in the gallbladder. Negative sonographic Murphy's sign.PANCREAS: Visualized portions of the pancreas are normal in appearance.SPLEEN: Spleen is normal in appearance measuring 10.3 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 11.8 cm. Left kidney measures 11.7 cm. OTHER: No significant abnormalities noted.", "output": "Sludge in the gallbladder without evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Renal stones RIGHT KIDNEY: Previously noted right renal stone is no longer present. No evidence for mass, hydronephrosis, or residual stone. Right kidney 11 cm in lengthLEFT KIDNEY: No significant abnormalities noted. 10.5 cm in lengthOTHER: Bladder nondistended", "output": "No evidence for residual renal stone. No obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Female 88 years old; Reason: assess interval change in size or character of thyroid nodule History: none. Hx of dominant large 4.2 x 3.3 cm heterogeneous nodule in R thyroid. FNA in 2004 colloid nodule, with no subsequent records or follow up imaging. RIGHT LOBE MEASUREMENTS: 5.4 x 2.0 x 2.6 cmLEFT LOBE MEASUREMENTS: 5.6 x 1.6 x 2.1 cmISTHMUS MEASUREMENT: 0.4 cmRIGHT LOBE: In the inferior pole of the right lobe is a 3.3 x 3.1 x 2.1-cm heterogeneous nodule with shadowing dystrophic calcification.LEFT LOBE: The gland is heterogeneous. In the mid aspect of the left lobe is a 2.5 x 1.8 x 1.8 cm solid, heterogeneous, but predominantly isoechoic, nodule with punctate hyperechoic foci.ISTHMUS: Small anechoic structure in the left aspect of Isthmus measures 0.4 x 0.3 x 0.5 cm.LYMPH NODES: 1.1 x 0.6 x 0.4 cm right level 2 lymph node with a fatty hilum.OTHER: No significant abnormality noted.", "output": "Bilateral thyroid nodules are amenable to percutaneous biopsy if clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "History of right buttock soft tissue injury. Surrounding induration. Evaluate for abscess. Targeted grayscale and color Doppler evaluation of the region of erythema and induration demonstrates a small hypoechoic focus measuring 1.1 x 0.4 x 1.0 cm which appears slightly decreased in size from the prior. No significant surrounding inflammatory changes. Shadowing is noted from the adjacent packed wound.", "output": "Probable 1.1 cm complex poorly loculated fluid collection within the subcutaneous soft tissues is too small to drain."}
{"instruction": "Generate impression based on findings.", "input": "Hypothyroidism RIGHT LOBE MEASUREMENTS: 5.1 x 1.9 x 2.6 cmLEFT LOBE MEASUREMENTS: 3.2 x 1.2 x 1.3 cmISTHMUS MEASUREMENTS: 1.1 cmRIGHT LOBE: Diffusely heterogeneous nodular appearing gland with multiple echogenic nodules. A representative inferior pole echogenic nodule measures 1.4 x 1.1 x 1.8 cm.LEFT LOBE: Diffusely heterogeneous gland with multiple subcentimeter hypoechoic nodules.ISTHMUS: Diffusely heterogeneous gland. Subcentimeter coarse calcific focus without obvious associated mass within the isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous and nodular appearing thyroid gland. Multiple echogenic right thyroid nodules. Multiple subcentimeter hypoechoic nodules within the left lobe. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Epigastric pain LIVER: Mildly 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: Diffuse gallbladder wall thickening with stable subcentimeter gallbladder polyps noted. Cholelithiasis and sludge. No Murphy's sign. No ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 10 cm in lengthRIGHT KIDNEY: Stable renal cyst. Right kidney 11.2 cm in lengthOTHER: Left kidney 10.6 cm in length.", "output": "Diffuse gallbladder wall thickening with subcentimeter gallbladder polyps noted associated with cholelithiasis and sludge. Negative Murphy's sign. Findings suggestive for chronic inflammation. No ductal dilatation.Mildly coarse and echogenic liver echotexture suggestive for chronic liver disease/parenchymal dysfunction without mass."}
{"instruction": "Generate impression based on findings.", "input": "Pleuritic chest pain Nondiagnostic exam secondary to contrast extravasation. Limited images through the level of the superior mediastinum.", "output": "Incomplete exam secondary to contrast extravasation. Nondiagnostic for pulmonary embolism. Limited images through the level of the superior mediastinum."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old female with multinodular goiter. Two-year follow-up study. Rule out growth of nodules. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.2 x 2.4 x 1.9 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.3 x 1.3 x 1.5 cm.ISTHMUS MEASUREMENTS: The isthmus measures 0.18 cm in thickness.RIGHT LOBE: Multinodular appearance. The largest nodule on the right is heterogenous with solid and cystic components measuring 2.4 x 1.6 x 2.1 cm (prior 2.7 x 1.6 x 1.8 cm), and a shadowing central calcification is unchanged.LEFT LOBE: Multinodular appearance. Small nodule of the left upper pole with a spongiform appearance is unchanged measuring 0.7 x 0.8 x 0.5 cm (prior 0.6 x 0.5 x 0.3 cm).Spongiform nodule in the posterior midportion of the left lobe measuring 1 x 0.8 x 1.2 cm is similar in accordance (prior 1 x 0.5 x 1.2 cm).Spongiform-appearing nodule of the anterior mid/lower pole measures 1.8 x 1.3 x 0.9 cm (prior 1.5 x 0.7 x 0.5).ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No suspicious cervical lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Stable bilateral thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "Male, 72 years old. Recurrent UTI RIGHT KIDNEY: The right kidney measures 11.1 cm in length with mild cortical thinning. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.6 cm in length with cortical thinning. No shadowing stones or hydronephrosis.OTHER: The bladder is distended and debris-filled, with two diverticula.", "output": "Distended, debris-filled bladder with diverticula. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: s/p lap sleeve gastrectomy with abdominal fluid collection, please correlate with recent outside CT scan Pt IR study 10-25-16 History: RUQ pain Limited ultrasound of the abdomen and pelvis demonstrates a nonspecific hypoechoic focus just superior to the bladder without internal vascularity. The fluid collection previously identified along the right upper abdominal wall is not identified.", "output": "Nonspecific hypoechoic focus just superior to the bladder. CT would be useful for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Epigastric pain after eating LIVER: Non-cirrhotic liver morphology. Mildly increased parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. 1.4 cm gallstone identified. Otherwise unremarkable appearance of the gallbladder. No sonographic Murphy's sign.PANCREAS: No definite sonographic abnormality evident in the visualized pancreatic head and body. The tail is obscured by bowel gas.KIDNEYS: The right kidney is 12.3 cm in length. The left kidney is 11.7 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 12.0 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites.", "output": "1. Cholelithiasis without specific evidence of cholecystitis.2. Mildly increased hepatic echogenicity compatible with parenchymal dysfunction or steatosis, without biliary ductal dilation."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female returns for follow-up evaluation of the biopsy-proven cancer in the left breast. A left breast ultrasound was performed at the area of previously proven cancer at the 11:00 location, 3 to 4 cm from the nipple. The biopsied hypoechoic mass with a central clip measures 1.4 x 1 cm (previously 1.5 x 1 cm). This mass demonstrates morphology changes with more spiculated margins and irregular shape.", "output": "The previously biopsied malignancy in the left breast slightly decreased in size with more irregular morphology. 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": "45 year old female who was recalled from screening mammogram for bilateral asymmetries or masses on baseline study. MAMMOGRAM: Three standard views of both breasts with additional 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. Asymmetries in the left retroareolar region and right lower outer breast, anterior depth are redemonstrated. These lesions become less conspicuous on compression imagingULTRASOUND: A targeted bilateral ultrasound was performed in the areas of mammographic abnormalities.In the left retroareolar region, at the 6:00 position, there is an anechoic, oval lesion with posterior acoustic enhancement measuring 5 x 4 x 3 mm. There is no internal vascularityIn the right lower outer breast, at the 9:00 position approximately 5 cm from the nipple there is an anechoic, oval lesion with posterior acoustic enhancement measuring 2 x 2 x 2 mm. There is no internal vascularity.In the right lower-outer breast at the 9:00 position approximately 4 cm from the nipple, there is an anechoic, oval lesion with posterior acoustic enhancement measuring 3 x 2 x 3 mm. There is no internal vascularity. Ultrasound of the remaining right lower outer breast demonstrates no other cysts and no solid masses.These lesions correlate with mammographic findings.", "output": "Tiny bilateral benign cysts as above. 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.The sensitivity of mammography for detecting breast cancer is decreased in patients with dense breasts such as this patient. Physical exam assumes a more important role. Additional screening with automated whole breast ultrasound can also be considered based on her mammographically dense breasts.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Female 65 years old; Reason: r/o growth of nodules or adenopathy History: multinodular goiter. 1.5 year follow up study RIGHT LOBE MEASUREMENTS: 5 x 2.4 x 3.3 cm, previously 4.1 x 1.9 x 2.4 cm.LEFT LOBE MEASUREMENTS: 5.1 x 2.1 x 3.8 cm, previously 5.1 x 2.0 x 3.0 cmISTHMUS MEASUREMENT: 1.0 cm, previously 1.2 cm.RIGHT LOBE: Enlarged heterogenous thyroid gland with multiple nodules are again noted, not significantly changed as compared to prior study. The right middle pole nodule measures 0.6 x 0.7 x 0.6 cm, previously 0.7 x 0.7 x 0.8 cm. The right lower lobe nodule measures 1.4 x 1.3 x 1.4 cm, previously 1.4 x 1.3 x 1.4 cm.LEFT LOBE: Enlarged heterogenous thyroid gland with multiple nodules are again noted. The nodules are not significantly changed as compared to prior exam. Heterogenous solid nodule in the left mid thyroid measures 1.3 x 1.0 x 0.8, compared to 1.1 x 0.9 x 0.7 cm. Additional midpole nodule measures 1.4 x 1.0 x 0.9 cm as compared to 1.7 x 1.5 x 1.1 cm on the prior exam. Additional lower pole nodule measures 0.5 x 0.7 x 0.5 cm, as compared to 0.6 x 0.6 x 0.5 cm.ISTHMUS: No significant abnormality noted.LYMPH NODES: Left neck level 1B benign-appearing node measures 1.7 x 1.1 x 0.6 cm.OTHER: No significant abnormality noted.", "output": "Stable multinodular thyroid."}
{"instruction": "Generate impression based on findings.", "input": "Urinary retention RIGHT KIDNEY: Echogenic renal parenchyma again noted. Stable right renal cyst. No stone or hydronephrosis. Right kidney 9.7 cm in length.LEFT KIDNEY: Echogenic renal parenchyma again noted. Minimally complex upper pole cyst again noted and relatively unchanged. No stone or hydronephrosis. Left kidney 10.7 cm in length.OTHER: Bladder nondistended", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without stone or obstruction. Stable bilateral renal cysts."}
{"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 suspicious solid or cystic mass identified. Bilateral cysts are noted. Bilateral breast implants do not show evidence of rupture.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Subcentimeter thyroid nodule. RIGHT LOBE MEASUREMENTS: 4.6 x 1.9 x 1.4 cm. Normal in size with normal background echotexture and vascularity.LEFT LOBE MEASUREMENTS: 4.0 x 1.4 x 1.0 cm. Normal in size with normal background echotexture and vascularity.ISTHMUS MEASUREMENTS: 1 mm in AP dimensionRIGHT LOBE: The benign-appearing 5 mm nodule in the lower pole is unchanged.LEFT LOBE: No significant abnormality noted.ISTHMUS: A new 5 mm cystic nodule is noted in the right aspect of the isthmus, without suspicious features.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "Subcentimeter thyroid nodules, without suspicious features."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal failure RIGHT KIDNEY: Echogenic renal parenchyma without worrisome mass.Mild hydronephrosis. Stable right renal cysts. Right kidney 11.8 cm in length.LEFT KIDNEY: Echogenic renal parenchyma without worrisome mass, stone, or hydronephrosis. Stable renal cysts. Left kidney 11.9 cm in lengthOTHER: Extensive debris within the bladder. Polyploid mass lesion arising from left bladder trigone region.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction. New mild right hydronephrosis.Worrisome polypoid mass lesion arising from left bladder trigone; while this may represent a somewhat unusual appearance for BPH, a transitional cell carcinoma must also be considered. Associated with extensive debris within the bladder"}
{"instruction": "Generate impression based on findings.", "input": "44-year-old woman with congenital renal cyst RIGHT KIDNEY: The right kidney measures 10.9 cm in length and shows normal echotexture. A right lower pole cyst measures 3.8 x 3.7 x 3.9 cm and contains no internal septations, debris or calcifications. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.2 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.URINARY BLADDER: The urinary bladder is normal in appearance.OTHER: There is no free or loculated fluid.", "output": "Simple appearing right lower pole cyst without internal septations, debris or calcifications. No worrisome renal mass or hydronephrosis is seen."}
{"instruction": "Generate impression based on findings.", "input": "Male 58 years old; Reason: R thyroid nodule r/o thyroid cancer vs. goiter History: asymptomatic nodule RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 1.7 x 1.7 x 7.9 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 1.6 x 1.5 x 5.0 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.7 cm.RIGHT LOBE: Along the inferior border between the right lobe and isthmus a predominantly cystic dominant nodule is visualized with internal mural nodularity. This measures 3.2 cm x 2.1 cm x 3.2 cm. No internal vascularity is seen.LEFT LOBE: There is a hypoechoic subcentimeter nodule in the left inferior thyroid lobe. Additionally, in the inferior left thyroid lobe there is a hyperechoic nodule measuring 0.7 cm x 0.4 cm x 1.1 cm. This has minimal internal vascularity.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted. On the left at level 3, a lymph node with a fatty hilum is seen measuring 0.5 cm x 0.3 cm x 1.2 cm.", "output": "1.At the inferior border between the right lobe and isthmus a dominant nodule is identified measuring 3.2 cm x 2.1 cm x 3.2 cm. This nodule is predominantly cystic with some mural internal nodularity; the nodular solid component is amenable to ultrasound-guided percutaneous biopsy.2.Two subcentimeter nodules are seen on the left thyroid lobe, as above.3.No suspicious regional adenopathy is identified."}
{"instruction": "Generate impression based on findings.", "input": "85-year-old female with acute kidney failure. RIGHT KIDNEY: The right kidney measures 9 cm in length. No hydronephrosis, shadowing calculi, or suspicious masses. Normal parenchymal echogenicity.LEFT KIDNEY: The left kidney measures 9.6 cm in length. No hydronephrosis, shadowing calculi, or suspicious masses. Normal parenchymal echogenicity.URINARY BLADDER: The urinary bladder is distended and shows no acute abnormality.OTHER: The partially visualized hepatic parenchyma has an echogenic echotexture.", "output": "1. Normal sonographic appearance of the kidneys and urinary bladder.2. Echogenic appearance of the hepatic parenchyma is nonspecific and could represent parenchymal dysfunction/fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "Rule out fatty liver LIVER: Liver measures 18.3 cm with moderate increased echogenicity consistent with hepatic steatosis. No focal lesions noted. No intrahepatic biliary ductal dilatation.BILIARY TRACT: Gallbladder is well-distended without any gallstones. Gallbladder wall thickness is within normal limits. Common bile duct measures up to 4 mm, within normal limits. No evidence of periprostatic fluid.PANCREAS: Head and body of pancreas appears mildly echogenic probably fatty involution. Tail of pancreas not visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 12 cmRIGHT KIDNEY: Right kidney measures 12.4 and left kidney measures 12.2 cm. No hydronephrosis. Normal echotexture. OTHER: No ascites", "output": "Increased echogenicity of the liver suggestive of hepatic steatosis. No focal lesions or 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 suspicious lesions 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 small liver lesions on prior CT. LIVER: There is a small, shadowing calcification of the liver which may be due to prior granulomatous disease. Liver parenchyma is minimally echogenic. In the right lobe there is a 7 mm cyst corresponding to the area visualized on CT. Other smaller areas are not visualized.BILIARY TRACT: No significant abnormalities noted.PANCREAS: The head and body are normal. The tail was not well seen due to bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Right kidney measures 9.9 cm in length. Arising from the mid to lower pole of the right kidney is an exophytic 1.5 x 1.7 x 1.6 cm hypoechoic but somewhat complex-appearing mass. This does not meet criteria for a simple cyst in the represent a highly complex cystic mass or even solid mass. No hydronephrosis.OTHER: The left kidney measures 9.9 cm in length without hydronephrosis or gross mass.", "output": "1. At least one hepatic cyst identified. Other smaller lesions by CT are not adequately seen.2. Solid or highly complex cystic right renal mass."}
{"instruction": "Generate impression based on findings.", "input": "Female; 25 years old. Reason: please evaluate gall bladder History: recurrent abdominal pain, right sided and upper abdomen, can last hours LIVER: The liver measures 16.4 cm in length. The liver surface is smooth, the parenchyma is slightly heterogeneous. No focal hepatic lesions are identified. There is no ascites.The main portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.31 m/sec.BILIARY TRACT: The gallbladder is unremarkable. There is no cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The common duct measures 2 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: Head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 10.8 cm in length.KIDNEYS: The right kidney measures 10.0 cm in length, the left kidney measures 9.3 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": "1.The liver parenchyma is slightly heterogeneous in echogenicity which is nonspecific. 2.Normal ultrasound of the gallbladder. Specifically there is no cholelithiasis, evidence of cholecystitis, or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Status post cardiac arrest LIVER: Coarse echogenic liver echotexture without mass. Liver length 16 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. Right kidney 11.5 cm in lengthOTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. Left kidney 12.3 cm in length. Spleen 7.9 cm in length. Mild ascites. Bilateral pleural effusions.", "output": "Coarse echogenic liver echotexture suggestive for parenchymal dysfunction without mass or ductal dilatation. Mild ascites. Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "History of chronic nausea and vomiting LIVER: Liver measures 14.8 cm with mild to moderate increased echogenicity consistent with hepatic steatosis. In the left lobe of liver there is a hyperechoic lobulated subcapsular lesion that measures 2.4 x 1.5 x 2.5 cm which could represent area of focal fatty infiltration or less likely hemangioma.Gallbladder appears unremarkable.Main portal vein demonstrates normal flow directionality and patency.BILIARY TRACT: No evidence of gallstones. Common hepatic duct measures 2 mm. No gallbladder wall thickening or pericholecystic fluid.PANCREAS: Limited evaluation, due to gassy abdomen.SPLEEN: Spleen measures 8 mm without any focal lesion.RIGHT KIDNEY: Right kidney measures 10.1 cm the left measures 9.9 cm. No hydronephrosis. No renal stones.OTHER: No ascites.", "output": "Hepatic steatosis. 2.5 cm subcapsular left lobe lesion most likely represents focal fatty infiltration or hemangioma."}
{"instruction": "Generate impression based on findings.", "input": "56 years old, Female, Reason: thyroid nodule seen on ct History: RIGHT LOBE MEASUREMENTS: 1.2 by 5.2 x 1.6 cmLEFT LOBE MEASUREMENTS: 1.4 by 4.7 x 1.2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: The right lower lobe is normal in architecture and without nodules.LEFT LOBE: The left thyroid lobe contains multiple subcentimeter hypoechoic nodules. A single predominantly cystic nodule with internal complexity, without internal vascularity is present in the inferior pole measuring 1.0 x 0.5 x 0.9 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing level 2 lymph node measures 0.8 by 1.5 x 0.5 cm.OTHER: No significant abnormality noted.", "output": "Predominantly cystic nodule with internal complexity in the left lower pole of the thyroid."}
{"instruction": "Generate impression based on findings.", "input": "5-month-old female with hip dysplasia.VIEWS: Pelvis AP (one views) 01/20/15 Faint ossification of the femoral epiphysis bilaterally. The femurs are symmetric and appear to be well seated in the acetabula.", "output": "Normal examination."}
{"instruction": "Generate impression based on findings.", "input": "Nephrotic syndrome RIGHT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. 11.5 cm in lengthLEFT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. 11.4 cm in lengthOTHER: Bladder nondistended. Moderate ascites.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis. Moderate ascites."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female with left breast palpable area, presents for follow-up ultrasound. On physical examination, there is a firm palpable area at the two o'clock position of the left breast, 5 cm from the nipple.A targeted left ultrasound was performed for the palpable area of concern, as marked by Dr. Chhablani. Focal area of dense breast tissue is identified subjacent to the area of palpable concern. There is no solid or cystic mass identified.", "output": "Focus of dense breast tissue at the site of palpable abnormality in the left breast. The patient was instructed to discuss the need for any further follow up with Dr. Chhablani.If the patient's physical exam remains unchanged, bilateral screening mammogram is recommended annually, for which the patient will be due in June 2015.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Female 63 years old; Reason: Change in nodules? History: Multinodular goiter RIGHT LOBE MEASUREMENTS: 4.6 x 1.7 x 1.6 cm, previously 4.6 x 1.6 x 1.8 cm.LEFT LOBE MEASUREMENTS: 4.6 x 1.5 x 1.6 cm, previously 4.3 x 1.4 x 1.6 cm.ISTHMUS MEASUREMENT: 0.7 cm, previously 0.6 cm.RIGHT LOBE: Diffusely heterogenous gland is again identified. No discernible nodule is noted. Focus of dense calcification in the medial right lobe is unchanged from the prior exam.LEFT LOBE: Diffuse heterogenous gland with no discernible nodule.ISTHMUS: Again noted is a round dense calcified nodule in the right isthmus which measures 0.7 x 0.5 x 0.8 cm compared to 0.7 x 0.9 x 0.9 cm on the prior exam, unchanged.LYMPH NODES: No significant lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Stable appearance of diffusely heterogenous thyroid with unchanged right isthmus nodule."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant abdominal pain LIVER: Liver measures 14.8 cm with coarse heterogenous echotexture. Portal vein demonstrates normal flow directionality and patency. No focal lesions within the liver.GALLBLADDER, BILIARY TRACT: Gallbladder is well-distended with normal gallbladder wall thickness measuring up to 2 mm. No evidence of gallstones. Minimal sludge noted within the gallbladder no pericholecystic fluid noted.PANCREAS: Pancreas is nonvisualized due to overlying bowel gas acuteRIGHT KIDNEY: Right kidney measures 10.5 cm, left kidney measures 10.2 cm. No hydronephrosis.OTHER: Spleen is not completely visualized due to technical difficulty but appears unremarkable.", "output": "Coarse echotexture of the liver without any focal lesion.Small amount of debris within the gallbladder without cholecystitis"}
{"instruction": "Generate impression based on findings.", "input": "Female 57 years old Reason: HCV, eval for Cirrhosis and HCC History: HCV LIVER: No sonographic evidence of liver cirrhosis. No focal hepatic mass. Liver measures 15.7 cm. Main portal vein is patent with normal directional flow measuring 22.0 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Common bile duct measures 3 mm. Within the gallbladder wall there is a heterogeneous nodule measuring 1.2 x 0.8 x 0.7 cm, which may represent a small polyp or a focus of adenomyomatosis. No evidence of inflammation. No gallstones.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 10.1 cmKIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 10.2 cm. Left kidney measures 11.2 cm.OTHER: No significant abnormalities noted.", "output": "1.Within the gallbladder wall there is a heterogeneous focus which may represent a small polyp or a focus of adenomyomatosis; special attention to this focus on future surveillance scans recommended.2.No focal hepatic mass."}
{"instruction": "Generate impression based on findings.", "input": "Status post liver transplant; increased bilirubin; evaluate vessels. LIMITED ABDOMENLIVER: Status post liver transplant. Subcapsular hypoechoic collection posterior to the right lobe of liver unchanged.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.OTHER: Trace ascites again noted and unchanged", "output": "Patent hepatic vasculature with normal directional flow."}
{"instruction": "Generate impression based on findings.", "input": "Transaminitis LIVER: Normal echogenicity without mass. Liver length 15.8 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.3 cm in lengthOTHER: Left kidney 12.5 cm in length. Spleen 11.3 cm in length. No ascites.", "output": "Negative right upper quadrant ultrasound. No hepatobiliary abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Elevated liver enzymes. Abdominal pain. LIVER: Multiple 1-2 cm hypoechoic hepatic solid masses are noted. A round hypoechoic right posterior liver lesion measures 2.2 x 1.9 x 1.8 cm. Non-cirrhotic liver morphology. Normal background parenchymal echogenicity. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Biliary sludge noted, without evidence of cholecystitis. No sonographic Murphy's sign noted.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 12.0 cm in length. The left kidney is 11.8 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 10.4 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid noted.", "output": "1. Multiple hepatic masses. Evaluation with CT or MRI is recommended.2. Biliary sludge. No evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Female 42 years old Reason: R/O Ventral Hernia. History: R/O Ventral Hernia. In the left paracentral abdominal wall, in the paraumbilical region, there was a predominantly hyperechoic, heterogeneous soft tissue lesion surrounded by fluid. It was not possible to localize a definite defect in the ventral abdominal wall musculature however the appearance was suggestive of a paraumbilical hernia. The soft tissue demonstrated no definite peristalsis to suggest bowel and the appearance was more suggestive of intra-abdominal fat. The hernia was not reducible at time of study.", "output": "Fluid and fat-containing paraumbilical hernia. There was no peristalsis to suggest bowel within the hernia and the hernia was not reducible at time of imaging."}
{"instruction": "Generate impression based on findings.", "input": "Female, 31 years old. History of renal angiomyolipoma, hx of partial nephrectomy x 2 RIGHT KIDNEY: The right kidney measures 9.9 cm in length, with normal cortical echogenicity. A small round hyperechoic focus in the upper pole measures 0.7 x 0.7 x 0.8 cm, unchanged in appearance from prior.LEFT KIDNEY: The left kidney measures 9.5 cm. Multiple punctate hyperechoic foci are again noted throughout the left kidney, similar to prior.OTHER: No significant abnormalities noted.", "output": "1.Unchanged right upper pole hyperechoic focus, compatible with an angiomyolipoma.2.Multiple punctate hyperechoic foci throughout the left kidney appear similar to prior."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Patient with renal failure, evaluate for hydronephrosis History: renal failure RIGHT KIDNEY: The right kidney measures 13.6 cm in length. There is increased renal parenchymal echogenicity. There is mild hydronephrosis. Right upper pole cyst with a single septation measures 3.4 x 3.5 x 3.5 cm. No focal masses or stones.LEFT KIDNEY: The left kidney is nonvisualized.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "1. Mild right hydronephrosis.2. Increased renal parenchymal echogenicity, which can be seen in medical renal disease.3. Nonvisualization of the left kidney."}
{"instruction": "Generate impression based on findings.", "input": "42 years old, Male, Reason: screning for aaa, pre-OHT History: PRE-CARDIAC TRANSPLANT evaluation LIVER: The liver is slightly enlarged measuring 17.7 cm. Focus of increased echogenicity in the liver measuring 0.8 x 0.7 x 0.7 cm may represent a hemangioma although is incompletely characterized on this ultrasound examination. This lesion may be further characterized by MRI if clinically warranted. The portal vein is patent with hepatic pedal flow at 0.3 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is somewhat contracted without evidence of cholelithiasis or cholecystitis. The common bile duct measures 0.3 cm.PANCREAS: Visualized portions of the pancreas are unremarkable.SPLEEN: The spleen measures 9.3 cm in length. No significant abnormalities are noted.KIDNEYS: The right kidney measures 11.5 centimeters in length. Left kidney measures 8.8 cm Increased echogenicity of the kidneys bilaterally is consistent with medical renal disease. No evidence of hydronephrosis or shadowing calculus. ABDOMINAL AORTA: No evidence of focal dilatation of the abdominal aorta. The abdominal aorta is mildly tortuous with a focus of wall calcification of the mid aorta. The proximal aorta measures 1.1 x 1.5 x 1.4 cm. The mid aorta measures 1.5 x 1.4 x 1.3 cm. The distal aorta measures 1.3 x 1.1 x 1.3 cm. Right iliac artery measures 0.9 cm. The left iliac artery measures up to 1.1 cm.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: The bladder is not completely distended. There is a hypoechoic focus in the anterior portion of the visualized prostate, best seen on image time stamped 10:58:34 which is nonspecific on this ultrasound examination which can be correlated with patient's PSA.", "output": "1. Subcentimeter focus of increased echogenicity within the liver is incompletely characterized on this ultrasound examination. This maybe further characterized with dedicated MRI if clinically warranted, but statistically favors a hemangioma.2. No evidence of focal dilatation of the abdominal aorta.3. Hypoechoic focus in the anterior portion of the visualized prostate is nonspecific on this ultrasound examination. Please correlate with patient's PSA."}
{"instruction": "Generate impression based on findings.", "input": "Multiple myeloma with increasing LFTs LIVER: Mildly coarse echogenic liver echotexture without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 13.2 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 8 cm in length.RIGHT KIDNEY: No significant abnormalities noted. 9.8 cm in length.OTHER: Left kidney 8.1 cm in length. No ascites.", "output": "Mildly heterogeneous and coarse liver echotexture; these findings may be representativeof fatty infiltration or parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old female presents with neck fullness. Evaluate thyroid. RIGHT LOBE MEASUREMENTS: 5.9 x 1.2 x 2.1 cm.LEFT LOBE MEASUREMENTS: 6.1 x 1.7 x 2.1 cm.ISTHMUS MEASUREMENTS: 0.4 cm.RIGHT LOBE: Mildly heterogenous parenchyma without nodule. Normal vascularity.LEFT LOBE: Mildly heterogenous parenchyma without nodule. Normal vascularity.ISTHMUS: Mildly heterogenous parenchyma without nodule. Normal vascularity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Mildly heterogeneous echotexture of the parenchyma of the thyroid without nodule. Normal vascularity."}
{"instruction": "Generate impression based on findings.", "input": "Reason: portal vein thromboses? History: rapidly accumulating abdominal ascites, presumably malignant. LIVER: The liver measures 11.2 cm in length. Focal solid hepatic lesion with hypoechoic rim within the right lobe measuring 6.1 x 3.7 x 2.8 cm compatible with metastatic lesion as seen on recent CT. The lesion appears slightly increased in size compared to the comparison CT. The portal vein is patent demonstrating hepatopetal flow with a velocity of 0.16 m/s.BILIARY TRACT: Cholelithiasis including stones within the gallbladder neck. Mild gallbladder wall thickening which is nonspecific but likely related to ascites. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 2.6 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 12.3 cm in length. RIGHT KIDNEY: Kidney measures 8.6 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.0 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: Large volume ascites, increased from comparison CT.", "output": "1.Large volume ascites, increased. Main portal vein grossly patent.2.Hepatic metastasis, increased in size.3.Cholelithiasis. Nonspecific gallbladder wall thickening which may related to ascites. If there is clinical concern for acute cholecystitis, nuclear medicine HIDA scan could be considered."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant abdominal pain. LIVER: The liver is mildly echogenic. It measures 15.6 cm in length without a focal lesion or intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 0.2 m/s.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 2 mm.Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid or focal tenderness.PANCREAS: The visualized portions of the pancreatic head and body are unremarkable. The remainder of the pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 9.6 cm in length without a focal abnormality.RIGHT KIDNEY: The right kidney measures 10.5 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. OTHER: The left kidney measures 10.9 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion.", "output": "Mildly echogenic liver parenchyma suggestive of diffuse fatty infiltration. No focal liver lesion, biliary ductal dilatation gallstones or gallbladder inflammation."}
{"instruction": "Generate impression based on findings.", "input": "50 year-old male with increasing liver function tests and right upper quadrant pain. Evaluate for gallstones and cholecystitis. LIVER: The liver is mildly coarse in echogenicity without a focal hepatic lesion or intrahepatic biliary ductal dilatation evident. Liver measures 18.8 cm in craniocaudal dimension. There is a small amount of perihepatic ascites.Normal hepatopetal portal venous blood flow at 19 cm/sec.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common bile duct measuring up to 3 mm. There is a normally distended gallbladder with mild diffuse wall thickening of approximately 5 mm, which is nonspecific in the setting of ascites. There is gallbladder sludge. Mild focal tenderness reportedly over the gallbladder fossa is present although the patient is diffusely tender.PANCREAS: The pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 9.3 cm in length without a discrete abnormality.RIGHT KIDNEY: The right kidney measures 10.9 cm in length without hydronephrosis or shadowing calculus evident. OTHER: The left kidney measures 10.5 cm without hydronephrosis or shadowing calculus evident.Incompletely imaged left pleural effusion and small volume ascites.", "output": "1. Gallbladder sludge and mild diffuse gallbladder wall thickening is nonspecific in the setting of ascites, and focal tenderness over the gallbladder fossa is also nonspecific in the setting of reportedly diffuse abdominal tenderness. If there is continued clinical concern for acute cholecystitis, a nuclear medicine HIDA scan should be considered.2. Mildly coarse hepatic echogenicity may represent diffuse fatty infiltration/parenchymal dysfunction.3. Partially visualized left pleural effusion and small volume ascites."}
{"instruction": "Generate impression based on findings.", "input": "Epigastric pain LIVER: Normal echogenicity. Liver length 19.3 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or duct dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right kidney 10.3 cm in length.OTHER: Left kidney 11.5 cm in length. Spleen 8 cm in length. No ascites.", "output": "Cholelithiasis without acute inflammation or ductal dilatation. Mild hepatomegaly; no ascites"}
{"instruction": "Generate impression based on findings.", "input": "42-year-old woman presents for call back from screening for a focal asymmetry in the left breast on 8/28/2015. Family history of breast cancer in a sister diagnosed at age 57. An ML view 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, unchanged in pattern and distribution. The approximately 6 cm focal asymmetry in the left inferior breast persists on spot compression images. LEFT BREAST ULTRASOUND", "output": "Left inferior breast cysts and mildly dilated ducts. Since the patient does not have prior exams, a left unilateral diagnostic mammogram and possible ultrasound examination are recommended in 6 months, as long as the patient's physical examination remains normal. Results and recommendation 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": "47 year old male with acute kidney injury, anuria. Evaluate for decreased kidney perfusion or hydronephrosis. RIGHT KIDNEY: No significant abnormalities noted. No evidence of hydronephrosis. The right kidney measures 11.1 cm in length.LEFT KIDNEY: The left kidney is not well visualized which may be related to the patient's body habitus.OTHER: No significant abnormalities noted.", "output": "Unremarkable ultrasound examination of the right kidney. No evidence of hydronephrosis, as clinically questioned. Limited evaluation of the left kidney, which may be related to the patient's body habitus."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodule. Previous thyroid FNA at Northwestern Hospital on 8/2/2012 demonstrated left lobe colloid nodule. RIGHT LOBE MEASUREMENTS: 3.7 x 1.2 x 1.1 cm, not significantly changed.LEFT LOBE MEASUREMENTS: 4.3 x 1.5 x 1.2 cm, not significantly changed.ISTHMUS MEASUREMENTS: 1 mm in AP dimension, not significantly changed.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: The predominantly hypoechoic nodule with peripheral calcifications is unchanged at 13 x 9 x 9 mmISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not identified.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Unchanged calcified 13 mm left thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female with history of thyroid nodules RIGHT LOBE MEASUREMENTS: 6.9 x 4.6 x 2.0 cmLEFT LOBE MEASUREMENTS: 6.0 x 4.7 x 1.9 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: 0.9 x 0.6 cm nodule in the inferior right lobe with colloid morphologic features.LEFT LOBE: 0.8 x 0.8 cm centrally solid peripherally cystic nodule in the right lower 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 thyroid nodules as described above. "}
{"instruction": "Generate impression based on findings.", "input": "37-year-old female with right upper quadrant pain and diarrhea. LIVER: Hepatomegaly without significant change when compared to prior exam. Mildly coarsened echotexture of the liver which is nonspecific and without change. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder is well-visualized appears normal without cholelithiasis, wall thickening or pericholecystic fluid.PANCREAS: The head and body appear normal. The tail was not well seen due to bowel gas.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Hepatomegaly with coarsened liver echotexture without change. Normal gallbladder and biliary tract."}
{"instruction": "Generate impression based on findings.", "input": "80-year-old male with swelling over right shoulder. Evaluate for change. There is an approximately 2.2 x 2.4 x 2.8 cm mixed solid-cystic area with internal echoes. With comparison to prior CT of the right shoulder dated March 2016, this is most consistent with a complex synovial cyst.", "output": "1. Complex synovial cyst as described above."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 46M adm with SBO, s/p lap lysis of adhesions, now with new transaminitis History: transaminitis LIVER: The liver measures 13.9 cm in length. Mildly coarse, echogenic hepatic parenchyma. The portal vein is patent with normal hepatopedal directional flow, peak velocity 14.4 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. No shadowing stones or sludge. No biliary ductal dilatation. The gallbladder wall measures 0.2 cm. The common bile duct measures 0.2 cm.PANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney measures 11.8 cm in length. The left kidney measures 10.2 cm in length. No hydronephrosis or shadowing renal calculi.OTHER: No ascites. The spleen measures 8.2 cm.", "output": "Mildly coarse, echogenic liver, consistent with parenchymal dysfunction or hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female presents for six-month follow-up of a benign-appearing left breast mass at the 3:00 position seen on prior left breast ultrasound dated 3/14/2016. Patient had left breast excisional biopsy for Phyllodes tumor in May 2016 with reexcision in June 2016. A targeted left ultrasound was performed in the area of previously described left breast mass. At 3:00, 2 cm from the nipple, there is a 1.4 x 0.7 x 1.3 cm oval circumscribed isoechoic mass, not significantly changed from prior study dated 3/14/2016.", "output": "When compared to prior study from 3/14/2016, there has been no significant interval change in a 1.4 cm left breast mass at the 3:00 position, suggestive of a fibroadenoma. No sonographic evidence for malignancy in the left breast. Patient will be due for bilateral diagnostic mammogram in February 2017.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Elevated lactic acid. Concern for cholangitis or cholecystitis. LIVER: Diffuse metastatic disease throughout the liver. 17 cm in length. There is reversed flow in the main portal vein, measuring approximately 18 cm/s.GALLBLADDER, BILIARY TRACT: Common bile duct at the upper limits of normal in width at 7 mm. The gallbladder is collapsed, with several small gallstones. Minimal gallbladder wall thickening is non-specific in the setting of ascites.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 10.6 cm in length. The left kidney is not well visualized. The renal parenchyma is echogenic bilaterally. No suspicious renal lesions are evident. No hydronephrosis is seen. SPLEEN: 10.2 cm in length, without focal lesions evident.OTHER: Moderate ascites is noted.", "output": "1. Diffuse metastatic disease throughout the liver, with reversal of portal venous flow.2. Moderate ascites.3. Cholelithiasis without specific evidence of cholecystitis.4. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old female with acute kidney injury RIGHT KIDNEY: Measures 7.2 cm in length. Unremarkable echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 10.8 cm in length. Unremarkable echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.", "output": "Unremarkable sonographic examination of the kidneys. No hydronephrosis, nephrolithiasis, or solid mass. "}
{"instruction": "Generate impression based on findings.", "input": "36 years old, Female, Reason: nontender goiter on exam, eval for nodules History: asymptomatic RIGHT LOBE MEASUREMENTS: 5.5 x 2.3 x 1.9 cmLEFT LOBE MEASUREMENTS: 5.2 x 1.9 x 1.2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Single hypovascular right thyroid nodule measures 2.1 x 1.0 x 1.4 cm. This nodule is hypoechoic to normal thyroid tissue with heterogeneous echotexture.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": "Single hypovascular right thyroid nodule measuring up to 2 cm which is hypoechoic to normal thyroid tissue and has heterogeneous echotexture."}
{"instruction": "Generate impression based on findings.", "input": "Renal transplant with elevated creatinine Normal echogenicity without mass or stone. Expected minimal hydronephrosis. Right iliac fossa renal transplant 12.3 cm in length.OTHER: Bladder nondistended", "output": "Unremarkable right iliac fossa renal transplant without evidence for mass, stone, or significant hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old pregnant female complaining of left upper inner breast tenderness. Patient denies any new palpable lump. Targeted ultrasound of the left upper inner breast, 11:00 12 cm from the nipple in patient's area of concern, reveals no cystic or solid mass.", "output": "No sonographic evidence of 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: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed. "}
{"instruction": "Generate impression based on findings.", "input": "22 years old, Male, Reason: evaluate gallbladder, ducts History: RUQ pain LIVER: The liver measures 17.3 cm in length. Echogenicity of the liver is borderline increased. No focal hepatic lesion identified. The main portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.3 m/s.BILIARY TRACT: Gallbladder sludge and possible small gallstones are present. Per ultrasound technologist, negative sonographic Murphy's sign. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct is mildly prominent measuring 7 mm in diameter. There is minimal tapering of the common bile duct at the midportion. The distal common bile duct is not well assessed on this exam and choledocholithiasis at this level cannot be entirely excluded.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 10.7 cm in length. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.3 cm in length. No hydronephrosis.", "output": "1.Gallbladder sludge and possible small gallstones without evidence of acute cholecystitis.2.Distal common bile duct not well assessed, as above."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess for portal hypertension in liver History: hcv LIVER: Coarse, echogenic and heterogeneous hepatic parenchyma. The liver measures 16.1 cm in length. The portal vein is patent with normal directional hepatopedal portal venous blood flow, peak velocity 29.8 cm/s with minimal pulsatility. No portosystemic collaterals. No focal mass.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. The gallbladder wall measures 0.3 cm. The common bile duct measures 0.3 cm. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The left kidney measures 11.0 cm, however is poorly visualized. No hydronephrosis.LEFT KIDNEY: The left kidney measures 11.8 cm in length, however is poorly visualized. No hydronephrosis.OTHER: No ascites. The spleen measures 11.1 cm in length.", "output": "1. Findings consistent with hepatic steatosis or parenchymal dysfunction. No specific evidence of portal hypertension."}
{"instruction": "Generate impression based on findings.", "input": "Male 69 years old Reason: eval for lesions, assess hepatic vessel patency History: cirrhosis LIVER: Liver measures 17.4 cm. Liver has coarsened increased echogenicity, which may be seen in fatty infiltration or diffuse hepatic disease. No focal mass.BILIARY TRACT: No intrahepatic biliary ductal dilatation. There are likely foci of pneumobilia. Gallbladder is not present.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: Spleen measures 12.2 cm. Calcified granulomas present within the spleen measuring 2.1 x 1.7 x 2.6 cm.KIDNEYS: Kidneys have increased echogenicity consistent with medical renal disease. No renal mass, shadowing calculus, or hydronephrosis. Right kidney measures 9.6 cm. Left kidney measures 9.7 cm. OTHER: No ascites", "output": "1.Unchanged coarsened echotexture of the liver without mass or ductal dilatation.2.Patent hepatic vasculature with normal flow.3.Echogenic kidneys consistent with medical renal disease/parenchymal dysfunction without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate hypoattenuating thyroid nodules visualized on CT soft tissue neck History: none. RIGHT LOBE MEASUREMENTS: 3.8 x 1.8 x 1.1 cm.LEFT LOBE MEASUREMENTS: 3.7 x 1.3 x 1.3 cm.ISTHMUS MEASUREMENTS: 0.2 cm.RIGHT LOBE: Inhomogeneous in echotexture. In the right lower pole, there is a cystic nodule measuring 0.6 x 0.6 x 0.5 cm, benign.LEFT LOBE: Inhomogeneous in echotexture. In the left superior pole, there is a spongiform nodule measuring 0.3 x 0.4 x 0.3 cm, likely benign.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: In the right level 3, there is a 2.4 x 0.8 x 0.3 cm lymph node. In the left level 3, there is a 1.1 x 0.6 x 0.4 cm lymph node. In the left level 4, there is a 1.6 x 0.6 x 0.6 cm lymph node.OTHER: No significant abnormality noted.", "output": "Subcentimeter likely benign nodules in each thyroid lobe."}
{"instruction": "Generate impression based on findings.", "input": "Septic shock LIVER: Stable cirrhotic morphology. No mass lesion. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 17.3 cmBILIARY TRACT: Gallbladder absent. No ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9.4 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 12.3 cm in lengthOTHER: Left kidney 12.9 cm in length. No ascites. Right pleural effusion.", "output": "Stable cirrhotic morphology without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female, 28 years old. Reason: AKI History: AKI RIGHT KIDNEY: The right kidney measures 11.6 cm in length with increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney is poorly visualized but measures approximately 10.1 cm in length. No shadowing stones or hydronephrosis.OTHER: The bladder is distended and debris-filled.", "output": "1.Increased renal cortical echogenicity compatible with medical renal disease. No hydronephrosis.2.Debris-filled bladder."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old female status post laparoscopic gastric sleeve surgery with abdominal pain. LIVER: Enlarged measuring 21.7 cm in length. Increased hepatic echogenicity without discrete focal lesion.BILIARY TRACT: No cholelithiasis, gallbladder wall thickening, or biliary ductal dilation.PANCREAS: Portions of the pancreas are not visualized due to 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 hepatic steatosis or parenchymal disease."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Please evaluate for cause of acute decompensation of cirrhosis; portal vein or other thrombosis, biliary obstruction History: h/o HCV cirrhosis, adm with SBP, acutely worsened bilirubinemia, ascites, generalized abd pain LIVER: Extensive cirrhotic changes, including nodular contour and coarse, heterogeneous echotexture. Extensive subcapsular adhesions. No focal mass. The hepatic veins are not visualized, but this may be related to decompensated cirrhosis and hepatic fibrosis. The portal vein demonstrates ambiguous directional slow flow. No definite evidence of thrombus in the main portal vein.GALLBLADDER, BILIARY TRACT: Echogenic shadowing stones in the gallbladder neck and sludge. The gallbladder wall measures 0.4 cm. No pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 9.5 cm. No shadowing stones or hydronephrosis.The left kidney measures 10.2 cm in length. No shadowing stones or hydronephrosis.OTHER: The spleen measures 15.8 cm in length, enlarged. Small to moderate volume of at least partially loculated ascites.", "output": "1. Findings consistent with advanced cirrhosis.2. Limited vascular exam. The portal vein is at least partially patent without complete thrombosis, however ambiguous directional slow portal venous flow is new since prior exam and may represent progressive portal hypertension.3. Extensive subcapsular adhesions, which may be related to history of spontaneous bacterial peritonitis.4. Cholelithiasis without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Patient is a 34-year-old female with known right breast cancer, on neoadjuvant therapy, who presents for ultrasound examination of treatment response. A right ultrasound was performed at the area of the known breast cancer. At 10:00 location, posterior right breast, 12 cm from the nipple, there is a 11 x 12 x 12 mm hypoechoic irregular mass with spiculated margin, compatible with known cancer, which previously measured 19 x 17 x 14 mm.", "output": "Interval reduction in size of the known right breast cancer. 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": "37-year-old pregnant female with concern for asymmetric breasts presents for sonographic evaluation. Patient does not complain of a palpable abnormality.On physical examination, the right breast is noted to be larger than the left breast. The right breast is not erythematous or warm to touch. Patient denies right breast tenderness.A whole right breast ultrasound was performed for area of concern. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male with history of cirrhosis. Evaluate for HCC. LIVER: The liver measures 12.4 cm, and has a coarse, hyperechoic parenchyma consistent with history of cirrhosis. No masses are seen.BILIARY TRACT: No significant abnormalities noted. Gallbladder wall thickening is again seen, unchanged, and there is no biliary dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. The spleen measures 16.4 cm.RIGHT KIDNEY: No significant abnormalities noted. The right kidney measures 8.7 cm.OTHER: No significant abnormalities noted. The left kidney measures 9.3 cm.", "output": "Coarse hepatic parenchymal echotexture, without focal mass."}
{"instruction": "Generate impression based on findings.", "input": "62 year old with biopsy proven right breast cancer. Ultrasound was performed to check the marker clip placement of the proven cancer. Focused ultrasound confirmed the proven cancer in the right breast at 1:00 position, without significant changes. A marker clip is identified within the cancer.", "output": "Biopsy proven right breast cancer BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "26 day old female neonate with apnea. History of ventriculomegaly. Please evaluate for ventriculomegaly/any mass effect. There is mild asymmetric enlargement of the left lateral ventricle on comparison to the right; however this finding is within normal limits and was seen on prior head ultrasound. There is no evidence of intracranial hemorrhage, mass or edema. No evidence of ventriculomegaly; the basal cisterns are normal in appearance.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses are normally pneumatized; the mastoid air cells are partially opacified.", "output": "No evidence of ventriculomegaly or other acute abnormality. "}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury. Currently increased from 1.5-2.7. RIGHT KIDNEY: Right kidney measures 10.2 cm. Right simple cyst measuring 1.2 x 1.1 x 1.3 cm, similar to prior. Echogenic upper pole lesion is slightly increased in size measuring 0.8 x 0.8 x 0.8 cm, previously 0.6 x 0.5 x 0.5 cm. No hydronephrosis or renal calculus identified.LEFT KIDNEY: Left kidney measures 11.0 cm. No renal calculus, hydronephrosis or suspicious lesion identified.URINARY BLADDER: Incompletely distended.OTHER: No significant abnormalities noted.", "output": "1.Right simple cyst. Additional indeterminate echogenic lesion, possibly an angiomyolipoma, slightly increased in size from prior presumably secondary to technical differences.2.No hydronephrosis or renal calculus identified."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid storm RIGHT LOBE MEASUREMENTS: 7.4 x 3.5 x 3.1 cmLEFT LOBE MEASUREMENTS: 8.7 x 3.7 x 3.6 cmISTHMUS MEASUREMENTS: 1.3 cmRIGHT LOBE: Diffusely enlarged heterogeneous gland now with marked increased diffuse vascularity.. Dominant mid pole nodule has slightly increased in size now measuring 2.8 x 2.5 x 1.7 cm and now demonstrates diffuse hyper echogenicityLEFT LOBE: Diffusely enlarged heterogeneous gland now with marked increased diffuse vascularity. Multiple nodules unchanged.ISTHMUS: Enlarged heterogeneous gland with increased diffuse vascularityPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely enlarged heterogeneous thyroid gland now with marked increased diffuse vascularity consistent with suspected thyroid storm vs acute thyroiditis. Interval increase in size of dominant right midpole thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs. LIVER: The liver is mildly coarse and echogenic. It measures 14 cm in length. No intrahepatic biliary ductal dilatation or focal lesion is identified. The liver morphology and capsule is smooth without specific stigmata of cirrhosis. Normal hepatopedal portal venous blood flow at 24 cm/s.BILIARY TRACT: Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid or focal tenderness. No extrahepatic biliary ductal dilatation with the common duct measuring 2 mm.PANCREAS: The pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen was not imaged.RIGHT KIDNEY: 1.4 x 1.3 x 1.5 cm right renal superior pole solid lesion better characterized on recent CT. OTHER: No significant abnormalities noted.", "output": "Coarse echogenic liver parenchyma suggesting fatty infiltration and/or parenchymal dysfunction. No biliary ductal dilatation or focal lesion.Approximately 1.5 cm right renal superior pole solid lesion, suspicious for neoplasm and better characterized on recent CT."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female complains of right flank pain x1 month. There is clinical concern for cholelithiasis versus nephrolithiasis. LIVER:The liver measures 16.6 cm. There is coarse and increased echogenicity of the hepatic parenchyma. No mass or ascites. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended, the wall measures 1.8 mm, there is no pericholecystic fluid, there are no stones or sludge. The common bile duct measures 2.3 mm. The common hepatic duct measures 2.4 mm.PANCREAS: The pancreas is mostly obscured by overlying bowel gas. The visualized portions are normal in appearance.SPLEEN: The spleen measures 9.9 cm. No abnormalities noted.KIDNEYS: Right kidney measures 10.8 cm. The cortex has normal echogenicity. No shadowing calculi or hydronephrosis present. Left kidney measures 11.2 cm. The cortex has normal echogenicity. No shadowing calculi or hydronephrosis present. OTHER: No significant abnormality noted.", "output": "1. Coarse echogenic liver consistent with chronic liver disease/parenchymal dysfunction. No mass or ascites.2. No sonographic evidence of cholelithiasis or nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without worrisome mass or stone. Minimal hydronephrosis. Right kidney 10.3 cm in length.LEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. Left kidney 10 centimeters in length.OTHER: Bladder nondistended. Moderate ascites.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass or stone. Minimal right hydronephrosis. Moderate ascites"}
{"instruction": "Generate impression based on findings.", "input": "71-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: Mildly asymmetric hypoechoic region in the inferior right bed is stable over the last 2 years.LEFT LOBE: No massesISTHMUS: No massesPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable exam without evidence for recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male patient with NRH, portal hypertension. Evaluate for HCC> LIVER: The liver measures 10.6 cm in length. No focal hepatic lesion is identified. Hepatic parenchymal echogenicity is increased. The main portal vein is thrombosed, unchanged. Multiple collateral vessels are redemonstrated with hepatopetal flow within the left portal vein.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 10.5 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.3 cm in length. No evidence of hydronephrosis.The spleen measures 21 cm in length. The splenic vein appears thrombosed near the portal confluence.No ascites.", "output": "1. Cirrhotic morphology of the liver with chronic thrombosis of the portal vein with collateral vessel formation. No discrete hepatic lesion is identified.2. Splenomegaly.3. No ascites.  "}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female patient with hemachromatosis. LIVER: The liver measures 13.3 cm in length. There is a 2.4 x 2.6 anechoic lesion with posterior acoustic enhancement compatible with a simple cyst in the right hepatic lobe, which is slightly larger in size compared to the 2008 study. An additional bilobed hepatic cyst is noted more posteriorly in the right hepatic lobe, not significantly changed. Main portal vein flow is hepatopetal and measures 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: There is normal echogenicity of the head and body of the pancreas. The tail of the pancreas is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 10.2 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.1 cm in length. No evidence of hydronephrosis. A subcentimeter mid pole simple cyst is again noted. Two echogenic foci within the mid pole of the left kidney are again seen compatible with nephrolithiasis.The spleen measures 6.2 cm in length.", "output": "1. Slightly increased size of one of two hepatic cysts. Unchanged simple left renal cyst.2. Left nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Female, 36 years old. Nephrotic proteinuria. Anasarca Three passes were performed. A small hematoma is noted after the third pass.", "output": "Right kidney biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Male, 48 years old. CKD. History of right nephrectomy RIGHT KIDNEY: The right kidney is surgically absent.LEFT KIDNEY: The left kidney measures 9.0 cm in length, with mildly increased cortical echogenicity. Multiple subcentimeter cysts are noted. A medial simple cyst measures 0.9 x 0.7 x 0.7 cm. No shadowing stones or hydronephrosis.OTHER: The bladder is incompletely distended.", "output": "1.Mildly increased renal cortical echogenicity raises the possibility of medical renal disease. Subcentimeter left simple renal cysts.2.Status post right nephrectomy."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain; celiac artery compression syndrome LIVER: No significant abnormalities noted. 19.4 cm in lengthGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.1 cm in lengthOTHER: Left kidney 10.7 cm in length. Spleen 11.8 cm in length. No ascites.", "output": "Negative right upper quadrant ultrasound. No hepatobiliary abnormality."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male with mass involving right shoulder. In the subcutaneous tissues of the right shoulder there is a large mildly heterogeneous mass. This is incompletely measured due to size but approximates 5.2 x 8.2 by at least 12 cm", "output": "Large subcutaneous mass right shoulder. Although the ultrasound appearance is not specific, the appearance is consistent with large lipoma.Report to Dr. Goetha Govindarajan: 773 834-0162"}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules seen on CT scan RIGHT LOBE MEASUREMENTS: 6.7 x 2.4 x 2.8 cmLEFT LOBE MEASUREMENTS: 5 x 1.7 x 2.1 cmISTHMUS MEASUREMENTS: 1 cmRIGHT LOBE: Diffusely heterogeneous gland with multiple predominantly solid nodules. The largest nodule arising from the mid pole measures 1.6 x 1.6 x 1.6 cm.LEFT LOBE: Diffusely heterogeneous gland. 0.9 x 0.9 x 1.1 cm mid pole nodule with thick rim calcification.ISTHMUS: Diffusely heterogeneous gland.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland with multiple predominantly solid nodules arising from the right gland. Mid pole left thyroid gland with thick rim calcification. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Female; 46 years old. Reason: R/O Amyloidosis History: Proteinuria Ultrasound guidance and technical assistance were provided for a native right kidney biopsy. Three passes were performed. The procedure was successfully completed.", "output": "Successful ultrasound guided biopsy of the native right kidney."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male with right flank pain. Evaluate for renal stone, hydronephrosis, renal parenchymal disease, gallstones, liver mass. Limited exam due to patient positioning as imaging was obtained in the upright position, patient was not able to lie supine.LIVER: Coarse echotexture of the liver with a nodular contour compatible with cirrhosis. The liver measures 16.1 cm in length. Main portal vein is patent with appropriate directional flow.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. No evidence of cholelithiasis. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: The visualized portions of the pancreas are normal in echogenicity. No evidence of pancreatic ductal dilatation.SPLEEN: Normal echogenicity of the spleen measuring 10.3 cm in length.KIDNEYS: Right kidney measures 9.6 cm in length and is increased in echogenicity with no evidence of hydronephrosis. Left kidney measures 10.1 cm in length and is increased in echogenicity with no evidence of hydronephrosis.ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Cirrhotic liver morphology. 2. Increased echogenicity of the kidneys suggestive of parenchymal dysfunction. No obstruction. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate fistula for abscess History: fever Images demonstrate a tubular structure within the superficial soft tissues of the left anterior arm which presumably represents a dialysis AV fistula. Color Doppler flow is present within the structure with some aliasing suggestive of turbulent flow. No abnormal fluid collections are identified within the adjacent surrounding soft tissues to suggest abscess.", "output": "1.No evidence of abscess associated with the left upper arm AV fistula. 2.Turbulent flow within the fistula. Dedicated vascular ultrasound can be considered as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old female with right upper quadrant pain, elevated alkaline phosphatase. LIVER: Measures 20.2 in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Small gallstones layer dependently within the gallbladder, without gallbladder wall thickening or pericholecystic fluid. There is dilation of the common bile duct proximally measuring up to 1.3 cm at the level of the porta hepatis. However, the distal common bile duct is not well visualized due to bowel gas.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": "1. Cholelithiasis without specific evidence of acute cholecystitis. Dilation of the common bile duct proximally up to 1.3 cm, with incomplete visualization of the distal common bile duct due to bowel gas. If there is high clinical suspicion for choledocholithiasis, an MRCP may be considered as warranted clinically.2. Hepatomegaly with increased echogenicity consistent with hepatic steatosis or parenchymal disease."}
{"instruction": "Generate impression based on findings.", "input": "Male, 83 years old. Bilateral hydro in patient with prior obstructive bph. AKI. Now status post stent placement. RIGHT KIDNEY: The right kidney measures 8.9 cm in length. Mild hydronephrosis. A nonobstructing stone in the renal pelvis measures 1.2 x 1.1 x 1.0 cm. The new left ureteral stent is not seen in the proximal collecting system.LEFT KIDNEY: The left kidney is not well-visualized. No obvious hydronephrosis within these limitations. An upper pole probable cyst measures 3.9 x 3.2 x 3.5 cm.OTHER: The bladder decompressed with Foley catheter in place and ureteral stents visualized.", "output": "Improved hydronephrosis status post ureteral stent placement, now mild on the right. Poorly evaluated left kidney without obvious hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old male with history of renal stones. RIGHT KIDNEY: Measures 11.3 cm. No hydronephrosis or renal calculi.LEFT KIDNEY: Measures 11.1 cm in length. Multiple small renal stones measuring approximately 5 mm with associated twinkle artifact. No hydronephrosis.OTHER: The bladder is partially collapsed.", "output": "Left nephrolithiasis without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Callback from whole breast ultrasound to evaluate a hypoechoic mass in the right breast 9:30 o'clock position. A targeted right ultrasound was performed at 9 to 10:00 position 7 to 9 cm from the nipple. There is no solid or cystic mass identified. Normal glandular tissue noted.", "output": "No sonographic evidence for malignancy in the right breast 9 to 10:00 position.Annual screening mammogram and whole breast ultrasound is recommended, due in November 2015Findings and recommendations were discussed with the patient in detail.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "42 year old female who was recalled from screening mammogram for left breast asymmetry. No family history of breast cancer. LEFT DIAGNOSTIC MAMMOGRAM: An ML view 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, unchanged in pattern and distribution. There is redemonstration of a 0.8 cm oval mass at the 6 o'clock position of the left breast, which persists on spot compression imaging.LEFT BREAST ULTRASOUND: A targeted left ultrasound is performed for the mammographic area of concern. The 6 o'clock position of the left breast, 4 cm from the nipple, there is question of a partially circumscribed hypoechoic lesion measuring 0.7 x 0.7 cm. This lesion is subtle and does not demonstrate increased vascularity.", "output": "Persistent 0.8 cm mass at the 6 o'clock position of the left breast, with questionable sonographic correlate. Given visualization of this area is best seen on mammogram, a stereotactic guided biopsy of this lesion is recommended. Results and recommendation were discussed with the patient, who expressed understanding. The patient's daughter was present to facilitate translation.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with history of hepatitis C. LIVER: Measures 16.2 cm in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Cholelithiasis without 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": "1. Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease, without discrete focal lesion. 2. Cholelithiasis. "}
{"instruction": "Generate impression based on findings.", "input": "8-week-old male presents with anuria and concern for compartment syndrome. BLADDER  Wall Thickness: Incompletely evaluated given underdistention.  Contents: Distended and normal. Distal Ureter -- SFU Grade**  Right: 0  Left: 0   Ureteral Jets Right: Not observed  Left: Not observedKIDNEYS  Cortical Echogenicity: Increased echogenicity.  Medullary Echogenicity: Increased echogenicity.   Pelvicaliceal System -- SFU Grade*  Right: 2 Left: 2   Length*** Right: 4 cm Left: 3.7 cm   Mean for age: 5 cm  Range for age: 4 - 6 cmADDITIONAL OBSERVATIONS: The urinary bladder is decompressed with a Foley catheter. Trace free fluid.", "output": "Echogenic kidneys suggestive of medical renal disease with bilateral grade 2 hydronephrosis. Trace free fluid.*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": "Male 56 years old with persistently elevated bilirubin. Evaluate for gallbladder or liver pathology. Limited exam as the patient is intubated, the left side cannot be assessed. In addition, an open wound over the abdomen limits evaluation of the mid abdomen.LIVER: The liver measures 22 cm in length. The parenchyma is diffusely coarse and echogenic. There is a small amount of ascites, unchanged. The main portal vein is patent with a normal direction of flow and a velocity of 22 cm/s.BILIARY TRACT: No cholelithiasis. The gallbladder wall measures 2 mm in thickness. The common duct measures 5 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreas could not be visualized due to the open abdominal wound and overlying bandages.SPLEEN: The spleen could not be visualized as the patient was intubated and could not be repositioned.RIGHT KIDNEY: The right kidney measures 13 cm in length. There is no hydronephrosis OTHER: The left kidney could not be visualized as the patient was intubated and could not be repositioned.", "output": "1.Hepatomegaly with coarse echotexture consistent with hepatic steatosis/parenchymal dysfunction.2.No cholelithiasis or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Male 70 years old Reason: BPH - H/O urinary retention, H/O urosepsis. Post-void residual. Please evaluate. The patient had voided immediately prior to the study. Distended images of the bladder were therefore not obtained. The residual urine within the bladder was measured at this time.RIGHT KIDNEY: The right kidney measures 12.3 cm. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone.LEFT KIDNEY: The left kidney measures 12.6 cm. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone. Previously identified renal cyst is poorly visualized today.BLADDER: The bladder is poorly distended.POSTVOID IMAGES: The residual urine was measured at 2.4 x 3.6 x 2.4 cm (volume is 7.8 mL).OTHER: The prostate gland is markedly enlarged measuring 4.2 x 4.7 x 5.0 cm.", "output": "1. No significant post void residual. 2. Prostatomegaly."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old male with hepatitis C and nausea and epigastric pain. LIVER: Liver is normal in size and appears mildly and coarsely echogenic which is nonspecific. Liver was not grossly cirrhotic and no focal abnormality is identified.GALLBLADDER, BILIARY TRACT: Gallbladder contains comet tail artifact consistent with adenomyomatosis/cholesterol deposition. No shadowing gallstones, wall thickening or pericholecystic fluid. Biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Mildly complex left renal cyst. Focal echogenic region in the left kidney may represent nonobstructive calcification.", "output": "Probable adenomyosis involving the gallbladder. There is no acute abnormality."}
{"instruction": "Generate impression based on findings.", "input": "1 day old female with history of ambiguous genitalia. Evaluate for presence of testes. No testes were identified within the inguinal canal or within the labia. There is clitorimegaly.", "output": "No testes identified. Clitorimegaly. Given these findings and those of the same day pelvic ultrasound, an MRI is recommended for further anatomic evaluation."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old female with end-stage renal disease, volume overload. RIGHT KIDNEY: Measures 10.7 cm in length. Echogenic renal parenchyma without hydronephrosis, nephrolithiasis, or suspicious mass lesion.LEFT KIDNEY: Measures 9.7 cm in length. Echogenic renal parenchyma without hydronephrosis, nephrolithiasis, or suspicious mass lesion.BLADDER: Collapsed with a Foley catheter in place.OTHER: No significant abnormality noted.", "output": "Increased renal echogenicity consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "47 years old, Male, Reason: heavy alcohol -- liver and spleen appear ULN History: none LIVER: The liver size is within normal limits measuring 15.2 cm in length. Diffuse coarse increased echogenicity of the hepatic parenchyma is consistent with fatty infiltration. No definite nodularity of the liver to suggest cirrhosis. 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 5 mm in diameter.PANCREAS: No significant abnormalities noted in 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 echotexture. Nodular echogenic focus in the superior pole of the right kidney without posterior shadowing measures 1.6 x 1.8 x 1.8 cm and is favored to represent a angiomyolipoma. No hydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 10.9 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Diffusely coarsened increased echogenicity of the liver is consistent with fatty infiltration.2.Nodular echogenic focus in the superior pole of the right kidney likely represents an angiomyolipoma.3.No evidence of hepatosplenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Baseline exam for heart transplant evaluation LIVER:Liver is 16.4 cm with normal echotexture. No intrahepatic biliary ductal dilatation noted. No focal lesions.Main portal vein demonstrates normal flow directionality and patency.GALLBLADDER, BILIARY TRACT: Gallbladder is well-distended without any focal lesions. No pericholecystic fluid collection. Gallbladder wall thickness measures within 3 mm.PANCREAS: Head and body of pancreas appears unremarkable. Tail of pancreas not visualized to overlying bowel gas.SPLEEN: Kidney measures 9.6 cm with normal morphology. No focal lesions noted.KIDNEYS: Right kidney measures 7.9 cm the left kidney measures 12 cm. Mild increased echogenicity of both kidneys. No hydronephrosis or focal lesionsABDOMINAL AORTA: Abdominal aorta measures 2.1 x 1.8 cm proximally, 1.6 x 1.4 cm in the midportion and distally 1.5 x 1.5 cm. No evidence of any atherosclerotic plaques noted.INFERIOR VENA CAVA: PatentOTHER: No ascites", "output": "Mild increased echogenicity of the kidneys suggestive of underlying chronic medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Thyrotoxicosis RIGHT LOBE MEASUREMENTS: 3.9 x 2 x 1.5 cmLEFT LOBE MEASUREMENTS: 1.9 x 1.7 x 3.6 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": "Slightly small gland without nodules or regional adenopathy. No evidence for increased vascularity to suggest acute inflammation.."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Galanina is a 36-year-old female with biopsy-proven fibroadenoma in the left breast. Per patient and Dr. Chhablani, the fibroadenoma appears to be getting larger. She presents today for US evaluation of this mass. Upon physical exam at the patient's area of concern, a pea-sized soft mobile mass is appreciated. Targeted left breast ultrasound was performed.In the left breast 1:00 location, approximately 1 cm from the nipple, there is reidentification of an ovoid hypoechoic mass measuring 1.2 x 0.4 x 0.8 cm, compared to 1.1 x 1.1 cm.", "output": "No significant change in biopsy-proven fibroadenoma in the left breast. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Patient had outside mammograms for which ultrasound of the right upper outer quadrant is requested. A targeted right ultrasound was performed for the upper outer quadrant. There is no solid or cystic mass identified. Dense normal parenchymal elements are noted, and these could be the cause of the mammographic focal asymmetry.", "output": "No sonographic evidence for malignancy. As long as the patient's physical exam remains normal, then a routine screening mammogram in a year is recommended.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old male with cirrhosis, evaluate for HCC. LIVER: The liver measures 15.1 cm in length. Cirrhotic hepatic morphology with increased hepatic echogenicity. No discrete focal lesions are identified. The portal vein is patent with antegrade flow measuring 0.3 m/s.BILIARY TRACT: Hydropic gallbladder with cholelithiasis. No gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilation.PANCREAS: The pancreas is partially imaged due to bowel gas. Imaged portions of the pancreas appear unremarkable.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "1.Cirrhotic liver morphology with increased echogenicity consistent with chronic liver disease. No discrete lesions identified.2.Cholelithiasis without evidence of acute inflammation."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid cancer status post thyroidectomy RIGHT LOBE: Status post thyroidectomy without mass.LEFT 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": "Reason: Abnormal lymph nodes? History: Thyroid microcarcinoma and atypical adenoma RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Status post thyroidectomy. No discrete nodules are identified in the thyroidectomy bed.LEFT LOBE: Status post thyroidectomy. No discrete nodules are identified in the thyroidectomy bed.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There are several mildly prominent lymph nodes in the bilateral level 2 and level 3 regions which retain their fatty hila and are favored to be reactive. The most prominent lymph node on the right is in the level 2 region and measures 1.3 x 0.4 x 1.6 cm. The most prominent lymph node on the left is in the level 2 region and measures 1.7 x 0.8 x 1.0 cm. OTHER: No significant abnormality noted.", "output": "1.No suspicious lesion within the thyroidectomy bed.2.Mildly prominent cervical lymph nodes, favor reactive, with continued attention on subsequent follow-up examinations recommended."}
{"instruction": "Generate impression based on findings.", "input": "Epigastric pain LIMITED ABDOMENLIVER: Normal parenchymal echogenicity without mass. Liver length 13.8 cmBILIARY TRACT: Status post cholecystectomy. No significant ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 8.3 cm in length RIGHT KIDNEY: No significant abnormalities noted. 10.6 cm in lengthOTHER: Left kidney 10.3 cm in length. No ascites.", "output": "Unremarkable Limited right upper quadrant ultrasound. No hepatobiliary abnormality. No ascites. Patent hepatic vessels with normal directional flow. Unremarkable hepatic artery waveforms without evidence for increased diastolic dampening or increased resistance pattern."}
{"instruction": "Generate impression based on findings.", "input": "85 years old, Female, Reason: thyroid nodules seen on 9/2013 ultrasound - please check for progression History: none RIGHT LOBE MEASUREMENTS: 4.7 x 2.2 x 2.4 cmLEFT LOBE MEASUREMENTS: 4.3 x 2.2 x 1.5 centimeters ISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Complex cystic nodule in the right inferior thyroid lobe is not significantly changed size measuring 1.8 x 1.3 x 1.3 cm.LEFT LOBE: Previously noted cystic nodule on the left is not significantly changed in size. There is a newly identified subcentimeter simple cystic nodule in the left lower lobe.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Complex cystic nodule in the right inferior thyroid lobe is not significantly changed.2.Two subcentimeter simple appearing cysts in the left lower lobe."}
{"instruction": "Generate impression based on findings.", "input": "Male 79 years old; Reason: r/o cholecystitis, choledocholithiasis History: Conjugated hyperbilirubinemia The gallbladder wall measures 1.0 mm. Several very small gallbladder polyps are seen in the neck the largest measuring 0.3 cm x 0.3 cm x 0.3 cm. No stones are seen. No pericholecystic fluid. The common bile duct measures 4.0 mm in diameter. Minimal intrahepatic ductal dilation is seen. No evidence of extrahepatic ductal dilation.", "output": "1. Several subcentimeter gallbladder polyps are seen in the neck however no sonographic evidence of cholelithiasis or acute cholecystitis.2. Minimal intrahepatic ductal dilation is seen without extrahepatic ductal dilation."}
{"instruction": "Generate impression based on findings.", "input": "Female; 50 years old. Reason: kidney stones History: stones RIGHT KIDNEY: Right kidney measures 10.8-cm. Normal cortical echotexture and thickness. No hydronephrosis. No stones or masses.LEFT KIDNEY: Left kidney measures 11.5-cm. Normal cortical echotexture and thickness. No hydronephrosis. No stones or masses.OTHER: Bladder is underdistended.", "output": "No renal calculi. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old male with hepatitis C, Stevens-Johnson syndrome and sepsis. Evaluate for cholecystitis. LIVER: Liver is diffusely and mildly echogenic which is non--- specific. Liver is enlarged measures 22 cm in length. Main portal vein is patent with appropriate flow direction.BILIARY TRACT: Gallbladder appears normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: Poorly visualized due to bowel gas.SPLEEN: Enlarged, measuring 16.7 cm in length without focal abnormality.RIGHT KIDNEY: Echogenic without hydronephrosis. OTHER: Left kidney is echogenic without hydronephrosis.", "output": "Normal gallbladder and biliary tract. Hepatosplenomegaly without change.Echogenic liver without change.Echogenic kidneys without change."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old female with cirrhosis. Evaluate for hepatic mass and ascites. LIMITED ABDOMENLIVER: Liver is cirrhotic in morphology and coarsely echogenic. Collateral vessels are noted extending into the abdominal wall. In the right lobe of the liver there is and almost isoechoic mass with a hypoechoic rim. Although the appearance is somewhat atypical for hepatocellular carcinoma, this remains a strong potential diagnosis in a cirrhotic patient. The main portal vein is patent with appropriate flow direction. A portion of the right portal vein does not demonstrate obvious flow and there could be intrahepatic isolated portal vein thrombus.BILIARY TRACT: No gross biliary tract dilatation.. Multiple dependent gallstones are identified within the gallbladder without gross wall thickening.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. RIGHT KIDNEY: No significant abnormalities noted.OTHER: Mild to moderate ascites.INDEX LESION MEASUREMENTS (Current exam date/time: 1/29/2016 10:06:47)RIGHT HEPATIC LOBE MASS: 2.6 x 2.6 cm (Image 8192, Series 1).RIGHT HEPATIC LOBE LESION LONG: 2.8 cm (Image 8448, Series 1).", "output": "1 cirrhotic liver with mass.2. Possible thrombus in the right portal venous system..3. Ascites"}
{"instruction": "Generate impression based on findings.", "input": "18-year-old with bilateral fibroadenomas presents for follow-up. Patient states she feels like the right fibroadenoma is larger. RIGHT BREAST ULTRASOUND:On physical exam, there is a palpable soft mobile mass in the right breast upper outer quadrant at the area of clinical concern.A targeted grayscale and color Doppler right ultrasound was performed for the palpable area of concern. In the 10:00 location 5 cm from nipple there is a 1.4 x 0.8 x 1.5 cm well-circumscribed mass with internal vascularity and posterior acoustic enhancement, favoring a fibroadenoma. This mass previously has not significantly changed in size since ultrasound 5/26/2015 when it measured 1.2 x 0.7 x 1.4 cm and ultrasound 11/17/2014 when it measured 1.2 x 0.6 x 1.0 cm, accounting for differences in technique LEFT BREAST ULTRASOUND: On physical exam there is a mobile soft palpable mass in the left upper quadrant.A targeted grayscale and color Doppler left ultrasound was performed for the palpable area of concern. In the left breast 12:00 location 5 cm from nipple there is a 1.6 x 2.4 x 1.2 cm well-circumscribed lobulated mass with internal vascularity consistent with the known fibroadenoma. This mass has not significantly changed in size since ultrasound 5/26/2015 when it measured 1.4 x 2.1 x 1.2 cm and ultrasound 11/17/2014 when it measured 1.7 x 2.0 x 1.3 cm, accounting for differences in technique.", "output": "No significant change in bilateral benign morphology masses. The left-sided mass has previously undergone FNA and proven to be fibroadenoma. Morphology and sonographic findings of the right mass favor a fibroadenoma as well.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "66 year old female who was recalled from screening mammogram for bilateral breast asymmetries. 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(BiRads Density Category B). Focal asymmetry in the left outer breast mid depth disperses into normal breast tissue.11 mm oval benign morphology circumscribed mass in the right upper inner quadrant posterior depth persist on spot compression views, with possible lucency within it most likely representing a lymph node.Ultrasound: Targeted right upper inner quadrant ultrasound was performed. No definite correlate was identified on ultrasound.", "output": "High probability benign morphology mass in the right upper inner quadrant without definite sonographic correlate. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended in 6 months to confirm stability. Results and recommendation 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": "29-year-old female. Evaluate kidney stones. ABDOMEN: Exam is not sensitive for solid organs or bowel to the lack of intravenous and oral contrast.LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Single 3-mm focus of nephrolithiasis midright kidney. No calcification seen along the course of the ureters. Kidney contour is normal. Perinephric fat is normal. No hydronephrosis.Left kidney is normal. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Small soft tissue focus exophytic off anterior uterus abutting the abdominal wall, may represent a small fibroid in and much less likely portion of a urachal remnant.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": "Single punctate calcification right kidney. Uterine finding as above."}
{"instruction": "Generate impression based on findings.", "input": "Status post liver transplant with increasing LFTs LIMITED ABDOMENLIVER: Status post liver transplant. No mass lesion. Small porta hepatis gallbladder fossa bland postoperative fluid collection. Liver length 20.2 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 12.8 cm in length. RIGHT KIDNEY: No significant abnormalities noted. Right kidney 11.1 cm in lengthOTHER: Left kidney 12.3 cm in length. Trace ascites", "output": "Patent hepatic vessels with normal directional flow. Trace ascites. No ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Ms. MISS KIM TOLIVER is a 54 years old female with a personal history of a new focal asymmetry in the left lower inner breast noted on the screening mammogram 12/30/2015. The patient has a family history of breast cancer in her grandmother. MAMMOGRAM:ML and CC views as well as 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(BiRads Density Category C), unchanged in pattern and distribution. The previously seen focal asymmetry is again noted, measuring approximately 15 mm in the lower inner quadrant of the left breast. Although the symmetry appeared to persist on the compression views, on the full field ML and CC view this region has the appearance of normal glandular tissue.ULTRASOUND:On physical examination, no palpable lesion was evident.A targeted left ultrasound was performed left breast. There is no solid or cystic mass identified.", "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": "Chronic kidney disease. RIGHT KIDNEY: The right kidney measures 10.3 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. The renal cortex is mildly echogenic.LEFT KIDNEY: The left kidney measures 9.0 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion evident. The renal cortex is mildly echogenic.URINARY BLADDER: Normally distended urinary bladder.OTHER: No significant abnormalities noted.", "output": "Echogenic kidneys compatible with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Hyperbilirubinemia LIVER: Cirrhotic liver morphology. No focal hepatic lesions evident. 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 13.0 cm in length, with a 3.5 cm superior pole cyst and 3.7 cm inferior pole cyst. The left kidney is 10.8 cm in length. Increased renal parenchymal echogenicity bilaterally. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 16.9 cm in length, without focal lesions evident.OTHER: Moderate amount of ascites noted. Layering debris in the bladder.", "output": "1. Cirrhotic liver morphology with splenomegaly and ascites, similar to prior.2. Findings compatible with medical renal disease, without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. Right kidney 9.4 cm in lengthLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. Left kidney 10.1 cm in length.OTHER: Bladder non-distended. Cholelithiasis", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Lacocque is a 62-year-old female recalled from screening mammogram of 08/31/16 for a posterior depth circumscribed mass in the right breast. A targeted right breast ultrasound was performed for the mammographic area of concern. Two benign lymph nodes are seen in the right breast at the 9:00 position, approximately 9 cm from the nipple. No solid or cystic mass is identified.", "output": "Benign intramammary lymph nodes of the right breast. No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually, due next in August 2017. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 33 years old. Acute kidney failure. RIGHT KIDNEY: The right kidney measures 11.2 cm in length with mildly increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.0 cm in length with mildly increased cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The bladder is distended without significant wall thickening.", "output": "Mildly increased renal cortical echogenicity compatible with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "HPV LIVER: Coarse heterogeneous echotexture again noted without mass. Liver length 14.5 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.2 cm in lengthOTHER: Left kidney 11.6 cm in length. Spleen 9.9 cm in length. No ascites.", "output": "Coarse heterogeneous liver echotexture again noted consistent with chronic liver disease without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male with end-stage renal disease on peritoneal dialysis with bilateral renal masses. Evaluate for solid mass. RIGHT KIDNEY: Measures 11.9 cm in length. Solid mass in the superior pole of the right kidney measures 3.4 x 2.3 x 2.3 cm. Numerous additional right renal cysts without septation or solid component. Likely extrarenal pelvis correlates with outside MRI examination. LEFT KIDNEY: Measures 11.5 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. Numerous cysts measuring up to 3.1 cm without obvious solid component.URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.", "output": "Multicystic kidneys with right upper pole solid mass suspicious for neoplasm."}
{"instruction": "Generate impression based on findings.", "input": "Female 37 years old Reason: Rule out LN's vs. Ganglion Cysts History: Pt has hx of left forearm nodules off/on x 3mos - that gradually decrease in size. Nodules are painful.Additional history obtained in radiology: The patient pointed to several nodules been recently decreasing in size or larger, painful and tender. There is an associated numbness or tingling. High-frequency grayscale and color Doppler imaging showed no discrete measurable lesion over the palpable abnormality.", "output": "No visible lesion by ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old male with alcoholic cirrhosis, ascites, and acute kidney failure. LIVER: Cirrhotic liver contour with significant perihepatic ascites. The liver measures up to 14 cm in length. The main portal vein demonstrates normal hepatopedal flow and measures 15 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is partially collapsed, which limits evaluation for wall thickening. Shadowing gallstones are suspected. Normal common bile duct measuring 2 mm in diameter.PANCREAS: Pancreas is obscured due to overlying bowel gas.SPLEEN: The spleen measures 12.4 cm in length, and a 1.8 x 1.7 cm splenule is noted.KIDNEYS: The right kidney measures 10.7 cm in length, and there is no hydronephrosis. The left kidney measures approximately 10 cm in length, and no hydronephrosis is identified. Nonspecific mild increased echogenicity of the bilateral renal parenchyma. ABDOMINAL AORTA: Proximal abdominal aorta measures 2.3 cm in AP diameter.INFERIOR VENA CAVA: Poor evaluation with color Doppler.OTHER: Prominent ascites, which is more evident of the upper abdomen.", "output": "1. Cirrhotic contour of the liver with prominent upper abdominal ascites.2. Cholelithiasis without sonographic evidence for acute cholecystitis.3. No hydronephrosis. Mildly increased echogenicity of the renal parenchyma could represent chronic renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Transaminitis LIVER: Mildly coarse and echogenic liver parenchyma without mass. Liver length 14.6 cm. GALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right kidney 10.4 cm in length.OTHER: Left kidney 9.5 cm in length. Spleen 9.6 cm in length. Mild ascites. Abnormally enlarged endometrial cavity.", "output": "Mildly coarse and echogenic liver parenchyma suggestive for fatty infiltration/chronic liver disease without mass or ductal dilatation. Mild ascites.Abnormally enlarged endometrial cavity; recommend correlation with GYN ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "Right testicular swelling and redness. RIGHT TESTIS: 4.4 x 1.9 x 2.8 cm. Mild heterogeneity of the testicular parenchyma, with normal vascularity.LEFT TESTIS: 4.2 x 1.5 x 2.5 cm. Mild heterogeneity of the testicular parenchyma, with normal vascularity.RIGHT EPIDIDYMIS: Mildly prominent with mildly increased vascularity.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: No evidence of hydrocele or varicocele.", "output": "1. Mild prominence in size and vascularity of the right epididymis, which may reflect mild or early epididymitis.2. No evidence of testicular torsion, per clinical query."}
{"instruction": "Generate impression based on findings.", "input": "Papillary thyroid carcinoma status post thyroidectomy 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 mass or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old female with history of hepatitis C. Presents for HCC screening. LIVER: The liver capsule is smooth. The liver is normal in morphology and size, measuring 15.6 cm in craniocaudal dimension. There is mild coarsening of the hepatic parenchyma. No intrahepatic biliary ductal dilatation or focal hepatic lesion is identified. There is normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common bile duct measuring 3 mm.PANCREAS: The visualized portions of the pancreatic head and body are normal.SPLEEN: The spleen has normal morphology, echogenicity and size, measuring 9.5 cm in length.RIGHT KIDNEY: The right kidney measures 10.2 cm in length without hydronephrosis or shadowing calculus. Note is made of a 2.7-cm peripelvic simple appearing cyst. Color Doppler demonstrates hilar blood flow.OTHER: The left kidney measures 11.2 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow.", "output": "Mildly coarsened liver may represent diffuse parenchymal dysfunction. No discrete hepatic lesion."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for left axillary abscess vs lymph node History: tender, swollen nodule in left axillae Benign-appearing lymph node measuring 1.4 x 1.0 x 0.7 cm is noted in the left axillary region demonstrating vascularity. No evidence of mass or abscess.", "output": "Benign-appearing left axillary lymph node."}
{"instruction": "Generate impression based on findings.", "input": "History of hydronephrosis status post drainage of obstructing pelvic cyst RIGHT KIDNEY: Normal parenchymal echogenicity without mass or stone. Interval resolution of hydronephrosis. Right kidney 10.4 cm in length.LEFT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. Left kidney 10.1 cm in length.OTHER: Bladder nondistended", "output": "Interval resolution of right hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Male; 44 years old. Reason: Ultrasound of Soft Module Mass over L5-S (Sacrum). Two bumps in lower back for three months. Fluctuating in Size - ? Cyst. In the subcutaneous tissues of the left lower back is a calcified lesion measuring 1.1 cm in craniocaudal dimension. Due to the heavy calcification this lesion cannot be further characterized by ultrasound. Similarly, in the subcutaneous tissues of the right lower back a calcified lesion measures 2.1 cm craniocaudal dimension and cannot be further characterized due to heavy calcification.In the midline of the lower back/sacrum is a subcutaneous solid nodule with no vascularity on color Doppler. This measures 2.7 x 1.9 x 0.7 cm.", "output": "1.Calcified lesions in the subcutaneous tissues superior to the left and right buttocks cannot be further characterized by ultrasound.2.Midline subcutaneous lesion may represent a lipoma however this lesion is considered indeterminate on ultrasound. If clinically indicated, MRI may be considered for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Leukocytosis and fever. 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. Normal appearance of the gallbladder. No gallstones identified.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 10.3 cm in length. The left kidney is 9.6 cm in length. The renal parenchymal echogenicity is elevated. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 8.5 cm in length, without focal lesions evident.OTHER: Small amount of abdominal free fluid identified.", "output": "1. Echogenic renal parenchyma, without hydronephrosis, compatible with medical renal disease.2. Minimal abdominal free fluid, which may be postsurgical.3. No evidence of cholecystitis, per clinical query."}
{"instruction": "Generate impression based on findings.", "input": "History of hepatitis C. Evaluate for HCC. LIVER: The liver is mildly coarse and echogenic. It measures 16.8 cm in length. No focal lesion or intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 32 cm/s. Undulating liver contour.BILIARY TRACT: Partially contracted gallbladder without gallstones. No extrahepatic biliary ductal dilatation with the common duct measuring 2 mm.PANCREAS: The visualized pancreatic head is unremarkable. The remainder the pancreas is obscured by overlying bowel gas.SPLEEN: The spleen measures 10.7 cm length with a nonspecific unchanged 7 mm probable cyst.RIGHT KIDNEY: The right kidney measures 9.9 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. OTHER: The left kidney measures 10.8 cm in length without hydronephrosis or suspicious lesion. Stable nonspecific echogenic nonshadowing 3 mm focus.", "output": "Cirrhotic liver morphology without a discrete lesion. Stable examination otherwise."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old female with thyroid nodules. RIGHT LOBE MEASUREMENTS: 1.6 x 1.9 x 4.3 cmLEFT LOBE MEASUREMENTS: 1.3 x 1.3 x 3.7 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Partially solid, partially cystic nodule measuring about 1.5 cm.LEFT LOBE: Solid nodule measuring 0.9 cm.ISTHMUS: No significant abnormality noted.LYMPH NODES: Benign, reactive appearing lymph nodes are visualized bilaterally.OTHER: No significant abnormality noted.", "output": "Bilateral nodules as described above are amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "History of papillary thyroid carcinoma status post thyroidectomy. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Status post thyroidectomy.LEFT LOBE: Status post thyroidectomy. Stable hypoechoic area within the inferior left thyroidectomy bed measuring 0.2 x 0.2 x 0.5 cm.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Stable examination without specific evidence of recurrence or regional lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "85-year-old female with history of intracystic papillary carcinoma on hormonal therapy. Follow-up study. Due to limited mobility of the patient, ultrasound was performed in sitting position.A targeted right ultrasound was performed for the known cancer.At 9:00 position, 5 cm from the nipple, there is redemonstration of a isoechoic mass. The mass now measures 6 x 7 x 10 mm (previously 6 x 8 x 9 mm). There is mild internal vascularity.", "output": "No interval changes in size of right breast cancer BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal distention and abnormal weight loss LIVER: No significant abnormalities noted. 15.4 cm in lengthBILIARY TRACT: Nonmobile subcentimeter gallbladder wall focus suggestive for polyp measuring 0.3 x 0.3 cm.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 8.9 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.1 cm in lengthOTHER: Left kidney 11.2 cm in length. No ascites", "output": "Subcentimeter gallbladder polyp; otherwise unremarkable examination."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old female with biopsy proven right breast cancer with metastatic axillary lymphadenopathy currently on chemotherapy here for diagnostic mammogram to assess response. Family history of breast cancer in maternal great aunt. RIGHT BREAST DIAGNOSTIC MAMMOGRAM: Three standard 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(BiRads Density Category C), unchanged in pattern and distribution. There is redemonstration of diffuse pleomorphic and linear branching calcifications which overall has decreased in size compared to prior study, currently measuring previously 12.5 cm x 10.2 cm previously 13.5 cm x 12.7 cm as measured on the MLO view. RIGHT BREAST ULTRASOUND:Physical exam demonstrated a firm mass in the upper outer quadrant of the right breast.A targeted right ultrasound was performed for the mammographic area of concern. In the upper outer quadrant of the right breast 10:00 position 5 cm from the nipple is an irregular heterogeneous mass with internal calcification measuring 2.8 cm x 1.0 cm x 2.7 cm, previously 4.3 cm x 2.9 cm x 4.0 cm; there is associated internal vascularity on Doppler evaluation.Two abnormal lymph nodes in the right axilla are again seen, one of which measures 0.8 cm x 0.5 cm x 0.7 cm, and the other measures 0.7 cm x 0.6 cm, with minimal associated internal vascularity. These are also decreased in size when compared to prior study, the largest of which measured 1.9 cm x 1.6 cm.", "output": "Decreasing size of right upper outer quadrant calcified breast mass and axillary lymph nodes. Consultation with the patient's physician is recommended for clinical correlation and to determine further management.BIRADS: 6 - Known cancer.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain, concern for cholecystitis versus appendicitis also with AKI, rule out hydronephrosis LIVER:Liver measures 12.9 cm demonstrates increased parenchymal echogenicity. Focal hypoechoic area adjacent to the gallbladder fossa is consistent with focal fatty sparing. Main portal vein demonstrates normal flow directionality and patency. No focal suspicious lesions noted. No intrahepatic biliary ductal dilatation.Minimal amount of ascites noted.GALLBLADDER, BILIARY TRACT: Gallbladder is well-distended with normal gallbladder wall thickness. No gallstones noted. Common bile duct measures within normal limits. No evidence of peri- cholecystic fluid.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: No significant abnormality noted. Spleen measures 8.2 cmKIDNEYS: Right kidney measures 10.4 cm and left kidney measures 11.4 cm. No hydronephrosis. Normal echotexture. Simple cyst in the mid to lower pole of the left kidney appears unchanged from prior examination. ABDOMINAL AORTA: Proximal abdominal aorta measures 2.3 x 2.3 cm. Mid aorta measures 2.3 x 11.9 cm and the distal abdominal aorta measures 2.5 x 2.4 cm, within normal limits. No evidence of aneurysmal dilatation.INFERIOR VENA CAVA: PatentOTHER: Partially distended bladder within normal limits.", "output": "Findings consistent with hepatic steatosis.Simple left renal cyst unchanged.No evidence of gallstones.Normal echotexture of the kidneys without hydronephrosis.Mild ascites."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female initially admitted for a GIB now has sepsis and renal failure. Evaluate for obstruction, hydronephrosis. RIGHT KIDNEY: The right kidney measures 11.4 centers. The cortex has normal echogenicity. No focal mass, hydronephrosis, or shadowing calculi.LEFT KIDNEY: Left kidney measures 11.0 cm. The cortex has normal echogenicity. No focal mass, hydronephrosis, or shadowing foci.URINARY BLADDER: The urinary bladder is decompressed and there is a Foley in place.OTHER: No significant abnormalities noted.", "output": "1. Normal ultrasound of the kidneys. No obstruction, hydronephrosis, or mass."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female status post 4 cycles of chemotherapy for left breast cancer. Interval follow-up. A targeted left breast ultrasound was performed at the 11:00 position, 6 cm from the nipple at the site of the known malignancy. On today's exam, the margins are less convex and the mass currently measures 1.2 x 0.9 x 0.7 cm compared to 1.3 x 1.1 x 0.8 cm on the prior study. There was marginal flow to the mass on the prior exam. No flow is seen on today's exam on color Doppler imaging.", "output": "Interval small decrease in the size of the mass as discussed above.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Provided history of right upper quadrant pain. Status post cholecystectomy. LIVER: The liver parenchyma is coarse and mildly echogenic compatible with fatty infiltration. The liver measures 15.2 cm in craniocaudal dimension, within normal limits. No focal lesion is identified. Focal fatty sparing near the falciform ligament. Normal hepatopedal portal venous blood flow at 0.3 m/s.BILIARY TRACT: The patient is status post cholecystectomy. The common bile duct measures 4 mm in caliber, within normal limits.PANCREAS: The visualized pancreatic head is unremarkable. The remainder of the pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen is normal in size without a focal lesion, measuring 10.5 cm.RIGHT KIDNEY: The right kidney is normal in size and appearance measuring 11.3 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. OTHER: The left kidney is normal in size measuring 10.8 cm without hydronephrosis, shadowing nephrolithiasis or discrete lesion.", "output": "Findings compatible with fatty infiltration of the liver without a focal lesion or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Clinical concern for primary sclerosing cholangitis. LIVER: The liver measures 15.4 cm in length. There is course, increased, and heterogeneous echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation or ascites.PORTAL VEIN: There is chronic occlusion of the portal vein with cavernous transformation and collateral formation, which was noted on the prior study.GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 3.0 mm. No stones are seen. No pericholecystic fluid. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 15.2 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.0 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen. There is a round 1.5 x 1.0 cm well-defined, hypoechoic lesion in the right kidney consistent with simple renal cyst.LEFT KIDNEY: The left kidney measures 10.9 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. Increased, course, and heterogenous echotexture of liver consistent for chronic liver disease with probable early cirrhotic morphology. No mass.2. There is a previously noted portal vein thrombosis involving the entire portal venous system with cavernous transformation and collateral formation.3. Interval resolution of ascites when compared to the prior study.4. Splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Female 90 years old; Reason: History of cholelithiasis with persistent RUQ pain. Evaluate for cholecystitis. History: As above GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.8 mm. No stones are seen. No pericholecystic fluid. Negative sonographic Murphy sign. The common bile duct measures 1.9 mm in diameter. OTHER: Limited views of the liver were obtained with any significant abnormalities noted. The portal vein is patent with hepatopetal flow.", "output": "No evidence of cholelithiasis or acute cholecystitis are seen on ultrasound. This study was partially limited due to patient cooperation with positioning."}
{"instruction": "Generate impression based on findings.", "input": "Pain and tenderness to palpation in the lower lumbar/sacral region. There is a circumscribed cystic mass measuring 3.3 x 3.7 x 2.9 cm situated approximately 3 mm below the skin surface in the lower lumbar/sacral region. This cystic mass has a thick vascular rim and internal septations demonstrating vascularity. No connection to the skin surface or deeper structures is seen. No definite solid nodule/mass is seen.", "output": "Cystic mass in the lower lumbar/sacral region. Although the appearance is slightly atypical, an abscess is most likely. Follow-up imaging is recommended after medical treatment to evaluate for improvement/resolution. If improvement is not seen, MRI should be considered."}
{"instruction": "Generate impression based on findings.", "input": "Male 66 years old; Reason: eval for etiology of RUQ pain and nausea, r/o gall bladder disease History: RUQ pain, nausea LIVER: The liver measures 15.7 cm in length. There is normal echogenicity of the liver parenchyma. A round well-circumscribed hyperechoic lesion is seen within the right lobe measuring 1.5 cm x 1.8 cm x 1.8 cm. This does not have internal vascular flow. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 19.7 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.5 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 2.5 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 12.1 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.9 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen. A renal cyst is seen in the superior pole measuring 3.1 cm x 2.7 cm x 2.9 cm.LEFT KIDNEY: The left kidney measures 10.5 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen. A renal cyst is visualized measuring 3.3 cm x 2.9 cm x 3.1 cm.", "output": "1. No evidence of cholelithiasis or acute cholecystitis.2. A well-circumscribed hyperechoic lesion is seen within the right lobe of the liver favored to be a benign hemangioma."}
{"instruction": "Generate impression based on findings.", "input": "85-year-old female with chronic kidney disease, volume overload. RIGHT KIDNEY: Measures 10.4 cm in length. Unremarkable echogenicity without hydronephrosis, nephrolithiasis, or solid mass. 2.0 x 1.9 cm right renal cyst without septation or solid component. Prominent extrarenal pelvis.LEFT KIDNEY: Measures 9.9 cm in length. Unremarkable echogenicity without hydronephrosis, nephrolithiasis, or solid mass. 1.5 cm hypoechoic structure in the mid polar region of the left kidney is incompletely characterized but favored to represent a cyst.URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.", "output": "1. No hydronephrosis or nephrolithiasis. 2. Other findings as described above. "}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury RIGHT KIDNEY: 10.5 cm in length. The renal parenchyma is echogenic. There is no suspicious lesion or hydronephrosis.LEFT KIDNEY: 7.7 cm in length. The renal parenchyma is echogenic. Several benign-appearing cysts are noted, measuring up to 2.7 cm. There is no suspicious lesion or hydronephrosis.BLADDER: The bladder is collapsed.OTHER: Small amount of ascites noted. Biliary sludge and small gallstones noted.", "output": "1. Echogenic renal parenchyma, without hydronephrosis, compatible with medical renal disease.2. Cholelithiasis.3. Small amount of ascites."}
{"instruction": "Generate impression based on findings.", "input": "83 year old female with thyroid nodules. Evaluate for interval growth, characteristics. RIGHT LOBE MEASUREMENTS: 4.6 cm x 2.2 cm x 1.8 cmLEFT LOBE MEASUREMENTS: 5.0 cm x 3.1 cm x 1.9 cmISTHMUS MEASUREMENTS: 1.0-cm in thicknessRIGHT LOBE: Two subcentimeter hypoechoic nodules are again seen, the largest of which measures 3 mm x 3 mm x 2 mm unchanged.LEFT LOBE: Predominantly solid nodule at the mid pole is again seen measuring 1.4 cm x 0.8 cm x 0.7 cm unchanged. Additional subcentimeter hypoechoic nodule in the lower pole is not significantly changed.ISTHMUS: Solid nodule extending towards the left lobe is retrospectively seen on prior exam and does not appear significantly changed.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right neck benign appearing lymph node measuring 1.3 cm x 1.0 cm x 0.3 cm. Left neck benign appearing lymph node measuring 0.7 cm x 0.5 cm x 0.3 cm. No lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Bilateral hypoechoic thyroid nodules unchanged. Solid nodules in the left thyroid lobe and isthmus unchanged. "}
{"instruction": "Generate impression based on findings.", "input": "History renal donor with left scrotal swelling RIGHT TESTIS: 3 x 2 x 3.7 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristicsLEFT TESTIS: 2.9 x 2.1 x 3.8 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristicsRIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: Subcentimeter benign epididymal cystOTHER: Moderately large left hydrocele. Bilateral moderate varicoceles", "output": "No intratesticular mass. Bilaterally symmetric Doppler flow characteristics. Moderately large left hydrocele. Bilateral moderate varicoceles."}
{"instruction": "Generate impression based on findings.", "input": "Rising bilirubin LIVER: Liver measures 15.9 cm with mild coarse echotexture. No focal lesions noted. Portal vein is patent with normal flow directionality and patency. Common hepatic duct measures up to 4 mm. Mild fluid noted in the Morison's pouch.BILIARY TRACT: No intrahepatic blurred ductal dilatation. Gallbladder is well-distended with normal gallbladder wall thickness measuring up to 2.3 mm.PANCREAS: Head of pancreas visualized appears unremarkable. Body and tail of pancreas is not visualized.SPLEEN: Spleen measures 9 cm without any focal lesions.RIGHT KIDNEY: Right kidney measures 9.6 cm and left kidney measures 11 cm. No hydronephrosis or hydroureter. Normal echotexture noted.OTHER: No significant abnormalities noted.", "output": "Mild fluid noted in the Morison's pouch. Gallbladder appears unremarkable. Mildly coarse and echogenic liver, may represent nonspecific fatty infiltration/parenchymal dysfunction. "}
{"instruction": "Generate impression based on findings.", "input": "Cardiogenic shock with leukocytosis LIVER: Mildly coarse echogenic liver without mass. Liver length 18.4 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Prominent hepatic veins.GALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.4 cm in lengthOTHER: No ascites", "output": "Mild hepatomegaly associated with mildly coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Prominent hepatic veins suggestive for right heart failure with associated hepatic congestion. Cholelithiasis without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "58 year old female with a history of abdominal pain, evaluate for gallstones. LIVER: The liver parenchyma is minimally coarse. The liver capsule is smooth. It is normal in size, measuring 15 cm in the craniocaudal dimension. No focal lesion or intrahepatic biliary ductal dilatation. There is normal hepatopetal portal venous blood flow with velocity measuring 20 cm/sec.GALLBLADDER, BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common bile duct measuring 3 mm at the pancreatic head. Normally distended gallbladder without wall thickening, pericholecystic fluid, gallstones, or focal tenderness.PANCREAS: The visualized pancreatic body and head are unremarkable.RIGHT KIDNEY: The right kidney measures 9.7 cm without hydronephrosis.OTHER: The left kidney measures 10.8 cm without hydronephrosis. The spleen measures 10 cm in length.", "output": "1. No gallstones or other specific findings to account for the patient's right upper quadrant pain.2. Minimally coarse liver parenchyma, may reflect diffuse fatty infiltration/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "34-year-old male with a history of Cowden syndrome presents with an enlarge thyroid. Evaluate thyroid. RIGHT LOBE MEASUREMENTS: 3.6 x 2.7 x 0.6 cm.LEFT LOBE MEASUREMENTS: 3.8 x 2.6 x 7.8 mm.ISTHMUS MEASUREMENTS: 0.9 cm.RIGHT LOBE: There are multiple solid nodules that have replaced much of the right thyroid parenchyma, the largest of which measures approximately 1.3 x 1.2 cm.LEFT LOBE: There are multiple solid nodules that have replaced much of the left thyroid parenchyma, the largest of which measures approximately 2.0 x 1.8 x 1.9 cm.ISTHMUS: There is a dominant solid nodule in the isthmus measuring approximately 2.2 x 1.8 x 2.9 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional adenopathy.OTHER: No significant abnormality noted.", "output": "1. Multinodular gland as described above with many solid lesions amenable to biopsy. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with hematuria RIGHT KIDNEY: Nephrolithiasis without hydronephrosis. The largest stone identified measures 1.8 cm.LEFT KIDNEY: Nephrolithiasis or hydronephrosis. The largest identified measures 0.9 cm.OTHER: Bladder is partially collapsed. Increased hepatic echogenicity consistent with chronic liver disease partially imaged.", "output": "Nephrolithiasis without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Decreased urine output. Acute tubular necrosis. RIGHT KIDNEY: 10.1 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 9.6 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: Collapsed, with Foley catheter identifiedOTHER: No significant abnormality noted.", "output": "Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Rule out embolic event to liver or kidney History: elevated LDH and creatinine in LVAD patient Limited exam due to overlying bowel gas.LIVER: Heterogeneous echogenic hepatic parenchyma. The liver measures 20.9 cm, enlarged. The portal vein is patent with normal hepatopetal directional flow, peak velocity 24.6 cm/s. No focal mass. GALLBLADDER, BILIARY TRACT: No significant abnormality noted. No cholelithiasis or pericholecystic fluid. The common bile duct measures 0.4 cm. The gallbladder wall measures 0.3 cm. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.SPLEEN: The spleen measures 12.5 cm in length.KIDNEYS: The left kidney measures 11.0 cm in length. The right kidney measures 10.1 cm in length. No shadowing stones or hydronephrosis. Color Doppler examination was not performed.ABDOMINAL AORTA: Not well visualized.INFERIOR VENA CAVA: The IVC appears patent with normal pulsatile venous waveform.OTHER: No ascites.", "output": "Hepatomegaly and heterogeneous hepatic parenchyma, which is nonspecific but may represent hepatic steatosis or parenchymal dysfunction. "}
{"instruction": "Generate impression based on findings.", "input": "58-year-old female post thyroidectomy for thyroid cancer. 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 enlarged or morphologically abnormal lymph nodes. Patient describes a small palpable area at level 2 on the right which corresponds to a normal appearing lymph node.OTHER: No significant abnormality noted.", "output": "No evidence for recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "Area of firmness around pleural catheter site. Concern for hematoma versus collection. There is mild skin thickening. No drainable fluid collection or mass is identified.", "output": "Skin thickening, without focal collection or hematoma."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old male with history of hepatitis B. LIVER: Measures 14.1 cm in length. Echogenic hepatic parenchyma without discrete focal lesion. Patent portal vein.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.KIDNEY: Small renal cysts without significant interval change.OTHER: No significant abnormalities noted.", "output": "Echogenic hepatic parenchyma without discrete focal lesion."}
{"instruction": "Generate impression based on findings.", "input": "Chronic kidney disease. History of left-sided hydronephrosis. Evaluate for obstruction. RIGHT KIDNEY: The right kidney measures 8.8 cm in length. The cortex is mildly echogenic. No hydronephrosis, shadowing nephrolithiasis or discrete lesion.LEFT KIDNEY: The left kidney measures 10.1 cm in length without hydronephrosis, or shadowing nephrolithiasis. The cortex is echogenic.Note is made of a 1.4 x 1.2 x 1.3 cm hypoechoic cortical lesion without definite enhanced through transmission. Additional adjacent hypoechoic probable cyst is noted.URINARY BLADDER: Normally distended urinary bladder. The left ureteral jet is visualized indicating patency.OTHER: No significant abnormalities noted.", "output": "Echogenic mildly atrophic kidneys compatible with medical renal disease.No hydronephrosis.1.4 cm left renal lesion is hypoechoic with equivocal enhanced through-transmission, therefore is not a definite simple cyst, and remains indeterminate. Consider dedicated renal CT/MR if the patient can tolerate contrast, or follow-up with ultrasound for size change. "}
{"instruction": "Generate impression based on findings.", "input": "Male, 49 years old. Urinary retention, CKD. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 10.3 cm in length with increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.9 cm in length with increased cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The bladder is decompressed with Foley catheter in place.", "output": "Increased renal cortical echogenicity compatible with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "88 years old, Male, Reason: CKD - cysts on CT History: see above RIGHT KIDNEY: Kidney measures 10.3 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. No evidence of hydronephrosis. No shadowing renal calculus. Complex right renal cyst with echogenic septum which is likely calcified measuring up to 4.6 cm appearing similar to recent abdominal CT exam.LEFT KIDNEY: Kidney measures 10.9 cm in length. Increased echogenicity of the kidney is consistent with known medical renal disease. No hydronephrosis, shadowing calculus or mass.Bladder: The bladder is markedly distended.", "output": "1.Increased echogenicity of the kidneys bilaterally is consistent with known medical renal disease.2.Complex right renal cyst with calcified septum measuring up to 4.6 cm appearing similar to recent CT examination."}
{"instruction": "Generate impression based on findings.", "input": "Reason: check for progression in nodules History: none RIGHT LOBE MEASUREMENTS: 6.0 x 2.3 x 1.7 cmLEFT LOBE MEASUREMENTS: 5.7 x 2.5 x 1.6 cm.ISTHMUS MEASUREMENTS: 0.7 cm.RIGHT LOBE: Index nodule at the junction of the superior and inferior right thyroid measures 0.5 x 0.6 x 0.4 cm, previously 0.6 x 0.6 x 0.4 cm and is unchanged in appearance.Index inferolaterally positioned nodule which is hypovascular is more solid-appearing than the prior exam but unchanged in size measuring 0.6 x 0.4 x 0.4 cm, previously 0.8 x 0.8 cm.LEFT LOBE: Index isoechoic nodule in the left mid thyroid is unchanged measuring 1.2 x 1.0 x 0.5 cm, previously 1.0 x 1.0 x 0.6 cm.Index poorly circumscribed heterogeneous mixed isoechoic and hypoechoic nodule in the left lower thyroid measures 0.8 x 0.7 x 0.9 cm, previously 1.0 x 0.9 x 0.9 cm. This lesion has previously been biopsied and represents a colloid cyst.Hypoechoic nodule along the left inferior pole of the thyroid may represent an exophytic nodule and measures 0.5 x 0.6 x 0.4 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Index thyroid nodules are overall unchanged in size, although an inferolateral right index nodule is more solid-appearing than the prior exam."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Bautista is a 22 year old female presenting with a palpable mass in the right breast for the past one year. Per patient, she had an ultrasound evaluation at St. Anthony Hospital whereby she was told she had a fibroadenoma. Patient presents at the University of Chicago for second opinion. Upon physical exam at the patient's area of concern, there is a soft mobile mass appreciated.Targeted right breast ultrasound was performed:-In the right breast 10:00 location, approximately 5 cm from the nipple, there is an oval hypoechoic mass measuring 1.9 x 1.2 x 1.5 cm. -In the right breast 10:00 location, immediately inferior to the previously described mass is an additional oval hypoechoic mass measuring 0.9 x 0.8 x 1.0 cm.", "output": "Benign morphology masses in the right breast, likely representing benign fibroadenomata. Given that these are palpable, a surgical consultation is warranted for further evaluation. As long as the patient's physical examination remains normal, right breast ultrasound is recommended in 6 months in order to confirm stability of these findings. All results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: C - Clinical Correlation Needed. "}
{"instruction": "Generate impression based on findings.", "input": "17-year-old woman presents with palpable mass left breast upper outer quadrant. On physical exam, there is a palpable nontender mobile mass in the left breast upper-outer quadrant.A targeted left ultrasound was performed for the palpable area of concern. Corresponding to palpable abnormality in the left breast 2:00 position 4 cm from nipple, there is a 39 x 18 x 36 mm (CC x AP x TV) circumscribed hypoechoic mass with macrolobulated margins and internal vascularity. This is likely a fibroadenoma, however given size, FNA or percutaneous biopsy is recommended for further evaluation.", "output": "Palpable mass left breast corresponds to a 39 x 18 x 36 mm mass, likely a fibroadenoma. Given it's size, surgical consultation for consideration of palpably guided FNA or percutaneous biopsy is recommended for further evaluation. Findings and recommendations were discussed with the patient at the time of the exam.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "63 years Male with elevated creatinine RIGHT KIDNEY: Kidney measures 12.3 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 12.2 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass. A simple left renal cyst measures 0.7 x 0.8 x 1.0 cm.BLADDER: Incompletely distended but no gross abnormalities.. OTHER: No significant abnormalities.", "output": "Simple left renal cyst. Otherwise unremarkable examination."}
{"instruction": "Generate impression based on findings.", "input": "Reason: left lobe suspicious for papillary thyroid cancer thyroid US and lymph node mapping please RIGHT LOBE MEASUREMENTS: 5.9 x 1.6 x 1.3 cm.LEFT LOBE MEASUREMENTS: 4.4 x 1 0.8 to 1.6 cm.ISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: Mixed solid and cystic nodule in the mid left thyroid lobe measures 1.3 x 1.1 x 1.3 cm. No internal vascularity. Small microcalcifications.Additional hypoechoic predominantly solid nodule in the left inferior pole measures 1.1 x 0.4 x 0.5 cm. Mild internal vascularity. Several microcalcifications.ISTHMUS: Predominantly solid nodule measures 1.5 x 0.6 x 2.0 cm. Mild internal vascularity. Several punctate calcifications.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted. No lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Multiple thyroid nodules as described above. Suspicious left mid pole thyroid nodule biopsied at the time of examination, please see subsequent report."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female with abnormal liver function. Elevated bilirubin. LIVER: There is normal in size and appears mildly echogenic consistent with parenchymal disease. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder contains a single shadowing gallstone in the region of the neck. Mobility could not be well assessed. No gallbladder wall thickening. Moderate ascites.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Significantly echogenic without hydronephrosis on limited view.OTHER: Left kidney significantly echogenic without hydronephrosis on limited view. Splenic size normal.Moderate ascites.Bilateral pleural effusions.", "output": "No focal hepatic abnormality. Gallstone but no other gross biliary tract abnormality.Ascites.Echogenic kidneys."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for cholelithiasis. Abdominal pain, nausea and vomiting, positive Murphy sign LIVER: Liver measures 17.6 cm with normal echogenicity. No focal lesions noted within the liver. No intrahepatic biliary ductal dilatation.GALLBLADDER, BILIARY TRACT: Gallbladder is well distended with mild sludge within it. Gallbladder wall thickness within normal limits. No peripheral or cystic fluid noted.PANCREAS: No significant abnormalities noted.KIDNEY: Right kidney measures 10.9 cm and left kidney measures measures 11.8 cm, both kidneys demonstrate normal echotexture. No focal lesions or hydronephrosis.OTHER: Spleen is mildly enlarged, measures 12.9 cm. No focal lesions noted.", "output": "Minimal sludge noted within the gallbladder without evidence of acute cholecystitis"}
{"instruction": "Generate impression based on findings.", "input": "Reason: 48M MRSA bacteremia, area of redness, induration on right forearm, ?thrombophlebitis, slow to improve History: RUE induration/pain Along the radial volar surface of the right forearm, there is a noncompressible tubular structure which lacks internal blood flow and is compatible with a thrombosed vein. Increased echogenicity and blood flow within the surrounding soft tissues is compatible with inflammation. No associated drainable fluid collections are identified.", "output": "Thrombophlebitis involving the volar/radial surface of right distal forearm."}
{"instruction": "Generate impression based on findings.", "input": "51 years old female with personal history of left breast cyst of 10 years duration. No current breast related complaints. Patient was recalled due to computer malfunction, with loss of ultrasound images on 6/14/2016. A targeted ultrasound was performed of the left breast, 6:00 position, 5 cm from the nipple, demonstrating a cluster of multiple small cysts, with the largest measuring 0.5 x 0.5 x 0.5 cm, and in total measuring 1.2 x 0.8 cm. No solid lesion is identified.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain nausea vomiting and elevated LFTs. The study is limited due to the patient's mental status. The patient was uncooperative and unable to finish the exam.LIVER: The liver parenchyma is echogenic limiting evaluation for a focal lesion. No focal lesion is evident. Normal size measuring 15.8 cm in craniocaudal dimension. Normal hepatopedal portal venous blood flow 0.3 m/s. BILIARY TRACT: Normally distended gallbladder containing a gallstone at the neck. The gallbladder wall measures 3 mm, top normal. Evaluation for focal tenderness was limited by the patient's mental status. No pericholecystic fluid. No biliary ductal dilatation with the common duct measuring 5 mm.PANCREAS: Not visualized.SPLEEN: Not visualized.RIGHT KIDNEY: 9.5 cm in length without hydronephrosis or shadowing nephrolithiasis. OTHER: No significant abnormalities noted.", "output": "Limited examination due to patient's mental status and poor cooperation. Echogenic liver may reflect fatty infiltration and/or parenchymal dysfunction. No biliary ductal dilatation. Cholelithiasis without specific sonographic evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male patient abdominal distention. Evaluate for ascites and cirrhosis. LIVER: The liver measures 17.1 cm in length. No focal hepatic lesion is identified. There is mild scalloping of the liver contour. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. A small amount of fluid is noted within the gallbladder fossa. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 6 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 12.3 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 12.9 cm in length. No evidence of hydronephrosis.The spleen measures 16.2 cm in length.Mild to moderate ascites.", "output": "1. Mild scalloping of the liver contour which can be seen in the setting of chronic liver disease.2. Mild to moderate ascites.3. Splenomegaly. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Rosalind Henderson is a 59 year old female inpatient with a personal history of a right mastectomy in 1990 with recurrent invasive carcinoma along the right chest wall in 2011. She presents today for evaluation of pain in her right axilla. ULTRASOUND:On physical examination, no discrete mass is palpated in the right axilla where the pain is located.A targeted right axillary ultrasound was performed for the patient\u2019s area of pain, designated by the patient. There is no solid or cystic mass identified.", "output": "No sonographic evidence of malignancy in the right axilla. Further evaluation of a clinically suspicious abnormality should not delayed by negative imaging. Rather, negative imaging may serve to reinforce a negative clinical impression. Therefore, continued clinical management is recommended. As long as the patient's physical examination remains normal, left diagnostic mammogram is recommended annually, due in January, 2017. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "61 year old with palpable thickening and tenderness in the left breast. With physical exam, mild thickening is palpated at left upper outer quadrant. With focused ultrasound, there are no abnormalities at the area of palpable concern. No solid or cystic masses are seen.", "output": "No sonographic evidence of malignancy. Clinical follow up is recommended. Results and recommendations were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old male with history of thyroid cancer. Evaluate for recurrent disease or adenopathy. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomy no massesRIGHT LOBE: No massesLEFT LOBE: No massesISTHMUS: No massesPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No enlarged or abnormal lymph nodes.OTHER: No significant abnormality noted.", "output": "No evidence for recurrent disease."}
{"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.This exam was double read by Dr. Abe.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Female 67 years old Reason: right upper quadrant pain History: right upper quandrant pain LIVER: Liver is enlarged measuring 19 cm. No focal liver lesions. Unremarkable echotexture of the liver.BILIARY TRACT: Cholelithiasis without sonographic evidence of cholecystitis. No evidence of intra or extrahepatic biliary dilatation.PANCREAS: The visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 9 cm.RIGHT KIDNEY: Right-sided hydronephrosis with stent in the collecting system of the right kidney. Right kidney measures 13.4 cm. No focal lesions. Left kidney measures 12.7 cm. No hydronephrosis. Echogenic kidney.OTHER: No significant abnormalities noted.", "output": "Hepatomegaly. Right hydronephrosis.Cholelithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for whole breast ultrasound for dense breast screening. Personal history of right breast ultrasound-guided core biopsy (7/7/2015) with pathology revealing foci of stromal and ductal hyperplasia, fibroadenomatoid change, and microcysts. Family history of breast cancer in paternal cousin. 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.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Dense breast tissue, routine whole breast ultrasound 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": "28-year-old female presents after overdose of acetaminophen. LIVER: The liver measures 13.1 cm. There is increased, coarse, heterogeneous echotexture of the liver. No masses, ascites, or intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: There is mild pericholecystic fluid and gallbladder wall is slightly thickened measuring approximately 5.5 mm. There is a negative sonographic Murphy's sign. No stones or sludge. PANCREAS: Evaluation the pancreas limited due to overlying bowel gas.SPLEEN: The spleen measures 11.7 cm. No sonographic abnormalities noted.KIDNEYS: The right kidney measures 11.8 cm. The cortex has normal echogenicity. No shadowing calculi, hydronephrosis, or worrisome masses. The left kidney measures approximately 12.4 cm. The cortex has normal echogenicity. No shadowing calculi, mass, or hydronephrosis. OTHER: No significant abnormality noted.", "output": "1. Increased, coarse, heterogeneous echotexture of liver consistent with hepatic parenchymal dysfunction. No mass or ascites.2. Mild pericholecystic fluid and gallbladder wall thickening with a negative sonographic Murphy's sign and without biliary dilation. Some element of acute inflammation cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": "19-year-old with known right breast masses compatible with fibroadenomas. A targeted right ultrasound was performed for the known masses. The lateral 11:00 benign morphology mass measures 1.6 x 1.3 x 1.6 cm. Previously, this measured 1.5 x 1.4 x 1.6 cm. The more medial 11:00 mass measures 0.9 x 0.8 x 0.9 cm. Previously, this measured 1.2 x 1.0 x 1.6 cm. At the 8:00 position, the additional benign morphology mass measures 1.4 x 1.3 cm. Previously this measured 1.4 x 1.2 cm.", "output": "No enlargement of any of the known right breast typically benign morphology masses. The medial mass at 11:00 measures somewhat smaller today. The patient will follow-up with Dr. Jaskowiak today. Based on the stability over slightly more than a year and if physical exam remains benign, options for follow up could include a 12 month follow-up ultrasound or clinical follow-up with imaging only if there is physical exam change.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "86 year old male with left groin mass/testicular mass RIGHT TESTIS: Atrophic changes seen, testis measures 4.0 cm x 2.5 cm x 2.2 cm.LEFT TESTIS: Atrophic changes seen, testis measures 3.7 cm x 2.4 cm x 2.5 cm.RIGHT EPIDIDYMIS: Measures 3.3 cm x 1.0 cm x 1.0 cm and contains cyst measuring 5 mm x 5 mm x 6 mm. LEFT EPIDIDYMIS: Measures 3.8 cm x 0.8 cm x 1.0 cm and contains cyst measuring 4 mm x 3 mm x 13 mm. OTHER: Heterogeneous structure in the region of the reported lump in the left groin measuring 2.3 cm x 2.0 cm x 3.2 cm which does not change in size with Valsalva maneuver. There is no significant internal vascularity. Bilateral moderate hydroceles, more complex on the left.", "output": "1. Nonspecific heterogeneous structure in the left groin which does not change with Valsalva maneuver making inguinal hernia less likely. Correlation with patient's clinical history recommended and MRI may be obtained for further evaluation. 2. Bilateral atrophic testes with moderate hydroceles, more complex on the left. Bilateral epididymal cysts. "}
{"instruction": "Generate impression based on findings.", "input": "Hematuria. Transplant kidney. TRANSPLANT KIDNEY: Located in the right iliac fossa. 10.5 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis. The transplant renal artery and vein are patent with normal velocities and waveforms.OTHER: No significant abnormality noted.", "output": "No specific findings to account for the patient's hematuria."}
{"instruction": "Generate impression based on findings.", "input": "39 year old female with proteinuria. Ultrasound guidance was provided for biopsy of right kidney", "output": "Ultrasound guidance."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old male with history of kidney transplant now with elevated creatinine. Two passes were made. Please refer to procedural report for additional details.", "output": "Ultrasound guidance provided for renal biopsy by nephrology service."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain with nausea and vomiting LIVER: Mildly coarse echotexture again noted. Liver length 19.3 cm. No mass.GALLBLADDER, BILIARY TRACT: Gallbladder sludge and stones without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.1 cm in lengthOTHER: Left kidney 13 cm in length. Spleen 13.6 cm in length.", "output": "Gallbladder sludge and stones without acute inflammation or ductal dilatation. Hepatomegaly with coarse echotexture suggestive for fatty infiltration again noted. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male with cirrhosis, screen for hepatocellular carcinoma. LIVER: Measures 14.7 cm in length. Cirrhotic morphology with increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: No cholelithiasis. Gallbladder wall thickening likely secondary to chronic liver disease. No 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: Mildly enlarged measuring 14.4 cm in length.KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "Cirrhotic morphology and increased hepatic echogenicity consistent with chronic liver disease, without discrete focal lesion. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: Question of multinodular goiter History: partial thyroidectomy of isthmus years ago on synthroid. RIGHT LOBE MEASUREMENTS: 2.9 x 1.8 x 1.4 cm.LEFT LOBE MEASUREMENTS: 5.6 x 2.4 x 2.8 cm.ISTHMUS MEASUREMENTS: 0.14 cm in thickness. RIGHT LOBE: Much of the right lobe is replaced by a dominant cystic and solid nodule measuring 2.4 x 1.6 x 1.5 cm which contains several echogenic foci which are nonspecific but may reflect inspissated colloid. No microcalcifications are detected.LEFT LOBE: Heterogeneous appearance of the left lobe of the thyroid. It is difficult to determine whether there is one large dominant mixed solid and cystic nodule or multiple individual nodules. No suspicious microcalcifications are delineated.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Few benign morphology cervical lymph nodes are noted.OTHER: No significant abnormality noted.", "output": "Multinodular goiter with multiple mixed cystic and solid nodules without specific evidence of malignancy."}
{"instruction": "Generate impression based on findings.", "input": "39 year old female. Thyroid nodules check for change. Also examine high left level 2 nodes/scar for stability. RIGHT LOBE MEASUREMENTS: 4.1 x 1.2 x 1.3 cm.LEFT LOBE MEASUREMENTS: 4.3 x 1.8 x 2.4 cm.ISTHMUS MEASUREMENTS: 0.2 cm in AP dimension.RIGHT LOBE: Nodule 1: Mid pole, spongiform, 2.4 x 0.8 x 1 cm (previously 2.3 x 0.6 x 0.9 cm), not significantly changed and most suggestive of a colloid nodule.Nodule 2: Upper pole, mixed echogenicity, 1.3 x 0.5 x 0.4 cm, likely present on prior though not measured, hyperechogenic focus with suggestion of comet tail artifact, most likely a colloid nodule.LEFT LOBE: Nodule 1: Lower pole, 3.4 x 1.8 x 2.2 cm (previously 3.2 x 1.5 x 1.8 cm), solid, no calcifications. Indeterminate.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign appearing right cervical lymph nodes. No left cervical lymphadenopathy. OTHER: No significant abnormality noted.", "output": "Mild increased size of solid left thyroid nodule, which is indeterminate, amenable to biopsy if clinically warranted. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for abscess over left forearm AV fistula History: erythema, tenderness Along the anterior aspect of the venous outflow limb there is a heterogeneous area of mixed echogenicity measuring approximately 0.2 x 0.2 cm, likely representing eccentric thrombus. The venous outflow limb is patent. Subcutaneous edema or inflammation is seen along the anterior aspect of the forearm superficial to the fistula. No focal fluid collection or abscess is identified.", "output": "1. Mild subcutaneous edema along the anterior aspect of the forearm superficial to the AV fistula may represent cellulitis, however no focal fluid collections or abscesses are identified."}
{"instruction": "Generate impression based on findings.", "input": "49 year-old woman called back for left breast asymmetry and calcifications presents for follow up. MAMMOGRAM: An ML view, spot compression and spot magnification views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3 (7 images). The breast parenchyma is composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. The focal asymmetry in the left inner breast persists partially on additional views. An ultrasound is recommended for further evaluation.Loosely grouped calcifications in the left upper outer breast have typically benign morphology with some calcifications layering on the lateral view, suggestive of milk of calcium. Their distribution is also of a typically benign appearance.  ULTRASOUND:On physical exam, there is no palpable abnormality. In the left breast and o'clock position 3 cm from nipple, there is an oval, tubular anechoic lesion consistent with a cyst. Internal vascularity is present. This measures approximately 12 x 2 x 6 mm and correlates with the findings on mammogram. No solid mass is appreciated.", "output": "Left breast cyst and benign calcifications. 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": "Conjugated hyperbilirubinemia. Abdominal pain. LIVER: Non-cirrhotic liver morphology. 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, without wall thickening or shadowing gallstones.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 9.5 cm in length, with increased parenchymal echogenicity. The left kidney is 10.0 cm in length, with increased parenchymal echogenicity. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9.2 cm in length, without focal lesions evident.OTHER: Small amount of upper abdominal ascites noted.", "output": "1. No specific evidence of cholecystitis or biliary ductal dilation.2. Increased hepatic parenchymal echogenicity, compatible with parenchymal dysfunction.3. Increased renal parenchymal echogenicity without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "68 years old, Male, Reason: micro hematuria History: hematuria RIGHT KIDNEY: Kidney measures 11.3 cm in length. Normal echotexture. Nohydronephrosis, or shadowing calculus. No definite evidence of renal mass.LEFT KIDNEY: Kidney measures 11.7 cm in length. Normal echotexture. Nohydronephrosis, or shadowing calculus. Simple appearing left renal cyst measuring 2.6 x 2.7 x 2.6 cm.BLADDER: The bladder is not well distended precluding complete evaluation.OTHER: No significant abnormalities noted.", "output": "1.No evidence of hydronephrosis or shadowing calculus. No specific findings to explain patient's symptoms.2.Simple appearing left renal cyst without evidence of suspicious mass."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female with history of thyroid cancer. Evaluate for recurrence and adenopathy. 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: No significant adenopathy.OTHER: Again seen is an approximately 0.6 x 0.5 x 0.5 cm round hypoechoic well-defined lesion posterior to the right thyroid bed which appears unchanged since the prior exam. The additional focus seen on the last exam is not visualized on this current study.", "output": "1. Surgical changes of a thyroidectomy without evidence of recurrence or adenopathy.]2. Round hypoechoic lesion as described above located posterior to the right thyroid bed unchanged since the prior study. Other focus seen on the prior study are not visualized today."}
{"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 suspicious solid mass identified. A few scattered bilateral cysts are noted. Exam was double read with Dr. Sheth.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "HCV cirrhosis LIVER: Stable cirrhotic morphology without mass. Liver length 14.9 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma again noted without mass, stone, or hydronephrosis. Right kidney 10.4 cm in lengthOTHER: Echogenic left renal parenchyma without mass, stone, or obstruction. Left kidney 10.6 cm in length. Spleen 11.1 cm in length. No ascites.", "output": "Stable cirrhotic morphology without mass or ductal dilatation. No ascites.Echogenic renal parenchyma again noted consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old male with hepatitis B, gallbladder polyps. LIVER: Again seen are 3 hepatic lesions as follows:2 circumscribed hyperechoic lesions in the right hepatic lobe measure 1.7 x 1.6 x 1.2 cm and 1.4 x 1.3 x 1.1 cm and are consistent with hepatic hemangiomas and unchanged. The third lesion, which is slightly hypoechoic with a hyperechoic rim and peripheral vascularity measures 2.0 x 1.7 x 1.6 cm, also does not appear acutely changed compared with prior examinations. No new discrete lesions are identified.BILIARY TRACT: Again seen are numerous gallbladder wall polyps measuring up to 0.7 cm. There is no evidence of cholelithiasis.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "1.Stable appearance of hepatic lesions corresponding to lesions characterized as hemangiomas on prior studies.2.Numerous gallbladder polyps measuring up to 0.7 cm. Continued follow-up is recommended."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old woman presents for follow-up right breast ultrasound for an indeterminate sonographic lesion which was diagnosed at outside hospital ultrasound. In the right breast 10:00 position, 10 cm from nipple, there is a round anechoic lesion measuring 4 x 4 mm with associated thin peripheral hyperechogenicity compatible with calcification with is most consistent with an oil cyst. This correlates with the lesion seen on ultrasound outside hospital dated 1/26/2016. On review of the outside mammogram dated 2/6/2016, several oil cysts are also seen in the right breast.", "output": "Right breast finding is probably benign, likely an oil cyst. Recommend a 6 month ultrasound follow up to evaluate stability. Note that the patient subsequently had two stereotactic biopsies after this ultrasound for other areas in the right breast. BIRADS: 3 - Probably benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Male 37 years old; Reason: History of heavy ETOH. Evaluate for liver disease. History: kidney donor LIVER: The liver measures 15.1 cm in length. There is 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 19.1 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.2 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 2.0 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 12.3 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.3 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 12.2 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "The liver has increased echogenicity compatible with fatty infiltration/hepatocellular dysfunction. No focal hepatic masses are seen."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury RIGHT KIDNEY: 12.9 cm in length. Echogenic renal parenchyma. Multiple simple appearing cysts are noted. An 8 mm nonobstructing stone is noted at the inferior pole. No hydronephrosis.LEFT KIDNEY: 10.9 cm in length. Echogenic renal parenchyma. Multiple simple and complex appearing cysts are noted. No hydronephrosis.BLADDER: No significant abnormality identified.OTHER: No significant abnormalities noted.", "output": "1. Findings compatible with medical renal disease, without hydronephrosis.2. Nonobstructing right nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old male with morbid obesity, elevated AST/ALT. Evaluate for fatty liver disease. Limited evaluation due to patient's body habitus.LIVER: Increased in echogenicity of the liver measuring 20.2 cm in length. Evaluation of the deep liver is limited by beam attenuation. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/s. GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. The common duct measures 3 mm in caliber. No intra-or extrahepatic ability ductal dilatation.PANCREAS: Not well visualized due to overlying bowel gas.RIGHT KIDNEY: Measures 12.7 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 13.6 cm in length. No hydronephrosis or shadowing calculi are noted.Normal echogenicity of the spleen measuring 13.8 cm in length.", "output": "Hepatomegaly with increased echogenicity suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesions. "}
{"instruction": "Generate impression based on findings.", "input": "Female; 76 years old. Reason: evaluate nodularity, History: concern for parathyroid adenoma RIGHT LOBE MEASUREMENTS: 4.9 x 1.8 x 1.1 cmLEFT LOBE MEASUREMENTS: 4.3 x 1.8 x 1.9 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: The thyroid gland is mildly heterogeneous. Along the posterior inferior aspect of the right lobe of the thyroid gland is an ovoid, heterogenous structure. This is hypervascular compared to the background thyroid. It measures approximately 1.1 by 0.8 cm transverse by AP however the margins are somewhat indistinct making precise measurement difficult.LEFT LOBE: Thyroid gland is mildly heterogeneous. In the midgland is a subcentimeter 0.8 x 0.7 x 0.5 cm (previously 0.7 x 0.7 x 0.5 cm) heterogeneous, hypoechoic at least partially solid nodule with internal vascularity.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: 0.7 x 0.7 x 0.5 cm right level 3 lymph node with fatty hilum.OTHER: Note is made of left internal jugular vein thrombosis.", "output": "1. Stable left thyroid nodule.2. Heterogeneous structure alluded to above appears to be outside of the right thyroid lobe and has imaging features suggestive of a parathyroid adenoma. Correlation is recommended with patient's clinical history and laboratory results.3. Left internal jugular vein thrombosis.Findings discussed with Louann Shea APN at 5:13 pm on 2/20/2015."}
{"instruction": "Generate impression based on findings.", "input": "History of hepatitis C. Evaluate for evidence of hepatocellular carcinoma. LIVER: The liver measures 18.8 cm in craniocaudal dimension. The liver parenchymal echogenicity is coarse and the liver contour is mildly nodular compatible with chronic liver disease. No focal suspicious lesion is evident. Normal hepatopedal portal venous blood flow at 0.2 m/s.GALLBLADDER, BILIARY TRACT: Normally distended gallbladder without gallstones wall thickening pericholecystic fluid or focal tenderness. No biliary ductal dilatation with the common duct measuring 4 mm.PANCREAS: The visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: The right kidney measures 11.2 cm in length without hydronephrosis or shadowing nephrolithiasis.OTHER: The left kidney measures 13.4 cm in length without hydronephrosis or shadowing nephrolithiasis.The spleen measures 13.1 cm at the upper limits of normal.", "output": "Findings of chronic liver disease without a focal suspicious lesion."}
{"instruction": "Generate impression based on findings.", "input": "Status post vein harvest with palpable right medial thigh masses Two adjacent complex cystic collections within the subcutaneous tissues of the right medial thigh. The superior collection measures 5.9 x 4.3 x 2.3 cm; the inferior adjacent collection measures 4.2 X 2.5 x 4.8 cm. These cystic collections demonstrate no evidence for increased vascularity.", "output": "Two adjacent complex cystic collections within the subcutaneous tissues of the right medial thigh without evidence for increased vascularity; favor benign etiology such as evolving hematomas."}
{"instruction": "Generate impression based on findings.", "input": "HCV LIVER: Mildly coarse and heterogeneous liver echotexture without mass. Liver length 15.5 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 11.4 cm in lengthOTHER: Echogenic left kidney without mass, stone, or hydronephrosis. 10.8 cm in length. Spleen 8.9 cm in length. No ascites.", "output": "Coarse and heterogeneous liver echotexture consistent with chronic liver disease without mass or ductal dilatation. No ascites. Echogenic renal parenchyma consistent with medical disease/parenchymal dysfunction without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old male with liver failure. History of amyloid and multiple myeloma. LIVER: Liver are normal in size. The liver parenchyma is diffusely and heterogeneously echogenic. Given this appearance, I cannot exclude underlying mass and CT or MR would be indicated. Liver has a cirrhotic morphology. Limited color and spectral Doppler demonstrates patency with flow reversal in the main portal vein which appears somewhat attenuated. GALLBLADDER, BILIARY TRACT: Cholecystectomy. Biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Mild ascites.", "output": "Heterogeneous hepatic parenchyma. Cannot exclude underlying mass.Reverse flow in portal venous system consistent with portal hypertension."}
{"instruction": "Generate impression based on findings.", "input": "Hypothyroidism. RIGHT LOBE MEASUREMENTS: The right lobe measures 5.2 cm x 1.8 cm x 1.7 cm.LEFT LOBE MEASUREMENTS: The left lobe measures 4.2 cm x 1.6 cm x 1.5 cm.ISTHMUS MEASUREMENTS: The isthmus measures 0.6 cm.RIGHT LOBE: The right lobe is diffusely heterogeneous, with a reticular pattern seen throughout. This also appears enlarged. No discrete dominant mass is seen in the right lobe.LEFT LOBE: The left lobe is diffusely heterogeneous with a reticular pattern. No discrete mass or dominant nodule is seen in the left lobe.ISTHMUS: The isthmus is enlarged and heterogeneous.PARATHYROID GLANDS: Nonvisualized on this study.LYMPH NODES: No suspicious adenopathy is noted.", "output": "1. The thyroid appears diffusely enlarged and heterogeneous which is suggestive of inflammatory thyroiditis such as Hashimoto's thyroiditis. There is no suspicious adenopathy seen and no discrete masses/dominant nodules visualized within the thyroid."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old female with palpable left breast abnormality. Per primary care physician, firm nontender mass in the left breast at the 2:00 position 3 cm from the nipple. History of benign right breast biopsy. A targeted left ultrasound was performed for the palpable area of concern at the 2:00 position 3 cm from the nipple. Prominent, though normal, breast parenchyma was identified. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy. Palpable abnormality should be managed clinically. Findings and recommendations were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female with history of throat tightness, globus sensation, thyroid enlargement on physical exam. Evaluate for thyromegaly, thyroid nodule RIGHT LOBE MEASUREMENTS: 1.6 cm x 2.0 cm x 5.5 cmLEFT LOBE MEASUREMENTS: 2.0 cm x 1.7 cm x 5.5 cmISTHMUS MEASUREMENTS: 0.4 cm in thicknessRIGHT LOBE: Along the midpole of the right thyroid lobe there is a cystic nodule measuring 0.3 cm x 0.3 cm x 0.3 cm and contains no internal vascularity and no definite microcalcifications. Along the inferior pole of the right thyroid lobe there is a mixed solid-cystic nodule measuring 0.6 cm x 0.4 cm x 0.5 cm with no increased internal vascularity and no definite microcalcifications. LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is a small lymph nodes in the left neck, at the level 3 measuring 0.8 cm x 0.4 cm x 1.3 cm.OTHER: No significant abnormality noted.", "output": "Two subcentimeter nodules in the right thyroid lobe with no suspicious features noted. "}
{"instruction": "Generate impression based on findings.", "input": "74-year-old male with history of myeloproliferative disease and ascites. LIVER: Enlarged liver measures 21.1 cm in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow measuring 0.2 m/s, with an abnormal pulsatile waveform.BILIARY TRACT: Cholelithiasis. Mild gallbladder wall thickening but no sonographic Murphy sign. No biliary duct dilation.PANCREAS: Portions of the pancreas are not clearly visualized due to bowel gas. The visualized portions of the pancreas are unremarkable.SPLEEN: Enlarged spleen measures 20.1 cm in length. No focal lesions.KIDNEY: Increased renal echogenicity without hydronephrosis. Mildly complex left renal cyst measures 3.5 x 2.7 x 2.6 cm.OTHER: Mild ascites.", "output": "1.Hepatosplenomegaly with increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease.2.Patent portal vein with abnormal pulsatile waveform suggestive of elevated right-sided pressures.3.Cholelithiasis and mild gallbladder wall thickening favored to be secondary to liver disease or elevated right sided pressures. No additional specific findings to suggest acute cholecystitis. 4.Mildly complex left renal cyst, for which further evaluation with dedicated MRI or CT is suggested. Medical renal disease. 5.Mild ascites."}
{"instruction": "Generate impression based on findings.", "input": "56 years old, Female, Chronic Kidney Disease, Stage IV. CKD IV. RIGHT KIDNEY: Kidney measures 11.2 cm in length. Increased echogenicity of the right kidney cortex. Moderate right hydronephrosis. No renal stone identified. No perinephric fluid.LEFT KIDNEY: Kidney measures 10.6 cm in length. Increased parenchymal echogenicity. Mild left caliectasis. No perinephric fluid. No renal stone identified.OTHER: No significant abnormalities noted.", "output": "Moderate right hydronephrosis and mild left caliectasis without clear etiology."}
{"instruction": "Generate impression based on findings.", "input": "47 year old female patient with history of thyroid cancer. Evaluate for recurrence. RIGHT LOBE: Status post thyroidectomy without recurrent or residual tissue identified. LEFT LOBE: Status post thyroidectomy. A hypoechoic focus in the mid left thyroid bed measures 0.5 x 0.3 x 0.6 cm, previously 0.5 x 0.2 x 0.6 cm, and is similar in morphology.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology right level II and left level III lymph nodes are noted. An additional benign morphology left level IV lymph node is noted, not definitely visualized on the prior study.OTHER: No significant abnormality noted.", "output": "Stable hypoechoic focus in the left thyroid bed without specific evidence of disease recurrence or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "12-year-old female patient with 3.5 x 3.0 cm oval mass in the central left breast. A targeted left breast ultrasound was performed. There is a well-circumscribed oval hypoechoic lesion with parallel orientation in the lower inner left breast that measures 2.2 x 1.2 x 2.5 cm.", "output": "Findings most compatible with a fibroadenoma."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal failure RIGHT KIDNEY: Atrophic echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Right kidney 10.6 cm in length.LEFT KIDNEY: Atrophic echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Left renal cyst. Left kidney 10.4 cm in length.OTHER: Nondistended", "output": "Atrophic echogenic parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "31 year old female patient with right sided thyroid nodule palpated by her classmate. Evaluate for right sided thyroid nodule. RIGHT LOBE MEASUREMENTS: 1.4 x 1.6 x 4.8 cm.LEFT LOBE MEASUREMENTS: 1.4 x 1.4 x 4.3 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: Homogeneous in echogenicity without dominant lesion.LEFT LOBE: Homogeneous in echogenicity without dominant lesion.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology lymph nodes noted in the left neck.OTHER: No significant abnormality noted.", "output": "No dominant thyroid lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "History of papillary thyroid carcinoma. Status post thyroidectomy at outside institution. There was metastatic disease in 2/2 perithyroid lymph nodes. The tumor was multifocal with the dominant tumor being in the left lobe. There was lymphovascular invasion to 4 vessels. This was followed, in 8/5/2013, by RAI ablative therapy. She received 100 mcI of I-131. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT THYROIDECTOMY BED: Mild interval increase in tissue in the right inferior thyroidectomy bed measuring approximately 1.1 x 0.9 x 0.6 cm compared to 0.7 x 0.6 x 0.4 cm.LEFT THYROIDECTOMY BED: No evidence of recurrent or residual disease in the left thyroidectomy bed.ISTHMUS: No evidence of recurrent or residual disease.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level 3 hypoechoic lymph node measuring 0.7 x 0.4 x 1.2 cm not noted on the prior study but present on the 3/19/2014 study where it measured 0.5 x 0.8 x 1.8 cm.Superior to the left thyroidectomy bed at level 2 there is a 0.6 x 0.6 x 0.8 hypoechoic lymph node without a definite fatty hilum.Left lateral level 3 hypoechoic lymph node measuring 0.5 x 0.4 x 0.7 cm without a definite fatty hilum.OTHER: No significant abnormality noted.", "output": "Right level 3 and left level 2 and 3 hypoechoic lymph nodes without a definite fatty hilum. The left level 2 and 3 lymph nodes were not noted on the prior study and may be new. At least short interval 3-4 month follow-up to assess stability is recommended. Alternatively these may be sampled if clinically warranted. Mild interval increase in the tissue in the right inferior thyroidectomy bed without specific suspicious sonographic features."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C. Cirrhosis. Evaluate for hepatocellular carcinoma. LIVER: Mildly lobulated liver morphology and mildly coarsened parenchymal echogenicity, compatible with chronic liver disease. The previously seen hypoattenuating lesion on CT possibly representing a cyst is not evident on the current examination. No suspicious hepatic lesions identified. Normal portal venous blood flow and direction, measuring 20 cm/s.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 12.4 cm in length. The left kidney is 12.2 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 11.2 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites identified.", "output": "Findings compatible with chronic liver disease, without suspicious lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female with dense breast underwent whole breast ultrasound on 9/18/2015 that demonstrated a questionable solid mass in the left breast 6:00 position for which hand-held ultrasound is recommended. Multiple simple cyst were identified in both breasts. A targeted left ultrasound was performed for the whole breast ultrasound area of concern. A complicated cyst with through transmission posteriorly is identified at 6:00 position of the left breast measuring 10 x 5 x 8 mm. This most likely corresponds to the lesion in question on the whole breast ultrasound. Multiple large simple cysts identified in the left upper-outer quadrant which was imaged as per patient's request due to prior history of cyst aspirations in that region. Largest cyst measures 2.3 x 1.7 x 2.4 cm.No suspicious solid mass noted.", "output": "Complicated cyst in the left breast 6:00 position. Multiple simple cyst identified in the left upper outer quadrant.Annual screening mammogram with tomo synthesis is recommended for further evaluation.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Left jaw swelling. Targeted ultrasound of the patient's site of swelling demonstrates a 2.5 x 2.0 x 2.6 cm hypoechoic mass demonstrating internal vascularity. The lesion has a central linear hyperechoic band suggesting that this may represent an abnormal infiltrated lymph node. Limited evaluation of the left cervical lymph node demonstrates normal appearing lymph nodes.", "output": "2.6 cm left submandibular area soft tissue mass may represent an abnormal infiltrated lymph node. A soft tissues of the neck CT with intravenous contrast is recommended to evaluate the aerodigestive tract for a potential primary malignancy. This mass is also amenable to ultrasound guided percutaneous biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: right abdominal pain and firmness; evaluate for hepatic congestion, biliary dilation, and/or RLQ mass LIVER: Echogenic liver parenchyma with coarse echotexture, consistent with hepatic steatosis, parenchymal dysfunction, or chronic liver disease. The liver measures 19.4 cm in length. The portal vein is patent with normal directional hepatopedal portal venous blood flow and peak velocity of 19.9 cm/s. No focal masses.GALLBLADDER, BILIARY TRACT: Several echogenic stones are noted in the dependent portion of the gallbladder body/fundus without evidence of inflammation or cholecystitis. Negative sonographic Murphy's sign. No biliary ductal dilatation. The proximal common bile duct measures 0.4 cm. The gallbladder wall measures 0.2 cm.PANCREAS: Obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 11.6 cm in length. Normal renal parenchymal echogenicity without hydronephrosis, mass, or shadowing calculi.LEFT KIDNEY: The left kidney measures 11.2 cm in length. Normal renal parenchymal echogenicity without hydronephrosis, mass, or shadowing calculi.SPLEEN: The spleen measures 10.1 cm in length.OTHER: No significant abnormalities noted.", "output": "1. Echogenic, coarse liver parenchyma, consistent with hepatic steatosis, parenchymal dysfunction, or chronic liver disease.2. Cholelithiasis without evidence of cholecystitis or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "56 year old male with cirrhosis. Evaluate for HCC. LIVER: Heterogeneous echotexture of the liver measuring 17.1 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: Cholelithiasis. No gallbladder wall thickening. No pericholecystic fluid. Common duct measures 3 mm in caliber. No intra or extrahepatic biliary ductal dilatation.PANCREAS: Pancreas not well seen in its entirety due to overlying bowel gas. RIGHT KIDNEY: Measures 11.9 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 11.2 cm in length. No hydronephrosis or shadowing calculi are noted. Normal echogenicity of the spleen measuring 12.3 cm in length.", "output": "1. Heterogeneous echotexture of the liver suggestive of parenchymal dysfunction/fatty infiltration. 2. Cholelithiasis with no evidence of cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "39-year-old male with sickle cell anemia, epigastric pain and aortic dilatation on prior exam. LIVER:Mild hepatomegaly without focal abnormality. Hepatic echotexture appears within normal limits. No focal mass.GALLBLADDER, BILIARY TRACT: Gallbladder appears unremarkable without cholelithiasis, wall thickening or pericholecystic fluid. Biliary tract is normal in caliber.PANCREAS: Limited due to bowel gas.SPLEEN: Not visualized.KIDNEYS: The right kidney measures 10.9 cm in length, and there is a 2.2 cm simple cyst in the mid upper pole. No hydronephrosis, shadowing calculus or solid mass. Echotexture normal. Left kidney measures 10.7 cm in length and there is a minimally complex 1.4 cm cyst in the lower pole with septation. No hydronephrosis, shadowing calculus or solid mass. Echotexture normal.ABDOMINAL AORTA: On today's study, the aorta is better visualized with proximal measurements of 2.9 x 3.1 cm, midportion measurement of 2.4 x 2.5 cm and distal measurement of 2.1 x 2.4 cm. Both common iliac arteries are within normal limits with the right measuring 1 cm in AP diameter and the left 1.1 cmINFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No interval change. No acute abnormality seen.Simple and minimally complex renal cysts.Aortic measurements as above."}
{"instruction": "Generate impression based on findings.", "input": "Male 27 years old; Reason: 27 yo with new ALL, with increasing lfts History: lfts LIVER: The liver measures 18 cm in length. There is normal echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 3.1 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 14.6 cm.RIGHT KIDNEY: The right kidney measures 13.1 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen. There is a circular 1.0 x 1.0 x 1.1 cm hypoechoic lesion seen in the right kidney consistent with a simple renal cyst.LEFT KIDNEY: The left kidney measures 13.7 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen. There is a circular 1.3 x 1.5 x 1.7 cm hyperechoic lesion seen in the left kidney consistent with a simple renal cyst.OTHER: No significant abnormality noted.", "output": "1. Mild hepatosplenomegaly. No masses or ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury Please note that images are limited due to inability to reposition the patient.RIGHT KIDNEY: 8.5 cm in length, with a 1.1 cm septated cyst. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 8.6 cm in length, with several benign-appearing cysts measuring up to 2.7 cm. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old female presents with enlargement of her left neck and exophthalmos. Evaluate thyroid. RIGHT LOBE MEASUREMENTS: 5.6 x 1.6 x 1.4 cm.LEFT LOBE MEASUREMENTS: 5.9 x 2.8 x 2.4 cm.ISTHMUS MEASUREMENTS: 0.4 cm.RIGHT LOBE: Unremarkable echotexture without nodule.LEFT LOBE: There is an approximately 4.1 x 2.2 x 1.9 cm well-defined complex nodule in the mid left lobe of the thyroid. It has a mixed echotexture and is predominantly solid.ISTHMUS: Unremarkable echotexture without nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Dominant complex left thyroid nodule amenable to biopsy if FNA is desired clinically."}
{"instruction": "Generate impression based on findings.", "input": "Reason: elevated LFTs - assess for fatty change and cirrhosis History: Occasional RUQ pain LIVER: The liver measures 19.8 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 0.17 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: The spleen measures 11.7 cm in length. There is a slightly hypoechoic, round lesion within the spleen measuring 4.1 x 3.6 x 3.9 cm which demonstrates mild internal vascularity and lacks posterior acoustic enhancement, suggesting that this is a solid lesion.RIGHT KIDNEY: Kidney measures 12.8 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 13.5 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Increased hepatic echogenicity suggestive of fatty infiltration/parenchymal dysfunction.2.Indeterminant solid appearing lesion within the spleen. In the absence of known malignancy, statistically this most likely represents a benign lesion."}
{"instruction": "Generate impression based on findings.", "input": "Reason: history of thyroid nodules History: enlargement of neck RIGHT LOBE MEASUREMENTS: 4.4 x 1.3 x 1.4 cm.LEFT LOBE MEASUREMENTS: 4.4 x 1.1 x 1.1 cmISTHMUS MEASUREMENTS: Up to 0.2 cm in thickness.RIGHT LOBE: Normal background parenchymal echotexture without suspicious nodules.LEFT LOBE: Normal background parenchymal echotexture. Single hypoechoic nodule within the upper pole measuring 0.3 x 0.2 x 0.4 cm which contains punctate reflectors, favor benign colloid nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology subcentimeter right level 3 cervical lymph node. OTHER: No significant abnormality noted.", "output": "Thyroid normal in size without suspicious nodules."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old male with abdominal distention. Evaluate for liver pathology. LIVER: The liver is normal in morphology, and echogenicity. It is borderline enlarged, measuring 20 cm in the craniocaudal dimension. No intrahepatic biliary dilatation or focal hepatic lesion is evident. There is normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: The common bile duct is normal in caliber, measuring 3 mm. The gallbladder is nearly completely contracted, resulting in apparent wall thickness of 3 mm. No gallstones or focal tenderness is evident. PANCREAS: The visualized pancreatic body and head are normal.SPLEEN: The spleen is mildly enlarged, measuring 11.6 cm.RIGHT KIDNEY: The right kidney is shrunken, measuring 7 cm in length and is markedly echogenic. No hydronephrosis. Note is made of a 1.4 cm simple appearing cyst. Color Doppler demonstrates hilar blood flow.OTHER: The left kidney has been removed.There is a moderate amount of ascites.", "output": "1. The liver is borderline enlarged, otherwise there are no specific findings of liver disease. 2. Moderate volume ascites.3. Atrophic right kidney."}
{"instruction": "Generate impression based on findings.", "input": "Male; 70 years old. Reason: assess for stones and medical renal disease History: urosepsis x2 RIGHT KIDNEY: Right kidney measures 13.2 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone.LEFT KIDNEY: The left kidney measured 13.3 cm in length. Simple appearing renal cyst measuring up to 0.8 cm. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone.BLADDER: The bladder is nondistended.OTHER: 0.9 x 0.8 x 0.8 cm hyperechoic right liver lesion. The prostate measures 5.6 x 5.3 x 6.3 cm.", "output": "1.No nephrolithiasis or hydronephrosis. Renocortical echogenicity within normal limits.2.Enlarged prostate.3.Subcentimeter hyperechoic right liver lesion may represent a hemangioma, should be confirmed with dedicated contrast enhanced CT or MRI."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old female with question of a thyroid nodule on outside CT scan. RIGHT LOBE MEASUREMENTS: 6.8 x 2.8 x 1.7 cmLEFT LOBE MEASUREMENTS: 3.1 x 1.9 x 2.3 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Mixed solid and cystic nodule in the left inferior thyroid lobe measures 3.1 x 1.9 x 2.3 cm.ISTHMUS: Mixed solid and cystic nodule in the isthmus measures 3.3 x 2.3 x 1.7 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Two thyroid nodules, one in the isthmus, and one in the inferior left lobe, have similar mixed solid and cystic morphologic features, and are amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old male with right testicular cyst. RIGHT TESTIS: The right testis is normal in morphology, echogenicity and size, measuring 2.5 x 2.9 x 5.2 cm. Spectral Doppler evaluation demonstrates normal flow. There are a few microliths without a discrete parenchymal lesion. LEFT TESTIS: The left testis is normal in morphology, echogenicity, and size, measuring 2.0 x 3.1 x 5.6 cm. Spectral Doppler demonstrates normal flow. There are a few microliths without a discrete parenchymal lesion. RIGHT EPIDIDYMIS: The right epididymis is unremarkable.LEFT EPIDIDYMIS: The left epididymis is unremarkable.OTHER: There are bilateral moderate degree varicoceles.", "output": "1. Bilateral varicoceles as above.2. Scattered testicular microlithiasis without a discrete focal soft tissue lesion."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with history of benign MRI guided right breast biopsy in March 2016. Now presents with palpable lump in the upper right breast. Family history of breast cancer in sister, diagnosed at age 26. Personal history of BRCA 2 mutation, enrolled in research study. Physical examination at the patient's palpable area of concern demonstrated a hard lump at the 1:00 position in the right breast, approximately 6 cm from the nipple. A targeted right breast ultrasound at the palpable area of concern demonstrated 2 mixed echogenicity avascular lesions containing debris and scattered septations. Findings are compatible with a hematoma that is comprised of two separate components separated by a thin layer of normal breast tissue. The deeper component of the hematoma contains the biopsy clip. The overall hematoma measures 3.0 x 3.4 cm. No suspicious cystic or solid lesions are identified.", "output": "Right breast hematoma as described above. No sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral breast MRI is recommended in September 2016 followed by bilateral diagnostic mammogram in March 2017 as per the patient's research study protocol.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female patient with history of elevated LFTs. Assess portal/hepatic vein flow. LIMITED ABDOMENLIVER: The liver measures 15.3 cm in length. No focal hepatic lesion is identified.BILIARY TRACT: No gallstones, pericholecystic fluid, or gallbladder wall thickening is identified. There is no intra or extrahepatic biliary ductal dilatation. The common duct measures 3 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The distal tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 9.5 cm in length. RIGHT KIDNEY: The right kidney measures 9.7 cm and the left kidney measures 11.8 cm in length. No evidence of hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Patent hepatic vasculature."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old male with proteinuria. Ultrasound guidance was provided for biopsy of right kidney", "output": "Ultrasound guidance."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male with sepsis. Previous CT scan was suspicious for cholecystitis. LIVER:The liver measures 18.3 cm. The parenchyma has normal echotexture. No worrisome mass, ascites, or intrahepatic biliary dilation. Limited Doppler of the portal vein shows patency and hepatopedal flow.GALLBLADDER, BILIARY TRACT: There is gallbladder wall thickening and pericholecystic fluid concerning for acute inflammation. There are no stones or sludge. The common bile duct measures 0.5 cm.PANCREAS: Evaluation the pancreas is limited by overlying bowel gas.SPLEEN: The spleen measures 10.7 cm. No abnormalities noted.KIDNEYS: The right kidney measures approximately 10.4 cm. The cortex has increased echogenicity. No worrisome mass or hydronephrosis noted. There is an echogenic focus measuring approximately 0.4 cm consistent with a nonobstructing renal stone. The left kidney cannot be accurately measured. The cortex appears to have increased echogenicity. No worrisome mass, stone or hydronephrosis noted.OTHER: No significant abnormality noted.", "output": "1. Sonographic evidence suggestive of acute cholecystitis without calculi or ductal dilatation.2. Increased echogenicity of kidneys consistent with medical renal disease/parenchymal dysfunction. No mass or hydronephrosis noted.3. Nonobstructive nephrolithiasis on the right as above. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old female with a palpable left breast mass for 2 weeks presents for ultrasound. No family history of breast cancer Targeted ultrasound of the left breast performed at the palpable area of concern. A pea sized mobile palpable mass noted in the left breast 12:00 position 5 cm from the nipple. This on demonstrates a parallel oriented hypoechoic mass, with smooth margins measuring 1.9 x 1.1 x 1.7 cm. Located 6 mm lateral to it is a smaller similar morphology mass that measures 1.2 x 0.4 x 1 cm. Mild to moderate peripheral blood flow noted in both these lesions.No suspicious mass noted.", "output": "Palpable abnormality in the left breast 12:00 position corresponds most likely to a benign fibroadenoma based on imaging. A smaller similar morphology mass is located 6 mm lateral to it.Surgical consultation is recommended.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Reason: hepatopathy or biliary colic? History: chronic intermittent RUQ pain in heavy drinker. LIVER: The liver measures 13.3 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 0.36 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 3.6 mm in diameter.PANCREAS: Not well visualized.SPLEEN: No significant abnormalities noted. The spleen measures 8.8 cm in length. RIGHT KIDNEY: Kidney measures 10.0 cm in length. Normal cortical echotexture. No hydronephrosis. Subcentimeter cyst.LEFT KIDNEY: Kidney measures 10.4 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "No sonographic evidence of acute cholecystitis or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Patient is a 14-year-old female who comes with her grandmother for imaging evaluation of multiple palpable lumps in her right breast. She reports a prior ultrasound revealing presumed fibroadenomata. She feels that some of her lumps have increased in size and some of them are new from the prior examination. A targeted right ultrasound was performed for the palpable areas of concern. Five hypo to isoechoic well-circumscribed masses with internal flow, of similar sonographic morphology are noted in the right breast and are probably fibroadenomata.1. At 9:00 position, 2 cm from the nipple, a palpable mass, increased in size as per patient, is now too big to be measured with ultrasound and is clearly greater than 4 cm.2. At 1:00 position, 2 cm from the nipple, there is a 3.2 x 2.1 x 3.4 cm mass, which is also palpable.3. At 1:00 position, 2 cm from the nipple, adjacent to the second mass, there is a1.1 x 0.7 x 1.2 cm hypoechoic mass, not palpable by patient.4. At 5:00 position, 5 cm from the nipple, there is a 1.3 x 1.2 x 1.4 cm hypoechoic mass, new as per patient.5. At 10:00 position, 5 cm from the nipple, there is a 1.8 x 1.8 cm hypoechoic mass, which is approximately 0.3 cm adjacent to the largest palpable mass (labeled as 1 as above).", "output": "Multiple palpable and nonpalpable masses, probably fibroadenomata in the right breast as described above. Surgical consultation is recommended. Results and recommendations were discussed with the patient and her grandmother. BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Male; 66 years old. Reason: Pt with low platelets and elevated AST, ALT. Please evaluate for liver disease. May also be working up for heart transplant History: elevated transaminases, thrombocytopenia LIVER: The liver measures 15.1 cm in length. The liver surface is smooth, the parenchyma echogenic and heterogenous in echotexture. No focal lesion identified.The main portal vein is patent with hepatopetal flow and a peak velocity of 0.3 m/s.GALLBLADDER, BILIARY TRACT: The gallbladder is unremarkable. There is no cholelithiasis or gallbladder wall thickening. The common duct measures up to 5 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 13.6 cm in length.KIDNEYS: The right kidney measures 9.3 cm in length. The cortex is normal echogenicity. There is no hydronephrosis or shadowing renal stone. The left kidney measures 10.9 cm in length. The cortex is normal in echogenicity. 1.6 x 1.4 x 2.3 cm exophytic, simple appearing renal cyst is seen. There is no hydronephrosis or shadowing stone.ABDOMINAL AORTA: The proximal aorta measures 2.5 cm in diameter, the mid aorta measures 2.2 cm in diameter. The distal aorta is not visualized.INFERIOR VENA CAVA: The most superior portion of the inferior vena cava is imaged it is patent and unremarkable.OTHER: The bladder is not distended and incompletely evaluated. A left ureteral jet is visualized.", "output": "1.Heterogenous and echogenic liver parenchyma compatible with hepatic steatosis/parenchymal dysfunction.2.Simple appearing left renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for abscess of ulcers, has drainage History: bacteremia In the mid right buttock area, open wound containing packing material is noted which sonographically appears as a heterogenous focal area measuring 6.4 x 2.3 x 3.8 cm.Inferior to the left buttock area, the dimple like wound with discharge is noted. Sonographically, it appears as a focal hypoechoic area with heterogenous echotexture and echogenic foci suggestive of phlegmon and gas bubbles, measuring 4.4 x 2.9 x 2.6 cm. Small amount of blood flow was seen with color Doppler.", "output": "A focal hypoechoic area with heterogenous echotexture and echogenic foci suggestive of phlegmon and gas bubbles inferior to left buttocks, An abscess cannot be ruled out in this area and further evaluation with CT or MRI is suggested if clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "Precardiac transplant evaluation. LIVER:The liver parenchyma is coarse and increased in echogenicity compatible with stated history of cirrhosis. It measures 14.4 cm in craniocaudal dimension. There is a multilobulated hypoechoic focus measuring approximately 3 cm in the right liver lobe. Additional hypoechoic round focus near the gallbladder fossa measuring 10 x 6 x 9 mm.Normal hepatopedal portal venous blood flow at 0.3 m/s.No intrahepatic biliary ductal dilatation.GALLBLADDER, BILIARY TRACT: Normally distended gallbladder without wall thickening, pericholecystic fluid or focal tenderness. No extrahepatic biliary ductal dilatation with the common duct measuring 5 mm in short axis.PANCREAS: The visualized portions of the pancreatic head are unremarkable.SPLEEN: The spleen is enlarged measuring 17 cm in length.KIDNEYS: The right kidney measures 11.7 cm in length without hydronephrosis or shadowing nephrolithiasis. The left kidney measures 12 cm in length without hydronephrosis or shadowing calculus.ABDOMINAL AORTA: The proximal abdominal aorta is obscured by overlying bowel gas. The mid abdominal aorta measures 3.1 cm in AP dimension. The distal abdominal aorta measures 1.9 cm in AP dimension. The right and left iliac arteries measure 1.3 and 1.4 cm in AP dimension respectively.INFERIOR VENA CAVA: The visualized IVC is patent.OTHER: Partially contracted urinary bladder with free pelvic fluid. Small volume perihepatic ascites.", "output": "1. Coarse echogenic liver parenchyma compatible with stated history of chronic liver disease/cirrhosis. Splenomegaly.2. Incompletely characterized liver lesions. Dedicated liver CT or MRI with and without contrast contrast is recommended for further characterization.3. Small volume ascites."}
{"instruction": "Generate impression based on findings.", "input": "Male 73 years old; evaluate for growth of left parotid mass. Again noted is a predominantly hypoechoic peripheral lesion within the inferior left parotid gland measuring 1.2 x 1.0 x 0.5 cm, unchanged from 1.2 x 1.1 x 0.6 cm previously.", "output": "Stable left parotid hypoechoic lesion."}
{"instruction": "Generate impression based on findings.", "input": "74 years old, Male, Reason: history of kidney stones and renal cell cancer History: none RIGHT KIDNEY: Kidney measures 9.5 cm in length. Normal echotexture. No hydronephrosis. Nonobstructing nephrolithiasis. No focal mass to suggest recurrence seen on this examination.LEFT KIDNEY: Kidney measures 11.2 cm in length. Normal echotexture. No hydronephrosis. No definite shadowing calculus. No focal mass.Bladder: The bladder is not distended.", "output": "1.Nonobstructing nephrolithiasis of the right kidney.2.No focal mass to suggest recurrence."}
{"instruction": "Generate impression based on findings.", "input": "Lower abdominal pain and lower urinary tract symptoms RIGHT KIDNEY: Atrophic and echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Benign renal cyst. Right kidney 11.7 cm in lengthLEFT KIDNEY: Atrophic and echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Benign renal cyst. Left kidney 12.4 cm in length.OTHER: Bladder collapsed", "output": "Atrophic and echogenic parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "79-year-old man with history of BPH, AKA. RIGHT KIDNEY: The right kidney measures 9.6 cm in length and shows slightly increased echogenicity. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.5 cm in length and shows slightly increased echogenicity. No mass, stone or hydronephrosis.URINARY BLADDER: The urinary bladder is normal in appearance.OTHER: There is no free or loculated fluid. The prostate is enlarged, measuring 5.9 x 6.5 x 6.0 cm.", "output": "1.Increased echogenicity of the renal parenchyma bilaterally, consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone or hydronephrosis. 2.Enlarged prostate gland."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs status post cardiac arrest LIVER: Non-cirrhotic liver morphology. 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 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 10.6 cm in length. The left kidney is 10.9 cm in length. The renal parenchymal echogenicity is mildly increased bilaterally. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 7.3 cm in length, without focal lesions evident.OTHER: Bilateral pleural effusions noted.", "output": "1. Mildly increased hepatic echogenicity, compatible with parenchymal dysfunction.2. Mildly increased renal parenchymal echogenicity, compatible with medical renal disease.3. Bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Acquired deformity of chest and rib. Left chest wall mass. The palpable abnormality corresponds to the costal cartilage. No other soft tissue abnormalities identified and evaluation of this by ultrasound is somewhat limited.", "output": "Palpable abnormality response to costal cartilage; ultrasound has limited ability to evaluate cartilage. No evidence of additional soft tissue mass."}
{"instruction": "Generate impression based on findings.", "input": "18-year-old male patient with persistent hematuria. Evaluate for clots in bladder or hydronephrosis. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. Distal Ureter -- SFU Grade**  Right: 0  Left: 0   Ureteral Jets Right: Not observed  Left: Not observedKIDNEYS  Cortical Echogenicity: Increased   Medullary Echogenicity: Poor corticomedullary differentiation.   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 12.2 cm Left: 12.7 cm   Mean for age: 10.8 cm  Range for age: 8.6 - 13.1 cmADDITIONAL OBSERVATIONS: Trace free fluid in the pelvis.", "output": "Medical renal disease without hydronephrosis or debris in the bladder.*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": "Right upper abdominal pain LIVER: Non-cirrhotic liver morphology. Hepatomegaly, measuring 20 cm. Increased parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Numerous subcentimeter gallstones noted. No specific signs of acute cholecystitis.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas. The previously described peripancreatic lymph node is not visualized.KIDNEYS: The right kidney is 10.1 cm in length. The left kidney is 11.7 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 7.3 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid is identified.", "output": "1. Cholelithiasis without specific evidence of cholecystitis.2. Increased liver echogenicity, compatible with steatosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: right sided thyroid nodule seen on chest CT RIGHT LOBE MEASUREMENTS: 6.9 x 2.0 x 2.4 cmLEFT LOBE MEASUREMENTS: 5.1 x 1.5 x 1.9 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Mid pole nodule is is predominantly cystic with some solid components and septations, measuring 2.2 x 1.5 x 1.7 cm. No vascularity or microcalcifications.There are two additional more inferior nodules with similar morphology and echogenicity. The dominant nodule measures 1.9 x 1.3 x 1.7 cm. No vascularity or microcalcifications.LEFT LOBE: Left lower pole mostly solid nodule measures 1.1 x 0.8 x 0.7 cm. No vascularity or microcalcifications.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted. No lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Multinodular thyroid as above."}
{"instruction": "Generate impression based on findings.", "input": "Rule out recurrence with special attention to new lesion in the thyroid bed. New small lesion. Six-month follow-up. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE:Previously noted two hypoechoic foci in the thyroidectomy bed are unchanged, one measures 3 x 3 x 3 mm (previously 4 mm x 4 mm x 6 mm) and the other located more inferiorly measures 7 x 7 x 6 mm previously 7 x 5 x 5 mm. Previously new hypoechoic focus in the thyroidectomy bed currently measures 4 x 4 x 2 mm (previously 4 mm x 3 mm x 2 mm), unchanged.LEFT LOBE:Two hypoechoic foci in the left thyroidectomy bed are not significantly changed, one of which measures 3 x 2 x 3 mm, (previously 2 mm x 2 mm x 3 mm) and the other measures 6 x 3 x 5 mm, (previously 6 mm x 3 mm x 4 mm).ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable exam. Previously described new hypoechoic focus in the right thyroidectomy bed is unchanged. Previously seen hypoechoic foci bilaterally are unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine RIGHT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. 12 cm in lengthLEFT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. 12.4 cm in lengthOTHER: Bladder collapsed. Mild ascites.", "output": "Normal renal parenchymal echogenicity without mass, stone, or obstruction. Mild ascites."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with prior benign bilateral biopsies and left breast duct excision presents for annual mammogram. No current complaints. Patient reports family history of breast cancer in a maternal cousin and ovarian cancer in a maternal cousin. MAMMOGRAM", "output": "Multiple bilateral cysts. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 2yo M with Neuroblastoma s/p chemotherapy and stem cell transplant undergoing immunotherapy with history of abscesses now with new buttock swelling History: erythematous induration on R buttock Soft tissue swelling without discrete fluid collection.", "output": "Soft tissue swelling without discrete fluid collection. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluation of CKD History: CKD RIGHT KIDNEY: The right kidney measures 10.0 cm in length. The renal echogenicity and echotexture is unremarkable. There is a simple cyst in the midpole of the right kidney measuring 1.8 x 1.7 x 1.8 cm. There is no hydronephrosis.LEFT KIDNEY: The left kidney measures 10.2 cm in length. The renal echogenicity and echotexture is unremarkable. There is a simple cyst in the midpole of the left kidney measuring 1.2 x 1.1 x 1.2 cm. There is no hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Negative ultrasound evaluation of the kidneys."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old female with acute kidney injury. Evaluate for hydronephrosis. Limited examination.RIGHT KIDNEY: The right kidney is moderately echogenic and measures 10.1 cm without evidence of hydronephrosis.LEFT KIDNEY: The left kidney is echogenic and measures 8 cm without evidence of hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Findings consistent with medical renal disease without evidence of hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female with recurrent pleural effusions. LIVER: Measures 17.1 cm in length. Mildly heterogeneous echogenicity without focal lesion.BILIARY TRACT: Status post cholecystectomy. Dilation of the common bile duct to 9 mm most likely postsurgical.PANCREAS: Portions of the pancreas is not clearly visualized due to bowel gas. The visualized pancreatic parenchyma is within normal limits.SPLEEN: No significant abnormalities noted.KIDNEY: No significant abnormalities noted. OTHER: Small pleural effusions.", "output": "1. Mildly heterogeneous hepatic parenchyma but no secondary signs of cirrhosis or discrete mass lesion. 2. Status post cholecystectomy.3. Small pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male patient with HCV, liver fibrosis. Evaluate for HCC. LIVER: The liver measures 16.8 cm in length. Hepatic parenchymal echogenicity is coarsened and increased. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.1 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. 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 10.5 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.3 cm in length. No evidence of hydronephrosis.The spleen measures 9.2 cm in length.", "output": "Coarsened, increased hepatic echogenicity consistent with chronic liver disease without focal hepatic lesion identified. "}
{"instruction": "Generate impression based on findings.", "input": "88-year-old female patient with right chest wall fullness and right arm swelling. History of left breast mastectomy in 2007 for IDC and right axillary lymph node dissection in 2009. Family history of breast cancer in maternal aunt at 58 years of age. A right ultrasound was performed for the patient\u2019s area of concern in the right axilla and right breast. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B. Evaluate for hepatocellular carcinoma. LIVER: Non-cirrhotic liver morphology. 18.5 cm in length. Slightly 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 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 9.7 cm in length. The left kidney is 12.7 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 15.0 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.", "output": "1. Increased hepatic echogenicity compatible with parenchymal dysfunction, without biliary ductal dilation.2. Mild splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Male 30 years old; Reason: 30M with Ph+ ALL admitted for stem cell mobilization/collection with Cytarabine/Etoposide, c/o RUQ pain and rebound History: RUQ pain, rebound LIVER: The liver measures 16.3 cm in length. There is normal echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.53 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 3.61 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.77 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.3 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.7 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.", "output": "Normal abdominal ultrasound without findings to explain patient's right upper quadrant pain."}
{"instruction": "Generate impression based on findings.", "input": "Is there evidence of cholecystitis?, Abdominal pain LIVER: Liver demonstrates coarse heterogenous echotexture, measures approximately 14.9 cm. No focal lesions noted within the liver. Portal vein demonstrates normal flow directionality and patency.BILIARY TRACT: Gallbladder is well-distended without any focal lesions. No evidence of gallstones. Gallbladder wall thickness is within normal limits. No pericholecystic fluid noted.PANCREAS: Head of the pancreas as visualized appears unremarkable. Body and tail of the pancreas is not visualized.SPLEEN: Spleen measures 12 cm without any focal lesions.RIGHT KIDNEY: Right kidney measures 11.5 cm and left measures 11.8 cm. No hydronephrosis or focal lesions noted. Both kidneys demonstrate increased echogenicity suggestive of chronic medical renal disease. OTHER: No ascites", "output": "No evidence of acute cholecystitis.Diffuse coarse echotexture of the liver without any focal lesions.Bilateral echogenic kidneys suggestive of chronic medical renal disease. "}
{"instruction": "Generate impression based on findings.", "input": "Renal transplant with low urine output and intraoperative complications Study technically limited due to body habitus and overlying bowel gasRENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality noted. 10.7 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 Patent renal transplant vasculature without evidence for inflow or outflow compromise. Increased diastolic dampening.OTHER: No significant abnormality noted", "output": "Right iliac fossa renal transplant without evidence for perinephric collection or hydronephrosis. Patent vasculature without inflow or outflow compromise. Diastolic dampening suggestive for increased parenchymal resistance pattern."}
{"instruction": "Generate impression based on findings.", "input": "NASH LIVER: Increased parenchymal echogenicity and coarseness consistent with fatty infiltration not significantly changed from prior study. No mass lesion. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 15.8 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 11.8 cm in length RIGHT KIDNEY: No significant abnormalities noted. 11.4 cm in lengthOTHER: Left kidney 11.2 cm in length. No ascites", "output": "No significant change in liver fatty infiltration. No mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old male with hepatitis C, evaluate for ascites Limited 4-quadrant grayscale ultrasound of the abdomen shows no ascites.", "output": "Limited exam without ascites."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old female with history of callback after baseline screening mammogram for left breast asymmetries. No reported family history of breast cancer. MAMMOGRAM: Three standard 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 upper inner breast, anterior depth, there is an oval, circumscribed, mass measuring 11 mm. In the left upper outer breast, posterior depth, a second oval circumscribed mass is noted measuring 6mm.These lesions persist on spot compression views.ULTRASOUND: A targeted left breast ultrasound was performed in the area of mammographic abnormalities.In the left medial breast at the 10: o'clock position approximately 3 cm from the nipple, there is a anechoic oval lesion with internal septations and increased posterior acoustic enhancement measuring 8 x 3 x 5 mm. There is no increased internal vascularity.In the left upper outer breast at the 2 o'clock position approximately 6 cm from the nipple, two benign appearing intramammary lymph nodes are noted.The above lesions correlate with mammographic findings.", "output": "Benign left breast cyst and intramammary lymph nodes as above. No mammographic evidence of malignancy. As long as the patient's physical exam remains unchanged, annual follow-up with diagnostic mammogram is recommended. Results and plan discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "66 year old female who was recalled from screening mammogram for asymmetry identified in the right inferior breast. Mammogram: An ML, MLO 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), unchanged in pattern and distribution. Small subcentimeter oval focal asymmetry in the lateral right breast is unchanged. Two subcentimeter focal asymmetries identified in the right lower inner quadrant which persist on spot compression views.Ultrasound: Targeted right lower inner quadrant ultrasound was performed that showed a septated cyst in the right breast 6:30 o'clock position measuring 6 x 3 mm and a simple cyst at 5:00 position measuring 3 x 3 mm. No suspicious solid mass noted.", "output": "2 new benign focal asymmetries in the right breast correspond to a septated cyst and a simple 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": "Female 70 years old Reason: assess for liver pathology History: RUQ tenderness to palpation in pt with AML on chemotherapy LIVER: Mildly coarsened appearance of the liver which is nonspecific but can be seen in the setting of fatty infiltration or diffuse hepatic dysfunction. No focal hepatic mass. Main portal vein is patent with normal directional flow and peak velocity of 32 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. The common bile duct measures 5 mm. No gallbladder, possibly removed.PANCREAS: The visualized portions of the pancreas are within normal limits.SPLEEN: Spleen measures 13.3 cm and is normal in appearance.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 9.4 cm. Cyst in superior pole of the left kidney measures 3.2 x 2.8 x 2.7 cm. Left kidney measures 10.4 cm. OTHER: No significant abnormalities noted.", "output": "Mildly coarsened appearance of the liver without focal mass. No intra or extrahepatic biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old male, advanced heart failure workup. LIVER: Liver measures 19.1 cm in length with slight nodular contour of the liver likely related to passive hepatic congestion. There is mild pulsatility of the main portal vein. There is perihepatic ascites. GALLBLADDER, BILIARY TRACT: Gallbladder is normal with pericholecystic fluid. Gallbladder wall measures 3 mm in thickness. Sonographic Murphy's sign is negative. Common bile duct measures 3 mm in caliber. No intra or extrahepatic biliary ductal dilatation.PANCREAS: Tail of pancreas is obscured by overlying bowel gas however the remaining pancreatic parenchyma is normal in echogenicity with no evidence of pancreatic ductal dilatation.RIGHT KIDNEY: Measures 11.4 cm in length with no hydronephrosis.OTHER: Left kidney is normal measuring 11.5 cm in length. Spleen is normal measuring 11.9 cm in length.", "output": "Perihepatic ascites with slight nodular contour of the liver likely related to passive hepatic congestion. Thickened gallbladder wall likely related to ascites. "}
{"instruction": "Generate impression based on findings.", "input": "Male 83 years old Reason: left testicular or epididymal lesion RIGHT TESTIS: Right testis has normal homogeneous echogenicity and normal vascular flow.LEFT TESTIS: Left testis has normal homogeneous echogenicity and normal vascular flow. No intratesticular mass. Inferior to the left testicle but separate there is a round, heterogeneous soft tissue mass with internal calcifications and vascular flow.RIGHT EPIDIDYMIS: Right epididymis measures 1.1 x 1.1 x 0.9 cm. Small right renal cyst. Small right hydrocele. Varicocele with calcification seen on the right.LEFT EPIDIDYMIS: Left epididymis measures 1.8 x 1.1 x 0.8 cm. Left epididymis cyst measures 0.4 x 0.4 x 0.4 cm. Small left hydrocele.OTHER: No significant abnormalities noted.", "output": "Extratesticular heterogeneous soft tissue nodule inferior to the left testicle with calcifications and vascular flow has a nonspecific sonographic appearance. Although the majority of extra-testicular masses are benign, metastasis cannot be excluded.Findings discussed with ordering service at time of dictation."}
{"instruction": "Generate impression based on findings.", "input": "Female 73 years old Reason: 73 yo with cirrhosis please screen for HCC History: none LIVER: The liver is normal in size measuring 15.2 cm in length. A mildly nodular contour and increased parenchymal echogenicity compatible with known history of cirrhosis. No focal hepatic lesions or masses are identified. The portal vein is patent with hepatopetal flow of 0.2 m/s.BILIARY TRACT: Gallbladder stones and sludge are seen. No sonographic Murphy's sign. No intra or extrahepatic biliary ductal dilatation. The common bile duct measures up to 4 mm.PANCREAS: The head and proximal body of the pancreas are seen without significant abnormality. Distal pancreas is obscured by overlying bowel gas.SPLEEN: No significant abnormalities noted. The spleen measures 9.6 cm in length.RIGHT KIDNEY: Right kidney measures 10.2 cm. Normal echotexture. There is a small simple appearing cyst in the right kidney measuring 0.7 x 0.7 x 0.7 cm. No hydronephrosis or shadowing calculi.LEFT KIDNEY: Kidney measures 11.4 cm in length. Normal echotexture. No hydronephrosis or shadowing calculus. Large simple appearing left renal cyst measures 6.0 x 6.2 x 5.2 cm.OTHER: No significant abnormalities noted.", "output": "1.Cirrhotic liver without focal lesions or masses.2.Cholelithiasis without evidence of cholecystitis.3.Bilateral simple renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "Male 68 years old; Reason: pre transplant eval; eval for cirrhosis History: SOB, orthopnea LIVER: The liver measures 18.1 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 25.1 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 4.1 mm. No stones are seen. No pericholecystic fluid. Negative sonographic Murphy sign. The common bile duct measures 1.8 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 13.1 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 11.7 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen. An exophytic renal cyst is seen near the mid pole measuring 0.9 cm x 0.8 cm x 0.8 cm.ABDOMINAL AORTA: The liver is patent with appropriate directional flow.Distal: 1.7 cm in AP dimension. Mild aortic ectasia is seen.Mid: 1.9 cm in APProximal: Shadowed by bowel gas and not adequately measured.RIGHT ILIAC ARTERY: Measures 1.3 cm in AP dimensionLEFT ILIAC ARTERIES: Measures 1.5 cm in AP dimensionBLADDER: Bladder is decompressed and not well visualized.", "output": "1. Mild hepatomegaly. Coarse increased echogenicity compatible with chronic liver disease/early cirrhosis. No focal hepatic masses or ascites is seen.2. Mild abdominal aortic ectasia is seen. There is mild aneurysmal dilatation of the distal abdominal aorta and right and left iliac arteries."}
{"instruction": "Generate impression based on findings.", "input": "Right thyroid nodule seen on recent CT RIGHT LOBE MEASUREMENTS: 4.2 x 1.4 x 1.7 cmLEFT LOBE MEASUREMENTS: 5.7 x 1.5 x 1.0 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: 2 subcentimeter spongiform nodules corresponding to the lesions seen on the recent CT within the mid right gland. One nodule measures 0.6 x 0.5 x 0.6 cm; the second measures 0.4 x 0.4 x 0.4 cm. The second nodule demonstrates a single coarse internal 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": "2 subcentimeter spongiform nodules corresponding to the lesions seen on the recent CT. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old female with history of thyroid nodules. RIGHT LOBE MEASUREMENTS: 5.4 x 2.0 x 1.4 cmLEFT LOBE MEASUREMENTS: 4.3 x 1.8 x 1.3 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Almost completely cystic nodule in the right inferior pole measures 1.1 x 0.9 cm, unchanged. Adjacent nodule with spongiform morphologic features measures 0.6 x 0.4 cm, also unchanged.LEFT LOBE: Small cystic and spongiform nodules measuring up to 0.7 cm are unchanged.ISTHMUS: 0.7 x 0.6 cm spongiform nodule in the left isthmus unchanged.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Thyroid nodules with benign morphologic features and no acute interval change."}
{"instruction": "Generate impression based on findings.", "input": "22-year-old female patient with palpable abnormality in the right outer breast since breast-feeding in October. Family history of breast cancer in maternal aunt in late 30s. Family history of ovarian cancer in maternal grandmother at 60 years of age. A targeted right ultrasound was performed for the palpable area of concern. In the area of the patient's palpable abnormality in the 9:00 position there was normal glandular breast tissue identified. In the 10:00 position the right breast 3 cm from the nipple, separate from the patient's palpable abnormality, there is a 0.7 x 0.6 cm simple cyst. This cyst was not palpable.", "output": "Normal appearing glandular tissue in the area of the palpable abnormality. Simple subcentimeter cyst separate from the palpable abnormality.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "38 year old female with history of hernia. Evaluate for umbilical hernia. Bowel is noted coursing posteriorly along a shallow defect in the anterior abdominal wall near the umbilicus, however no bowel is seen herniating into the anterior wall.", "output": "Intraperitoneal bowel adjacent to a shallow anterior abdominal wall defect, without frank herniation."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Jackson is a 46 year old female recalled from screening exam for additional imaging of a right retroareolar mass and additional right breast asymmetries. An ML view and five 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), unchanged in pattern and distribution. Again seen is a tubular mass in the right retroareolar region, which persists on spot compression. A mass in the right upper outer breast also persists on spot compression. Two additional asymmetries in the right breast disperse with spot compression. ULTRASOUND", "output": "Focal ductal ectasia in the inferior right breast. Benign-appearing lymph node in the right upper outer breast. 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."}
{"instruction": "Generate impression based on findings.", "input": "Left hydronephrosis RIGHT KIDNEY: No significant abnormalities noted. 12.9 cm in lengthLEFT KIDNEY: Two lower pole nonobstructing stones. The largest measures 1.3 x 0.7 x 1 cm. No worrisome mass or hydronephrosis. Left renal cyst. Left kidney 12.1 cm in length.OTHER: Bladder nondistended", "output": "Two lower pole nonobstructing left renal stones. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Renal dialysis with ascites LIVER: Coarse echogenic liver echotexture without mass. Liver length 14.7 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Atrophic echogenic kidney. Right kidney 4.7 cm in lengthOTHER: Spleen 9.6 cm in length. Trace ascites.", "output": "Coarse echogenic liver echotexture consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Trace ascites. Atrophic echogenic kidneys."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Davis is a 27-year-old female with history of myeloid sarcoma in the right breast, status post radiation, presenting for follow-up of palpable lesion in the right axilla. A targeted right ultrasound was performed for the palpable area of concern, in preparation for ultrasound guided biopsy. In the right axilla, there is revisualization of a superficial, focally echogenic area, which currently measures 6 x 7 mm, compared to 8 x 9 mm (from prior ultrasound 09/20/2016). This area is much less prominent when compared to prior ultrasound and has a sonographic appearance typical for benign fat necrosis.", "output": "Palpable area of concern in the right axilla corresponds to a hyperechoic area which has decreased in size when compared to the prior study. Sonographic findings are typical for benign fat necrosis. After discussion with Dr. Artz and patient, a plan was made to have a short term 2-4 week follow-up ultrasound and physical exam (performed by Dr. Jaskowiak) to reassess the area. If the area persists or is larger, than an ultrasound-guided biopsy can be performed at that time. All results and recommendations were discussed with the patient, Dr. Artz and Dr. Jaskowiak. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "HCV LIVER: Coarse echogenic liver parenchyma without mass. Liver length 15.1 cmGALLBLADDER, BILIARY TRACT: Gallbladder absent. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 8.9 cm in lengthOTHER: Left kidney 9.5 cm in length. Spleen 12.2 cm in length. No ascites.", "output": "Coarse echogenic liver parenchyma consistent with chronic liver disease/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Rule out adenopathy History: History of thyroid cancer RIGHT LOBE: Status post thyroidectomy without new suspicious nodules in the thyroidectomy bed.LEFT LOBE: Status post thyroidectomy without new suspicious nodules in the thyroidectomy bed.ISTHMUS: Status post thyroidectomy without new suspicious nodules in the thyroidectomy bed.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Multiple prominent to mildly enlarged benign appearing cervical lymph nodes bilaterally:Right level 2 cervical lymph node measures 1.6 x 0.9 x 0.3 cm, previously 1.9 x 0.7 x 0.3 cm.Left level 2 cervical lymph node measures 1.7 x 1.0 x 0.3 cm, previously 1.6 x 0.8 x 0.3 cm.Left level 4 cervical lymph node has an atypical appearance with a prominent echogenic hilum measures 0.6 x 0.7 x 0.7 cm, not measured previously.OTHER: No significant abnormality noted.", "output": "1. Left level 4 cervical lymph node with an atypical appearance should at least be followed by repeat ultrasound in 6 months if not biopsied.2. Status post thyroidectomy without evidence of recurrence in the thyroidectomy bed.These findings were communicated to ordering physician Dr. Ronald Cohen at 1:41 PM on 2/24/16 "}
{"instruction": "Generate impression based on findings.", "input": "59 year-old male with cirrhosis status post OLT. Evaluate for lesions, assess hepatic vessel patency. LIMITED ABDOMENLIVER: Cirrhotic liver morphology measuring 16.0 cm in length. No focal hepatic lesion.BILIARY TRACT: Gallbladder is not visualized. No intra or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are unremarkable.SPLEEN: Heterogeneous echotexture measuring 14.2 cm. RIGHT KIDNEY: Measures 7.8 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 9.1 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "1. Cirrhotic liver morphology with no focal hepatic lesion. Patent hepatic vasculature.2. Splenomegaly. "}
{"instruction": "Generate impression based on findings.", "input": "Male 59 years old Reason: eval for portal vein thrombus, p/w Acute liver and kidney failure History: as above LIVER: The liver measures 16.1 cm in length and demonstrates coarsened parenchymal echogenicity. There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma. The main portal vein is patent and demonstrates hepatopetal flow with a maximum velocity of 21 cm/s.BILIARY TRACT: The gallbladder wall is thickened and there is ill-defined heterogeneous material filling the lumen suggestive of hyperechoic sludge.PANCREAS: The pancreas is not well seen secondary to overlying bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 13.4 cm in length and demonstrates appropriate parenchymal echogenicity. OTHER: No significant abnormalities noted.", "output": "1.Coarsened hepatic parenchymal echogenicity suggesting parenchymal function.2.Patent portal vein.3.Gallbladder wall thickening with associated echogenic biliary sludge."}
{"instruction": "Generate impression based on findings.", "input": "Status post hepatectomy with increasing LFTs LIVER: Status post partial hepatectomy. 5.3 x 6 x 2.8 cm complex inferior peri- hepatic loculated fluid collection not significantly changed. Mildly coarse liver echotexture without massGALLBLADDER, BILIARY TRACT: No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 13 centimeters in length.OTHER: Moderate ascites again noted.", "output": "Mildly coarse liver echotexture suggestive for parenchymal dysfunction/fatty infiltration without mass or ductal dilatation. Stable complex inferior perihepatic loculated fluid collection and degree of ascites."}
{"instruction": "Generate impression based on findings.", "input": "Left hydrocele RIGHT TESTIS: 3.3 x 2 x 4.5 cm. Slightly heterogeneous and hypoechoic testicle without evidence for mass.LEFT TESTIS: 3.4 x 2.9 x 4.7 cm. No intratesticular mass.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Bilaterally symmetric Doppler flow characteristics. Large left hydrocele", "output": "Large left hydrocele. No intratesticular mass. Bilaterally symmetric Doppler flow characteristics. Somewhat heterogeneous and hypoechoic right testicle may be the sequela of prior inflammatory/infectious insult"}
{"instruction": "Generate impression based on findings.", "input": "14-year-old female with right lower quadrant pain The appendix measures 9 mm diameter with thickened wall but is partially compressible, without surrounding inflammatory changes or fluid.", "output": "Dilated partially compressible appendix without surrounding inflammatory changes, equivocal for appendicitis. Follow up clinical exam and/or imaging is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 14 y/o M with mixed phenotype ALL; concerns for cholecystitis; liver toxicity; VOD; please comment on presence of ascites History: RUQ and RLQ abdominal tenderness and guarding LIMITED ABDOMENLIVER: The liver is mildly echogenic with a slightly coarsened echotexture, measuring 16.2 cm in length. No focal liver masses are identified. There is no significant intrahepatic biliary ductal dilatation. BILIARY TRACT: The gallbladder is nondistended and filled with debris, as seen previously. Mild echogenicity in the gallbladder fossa may reflect focal fat deposition. The gallbladder wall is upper limits of normal in thickness, measuring 3 mm. No definite pericholecystic fluid is identified. The common bile duct is 4 mm in diameter, within normal limits.PANCREAS: The pancreatic head is visualized and appears normal. The distal pancreas is obscured.SPLEEN: No significant abnormalities noted. KIDNEYS: The right kidney is normal in size and echogenicity without hydronephrosis or nephrolithiasis. The left kidney is also normal in appearance, without hydronephrosis or nephrolithiasis. OTHER: No free fluid.", "output": "1.Echogenic and coarsened texture of the liver, compatible with an infiltrative process, as can be seen in hepatic steatosis among other etiologies.2.Mild gallbladder distention and gallbladder debris/sludge without definite evidence of acute cholecystitis. No biliary ductal dilatation.3.No free fluid."}
{"instruction": "Generate impression based on findings.", "input": "Male 74 years old; Reason: evaluate aneurysms History: aneurysm Proximal abdominal aorta: 2.5 x 2.6 cmMid abdominal aorta: 5.0 x 4.8cmDistal abdominal aorta: 4.9 x 4.7cmThe shape of the aorta especially on the left lateral aspect shows an asymmetric bulge.", "output": "1.Abdominal aortic aneurysm.2.Asymmetry of the aneurysm with a left lateral bulge."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old male with chronic kidney disease stage IV, assess for kidney size RIGHT KIDNEY: The right kidney measures 11.2 cm in length. There is slight increased echogenicity within the cortex. There is no hydronephrosis, stones, or worrisome masses seen.LEFT KIDNEY: The left kidney measures 10.7 cm in length. There is slight increased echogenicity within the cortex. No hydronephrosis, stones, or worrisome masses are seen.OTHER: The bladder is visualized, is nondistended, with no significant abnormalities noted. Bilaterally the renal jets were not visualized.", "output": "1. Bilaterally within the renal cortex there is slightly increased echogenicity. This is compatible with medical renal disease. No hydronephrosis, stones, or worrisome masses are seen bilaterally."}
{"instruction": "Generate impression based on findings.", "input": "35 years old, Male, Reason: 35yo male with ETOH use and low platelets, assess for cirrhosis. History: abnormal LFTs LIVER: The liver is enlarged measuring 20.2 cm in length. Increased hepatic parenchymal echogenicity suggestive of fatty infiltration. 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. No nodularity of the hepatic parenchyma to suggest cirrhosis.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 0.2 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 9.4 cm in length. RIGHT KIDNEY: Kidney measures 10.8 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.5 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Hepatomegaly and increased echogenicity of the liver suggestive of fatty infiltration. No nodularity of the liver contours are widening of the fissures to suggest cirrhosis.2.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "History of dense breast, presents for automated whole breast ultrasound. 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 exam was double read by Dr. Schacht.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NSD - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old woman with personal history of a benign right breast biopsy recalled from screening mammogram for a questioned asymmetry in the left medial breast. MAMMOGRAM: ML, CC 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 composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. The asymmetry in the medial left breast, anterior to mid depth best seen on the CC view partially disperses on additional views and lacks spiculation. An ultrasound will be performed for further evaluation. Benign morphology masses in the left central to outer breast are unchanged. No suspicious microcalcifications.ULTRASOUND:On physical exam, there is no palpable abnormality of the left breast.Targeted grayscale ultrasound the left breast was performed for the mammographic area of concern. In the 7:00 position 3 cm from nipple, unremarkable fibroglandular tissue and fat lobules are seen. No suspicious solid or cystic masses are identified in the 7:00 position and in the adjacent areas.", "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": "52-year-old female with known right breast cysts. Request is made for additional imaging. A targeted right ultrasound was performed for the patient\u2019s area of concern. At the 6 o'clock position of the right breast, 6 to 7 cm from the nipple, there is redemonstration of a well-circumscribed, oval, nearly anechoic cyst with posterior acoustic enhancement measuring 0.6 x 0.3 x 0.3 cm.", "output": "Minimally complicated cyst at the 6 o'clock position of the right breast. Short-term follow-up right breast mammogram and ultrasound are recommended in 6 months to assess stability of the sonographic and mammographic appearances. Results and recommendation were discussed with the patient, and all of her questions were answered.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "84 year old female. Imaging provided for suprapubic bladder catheter placement. The urinary bladder catheter bulb is situated in a partially distended urinary bladder.", "output": "Imaging confirmation of suprapubic catheter placement."}
{"instruction": "Generate impression based on findings.", "input": "Female 78 years old Reason: 78yo F w/ acute on chronic renal failure, r/o obstruction History: as above RIGHT KIDNEY: The right kidney measures 8.1 cm. The renal cortex is hyperechoic. There is no hydronephrosis and no shadowing renal stone. There is a 2.9-cm simple cyst.LEFT KIDNEY: The left kidney measures 8.5 cm. The renal cortex is hyperechoic. There is no hydronephrosis and no shadowing renal stone.BLADDER: The bladder is decompressed by a Foley catheter and is not evaluated.OTHER: No significant abnormalities noted.", "output": "The renal cortex is hyperechoic bilaterally consistent with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate hepatomegaly History: RUQ pressure, increased liver span LIVER: The liver measures 16.7 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 0.33 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 3.5 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 13.6 cm in length. RIGHT KIDNEY: Kidney measures 12.3 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 11.9 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "No evidence of hepatomegaly or other significant abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Female 27 years old Reason: midline neck mass, consider thyroglossal duct cyst vs other. The visible palpable nodule in the midline below the chin measures 1.8 x 1.4 x 0.6 cm. It is solid in echotexture suggestive of a lymph node with a possible fatty hilum. It is moderately vascular on color Doppler imaging.Just to the right of this is a second nonpalpable focus with similar morphology likely representing a lymph node, measuring 0.7 x 0.5 x 0.3 cm. Is mildly vascular on color Doppler imaging.Small nodes is seen in the neck however there is a large palpable cluster of lymph nodes in level 5 on the left largest measuring 1 x 1 x 0.3 cm. Lymph nodes are also seen on the right side level 5 largest measuring 1.1 x 1.1 x 0.3 cm.", "output": "Several nodules with characteristics of lymph nodes level 5 neck bilaterally.The midline submandibular lesion has characteristics of a lymph node, not thyroglossal duct cyst."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Taylor is a 23-year-old female presenting with a palpable abnormality left axilla. She states that she initially felt this abnormality for the past one month, but has progressively gotten smaller in size. Last week, she noted some yellowish discharge from the area. Upon physical exam at the patient's area of concern, a small pimple-like area is noted in the central left axillary region. No discharge is able to be extruded.A targeted left ultrasound was performed for the patient\u2019s area of concern. In the central left axillary region, there is a superficial hypoechoic lesion measuring 0.9 x 0.4 x 1.3 cm. There is no suspicious solid or cystic mass identified.", "output": "Benign epidermal inclusion cyst in the left axillary region. No sonographic evidence for malignancy. Patient should follow-up with her primary care physician as clinically warranted. All results and recommendations were relayed to the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Bladder carcinoma with acute renal failure RIGHT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 12.3 cm in length.LEFT KIDNEY: Mildly echogenic renal parenchyma without mass or stone. Mild left hydronephrosis new since 3/19/2016. Left kidney 12.9 cm in length.OTHER: Anterior bladder mass again noted.", "output": "Mildly echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without mass or stone. New mild left hydronephrosis. Bladder mass again noted."}
{"instruction": "Generate impression based on findings.", "input": "Neurogenic bladder with hydronephrosis RIGHT KIDNEY: Interval improvement in right hydronephrosis which is now mild in degree. No worrisome mass or stone. 10.7 cm in length.LEFT KIDNEY: Interval improvement in the left hydronephrosis which is now mild in degree. No worrisome mass or stone. 10.1 cm in length.OTHER: Bladder collapsed around Foley catheter", "output": "Interval improvement in bilateral hydronephrosis which is now mild in degree."}
{"instruction": "Generate impression based on findings.", "input": "Female 55 years old s/p renal transplant 11/4/2016 now with fevers, leukocytosis, and elevated creatinine. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: Medial to the transplant kidney and lateral to the urinary bladder is a 12.4 x 10.8 x 7.2 cm heterogeneous collection without color Doppler flow. A small amount of simple appearing fluid is present lateral to the transplant kidney.KIDNEY: The transplant kidney measures 12.3 centimeters in length. The parenchyma is echogenic with increased cortical medullary differentiation. There is no hydronephrosis.COLLECTING SYSTEM/URETER: No hydronephrosis.URINARY BLADDER: The bladder is decompressed.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels Iliac artery peak systolic velocity 119 cm/s; resistive index 0.83Peak systolic velocity at the anastomosis is 104 cm/s; resistive index 0.93Proximal right renal artery peak systolic velocity 131 cm/s; no forward flow during diastole; resistive index 0.94Mid right renal artery peak systolic velocity 114 cm/s; reversal of diastolic flow; resistive index 1.13Distal right renal artery peak systolic velocity 111 cm/s; reversal of diastolic flow; resistive index 1.09Right renal artery at the hilum peak systolic velocity 117 cm/s; reversal of diastolic flow; resistive index 1.08The arcuate arteries have peak systolic velocities between 30.6 and 99.6 cm/s and resistive indices of 1.0-1.2. Diastolic flow is reversed throughout.The renal vein and renal vein anastomosis appear patent. In retrospect, there was a nonocclusive thrombus in the renal vein on the prior CT of the abdomen and pelvis.OTHER: No significant abnormality noted", "output": "1.Echogenic renal transplant parenchyma compatible with acute rejection or ATN, see discussion below.2.Elevated resistive indices throughout the transplant kidney vessels and reversal of diastolic flow from the proximal right renal artery and more distally. The renal vein appears patent however, in retrospect, a small nonocclusive thrombus was present within the renal vein on the prior CT. The findings may be secondary to nonocclusive renal vein thrombus or mass effect from the perinephric collection.3.12.4 x 10.8 x 7.2 cm heterogeneous collection medial to the transplant kidney corresponds to the previously described hematoma, which may now be infected."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old male presents with prominent aortic pulse. There is clinical concern for an AAA. ABDOMINAL AORTA: The aorta is patent with normal dimensions.The proximal aorta measures 2.6 x 2.4 cm.The mid aorta measures 1.9 x 1.9 cm.The distal aorta measures 1.8 x 1.9 cm.After the bifurcation the right iliac artery measures 1.2 x 1.3 cm and the left iliac artery measures 1.3 cm.There is no evidence of aneurysm.Doppler flow of the abdominal aorta is within normal limits.OTHER: No significant abnormality noted.", "output": "Normal ultrasound of the abdominal aorta."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 69 y/o M with presumed congestive hepatopathy, evaluate for liver cirrhosis History: Shortness of breath LIVER: The liver measures 20.3 cm in length, enlarged. Coarse parenchymal echotexture, however there is no other specific evidence of cirrhosis. The contour of the liver is smooth. The portal vein is patent with normal hepatopetal directional flow, peak velocity 31 cm/s with pulsatile waveform. No focal mass.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. Status post cholecystectomy. The common bile duct measures 0.5 cm. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 10.6 cm in length. There is a minimally complex right mid pole cyst measuring 3.2 x 2.5 x 2.7 cm with partial septation. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.3 cm in length. No shadowing stones or hydronephrosis.OTHER: Moderate volume ascites.", "output": "1. Hepatomegaly, coarse parenchymal echotexture, and pulsatile portal venous waveform are consistent with congestive hepatopathy. No other specific evidence of cirrhosis.2. Moderate volume ascites.3. Minimally complex right midpole renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "Male 64 years old Reason: R/O HCC History: HCV, cirrhosis LIVER: The liver measures 16.0 cm in length with a mildly nodular contour. The parenchyma is mildly coarse and echogenic . No focal liver lesion is identified. The main portal vein is patent and demonstrates normal direction of flow with a velocity of 2.7 m/s. There is no ascites.BILIARY TRACT: The gallbladder is absent. The common duct measures 1.6 cm in diameter, it previously measured 2 cm. There is no intrahepatic biliary ductal dilatation.PANCREAS: The imaged head of the pancreas is normal with no evidence of mass. The body and tail are obscured by bowel gas. The pancreatic duct is mildly dilated but unchanged.KIDNEYS: The right kidney measures 8.7 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 8.6 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 8.8 cm. in length. OTHER: No significant abnormalities noted.", "output": "1.Mildly coarse and echogenic liver compatible with chronic liver disease.2.No hepatic masses identified.3.Chronic, duct and pancreatic ductal dilatation is stable to slightly decreased."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Rudolph is a 52-year-old female with history of biopsy-proven right breast cancer status post neoadjuvant chemotherapy. Three standard views of the right breast and an additional right CC view 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 seen is a speculated mass in the right breast at the 12:00 position. There has been interval decrease in size and conspicuity of the calcifications within the mass. The biopsy clip is well seated within the center of the mass.ULTRASOUND", "output": "Interval decrease in size of known right breast cancer status post neoadjuvant chemotherapy. Continued surgical management is recommended. Patient is scheduled to have an MRI later on this date (09/23/16).BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old female with enlarged thyroid. Evaluate RIGHT LOBE MEASUREMENTS: 7.8 x 3.9 x 3.4 cmLEFT LOBE MEASUREMENTS: 8.1x 3.2 x 3.4 cmISTHMUS MEASUREMENTS: 0.8 cmRIGHT LOBE: Both thyroid lobes are diffusely enlarged with coarse echotexture consistent with patient's known thyroiditis. Vascularity is also increased.LEFT LOBE: Both thyroid lobes are diffusely enlarged with coarse echotexture consistent with patient's known thyroiditis. Vascularity is also increased.ISTHMUS: Coarse echotexture. On the left side of the isthmus there is a predominantly solid nodule measuring 2.8 x 2.6 x 1.6 cm; although this nodule is more solid compared of the previous examination, there has been no significant interval change in the size of this nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable enlarged thyroid with diffuse coarse echotexture and stable left isthmic solid nodule."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter RIGHT LOBE MEASUREMENTS: 2.9 x 2 x 1.5 cmLEFT LOBE MEASUREMENTS: 6.7 x 2.5 x 3.3 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Interval appearance of upper pole spongiform nodule measuring 1 x 1 x 1 cm. Previous noted mid pole solid nodule stable measuring 1.7 x 1.5 x 2.1 cm.LEFT LOBE: Stable dominant solid nodule measuring 4.7 x 3.4 x 3.5 cm.ISTHMUS: Stable dominant solid isthmic nodule measuring 3.6 x 2.3 x 3.4 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Interval appearance of right upper pole spongiform nodule; favor benign etiology. Other solid bilateral thyroid nodules stable. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "60 year-old female complaining of right-sided pain and mass which has increased in size. History of prior fine needle aspiration of the right breast mass with findings of fat necrosis. A targeted right ultrasound was performed for the patient\u2019s area of concern, as marked by Dr. Chhablani. Vague hypoechoic areas with internal hyperechogenicity are present throughout the upper central and outer right breast, compatible with fat necrosis. There is no solid or cystic mass is identified.", "output": "Vague areas of mixed echogenicity in the area of concern within the right breast, compatible with fat necrosis. No sonographic evidence for malignancy. Findings are discussed with Dr. Chhablani at the time of the examination. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: Coarse echogenic liver echotexture again noted without mass. Liver length 12.8 cm. Limited interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: Gallbladder not well visualized. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10 cm in length.OTHER: Left kidney 9.97 m in length. Spleen 12.2 cm in length. No ascites.", "output": "Coarse and echogenic liver echotexture consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "End stage renal disease on dialysis with nodular thyroid RIGHT LOBE MEASUREMENTS: 5.1 x 2.8 x 2.7 cmLEFT LOBE MEASUREMENTS: 5.1 x 1.9 x 2.8 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Right lobe replaced by mixed cystic and solid nodule with coarse internal calcifications measuring 2.8 x 3.5 x 2.6 cm.LEFT LOBE: Diffusely heterogeneous gland. Multiple mixed cystic and solid nodules. A representative superior pole left thyroid nodule measures 1.7 x 1.6 x 1.5 cm. Coarse internal calcifications versus colloid concretions observed within this nodule. Spongiform nodule within the lower pole measuring 1.7 x 1.7 x 1.7 cm.ISTHMUS: Diffusely heterogeneous gland.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland with multiple thyroid nodules as described. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal LFTs; history breast carcinoma LIVER: Numerous bilobar mass lesions throughout the liver. Liver length 16.7 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without obvious acute inflammation. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.3 cm in lengthOTHER: Left kidney 8.9 cm in length. Spleen 7.8 cm in length. Moderate ascites. Pleural effusions.", "output": "Numerous bilobar hepatic mass lesions consistent with extensive hepatic metastases. Cholelithiasis without acute inflammation or ductal dilatation. Moderate ascites."}
{"instruction": "Generate impression based on findings.", "input": "History of thyroid cancer 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 lymphadenopathy.OTHER: No significant abnormality noted.", "output": "No evidence of disease recurrence or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Assess for abdominal aortic aneurysm Extensive atherosclerotic calcification involving the abdominal aorta without evidence for significant aneurysmal dilatation. Maximal AP diameter of the abdominal aorta 2.2 cm", "output": "Extensive atherosclerotic calcification involving the abdominal aorta without evidence for significant aneurysmal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old male with history of renal transplant, CHF, osteomyelitis, altered mental status. Evaluate for urosepsis. RIGHT KIDNEY: Echogenic atrophic native right kidney secondary to endstage renal disease.LEFT KIDNEY: Echogenic atrophic multicystic native left kidney secondary to end-stage renal disease. The largest cyst measures 2.9 cm without evidence of septation or solid component.TRANSPLANT KIDNEY: Transplant kidney in the right iliac fossa measures 7.9 cm in length. No hydronephrosis. Linear echogenic focus in the proximal collecting system may represent a renal transplant stent, however this is incompletely visualized. There is no perinephric collection.URINARY BLADDER: Collapsed with a Foley catheter in place and possible wall thickening, though accentuated by bladder collapse.OTHER: No significant abnormalities noted.", "output": "1. No hydronephrosis or perinephric collection. Linear echogenic focus in the proximal transplant collecting system could possibly represent a stent catheter, however this is incompletely imaged. This may be further imaged with abdominal radiographs as warranted clinically.2. Collapsed bladder with questionable wall thickening raises a possibility of cystitis. 3. Echogenic multicystic native kidneys consistent with end stage renal disease. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: Right upper quadrant pain, please evaluate for cholecystitis or cholelithiasis. LIVER: The liver measures 15.9 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 0.26 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 8.8 cm in length. RIGHT KIDNEY: Kidney measures 11.7 cm in length. Increased parenchymal echogenicity. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 13.6 cm in length. Increased parenchymal echogenicity. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.No evidence of acute cholecystitis or biliary ductal dilatation.2.Mildly echogenic kidneys raising the possibility of medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Thrombocytopenia; right heart failure LIVER: Coarse heterogeneous liver without mass. Liver length 17.9 cm. Prominent hepatic veins. Limited Doppler interrogation demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: Prominent extra hepatic duct without intrahepatic ductal dilatation.. Gallbladder not visualized.PANCREAS: No significant abnormalities noted.SPLEEN: 17.3 cm in lengthRIGHT KIDNEY: Mild cortical atrophy. Right kidney 10.3 cm in length. No hydronephrosis. OTHER: Mild left renal cortical atrophy. Left kidney 10.7 cm in length. No ascites.", "output": "Coarse heterogeneous liver with prominent hepatic veins consistent with liver congestion. No mass or intrahepatic ductal dilatation. Mild splenomegaly. Bilateral renal cortical atrophy without hydronephrosis. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old male with hepatitis B. LIVER: Hepatic echogenicity and morphology within normal limits. No discrete hepatic masses.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": "Unremarkable examination without evidence of hepatic mass lesion. "}
{"instruction": "Generate impression based on findings.", "input": "Female 41 years old Reason: liver, cirrhosis, hcc screen LIVER: Cirrhotic morphology of the liver. No focal hepatic lesion or mass. Liver measures 15.2 cm in length. Portal vein is patent with normal directional flow and a peak velocity of 20.3 cm/s.BILIARY TRACT: Gallbladder is normal in appearance. No intra or extra hepatic biliary ductal dilatation. Common hepatic duct measures 3 mm.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 with a length of 13.4 cm. Mild splenomegaly.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 10.5 cm. Left kidney measures 11.2 cm.OTHER: No ascites.", "output": "Cirrhotic morphology to the liver. No focal hepatic mass. Stable splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Male; 59 years old. Reason: renal failure History: renal failure The exam is somewhat limited by and and patient's body habitus.RIGHT KIDNEY: The right kidney measures 12.9 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone.LEFT KIDNEY: The left kidney measures 13.4 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone.URINARY BLADDER: The bladder is not visualized.OTHER: There is a small amount of ascites.", "output": "1.No hydronephrosis. 2.Small amount of ascites"}
{"instruction": "Generate impression based on findings.", "input": "49-year-old man with chronic kidney disease RIGHT KIDNEY: Measures 10.0 cm in length. 1.1 cm right renal cyst without septation or suspicious nodular component. Increased renal echogenicity without hydronephrosis.LEFT KIDNEY: Measures 10.3 cm in length. Increased renal echogenicity without hydronephrosis.BLADDER: Partially collapsed, otherwise unremarkable.OTHER: No significant abnormalities noted.", "output": "Increased renal echogenicity consistent with medical renal disease. "}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female patient with liver disease. Recent retroperitoneal bleed and cholelithiasis on CT abdomen without cholecystitis. Now with right upper quadrant pain. Evaluate for cholecystitis. LIVER: The liver measures 22.6 cm in length. Hepatic parenchymal echogenicity is coarsened. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.1 m/sec.GALLBLADDER, BILIARY TRACT: There are multiple gallstones. No gallbladder wall thickening or significant pericholecystic fluid is identified. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 3 mm in diameter.PANCREAS: The head of the pancreas demonstrates normal echogenicity. The body and tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 12 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 12.8 cm in length. No evidence of hydronephrosis.The spleen measures 8.7 cm in length.There is mild ascites.", "output": "1. Cholelithiasis without sonographic evidence of acute cholecystitis.2. Hepatomegaly and coarsened hepatic echogenicity suggestive of chronic liver disease/hepatic parenchymal dysfunction.3. Mild ascites. "}
{"instruction": "Generate impression based on findings.", "input": "60 years old, Male, Reason: AKI, ? obstruction History: elevated Cr, fluid overload RIGHT KIDNEY: Kidney measures 10.5 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. No evidence of hydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 10.2 cm in length. Increased echogenicity of the kidney consistent with medical renal disease. No hydronephrosis or shadowing calculus. Upper pole the left kidney is not well visualized due to overlying bowel gas.BLADDER: No significant abnormalities. OTHER: Incidental note is made of an echogenic liver and a moderate amount of ascites.", "output": "1.Echogenic kidneys consistent with medical renal disease without evidence of hydronephrosis.2.Moderate amount of ascites. 3.Increased echogenicity of the liver is consist with fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female patient with recurrent neck swelling and dysphasia. Evaluate thyroid. RIGHT LOBE MEASUREMENTS: 4.3 x 0.9 x 1.5 cm.LEFT LOBE MEASUREMENTS: 3.8 x 1.2 x 1.7 cm.ISTHMUS MEASUREMENTS: 4 mm in thickness.RIGHT LOBE: The gland is homogeneous in echogenicity without dominant lesion.LEFT LOBE: The gland is homogeneous in echogenicity without dominant lesion.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology lymph nodes are noted in the right level III and IV stations and the left level I station.OTHER: No significant abnormality noted.", "output": "No dominant thyroid lesion is identified."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B. Evaluate for hepatocellular carcinoma. LIVER: Non-cirrhotic liver morphology. Mildly coarse 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 10.3 cm in length. The left kidney is 11.5 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9.1 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites identified.", "output": "1. No suspicious hepatic lesions. 2. Mildly increased hepatic echogenicity, compatible with parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Maxwell is a 79 year old female with a personal history of biopsy proven left breast cancer, currently on anti-estrogen therapy. Targeted ultrasound was performed for the left breast at 2 o'clock and 3 o'clock. The intramammary node at 2 o'clock is about the same size, measuring 5 x 4 mm. No abnormal findings were seen in the 3 o'clock position.", "output": "Known left breast cancer; no significant changes since the prior study.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Martinez is a 60 year old female with known right breast cancer. On physical exam today, Dr. Chhablani felt a palpable node in the right axillary region. She presents today for an ultrasound examination of this area. Upon physical exam, no discrete masses were appreciated. The site has been marked by Dr. Chhablani.A targeted right axillary ultrasound was performed for the palpable area of concern. A normal lymph node is identified at the palpable area of concern, measuring 3 mm in cortical thickness and with normal hilar vascularity. There is no suspicious solid or cystic mass identified.", "output": "Benign lymph node in the right axilla. No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Ms. McCarter is a 67-year-old female with known malignancy in a left supraclavicular lymph node. She presents today for ultrasound-guided biopsy for additional tissue for receptor status confirmation. Targeted ultrasound was performed in the left supraclavicular region. There is an oval hypoechoic lesion identified measuring 0.7 x 0.4 x 0.5 cm. Nonhilar vascular flow was seen on color flow imaging. The target node is very subtle.ULTRASOUND-GUIDED BIOPSY", "output": "Successful ultrasound guided core biopsy of an abnormal left supraclavicular lymph node with clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Status post liver transplant with history of portal vein stenosis requiring stent placement LIMITED ABDOMENLIVER: Mildly coarse and heterogeneous liver echotexture without mass. Liver length 15.1 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: Stable mild splenomegaly; spleen length 17 cm RIGHT KIDNEY: No significant abnormalities noted. 8.5 cm in lengthOTHER: Left kidney 10 cm in length. No ascites", "output": "Stable examination. Patent portal vein with normal directional flow. Patent portal vein stent without significant stenosis or gradient. No ascites. Stable mild splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for pyelonephritis History: fever, leukocytosis, uti RIGHT KIDNEY: The right kidney measures 11.4 cm in length. Unremarkable renal parenchyma. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.7 cm in length. Unremarkable renal parenchyma. No shadowing stones or hydronephrosis.OTHER: The bladder is decompressed by Foley catheter, limiting its evaluation.", "output": "No acute renal abnormality."}
{"instruction": "Generate impression based on findings.", "input": "47 year old with palpable bilateral axillary lymph nodes. History of fibromyalgia and seronegative arthritis. Focused ultrasound was performed for both axillae. There are multiple lymph nodes with borderline cortical thickening. As they are multiple and symmetric, they are likely due to her systemic condition.", "output": "No sonographic evidence of malignancy. Benign lymphadenopathy in both axillae. Results were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "VP shunt. Altered mental status. Elevated liver enzymes. Limited examination due to difficulty repositioning the patient.LIVER: Non-cirrhotic liver morphology. 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 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. The left kidney is 12.2 cm in length. The renal parenchyma is echogenic bilaterally. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: Not visualized.OTHER: No significant abnormalities noted. No ascites identified.", "output": "1. Increased liver echogenicity, compatible with hepatic dysfunction.2. Increased renal parenchymal echogenicity, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old male with hyperbilirubinemia and history of AML status post stem cell transplant, assess for obstruction LIMITED ABDOMENLIVER: The liver measures 19.0 cm in length. There is coarse increased echogenicity within the liver. There is round area of hypoechogenicity adjacent to the gallbladder likely representing an area of focal fatty sparing. There is a trace amount of free fluid of the lower pole of the right lobe of the liver.BILIARY TRACT: The gallbladder wall measures 2.8 mm. There is no stones or significant sludge within the gallbladder. The common bile duct measures 4.3 mm. PANCREAS: No significant abnormalities noted.SPLEEN: The spleen measures 12.3 cm in length. No significant abnormalities are noted. RIGHT KIDNEY: The right kidney measures 10.9 cm in length. The cortex is normal in echogenicity. There is no hydronephrosis, stones, and no worrisome mass is apparent.LEFT KIDNEY: The left kidney measures 10.9 cm in length. The cortex is of normal echogenicity. There is no hydronephrosis or stones present, no worrisome mass. There is a cyst located in the upper pole of the left kidney measuring 2.8 cm x 2.0 cm.", "output": "1. Coarse increased echogenicity within the liver is compatible with fatty liver or parenchymal dysfunction.2. Portal venous system, hepatic arteries, hepatic vein, and inferior vena cava are patent with appropriate flow."}
{"instruction": "Generate impression based on findings.", "input": "Male 35 years old with left flank pain RIGHT KIDNEY: Right kidney measures 10.3 cm. Mild increased cortical echogenicity. No hydronephrosis, shadowing calculi, or mass.LEFT KIDNEY: Left kidney measures 11.1 cm. Mildly increased cortical echogenicity. No hydronephrosis, shadowing calculi, or mass. OTHER: Bladder is visualized, mildly distended, and normal in appearance.", "output": "Mildly increased echogenicity of the kidneys is nonspecific but can be seen in the setting of medical renal disease. No hydronephrosis or shadowing calculus."}
{"instruction": "Generate impression based on findings.", "input": "Right flank pain and dysuria RIGHT KIDNEY: Unremarkable echogenicity without mass, stone, or hydronephrosis. 10.5 cm in lengthLEFT KIDNEY: Unremarkable echogenicity without mass, stone, or hydronephrosis. 12.6 cm in lengthOTHER: Bladder nondistended", "output": "Negative renal ultrasound. Normal parenchymal echogenicity without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male with HCV cirrhosis. Evaluate for HCC. LIVER: The liver parenchyma is moderately coarsened and nodular in contour. It is normal in size, measuring 19.4 cm in the craniocaudal dimension. No intrahepatic biliary ductal dilatation or focal hepatic lesion is evident. Normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common bile duct measuring 5 mm at the level of the pancreatic head. The gallbladder is full of gallstones, but does not appear significantly distended. There is no wall thickening, pericholecystic fluid, or focal tenderness.PANCREAS: The visualized pancreatic head is unremarkable.SPLEEN: The spleen is mildly enlarged, measuring 13.5 cm in length without a discrete abnormality.RIGHT KIDNEY: The right kidney measures 11.6 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 12.7 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow.No significant ascites.", "output": "1. Cirrhotic liver morphology, and mild splenomegaly. No biliary ductal dilatation or focal hepatic lesion.2. Partially contracted gallbladder filled with gallstones."}
{"instruction": "Generate impression based on findings.", "input": "female presents for evaluation of a birth mark on right superior back. Evaluate for vascularity. An approximately 0.9 x 0.2 x 0.4 cm hypoechoic lesion is present in the right superior back. Evaluation of internal vascularity demonstrates venous waveforms.", "output": "Low flow vascular malformation."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old woman with clinical concern of enlarged right axillary lymph nodes presents for right axilla ultrasound. A targeted right axilla ultrasound was performed for the patient\u2019s area of concern.There are two normal size and morphology lymph nodes identified in the right axilla. The first lymph node is seen in the mid axilla, posterior depth with normal hilar flow and cortical thickness measuring 1.6 x 0.7 cm. The second lymph node is seen in the low axilla middle depth with normal hilar flow measuring 1.5 x 1.4 cm, also with normal cortical thickness.", "output": "Morphologically normal right axilla lymph nodes.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "19-year-old male with right upper quadrant pain. LIVER: Normal in size and echotexture. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: Head and body are normal. Tail was not well seen.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Negative examination."}
{"instruction": "Generate impression based on findings.", "input": "Prior history of renal infection RIGHT KIDNEY: Lower pole benign-appearing cyst. No significant scarring or mass. No stone. No hydronephrosis. Right kidney 9.87 m in length.LEFT KIDNEY: No significant scarring or mass. No stone. No hydronephrosis. Left kidney 9.8 cm in length.OTHER: Bladder nondistended", "output": "No significant renal scarring or mass. No stone or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old female with right upper quadrant pain and nausea. History of lung cancer and prior liver metastases. LIVER: The liver parenchyma is moderately coarsened and hyperechogenic. It is normal in length, measuring 14.8 cm in length. No intrahepatic biliary ductal dilatation or focal hepatic lesion is identified. Normal hepatopetal portal venous blood flow at 22 cm/sec.BILIARY TRACT: No biliary ductal dilatation with the common bile duct measuring 4 to 5 mm. A normally distended gallbladder is seen without gallstones, wall thickening, pericholecystic fluid, or focal tenderness.PANCREAS: The suboptimally visualized pancreatic body and head are unremarkable.SPLEEN: The spleen measures 10.5 cm in length without a discrete focal abnormality.RIGHT KIDNEY: The right kidney measures 10.9 cm in length without hydronephrosis or shadowing calculus. Color Doppler demonstrates hilar blood flow. OTHER: There is a small right pleural effusion. The left kidney is suboptimally visualized without hydronephrosis. It measures approximately 8.3 cm in length.There is trace ascites in the right upper quadrant.", "output": "1. Findings suggesting diffuse fatty infiltration and/or parenchymal hepatic dysfunction.2. No specific findings to account for the patient's right upper quadrant pain.2. Trace ascites and a small right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old female with Li Fraumeni syndrome. Evaluate for malignancy. LIVER: Liver is enlarged measuring 21 cm in length. The hepatic parenchyma is heterogeneous with a regular increased attenuation consistent with irregular fatty liver. In the right lobe there is noted a nondescript, hypoechoic ovoid mass measuring 4.4 x 4.9 x 6.3 cm. Although images of this mass were limited on prior ultrasound from 1/12/2015, the mass looks larger than on MR and CT studies from 2013. This was characterized as a hemangioma on prior MR.GALLBLADDER, BILIARY TRACT: Gallbladder contains multiple, dependent shadowing, calculi without definite wall thickening. No pericholecystic fluid.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Right kidney measures 12.6 cm in length with a simple-appearing 2.8 cm cyst in the midportion. No hydronephrosis, shadowing calculus or mass.OTHER: The left kidney measures 11.6 cm in length. No hydronephrosis, shadowing calculus or mass.Splenic size normal.", "output": "Irregular fatty liver with hepatomegaly. Enlarging hepatic mass demonstrated to represent hemangioma on prior MR.Right renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female patient with abdominal distention. Assess for ascites. Targeted ultrasound of the abdomen performed for evaluation of ascites demonstrates mild ascites.", "output": "Mild ascites."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old male with left lower quadrant pain and CKD, question of ascites. LIVER: Normal echogenicity of the liver measuring 15.9 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 5 mm in caliber. No intra-or extra hepatic biliary ductal dilatation.PANCREAS: Not visualized in its entirety due to overlying bowel gas. The visualized portions are unremarkable.SPLEEN: Normal echogenicity of the spleen measuring 7.9 cm in length.KIDNEYS: Increased echogenicity of the right kidney measuring 10.5 cm in length. No hydronephrosis or shadowing calculi are noted. Increased echogenicity of the left kidney measuring 11.3 cm in length. No hydronephrosis or shadowing calculi are noted. ABDOMINAL AORTA: Proximal aorta measures 2.9 cm x 2.6 cm.INFERIOR VENA CAVA: The visualized IVC is patent with appropriate directional flow.OTHER: No ascites.", "output": "Increased echogenicity of the kidneys suggestive of parenchymal dysfunction. No obstruction. "}
{"instruction": "Generate impression based on findings.", "input": "41-year-old male with history of renal transplantation presents for further characterization of a perinephric fluid collection. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: The fluid collection with a drain in it now measures approximately 3.7 x 2.1 x 4.0 cm and appears smaller in size in comparison to the prior study. There is a second collection noted in addition to the collection with a drain that measures approximately 8.0 x 5.8 x 7.6 cm without internal complexity.KIDNEY: Measures 12.5 cm. Normal echogenicity. No focal mass, shadowing calculi, or hydronephrosis.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 notedOTHER: No significant abnormality noted", "output": "Multiple fluid collections. The fluid collection with visualized drain appears smaller in comparison to the prior study. The other fluid collection has no drain."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female with distant history of thyroid cancer. RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered cervical lymph nodes without suspicious morphologic features.OTHER: No significant abnormality noted.", "output": "No evidence of recurrent or metastatic disease."}
{"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. A known fibroadenoma is seen in the left 3:00 position. Elsewhere, there is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Questionable right thyroid nodule RIGHT LOBE MEASUREMENTS: 6.3 x 2.7 x 3.7 cmLEFT LOBE MEASUREMENTS: 9 x 3.5 x 4 cmISTHMUS MEASUREMENTS: 2.4 cmRIGHT LOBE: Enlarged diffusely heterogeneous gland without discrete nodule. No increased vascularity.LEFT LOBE: Enlarged diffusely heterogeneous gland without discrete nodule. No increased vascularity.ISTHMUS: Enlarged diffusely heterogeneous gland without discrete nodule. No increased vascularity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Enlarged diffusely heterogeneous gland without discrete nodule. No increased vascularity. No regional adenopathy. "}
{"instruction": "Generate impression based on findings.", "input": "Female 75 years old abnormal LFTs LIVER: Liver measures 16.3 cm. Echogenicity is within normal limits. No focal masses. Main portal vein is patent with normal directional flow and peak velocity of 27.1 cm/s.BILIARY TRACT: Patient is status post cholecystectomy. There is mild extrahepatic ductal dilatation with the common bile duct measuring up to 9 mm, however there is no intrahepatic biliary ductal dilatation. This finding is favored to be a chronic benign finding in a postcholecystectomy patient.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 within normal limits measuring 7.2 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 10.47 m. Right renal cyst measures 2.2 x 2.4 x 2.9 cm. Left kidney measures 10.3 cm. Left renal cyst measures 0.7 x 0.8 x 0.8 cm.OTHER: No significant abnormalities noted.", "output": "1.No focal hepatic mass or intrinsic liver pathology.2.Mild extra hepatic biliary ductal dilatation which is likely normal in this postcholecystectomy patient. No intrahepatic biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old female with known left breast cancer on neoadjuvant chemotherapy to assess response Mammogram: 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, unchanged in pattern and distribution. Irregular multilobulated hyperdense mass corresponding to biopsy-proven cancer is identified in the left breast 10:00 position that measures 35 x 40 x 34 mm on the mammogram, previously measured 33 x 36 x 34 mm minimally increased in size in the superoinferior dimension. Clip from prior biopsy identified within the mass. The mass appears multilobulated and more dense on the current mammogram. A hydromark clip is identified 18 mm from the anteriormost margin of the mass. Multiple scattered calcifications seen in the left breast. A clip is identified within the left axillary lymph node which is reduced in size and now measures 12 mm.Ultrasound: Targeted ultrasound left breast and axilla performed. Index cancer now measures 30 x 30 x 27 mm, previously measured 28 x 23 x 24 mm, minimally increased in size mostly in the superior-inferior dimension. A hydromark clip is identified anteriorly by 1.4 cm. No mass is identified around the hydro mark clip. At least 3 lymph nodes were identified in the right axillary region, the previously biopsied lymph node now measures 7 x 10 x 8 mm, previously measured 14 x 12 x 16 mm. The second elongated lymph node now has eccentrically thickened cortex and measures 25 x 7 x 8 mm, previously measured 18 x 8 x 17 mm.", "output": "Mild interval increase in size of the left breast index cancer mostly in the superoinferior dimension with increased densityy on the mammogram.Interval decrease in the size of previously biopsied left axillary lymph nodes.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: Non-cirrhotic liver morphology. 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 gallbladderPANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney is 10.6 cm in length. The left kidney is 10.5 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.6 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.", "output": "Increased hepatic echogenicity, compatible with parenchymal dysfunction. No biliary ductal dilation."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old female with thyroid nodules. Please evaluate. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.7 x 1.7 x 1.8 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.6 x 1.7 x 2.2 cm.ISTHMUS MEASUREMENTS: The thyroid isthmus measures 0.5 cm in thickness.RIGHT LOBE: 1.4 x 1.1 x 1 cm right upper pole nodule is stable in size and again demonstrates a multicystic appearance compatible with a benign colloid nodule. Additional right lower thyroid pole nodule not measured on the prior exam but similar in appearance measuring 1.6 x 1.4 x 1.5 cm.LEFT LOBE: Multinodular appearance of the left thyroid lobe. Left lower pole thyroid nodule measuring 2.5 x 1.5 x 2.5 cm mildly hypoechoic nodule with small cystic component is similar in size when accounting for changes in technique. Additional spongiform type nodule in the left mid pole measuring 0.9 x 0.6 x 0.9 cm is noted.ISTHMUS: Heterogenous partially cystic nodule of the isthmus measuring 1.2 x 1.2 x 0.6 cm is similar in size (prior 1.4 x 1.4 x 0.7 cm).PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multinodular goiter. Bilateral nodules without significant change in size. "}
{"instruction": "Generate impression based on findings.", "input": "77 years old, Male, Reason: Masses, abnormal nodes? History: Thyroid cancer s/p thyroidectomy MEASUREMENTS: Patient status post thyroidectomy.RIGHT LOBE AREA: No definite mass within the right thyroidectomy bed.LEFT LOBE: No definite mass within the left thyroidectomy bed.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Redemonstrated is a right level 3 benign appearing lymph node with a fatty hilum measuring 1.1 x 0.7 x 0.7 cm. Left level 3 benign appearing lymph node with a fatty hilum and measuring 2.0 x 1.0 x 0.8 cm. An adjacent to this larger left level 3 lymph node there is a smaller level 3 lymph node measuring 0.5 x 0.3 x 0.5 cm.OTHER: No significant abnormality noted.", "output": "1.No definite evidence of local recurrence.2.Multiple benign appearing lymph nodes are redemonstrated. Follow up of lymph nodes is recommended to ensure stability."}
{"instruction": "Generate impression based on findings.", "input": "74 year old female status post right lumpectomy in July 2014 for DCIS and ADH and left lumpectomy for invasive ductal carcinoma and DCIS in 2011. Patient has undergone radiation and hormonal therapy with tamoxifen. Patient presents today with focal tenderness and swelling of the left breast in the periareolar and retroareolar region and in an arc extending from the 11:00 radian laterally to the 3:00 radian. The patient also reports left axillary swelling. The patient had a recent mammogram on 5/13/2015 was benign. A targeted left ultrasound was performed for the patient\u2019s areas of concern. Ultrasound of the entire left breast was performed, with special attention to the periareolar and retroareolar regions from 11:00 to 3:00. Patient reported moderate focal tenderness when the transducer was passed over those locations. Ultrasound of the left axilla was also performed. There is no solid or cystic mass identified. No abnormal-appearing left axillary lymph nodes.", "output": "No sonographic evidence for malignancy. No sonographic abnormality to explain the patient's symptoms for the swelling. Continued clinical management recommended. Further evaluation, including biopsy, of a clinically suspicious abnormality should not be delayed by negative imaging. Rather, negative imaging may serve to reinforce a negative clinical impression. The results were discussed with the patient at the completion of the exam, and the patient understood to follow-up with her physician.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "63 year old female with multinodular goiter. Evaluate for change in nodules. RIGHT LOBE MEASUREMENTS: 4.7 cm x 1.3 cm x 1.3 cmLEFT LOBE MEASUREMENTS: 5.3 cm x 3.6 cm x 3.2 cmISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: Solid nodule in the superior pole measures 1.5 cm x 1.0 cm x 0.9 cm, previously measured 1.4 cm x 0.9 cm x 1.2 cm and contains small echogenic foci suspicious for calcifications.LEFT LOBE: Dominant solid nodule measures 4.6 cm x 3.2-cm x 3.0 cm, previously measured 4.3 cm x 3.3 cm x 3.2 cm. There is some peripheral vascularity again seen. ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Right thyroid nodule is unchanged in size however contains calcifications better seen on today's examination. If not already performed, further evaluation with FNAB recommended,2. Dominant solid left thyroid nodule unchanged. "}
{"instruction": "Generate impression based on findings.", "input": "Male, 68 years old. Urothelial cancer, s/p nephroureterectomy, now with rising creatinine. RIGHT KIDNEY: The right kidney measures 12.3 cm in length, with slightly increased cortical echogenicity. A lower pole simple cyst measures 1.2 x 1.3 x 1.3 cm. A 4 mm nonobstructing mid pole stone is noted. No hydronephrosis.LEFT KIDNEY: Surgically absent.OTHER: The bladder is incompletely distended.", "output": "1.Status post left nephrectomy. Mildly increased right renal cortical echogenicity, compatible with medical renal disease. 2.Small nonobstructing right renal stone. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "68 year old female patient, baseline examination as part of heart transplant evaluation. LIVER:The liver measures 14.5 cm in length and demonstrates mildly increased echogenicity. No focal hepatic lesion is identified. The main portal vein is patent with hepatopetal flow measuring 0.2 m/s. GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. There is no intra or extrahepatic biliary ductal dilatation. The common duct measures 5 mm in diameter.PANCREAS: The head of the pancreas demonstrates normal echogenicity. The remaining pancreas is not visualized secondary to overlying bowel gas.SPLEEN: The spleen measures 9.3 cm in length.KIDNEYS: The right kidney measures 9.0 cm in length and the left kidney measures 10.1 cm in length. No evidence of hydronephrosis. A hypoechoic lesion within the right lower pole measures 2.9 x 2.7 x 2.6 cm. An additional hypoechoic lesion within the right lower pole measures 2.1 x 1.1 x 1.2 cm.ABDOMINAL AORTA: The abdominal aorta is normal in caliber. The proximal aorta measures 1.9 x 1.8 cm, the mid aorta measures 1.5 x 1.5 cm, and the distal aorta measures 1.6 x 1.3 cm. There is calcific atherosclerotic disease of the abdominal aorta.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Mildly echogenic liver which can be seen with hepatic steatosis.2. Right renal cysts. 3. Calcific atherosclerotic disease of the abdominal aorta. "}
{"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": "Elevated LFTs. 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. Mild gallbladder wall thickening, which is nonspecific in the setting of ascites. Biliary sludge noted. No cholelithiasis or 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 10.6 cm in length. The left kidney is 11.0 cm in length. The renal parenchymal echogenicity is elevated bilaterally. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.1 cm in length, without focal lesions evident.OTHER: Mild to moderate amount ascites.", "output": "1. No cholelithiasis or biliary ductal dilation, per clinical query2. Mild to moderate amount of ascites.3. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "79 year old female with history of right flank pain, evaluate for biliary colic versus renal colic. Possible gallstones. Evaluate for right renal hydronephrosis please. LIVER: The hepatic parenchyma demonstrates subtle increased echogenicity, nonspecific. The liver measures 13 cm in length.BILIARY TRACT: No gallbladder wall thickening, cholelithiasis or pericholecystic fluid. No biliary dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. The spleen measures 6.6 cm.RIGHT KIDNEY: No significant abnormalities noted. The right kidney measures 10.7 cm, and there is a small (8 x 5 x 7 mm) simple cyst.OTHER: No significant abnormalities noted. The left kidney measures 10 cm.", "output": "No findings of cholecystitis or hydronephrosis, as above."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old female bilateral axillary adenopathy and history of systemic lupus erythematosus. Please evaluate for stability. A targeted right axillary ultrasound was performed. Multiple enlarged lymph nodes with symmetric cortical thickening are visualized. The largest lymph node measures 2.1 x 1.2 x 3.7 cm and demonstrates normal hilar vascularity.Retarded left axillar ultrasound was performed. Again, multiple enlarged lymph nodes with symmetric cortical thickening are visualized. The largest lymph node measures 2.5 x 1.0 x 3 .8 cm, and demonstrates normal hilar vascularity.", "output": "Bilateral symmetric axillary adenopathy, compatible with the patient's history of lupus.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Female 64 years old; Reason: RUQ US to evaluate for gallbladder pathology in setting of pancreatitis. History: As above LIVER: The liver measures 15.8 cm in length. The liver parenchyma has normal echogenicity. No worrisome masses are seen within the liver. There is no intrahepatic ductal dilation seen. The main portal vein is patent with hepatopetal flow measuring 49.7 cm/s.GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 3.4 mm. Several small shadowing stones are seen within the gallbladder. Negative sonographic Murphy sign. No pericholecystic fluid. The common bile duct measures 4.2 mm in diameter. RIGHT KIDNEY: The right kidney measures 11.4 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "Cholelithiasis without sonographic evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid cancer status post surgery and I-131. 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: Not identified.LYMPH NODES: Benign morphology subcentimeter cervical lymph nodes.OTHER: No significant abnormality noted.", "output": "No evidence of recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female with history of multinodular goiter. Annual surveillance. RIGHT LOBE MEASUREMENTS: 5.7 x 2.6 x 2.5 cmLEFT LOBE MEASUREMENTS: 6.1 x 2.8 x 2.4 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Multinodular right thyroid gland. The largest nodule mixed solid and cystic measures 2.6 x 2.2 x 1.6 cm, not significantly changed. Superior smaller solid and cystic nodule measures 0.8 x 0.5 x 0.4 cm, unchanged.LEFT LOBE: Multinodular left thyroid gland. The adjacent largest solid and cystic nodules measure 2.1 x 2.5 x 1.1 cm and 2.6 x 1.9 x 1.7 cm, without significant interval change. A smaller solid nodule with peripheral cystic components superiorly measures 0.9 x 1.1 x 0.7 cm, unchanged.ISTHMUS: Solid nodule in the isthmus measures 2.0 x 1.6 x 1.0 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multinodular thyroid without significant interval change since the prior study."}
{"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. A 2 cm gallstone is noted. No gallbladder wall thickening, pericholecystic fluid, or sonographic Murphy's sign is noted.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 8.7 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.2 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites.", "output": "Cholelithiasis without specific evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: history of thyroid nodules, please evaluate for characteristics. RIGHT LOBE MEASUREMENTS: Measures 4.8 x 1.7 x 2.0 cm.LEFT LOBE MEASUREMENTS: Measures 5.2 x 2.1 x 1.4 cm.ISTHMUS MEASUREMENTS: Measures up to 0.3 cm in thickness.RIGHT LOBE: Heterogeneous parenchymal echotexture. Inferior pole nodule measuring 1.9 x 1.1 x 1.6 cm which is mixed cystic/predominantly solid, predominantly isoechoic, contains mild internal vascularity, and lacks suspicious microcalcifications. Nodule is low suspicion for neoplasm.LEFT LOBE: Heterogeneous parenchymal echotexture. ISTHMUS: Heterogeneous parenchymal echotexture. PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are noted.OTHER: No significant abnormality noted.", "output": "1.Heterogeneous thyroid suggestive of thyroiditis.2.Dominant 1.9 cm nodule in the right inferior pole, low suspicion for neoplasm."}
{"instruction": "Generate impression based on findings.", "input": "History of hepatitis C and liver lesion seen on outside MR. LIVER: The liver is coarse in echotexture and mildly echogenic. It demonstrates a mildly undulating contour. In the right hepatic dome there is a 2.0 x 1.1 x 1.8 cm hypoechoic lesion likely corresponding to that seen on the prior MRI. No additional liver lesion.Normal hepatopedal portal venous blood flow at 0.1 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation with the common duct measuring 2 mm. Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid or focal tenderness.PANCREAS: The partially imaged pancreatic head is unremarkable. The remainder of the pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 12 cm in length without a focal lesion.RIGHT KIDNEY: The right kidney measures 11.2 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. OTHER: The left kidney measures 11.6 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion.", "output": "2.0 cm right hepatic dome lesion better characterized on the outside MRI where it appears to have demonstrated arterial enhancement, washout and capsule formation, meeting imaging criteria for HCC in the setting of chronic liver disease."}
{"instruction": "Generate impression based on findings.", "input": "67 years old, Female, Reason: abnormal lfts need vascular imaging History: abnormal LFTs need vascular imaging to r/o liver thrombosis. Ultrasound exam is extremely limited due to patient body habitus.LIVER: The liver measures 19.8 cm in length. Increased hepatic parenchyma echogenicity is consistent with fatty infiltration. No focal hepatic lesions or masses are definitely identified. BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. The common bile duct is not well visualized.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: The spleen is not well visualized. No significant abnormalities noted. The spleen measures 9.6 cm in length. RIGHT KIDNEY: No hydronephrosis or shadowing calculus.LEFT KIDNEY: No hydronephrosis or shadowing calculus.OTHER: No significant abnormalities noted.", "output": "1.Exam is limited due to patient body habitus. Within these limitations the portal vein appears patent with an increased peak systolic velocity. No definite thrombus is identified. Recommend dedicated CT to evaluate vascular patency. 2.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Female 54 years old; Reason: evaluate for lymph nodes concerning for thyroid cancer spread History: hx of left papillary thyroid cancer RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.9 x 2.3 x 2.4 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 3.9 x 1.7 x 1.5 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.4 cm.RIGHT LOBE: There is a dominant cystic/solid nodule within the right mid thyroid lobe measuring 2.2 cm x 2.1 cm x 2.6 cm.LEFT LOBE: The left thyroid lobe is heterogeneous. There is a hypoechoic nodule at the lower pole measuring 0.8 cm x 0.7 cm x 0.8 cm. This has internal vascular flow.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted. At the right there is a level 2/3 lymph node with a fatty hilum visualized measuring 0.8 cm x 0.5 cm x 1.1 cm. Additionally there is a mildly prominent left submandibular lymph node is visualized with benign appearing morphology. This measures 2.1 cm x 1.1 cm x 0.8 cm. A fatty hilum is present.", "output": "1.No evidence of suspicious regional lymphadenopathy is identified.2.There is a dominant nodule identified in the right middle lobe, as above, which is amenable to percutaneous biopsy.3.A hypoechoic nodule seen in the left lower pole is favored to be indeterminate but may be related to the patient's known diagnosis of left papillary cancer."}
{"instruction": "Generate impression based on findings.", "input": "57 years old, Male, Reason: 57 male with lung cancer, known liver mets. Worsening RUQ pain, transaminitis. Assess status of liver mets, evaluate for biliary disease History: RUQ pain, transaminitis LIVER: The liver is enlarged measuring 26.7 cm in length. The hepatic parenchyma is extremely heterogeneous consistent with metastatic disease appearing similar to prior exam. The main portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.3 m/s.BILIARY TRACT: The gallbladder is contracted and not well visualized. No intrahepatic or extrahepatic biliary ductal dilatation is present, the common bile duct measures 4.5 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: The spleen measures 9.6 cm in length. RIGHT KIDNEY: Kidney measures 11.4 cm in length, no hydronephrosis.LEFT KIDNEY: Kidney measures 11.3 cm in length, no hydronephrosis.OTHER: No evidence of ascites.", "output": "1.Suboptimal assessment of gallbladder secondary to contracted state. 2.Hepatomegaly with extremely heterogeneous hepatic parenchyma, consistent with known metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Reason: pre-op bariatric surgery LIVER:The liver measures 16 cm in length. Coarse, echogenic hepatic parenchyma. The portal vein is patent with normal hepatopedal directional flow, peak velocity 31 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: No significant abnormality noted. No shadowing stones are sludge. The gallbladder wall measures 0.4 cm. The common bile duct measures 0.3 cm. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.SPLEEN: The spleen measures 8.2 cm in length.KIDNEYS: The right kidney measures 10.9 cm in length. The left kidney measures 10.5 cm in length. Unremarkable renal parenchymal echogenicity and echotexture. No shadowing stones or hydronephrosis. ABDOMINAL AORTA: The proximal aorta measures 2.3 x 2.1 cm, mid aorta 1.9 x 1.7 cm, distal aorta 2.1 x 1.6 cm. The iliac arteries are not visualized.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No ascites.", "output": "Coarse, echogenic hepatic parenchyma, consistent with hepatic steatosis or parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female evaluate for thyroid nodules RIGHT LOBE MEASUREMENTS: The right lobe measures 4.3 x 1.6 x 1.5 cm.LEFT LOBE MEASUREMENTS: The left lobe measures 4.5 x 0.7 x 1.6 cm.ISTHMUS MEASUREMENTS: The isthmus measures 0.2 cm.RIGHT LOBE: The right lobe is heterogeneous. There is a dominant nodule in the mid right lobe that measures 1.6 cm x 1.5 cm x 1.7 cm. This nodule appears solid, measures taller than wide, has irregular borders, and has internal microcalcifications.LEFT LOBE: There is a smaller hyperechoic nodule in the mid left thyroid that measures 0.5 cm x 0.3 cm x 2.6 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized on this study.LYMPH NODES: No suspicious adenopathy is seen.", "output": "1. In the mid right thyroid lobe there is a dominant nodule that measures 1.6 cm x 1.5 cm x 1.7 cm. This nodule is suspicious for malignancy and would recommend ultrasound-guided biopsy. No suspicious adenopathy is seen.2. In the mid left thyroid lobe there is a nodule measuring 0.5 cm x 0.3 cm x 2.6 cm favored to be benign."}
{"instruction": "Generate impression based on findings.", "input": "Recently passed right ureteral stone RIGHT KIDNEY: Normal echogenicity without worrisome mass, stone, or hydronephrosis. Benign appearing lower pole cyst. Right kidney 12.3 cm in length.LEFT KIDNEY: Echogenicity without worrisome mass, stone, or hydronephrosis. Left kidney 12.3 cm in length.OTHER: Nondistended", "output": "Negative renal ultrasound. Normal parenchymal echogenicity without worrisome mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female with history of renal failure. Evaluate for hydronephrosis. RIGHT KIDNEY: Measures 9.2 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. 1.9 cm right renal cyst without septation or solid component.LEFT KIDNEY: Measures 8.9 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. 1.2 cm left renal cyst without septation or solid component.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. "}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male with abnormal sestamibi scan in the region of the lower pole of the left lobe of the thyroid. Patient has primary hyperparathyroidism with hypercalcemia. RIGHT LOBE MEASUREMENTS: The right lobe measures approximately 1.4 x 1.7 x 4.1 cmLEFT LOBE MEASUREMENTS: The left lobe measures approximately 1.5 x 1.5 x 4.8 cm.ISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Homogeneous without mass.LEFT LOBE: Homogeneous without mass. However, the left lobe extends low in the neck.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Caudal to the left lobe of the thyroid is a complex cystic mass with internal vascularity measuring approximately 1 x 1.1 x 1.7 cm.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Complex cystic and vascular mass caudal to the left lobe of the thyroid consistent with atypical parathyroid adenoma and corresponding to the location of the abnormality on the sestamibi scan."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 10.1 cm in lengthLEFT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Benign renal cysts. Left kidney 11.9 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": "Female 57 years old; Reason: HCC screening History: Hep B LIVER: The liver measures 13.5 cm in length. There is slight 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 32.2 cm/s. A small right lobe liver cyst is reidentified from prior ultrasound measuring 0.4 cm x 0.3 cm x 0.4 cm, this is stable in size from prior ultrasound.GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.1 mm. No stones are seen. No pericholecystic fluid. The gallbladder polyp is reidentified measuring 0.6 cm x 0.6 cm x 0.5 cm. This previously measured 0.6 cm x 0.6 cm. No internal vascularity seen within the polyp. The common bile duct measures 3.1 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9.0 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.0 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.2 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. There is a slightly coarse increased echogenicity to the liver parenchyma compatible with fatty infiltration/hepatocellular dysfunction. No focal hepatic lesions are seen.2. A gallbladder polyp is re-identified and stable in size from prior ultrasound. Continued surveillance of this gallbladder polyp is recommended. No evidence of cholelithiasis or acute cholecystitis are seen."}
{"instruction": "Generate impression based on findings.", "input": "65 year old male patient, evaluate for liver disease pre-transplant. LIVER: The liver measures 12.4 in length. 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 3 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.KIDNEYS: The right kidney measures 10.3 cm in length. The left kidney measures 10.9 cm in length. No evidence of hydronephrosis. The bladder is decompressed and contains a Foley catheter.SPLEEN: The spleen measures 9.1 cm in length.ABDOMINAL AORTA: The abdominal aorta is normal in caliber. The proximal aorta measures 1.8 x 1.7cm, the mid-aorta measures 1.7 x 2.4 cm, and the distal aorta measures 1.7 x 2.0 cm.INFERIOR VENA CAVA: The IVC is patent.OTHER: No significant abnormality noted.A right pleural effusion is noted.", "output": "1. No focal hepatic lesion is identified.2. Right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with HCV cirrhosis. Evaluate for HCC. LIVER: Measures 18.7 cm in length with nodular contour and coarse echotexture.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. Common bile duct measures 8 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: The distal tail of the pancreas is obscured by overlying bowel gas. The remaining pancreatic parenchyma is normal in echogenicity with no evidence of pancreatic ductal dilatation.RIGHT KIDNEY: Measures 10.0 cm in length and is normal in echogenicity with no evidence of hydronephrosis.OTHER: Left kidney measures 12.1 cm in length and is normal in echogenicity with no evidence of hydronephrosis. Spleen measures 14.7 cm in length and is normal in echogenicity.", "output": "Cirrhotic liver morphology with no focal hepatic lesions. Hepatosplenomegaly. "}
{"instruction": "Generate impression based on findings.", "input": "Thyroid cancer status post thyroidectomy RIGHT LOBE: Status post thyroidectomy without mass.LEFT LOBE: Status post thyroidectomy. Stable subcentimeter hypoechoic focus within the left thyroid bed measuring 0.4 x 0.3 x 0.4 cm.ISTHMUS: Status post thyroidectomy without massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable examination. Status post thyroidectomy. Stable subcentimeter hypoechoic focus within the left thyroid bed. No regional adenopathy."}
{"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.This exam was double read by Dr. Kulkarni.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for parotid mass History: incidental finding on MRI No lesion identified on ultrasound that corresponds with the right medial parotid lesion seen on MRI. Small 0.8 x 0.5 x 0.9 cm hypoechoic lesion in the superficial right parotid gland represents a lymph node.", "output": "No lesion identified corresponding to right parotid gland lesion seen on MRI. This does not mean that it is not present, moreso that it was unable to be visualized on ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female recalled from screening due to bilateral breast asymmetries. 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. Redemonstration of a focal asymmetry in the right upper outer breast, mid depth. On spot compression views this largely disperses, however there are small residual nodular foci within the region.The left breast there is also redemonstration of a focal asymmetry in the upper outer breast, mid depth. On spot compression views this also largely disperses, however there is some degree of persistent focal asymmetry with obscured margins. Targeted ultrasound of the right breast upper outer quadrant showed normal fibroglandular tissue. No suspicious lesion was identified.Targeted ultrasound of the left breast upper outer quadrant showed normal fibroglandular tissue. No focal suspicious lesion was identified.", "output": "Focal asymmetries in the upper outer quadrants of both breasts which largely disperse on compression imaging. Sonographic examination of the areas showed normal fibroglandular tissue. Based on these benign results, routine screening is recommended. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. "}
{"instruction": "Generate impression based on findings.", "input": "Left neck fullness RIGHT LOBE MEASUREMENTS: 6.4 x 2.7 x 2.2 cmLEFT LOBE MEASUREMENTS: 5.4 x 2.2 x 1.7 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Heterogeneous echotexture.LEFT LOBE: Heterogeneous echotexture with spongiform nodules measuring up to 0.8 x 0.5 x 0.8 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.", "output": "Prominent thyroid gland with spongiform left lobe nodules, likely benign."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain, evaluate for pseudocyst LIVER: Measures 13.0 cm. Coarsened hepatic echotexture without focal lesions. The portal vein is patent.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Measures 9.0 cm. No hydronephrosis or mass.OTHER: Left kidney measures 9.6 cm. No hydronephrosis or mass. No intra-abdominal fluid collections. Spleen measures 10.2 cm. The bladder is nondistended.", "output": "No loculated fluid collections."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain; history of leukemia LIVER: Coarse echogenic liver echotexture without mass. Liver length 16.5 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent portal vein with normal directional flowGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.7 cm in lengthOTHER: Left kidney 11.3 cm in length. Spleen 11.8 cm in length. Porta hepatis regional adenopathy. No ascites.", "output": "Coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Unremarkable gallbladder. No ascites. Porta hepatis regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis LIVER: Cirrhotic morphology without mass. Liver length 15.2 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.2 cm in lengthOTHER: Left kidney 10 cm in length. Spleen 12 cm in length. Moderate ascites", "output": "Cirrhotic morphology without mass or ductal dilatation. Cholelithiasis without acute inflammation. Moderate ascites."}
{"instruction": "Generate impression based on findings.", "input": "Kidney stone RIGHT KIDNEY: Stable renal scarring. No worrisome mass. Minimal hydronephrosis again noted and unchanged. Stable renal cyst. No renal stone. Right kidney 11.8 cm in length.LEFT KIDNEY: Echogenic and atrophic parenchyma again noted. No mass. Mild hydronephrosis unchanged. Lower pole parenchymal calcification again noted and unchanged. Left kidney 8.6 cm in length.OTHER: Bladder nondistended", "output": "Stable examination. No change in minimal right hydronephrosis and mild left hydronephrosis. No evidence for nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury. Decreased urine output. LIVER: Cirrhotic liver morphology. Coarse parenchymal echogenicity. No focal hepatic lesions. Reversed portal venous blood flow direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Distended gallbladder with biliary sludge and some centimeter gallstones. No gallbladder wall thickening or sonographic Murphy's sign.PANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney is 12.3 cm in length. The left kidney is 12.8 cm in length. The renal parenchyma is echogenic bilaterally. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 12.4 cm in length, without focal lesions evident.ABDOMINAL AORTA: Patent without aneurysm.INFERIOR VENA CAVA: Patent.OTHER: Moderate amount of ascites present.", "output": "1. Cirrhosis with reversed portal venous flow and moderate ascites.2. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease.3. Cholelithiasis without specific evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Chronic renal disease RIGHT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 10.7 cm in lengthLEFT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 11.2 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": "50 year-old female with goiter. RIGHT LOBE MEASUREMENTS: 8.3 x 7.2 x 5.4 cm.LEFT LOBE MEASUREMENTS: 5.5 x 3.4 x 2.7 cm.ISTHMUS MEASUREMENTS: 7 mm.RIGHT LOBE: The right lobe is enlarged and nearly entirely replaced by a dominant predominantly solid nodule with cystic components. LEFT LOBE: The left lobe of the thyroid is enlarged and nearly entirely replaced by a dominant predominantly solid isoechoic nodule with cystic components, measuring 4.6 x 2.5 x 3.2 cm. There is associated internal vascularity as well as a peripheral hypoechoic halo. These findings are consistent with an indeterminate nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. 4.6-cm indeterminate nodule in the left lobe of the thyroid gland. Further evaluation with FNA is recommended.2. Diffusely enlarged, heterogeneous thyroid gland, consistent with the stated history of goiter."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old male with growing lesion behind left ear. There is a complex structure in the region of interest measuring 3.7 x 3.6 x 1.4 cm which is sonographically complex with cystic areas with septations as well as solid hypoechoic and hyperechoic regions.", "output": "Complex left postauricular lesion as described above has a wide differential and could represent a lesion such as a complex/sebaceous cyst or dermoid, but is best considered indeterminate. "}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female with chronic viral hepatitis and cirrhosis. Evaluate for hepatocellular carcinoma. LIVER: Overall hepatic size is within normal limits. The hepatic contour scalloped with enlargement of the left lobe and caudate consistent with cirrhosis. Echotexture is highly heterogeneous. No focal mass is identified. Main portal vein is patent with appropriate flow direction.BILIARY TRACT: No biliary tract dilatation. Gallbladder appears unremarkable without cholelithiasis, wall thickening or pericholecystic fluid.PANCREAS: Prominence the pancreatic duct, likely within normal limits.SPLEEN: Upper normal to mildly enlarged.RIGHT KIDNEY: Echogenic without hydronephrosis. OTHER: Left kidney is echogenic with mild prominence of the upper pole renal collecting system which is unchanged from prior renal ultrasound dated 4/13/2015Trace ascites.", "output": "Cirrhotic liver without mass.Echogenic kidneysTrace ascites"}
{"instruction": "Generate impression based on findings.", "input": "Female 19 years old Reason: rising SCr, rejection? History: AKI Ultrasound guidance and technical assistance was provided for a renal allograft in the right iliac fossa . 2 passes were made by Dr. Cunningham The procedure was successfully completed.", "output": "Successful ultrasound guided biopsy of the right kidney."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Assess driveline on LVAD History: prior driveline infections, hypotension There is a small amount of fluid adjacent to the driveline and within the left anterior abdominal wall. No focal fluid collections are identified.", "output": "Small amount of fluid adjacent to the driveline is nonspecific. No focal fluid collection or abscess is identified."}
{"instruction": "Generate impression based on findings.", "input": "Female 53 years old Reason: r/o hydro, renal stones, infection, patient has CT last year and was negative for same pain RIGHT KIDNEY: Right kidney measures 11.5 cm. Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. LEFT KIDNEY: Left kidney measures 11.4 cm. Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. OTHER: Partially visualized liver is echogenic suggesting fatty infiltration.", "output": "1.No renal stone, mass, or hydronephrosis.2.Fatty infiltration of the liver."}
{"instruction": "Generate impression based on findings.", "input": "63 year-old male with questionable history of sarcoidosis. Evaluate liver, hepatic vein and artery. LIMITED ABDOMENLIVER: Coarse and echogenic in appearance measuring 18.3-cm in length. No focal hepatic lesions.BILIARY TRACT: Sludge and stones within the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. Sonographic Murphy's sign is negative. 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.SPLEEN: Normal in echogenicity measuring 14.9 cm in length. RIGHT KIDNEY: Measures 11.4 cm in length and is normal in echogenicity. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 12.1 cm in length and is normal in echogenicity. No hydronephrosis or shadowing calculi are noted.Moderate ascites.", "output": "1. Hepatomegaly with coarse and increased echotexture suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesions. Patent hepatic inflow and outflow vasculature.2. Sludge and cholelithiasis with no evidence of cholecystitis.3. Moderate ascites."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old female with thyromegaly, follow up cyst. RIGHT LOBE MEASUREMENTS: 5.3 x 2.0 x 1.4 cmLEFT LOBE MEASUREMENTS: 5.8 x 2.2 x 1.7 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Redemonstration of multiple nodules. The cystic component of the largest nodule in the inferior aspect of the right thyroid is decreased in size since the prior study, now measuring 1.0 x 0.8 x 0.7 cm. Adjacent smaller spongiform and mixed solid/cystic nodules are without significant interval change and most likely benign.LEFT LOBE: Predominantly cystic nodule with internal septations measures 1.6 cm, not significantly changed since the prior study. Adjacent spongiform nodule measuring up to 1.0 cm is also unchanged.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Predominantly cystic thyroid nodules as described above, which are most likely benign."}
{"instruction": "Generate impression based on findings.", "input": "Prior enlarged right level 1B node, now with partial interval resolution, assess for persistent/any suspicious ultrasound features Normal parotid gland identified on the right side. No abnormal lymph nodes identified in the right lateral neck.", "output": "No suspicious right level 1B lymph node identified as clinically questioned."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter. 2 year follow-up. RIGHT LOBE MEASUREMENTS: Heterogeneous and measuring 6.2 x 2.1 x 2.0 cm, previously 6.9 x 2.1 x 1.9 cm.LEFT LOBE MEASUREMENTS: Heterogeneous and measuring 6.3 x 3.4 x 2.7 cm, previously 6.3 x 2.5 x 2.4 cm.ISTHMUS MEASUREMENTS: 1.0 cm in AP dimension, previously 0.7 cm.RIGHT LOBE: Multiple heterogenous nodules identified, not significantly changed from prior study with reference measurements as below: Superior pole nodule: 1.8 x 1.3 x 1.0 cm, previously 1.7 x 1.2 x 0.7 cm.Midpole nodule: 1.1 x 0.9 x 0.6 cm, previously 1.2 x 1.5 x 0.5 cm.Lower pole nodule: 0.7 x 0.7 x 0.5 cm, previously 0.7 x 0.6 x 0.5 cm. No new suspicious nodules identified.LEFT LOBE: Multiple heterogeneous nodules identified, not significantly changed from prior study with reference measurements as below: Superior pole nodule: 1.2 x 0.7 x 0.7 cm, previously 1.3 x 1.2 x 0.9 cm. Mid pole nodule: 1.9 x 2.0 x 2.1 cm, previously 1.0 x 1.0 x 0.7 cm, though without new or suspicious features. Inferior pole nodule: 3.6 x 2.5 x 2.9 cm, previously 3.3 x 2.1 x 2.6 cm No new suspicious nodules identified.ISTHMUS: Stable appearance of the heterogeneous nodule measuring 1.4 x 1.7 x 1.3 cm, previously 1.4 x 1.3 x 0.9 cm, without suspicious features.PARATHYROID GLANDS: Not visualized.LYMPH NODES: A left level 3 lymph node measures 1.1 x 0.6 x 0.2 cm, without suspicious features.", "output": "Multinodular goiter. Stable appearance of the multiple thyroid nodules, some with minimal interval growth over 2 years, though without development of suspicious features."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male patient with chronic HCV. Question of cirrhosis or cancer. LIVER: The liver measures 15.6 cm in length and demonstrates increased parenchymal echogenicity. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.35 m/sec.GALLBLADDER, BILIARY TRACT: There are gallstones, but no pericholecystic fluid or gallbladder wall thickening. Sonographic Murphy's sign is negative. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 9 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 8.4 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 8.9 cm in length. No evidence of hydronephrosis.The spleen measures 11 cm in length.", "output": "1. Increased hepatic parenchymal echogenicity which can be seen with hepatic steatosis/hepatic parenchymal dysfunction. No hepatic lesion identified.2. Cholelithiasis without sonographic evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": " Assuming 12 rib bearing vertebrae, there appear to be 4 truly lumbar appearing vertebrae. There is suggestion of a segmentation anomaly at L5-S1 without evidence of intervening disk, although there are two sets of posterior elements. For the purposes of this exam, the last fully formed disk is at S1-S2.The lumbar spine is in normal alignment, with significant straightening of the normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is abnormal ventral T2 hyperintensity within the distal cord with axial confirmation to the lower T12 level from the tip of the conus, although sagittal images suggest additional abnormality extending cranially although not well delineated. This measures up to 3 x 2 mm at the T12-L1 level. The distal spinal cord and conus are otherwise within normal limits with the conus terminating at the L3-L4 level. There is no evidence of fat signal intensity along the distal thecal sac. On prone imaging, there does appear to be some degree of ventral movement of the distal cord and conus. Under within the thecal sac.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine.", "output": "1. Transitional spinal anatomy, incompletely assessed as the counting sequence is not available. For the purposes of this exam, the last fully formed disk is at S1-S2. If surgery is to be contemplated, correlation with imaging of the entire spine is recommended.2. Segmentation anomaly of L5-S1 without intervening disk although with separate posterior elements.3. Utilizing the above counting convention, conus termination is abnormally low at L3-L4 without evidence of a fatty filum. Some degree of ventral motion of the distal cord and conus are noted on the images. Please correlate clinically for tethered cord.4. Small caliber syringohydromyelia within the visualized distal cord extending at least to the lower T12 level is confirmed on axial imaging, although likely also involving additional lower thoracic cord which extends out of the field-of-view. Consider dedicated MRI cervical and thoracic spine as clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old male with gram-negative rod sepsis. Evaluate for biliary cause. LIVER: The liver is mildly coarse in echogenicity. It is normal in size measuring 15.8 cm in the craniocaudal dimension. No intrahepatic biliary ductal dilatation or focal hepatic lesion is evident. Normal hepatopetal portal venous blood flow at 31 cm/sec.BILIARY TRACT: A normally distended gallbladder is present without wall thickening, or pericholecystic fluid. Evaluation for focal tenderness is limited by the patient's mental status.Minimal sludge and possible non-shadowing gallstone.No extrahepatic biliary ductal dilatation, measuring 4 mm.PANCREAS: The visualized pancreatic body and head are unremarkable. There is mild dilatation of the pancreatic duct, measuring 3 mm. There may be a small amount of peripancreatic fluid posteriorly, correlate with lipase.SPLEEN: The spleen measures 10.2 cm in length without a discrete abnormality.RIGHT KIDNEY: The right kidney measures 11.6 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident.OTHER: The left kidney measures 11.5 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow.Bilateral pleural effusions are noted.", "output": "1. Biliary sludge and possible gallstone without other specific findings of acute cholecystitis, given the limited evaluation for focal tenderness in the patient's current state.2. Mild pancreatic ductal dilatation and possible peripancreatic fluid. Correlate with lipase.3. No biliary ductal dilatation.4. Bilateral pleural effusions. "}
{"instruction": "Generate impression based on findings.", "input": "Weakness Prominent partial fusion is noted at the C2 and C3 vertebrae. There is mild grade 1 subluxation in the C3-C4 level with minimal retrolisthesis at C6-C7. Prominent endplate degenerative irregularities are also present at C6-C7 and to a lesser degree at C5-C6. There is no acute appearing compression deformity.The axial images show prominent disk/spur complex at the C3-C4 level resulting in mild central canal and moderate left-sided foraminal stenosis. Mild stenotic findings are present at C4-C5 and C5-C6 although there is moderate right sided foraminal stenosis. C6-C7 shows mild central canal and bilateral foraminal stenosis. C7-T1 has milder degenerative findings without significant stenosis. Incidental note is made of prominent enlargement with heterogeneous attenuation of the thyroid gland including dystrophic calcification with deviation of the trachea to the right side of midline. This may be further evaluated with ultrasound performed clinically.", "output": "Moderate degenerative changes with partial fusion C2-C3 and no acute fracture.Prominent enlargement of heterogeneous appearing thyroid possibly goiter. This would be better evaluated with ultrasound if warranted clinically."}
{"instruction": "Generate impression based on findings.", "input": "Male 75 years old Reason: AKI on CKD with uptrending Cr despite holding diuresis, reduced UOP. Please assess. History: As above RIGHT KIDNEY: The right kidney measures 10.1 cm. The renal cortex is increased in echogenicity. There is no hydronephrosis or shadowing calculus.LEFT KIDNEY: The left kidney measures 10.3 cm. The renal cortex is increased in echogenicity. There is no hydronephrosis or shadowing calculus. Left upper pole renal cyst is again noted.OTHER: The bladder is incompletely distended.", "output": "No evidence of hydronephrosis. Echogenic renal cortex bilaterally consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Female 71 years old; Reason: Evaluate left thyroid nodules seen on CT scan. RIGHT LOBE MEASUREMENTS: 4.8 x 1.4 x 1.5 cmLEFT LOBE MEASUREMENTS: 3.7 x 1.7 x 1.1 cmISTHMUS MEASUREMENT: No significant abnormality noted. 0.4 cm AP.RIGHT LOBE: The background thyroid gland has a mildly coarse echotexture. Multiple, subcentimeter solid, hypoechoic nodules are seen throughout the right lobe of the thyroid. A dominant nodule in the inferior aspect of the right thyroid lobe measures 5 x 4 x 4 mm.LEFT LOBE: The background thyroid gland has a mildly coarse echotexture. There are multiple subcentimeter solid, hypoechoic nodules. The dominant nodule is predominantly hypoechoic with some isoechoic components and measures 4 x 5 x 3 mm.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.", "output": "Bilateral subcentimeter thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old female with abdominal pain, assess for gallbladder pathology, cholecystitis. LIVER: Increased hepatic echogenicity without discrete focal lesion.GALLBLADDER, BILIARY TRACT: No evidence of cholelithiasis, gallbladder wall thickening, pericholecystic fluid, or sonographic Murphy sign. No biliary ductal dilation.PANCREAS: Portion of the pancreas are obscured due to bowel gas. The visualized portions of the pancreas are unremarkable.KIDNEY: Increased renal echogenicity without hydronephrosis. Hyperechoic 1.6 x 1.4 cm lesion in the left kidney correlates with fat-containing lesion seen on prior CT and is consistent with an angiomyolipoma.OTHER: No significant abnormalities noted.", "output": "1. No evidence of cholelithiasis or cholecystitis.2. Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease.3. Increased renal echogenicity consistent with medical renal disease. Left renal hyperechoic lesion consistent with an angiomyolipoma."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Concern for ventral hernia. Please evaluate. History: As above There is interruption of the anterior abdominal wall, immediately cranial to the umbilicus. There is a narrow neck fat-containing hernia measuring 7.2 cm in transverse dimension and 2.7 cm in depth. This is grossly similar to a prior CT from 2010. No bowel loops are present within the lesion.", "output": "Narrow necked fat-containing ventral hernia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old female with bilateral palpable areas of concern. Areas of concern are marked by Dr. Jaskowiak. A targeted right ultrasound was performed for the palpable area of concern, as marked. At the approximate 10 o'clock position of the right areolar border, there is a lobulated, heterogeneous mass measuring 1.3 x 0.9 x 1.0 cm. There is mild posterior acoustic shadowing with minimal peripheral vascularity appreciated.A targeted left ultrasound was performed for the palpable area of concern, as marked. At the approximate 3 o'clock position of the left areolar border, there is an ill-defined, heterogeneous lesion measuring 1.2 x 0.4 x 0.8 cm with mild posterior acoustic shadowing. Mild peripheral vascularity is present.", "output": "1. Lobulated, heterogeneous mass at the area of palpable concern at the 10 o'clock position of the right retroareolar breast. Differential considerations include fat necrosis and malignancy. Fine needle aspiration is recommended.2. Heterogeneous mass at the 3 o'clock position of the left retroareolar breast, which demonstrates similar sonographic characteristics to the right breast lesion.Results and recommendations were discussed with the patient and Dr. Jaskowiak. The patient will be scheduled for ultrasound guided FNA.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old female with liver enlargement. LIVER: Measures 12.4 cm in length. Unremarkable hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Cholelithiasis without 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. Right renal cyst measures 2.0 cm without septation or solid component.OTHER: No significant abnormalities noted.", "output": "1. No evidence of focal hepatic mass or biliary obstruction. 2. Cholelithiasis without evidence of cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "Acute flank pain, ileal conduit with past medical history of multidrug resistant UTIs RIGHT KIDNEY: Measures 9.9 cm. Echogenic parenchymal echotexture without hydronephrosis. Renal cyst measures up to 1.2 cm. No solid renal mass.LEFT KIDNEY: Measures 10.2 cm. Echogenic parenchymal echotexture without hydronephrosis. No mass.OTHER: Status post cystectomy.", "output": "Medical renal disease without hydronephrosis or mass."}
{"instruction": "Generate impression based on findings.", "input": "Congestive heart failure; transplant candidate LIVER:Mildly heterogeneous liver echotexture without mass. Liver length 16 cmGALLBLADDER, BILIARY TRACT: No significant abnormality noted.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. Spleen length 8.9 cmKIDNEYS: No significant abnormality noted. Right kidney 10.4 cm in length. Left kidney 9.2 cm in length.ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted. No ascites", "output": "Mildly heterogeneous liver echotexture without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "68 year old female with history of hypertension. RIGHT KIDNEY: Slightly increased echogenicity of the cortex. Right kidney measures 9.2 cm.LEFT KIDNEY: Slightly increased echogenicity of the cortex. Left kidney measures 9.7 cm.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Slightly increased echogenicity of the bilateral kidneys, suggestive of medical renal disease. No additional significant abnormality."}
{"instruction": "Generate impression based on findings.", "input": "68 year old male with abdominal distention, hepatomegaly on exam. LIVER: Heterogeneous echotexture of the liver measuring 15.7 cm in length. Portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Small shadowing stones within the gallbladder. No pericholecystic fluid. No gallbladder wall thickening. Sonographic Murphy's sign is negative. Common duct measures 5 mm in thickness. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 10.8 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the left kidney measuring 10.3 cm in length. No hydronephrosis or shadowing calculi are noted. Exophytic lower pole cyst measures 1.4 cm x 1.9 cm x 1.9 cm.Normal echogenicity of the spleen measuring 9.1 cm in length.", "output": "1. Heterogeneous echotexture of the liver which may represent areas of focal fatty sparing, however recommend MRI or triple phase CT scan for further evaluation. 2. Cholelithiasis with no evidence of cholecystitis.3. Exophytic left renal cyst. Findings were discussed with Dr. Katarina Veskovic by phone on 3/18/2015 at 4:20 PM. "}
{"instruction": "Generate impression based on findings.", "input": "63 year old female who was recalled from screening mammogram for right breast calcifications. Family history of breast carcinoma in her mother at age 63 a maternal aunt at age 62. RIGHT DIAGNOSTIC MAMMOGRAM: An ML view and two spot magnification 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 densities. There is redemonstration of pleomorphic, branching calcifications within the upper outer right breast, a middle depth associated with a persistent, partially obscured mass. RIGHT BREAST ULTRASOUND: A targeted right ultrasound was performed for the mammographic area of concern. At the 11 o'clock position, approximately 3 cm from the nipple, there is an irregular hypoechoic mass with internal echogenic foci, and an echogenic halo measuring 1.3 x 1.2 x 2.1 cm. Mild internal vascularity is present.", "output": "Suspicious 2.1 cm mass with associated calcifications at the 11 o'clock position of the right breast for which ultrasound guided core needle biopsy is recommended. Findings and recommendations were discussed with the patient, and all questions were answered.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 58 yo F with newly diagnosed colon cancer with metastases to liver now having fever, evaluate for biliary digitation History: fever, abdominal pain LIVER: The liver is enlarged and measures 20.8 cm in length. Innumerable predominantly hyperechoic hepatic lesions in both lobes compatible with metastatic disease. Additional scattered hepatic cysts of varying sizes. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.22 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 2 mm in diameter.PANCREAS: Not well visualized.SPLEEN: No significant abnormalities noted. The spleen measures 9.2 cm in length. RIGHT KIDNEY: Kidney measures 11.0 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or massLEFT KIDNEY: Kidney measures 10.8 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or massOTHER: Abdominal ascites. Bilateral pleural effusions, increased from recent CT.", "output": "1.Diffuse hepatic metastatic disease.2.No evidence of acute cholecystitis or biliary ductal dilatation.3.Ascites. Increasing bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "History of esophageal cancer with prior lymph node metastases status post treatment, evaluate for cervical lymphadenopathy or thyroid nodules. RIGHT LOBE MEASUREMENTS: 5.2 x 1.4 x 2.3 cm.LEFT LOBE MEASUREMENTS: 4.3 x 1.6 x 2.1 cm.ISTHMUS MEASUREMENTS: Up to 0.4 cm in thickness.RIGHT LOBE: Normal background parenchymal echotexture. Hypoechoic nodule within the midpole measuring 0.8 x 0.5 x 0.6 cm with internal reflectors suggestive of colloid, favor benign.LEFT LOBE: Normal background parenchymal echotexture. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No cervical lymphadenopathy identified.OTHER: No significant abnormality noted.", "output": "Single right subcentimeter thyroid nodule, favor benign. No cervical lymphadenopathy identified."}
{"instruction": "Generate impression based on findings.", "input": "77 year-old female with thyroid masses. Also findings of lung cancer with metastatic disease on CT. RIGHT LOBE MEASUREMENTS: 5.9 x 2.9 x 2.5 cmLEFT LOBE MEASUREMENTS: 5.5 x 2 x 2.1 cm.ISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Highly heterogeneous in echotexture with multiple ill-defined nodules including small complex cystic nodules consistent with colloid nodules. Most measurable nodule is in the lower pole measuring 1.6 x 2.1 x 2.1 cm. This is solid and demonstrates rim calcification.LEFT LOBE: Highly heterogeneous in echotexture with multiple ill-defined nodules. Most measurable nodule in the midportion of the left lobe is predominantly solid with cystic components measuring 0.9 x 1.1 x 1.2 cm. There are some internal bright reflectors which could represent comet tail artifact, which is seen with colloid, although small calcifications cannot be completely excluded. Several other smaller nodular areas within the left lobe have the appearance of colloid nodulesISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Morphologically abnormal level 3 node on the right measuring 0.8 x 1.2 x 1.5 cm and may contain small calcifications.OTHER: No significant abnormality noted.", "output": "Multiple thyroid nodules including a nodule with rim calcification on the right.Abnormal level 3 right lymph node."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old woman presents for call back for left axillary lymph node larger in comparison to prior exams. Targeted grayscale sonography of the left axilla demonstrates a well circumscribed enlarged lymph node with loss of normal fatty hilum, measuring approximately 3.0 x 1.1 x 2.1 cm. Color Doppler shows internal vascularity. Further evaluation is recommended with an ultrasound guided core biopsy. A few normal size lymph nodes with fatty hilum and smooth cortex are also seen in the axilla.", "output": "3.0 x 1.1 x 2.1 cm abnormal left axillary lymph node, indeterminate. Ultrasound-guided core biopsy is recommended for further evaluation. Findings and recommendations were discussed with the patient at the time of examination. She takes aspirin and should be off of that medication for 5 days before the biopsy is done. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Alcoholism with disorientation LIVER: Coarse echogenic liver parenchyma without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 11.2 cmGALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 8.5 cm in length.OTHER: Left kidney 7.3 cm in length. No ascites", "output": "Coarse echogenic liver parenchyma suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites. Gallbladder sludge without acute inflammation."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain, evaluate for cholecystitis. LIVER: The liver measures approximately 16 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 0.2 m/s.BILIARY TRACT: Cholelithiasis with layering stones in the gallbladder neck. Additional adherent stone versus 5 mm polyp along fundus wall. Equivocal gallbladder wall thickening. The sonographic Murphy's sign is negative, however, the patient recently received pain medications. 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 9.4 cm in length. RIGHT KIDNEY: Kidney measures 11.4 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 11.9 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Cholelithiasis. Equivocal gallbladder wall thickening which is nonspecific but could reflect early acute cholecystitis. Nuclear medicine HIDA scan can be considered for further evaluation if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male patient with an elevated creatinine. Assess for hydronephrosis. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No perinephric fluid collection is identified.KIDNEY: The kidney measures 10.2 cm in length. Renal cortical echogenicity is within normal limits.COLLECTING SYSTEM/URETER: No significant abnormality noted.URINARY BLADDER: The bladder is decompressed.VASCULAR DOPPLER DATA: Color Doppler were performed on inflow and outflow vessels. No significant abnormality notedOTHER: No significant abnormality noted", "output": "No evidence of hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodule seen on CT RIGHT LOBE MEASUREMENTS: 1.4 x 1.6 x 5.1 cmLEFT LOBE MEASUREMENTS: 1.5 x 1 x 4.9 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Subcentimeter benign-appearing spongiform nodules mid thyroid glandLEFT LOBE: 1.1 x 0.7 x 1.2 cm spongiform nodule corresponding to the lesion seen on the recent CT.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: 0.7 x 0.6 x 1.1 cm extrathyroidal mixed echogenicity nodule posterior and inferior to the right thyroid gland.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Spongiform nodule corresponding to the lesion seen on the recent CT left thyroid gland; favor benign etiology. Subcentimeter benign-appearing spongiform nodules mid right thyroid gland. No regional adenopathy.Extrathyroidal mixed echogenicity nodule posterior and inferior to the right thyroid gland; cannot exclude parathyroid adenoma. Would recommend correlation with calcium and PTH levels."}
{"instruction": "Generate impression based on findings.", "input": "Ventriculomegaly, seizure. There is moderate prominence of the lateral ventricles bilaterally. Cortical sulci are also prominent and there is relative lucency in the periventricular white matter. There is no gross hemorrhage or mass. Subtle scalp swelling is incidentally noted in the frontal region.", "output": "Immature appearance with prominent ventricles and sulci especially in the frontal region and decreased attenuation white matter with no hemorrhage."}
{"instruction": "Generate impression based on findings.", "input": "Female 52 years old Reason: Evaluate for HCC History: HCV LIVER: Liver echogenicity is within normal limits and homogeneous. No significant nodularity to the capsule. No focal hepatic mass. Main portal vein is patent with normal directional flow with peak velocity of 19 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Common bile duct measures 2 mm. No gallstones. No evidence of acute inflammation of the gallbladder.PANCREAS: The visualized portions of the pancreas are normal.SPLEEN: Spleen is normal measuring 8.8 cm.KIDNEYS: Cortical echogenicity is within normal limits bilaterally. No hydronephrosis or shadowing calculus. Left kidney measures 10.6 cm. Right kidney measures 8.2 cm.OTHER: No ascites.", "output": "No focal hepatic mass or sonographic evidence of cirrhosis."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old female, with right breast lumpectomy March 11, 2016 for invasive ductal carcinoma, with negative sentinel lymph node biopsy, presents for palpable lesion in the right axilla. A targeted right ultrasound was performed of the axilla. There is no solid or cystic mass identified. Few lymph nodes are identified with normal morphology. Representative normal lymph node measures 1.0 x 0.5 x 1.5 cm.", "output": "No sonographic evidence for malignancy. Patient to return for normal follow-up post right lumpectomy for invasive ductal carcinoma.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Right upper abdominal quadrant pain. LIVER: 14.9 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 10.5 cm in length. The left kidney is 10.7 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9 cm in length, without focal lesions evident.OTHER: No abdominal free fluid identified.", "output": "No acute intra-abdominal abnormality evident."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old male with right upper quadrant pain, positive Murphy's sign. Evaluate for cholelithiasis and fatty liver disease. LIVER: Heterogenous echotexture of the liver which measures 18.9 cm in length. Fatty liver with areas of sparing. No intra or extrahepatic biliary ductal dilatation.GALLBLADDER, BILIARY TRACT: No gallbladder wall thickening, pericholecystic fluid, or cholelithiasis to suggest cholecystitis. Common hepatic duct measures 2 mm. Negative Murphy's sign.KIDNEYS: The right kidney measures 12.3 cm and left kidney measures 11.9 cm in length. No evidence of hydroureteronephrosis.OTHER: Spleen measures 8.3 cm in length.", "output": "1.No evidence of cholecystitis or cholelithiasis.2.Hepatomegaly and hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "Incidental liver lesion LIVER: Coarse echogenic liver echotexture. 3.9 x 3.2 x 4.3 cm peripheral hypoechogenic focus within segment 4A of the liver corresponding to the lesion seen on the noncontrast chest CT. Liver length 14.6 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 11.8 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.9 cm in lengthOTHER: Left kidney 11.2 cm in length. No ascites.", "output": "Peripheral hypoechoic echogenic lesion within segment 4A of the left lobe of the liver corresponding to lesion seen on the noncontrast CT. This lesion is incompletely characterized on ultrasound. After talking to the patient, he confirms that prior CTs are available from an outside institution. Comparison with these images would be very helpful to document temporal stability of this lesion. If these images are not available or if this lesion is new relative to these prior studies, would recommend correlation with dedicated cross sectional imaging.Coarse echogenic liver suggestive for fatty infiltration/parenchymal dysfunction. No ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "History of multiple thyroid nodules, evaluate interval change RIGHT LOBE MEASUREMENTS: 4.1 x 1.8 x 2.3 cm, mildly heterogenous, unchanged from prior studyLEFT LOBE MEASUREMENTS: 4.3 x 0.9 x 1.6 cm, mildly heterogenous, unchanged from prior studyISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: Hypoechoic nodule in the right upper lobe measures 1.9 x 1.1 x 1.7 cm, unchanged from prior exam. Small hypoechoic lower lobe nodule measures 0.7 x 0.5 x 0.9 cm, also unchanged from prior exam.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 interval change in right hypoechoic thyroid nodules. Overall diffuse heterogenous echotexture of the thyroid gland is also unchanged."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female presents with acute liver failure. There is a clinical concern for hepatic vein thrombosis. The study is limited due to mechanical ventilation. LIMITED ABDOMENLIVER: The liver measures 15.0 cm. There is increased echogenicity of the liver parenchyma. No masses or intrahepatic biliary dilation.BILIARY TRACT: Evaluation of the gallbladder and biliary tract are limited due to increased echogenicity of the liver parenchyma. The common bile duct measures 6.5 mm.PANCREAS: Evaluation of the pancreas is limited due to overlying bowel gas.SPLEEN: Evaluation of the spleen is limited. RIGHT KIDNEY: The right kidney measures approximately 11.2 cm. The cortex has normal echogenicity. No hydronephrosis or shadowing calculi.LEFT KIDNEY: Evaluation left kidney is limited.OTHER: No significant abnormalities noted.", "output": "1. There is no convincing flow appreciated in the portal vein or in the hepatic veins, although it is unclear if this is real or due to technical limitations of the exam.2. Coarse echogenic liver consistent with chronic liver disease/parenchyma dysfunction. No masses or ascites."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old female with diabetes, elevated BUN/creatinine. RIGHT KIDNEY: Measures 10.7 cm in length. Unremarkable morphology with preserved cortical medullary differentiation without hydronephrosis. Nephrolithiasis with a 0.2 cm stone in the mid polar region.LEFT KIDNEY: Measures 12.4 cm in length. Unremarkable morphology with preserved cortical medullary differentiation without hydronephrosis. Nephrolithiasis with a 0.4 cm stone noted in the interpolar region.URINARY BLADDER: Incompletely distended.OTHER: No significant abnormalities noted.", "output": "Bilateral nephrolithiasis without hydronephrosis. "}
{"instruction": "Generate impression based on findings.", "input": "27-year-old female with history of a previously palpable breast mass for 3 weeks who presents for evaluation. Patient currently does not palpate a breast mass. Patient complains of nipple tenderness. Denies nipple discharge. No history of past or present breast-feeding.On physical examination, no mass is palpated at the patient's location of concern. No evidence of erythema, edema, or warmth overlying nipple.A targeted left ultrasound was performed for the patient\u2019s area of concern. There is a anechoic focus measuring up to 4 mm without internal vascularity in the skin at approximately 9:00 position, 2 cm from the nipple; findings consistent with an epidermal cyst. There is no solid or cystic mass identified within the breast.", "output": "Findings consistent with subcentimeter epididymal cyst.No sonographic evidence of malignancy.If the palpable mass returns, additional evaluation may be warranted. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female patient in ARDS with refractory shock. Evaluate for biliary/gallbladder pathology. LIVER: The liver measures 17.2 cm in length and demonstrates coarsened hepatic echotexture. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.4 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. 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 10.2 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. OTHER: The left kidney measures 10.0 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis.The spleen measures 9.6 cm in length.", "output": "1. Coarsened hepatic echotexture which can be seen with hepatic parenchymal dysfunction.2. Medical renal disease. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for suspicious lateral and central neck lymph nodes in patient with 2.7 cm papillary thyroid carcinoma. RIGHT LOBE MEASUREMENTS: 4.1 x 1.7 x 1.5 cm.LEFT LOBE MEASUREMENTS: 4.5 x 1.0 x 1.4 cm.ISTHMUS MEASUREMENTS: 0.5 cm in thickness.RIGHT LOBE: Normal background parenchymal echotexture.LEFT LOBE: Normal background parenchymal echotexture.ISTHMUS: Within the isthmus, slightly eccentric to the right, there is a nodule measuring 2.5 x 2.1 x 2.2 cm which appears solid, is predominantly hypoechoic, demonstrates internal vascularity, and contains probable microcalcifications. This nodule is compatible with reported history of papillary thyroid carcinoma.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small, benign morphology lymph nodes identified within the right level 4 and left level 3 stations.OTHER: No significant abnormality noted.", "output": "Isthmic thyroid nodule compatible with reported history of papillary thyroid carcinoma. No morphologically suspicious cervical lymph nodes identified."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old male with history of thyroid cancer status post thyroidectomy. Evaluate for recurrence and adenopathy. 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: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Surgical changes of a thyroidectomy without evidence of recurrence."}
{"instruction": "Generate impression based on findings.", "input": "54 year-old female with history of right thyroid lesion, evaluate for progression. RIGHT LOBE MEASUREMENTS: 5.0 x 2.4 x 2.4 cm, previously 4.5 x 2.4 x 2.8 cmLEFT LOBE MEASUREMENTS: 5.2 x 2.4 x 2.2 cm, previously 4.7 x 2.9 x 2.7 cmISTHMUS MEASUREMENTS: 0.6 cm in thickness. RIGHT LOBE: Diffusely heterogeneous thyroid. Small hyperechoic nodule in the right superior gland measures 0.3 x 0.3 x 0.3 cm, unchanged.LEFT LOBE: Diffusely heterogeneous thyroid.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No parathyroid glands visualized. LYMPH NODES: Several benign appearing right level 2 and level 3 lymph nodes are present.", "output": "Diffusely heterogeneous thyroid with small hyperechoic lesion in the right superior gland, not significantly changed and likely benign. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Kimbrough is a 47 year old female presenting for short term follow up of a prominent right axillary lymph node. No current complaints or palpable abnormalities. Targeted right axillary ultrasound demonstrates two normal morphology lymph nodes. Reference right axillary lymph node now has a cortical thickness of 0.3 cm, compared to 0.7 cm. Normal hilar vascular flow is identified. No additional suspicious masses are present.", "output": "Benign morphology right axillary lymph nodes. No sonographic evidence for malignancy. As long as the patient's physical examination remains normal, she can resume routine screening mammography, due next in September 2016. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Female 40 years old; Reason: S/p heart and renal transplant, now with elevated creatinine. Non-compliant on immunosuppression. Assess for rejection History: Elevated creatinine Ultrasound guided biopsy of a right iliac fossa renal transplant. 2 passes were made. No complications.", "output": "Biopsy as above."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male with neutropenic fever, increased LFTs. LIVER: Measures 18.3 cm in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Gallbladder not clearly visualized, likely collapsed. No evidence of cholelithiasis, 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: Enlarged measuring 18.2 cm in length.KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "1. No evidence of cholelithiasis or cholecystitis. 2. Hepatomegaly with increased echogenicity consistent with hepatic steatosis or parenchymal disease, without discrete focal lesion. 3. Splenomegaly. "}
{"instruction": "Generate impression based on findings.", "input": "77 years old, Male, Reason: hx of pancreatic ca and AAA now w/ fever, chills, RUQ pain, leukocytosis; eval for acute cholecystitis History: fever, RUQ pain LIVER: The liver is enlarged measuring 19.7 cm in length. Parenchymal echogenicity is within normal limits. 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: Gallbladder stones and sludge are present. Marked gallbladder wall thickening and pericholecystic fluid with surrounding inflammatory changes. Findings compatible with acute cholecystitis. Mild intrahepatic biliary ductal dilatation. The common bile duct measures 6 mm in diameter. Biliary stent is not well visualized on this exam.PANCREAS: Marked pancreatic ductal dilatation measuring up to 9 mm. Patient's pancreatic tumor is not well visualized, please refer to abdominal CT of the same date.SPLEEN: No significant abnormalities noted. The spleen measures 12.6 cm in length. RIGHT KIDNEY: Kidney measures 11.6 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. No hydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 10.5 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. No hydronephrosis or shadowing calculus.OTHER: No significant abnormalities noted.", "output": "1.Findings consistent with acute cholecystitis.2.Marked pancreatic ductal dilatation related to known pancreatic cancer.3.Mildly increased echogenicity of the kidneys consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter RIGHT LOBE MEASUREMENTS: 3.9 x 1 x 1.5 cmLEFT LOBE MEASUREMENTS: 2.5 x 1.3 x 1.1 cmISTHMUS MEASUREMENTS: 0.1 cmRIGHT LOBE: Stable solid nodule inferior right thyroid gland measuring 0.8 x 0.8 x 0.5 cm.LEFT LOBE: No change in either extrathyroidal or exophytic lower pole left thyroid nodules, the largest measuring 1.1 x 1 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": "Stable examination. No change in right inferior subcentimeter solid nodule. No change in either extrathyroidal or exophytic lower pole thyroid nodules. If these are extrathyroidal, parathyroid adenomas should be considered."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Dale is a 64 year old asymptomatic female presenting for whole breast ultrasound for dense breast screening. She has a personal history of multiple bilateral cyst aspirations in 2006, 2007, and 2009. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. Multiple anechoic lesions of varying sizes are seen bilaterally, compatible with simple cysts. However, in the left upper outer breast, 1:00 location, there is an oval hypoechoic lesion identified measuring 1.1 x 0.8 cm. This exam was interpreted by two radiologists.", "output": "(1) 1.1 cm lesion in the left upper outer breast. Dedicated left unilateral ultrasound is recommended for further evaluation. (2) No sonographic evidence for malignancy in the right breast .BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess for fatty liver LIVER: Coarse, echogenic hepatic parenchymal echotexture. The liver measures 16.1 cm in length. No focal masses. The portal vein is patent with normal directional hepatopedal portal venous blood flow, peak velocity 13.1 cm/s.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. The common bile duct measures 0.3 cm. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 12.9 cm in length. Right lower pole anechoic cyst measures 2.3 x 1.9 x 1.9 cm. No hydronephrosis, masses, or stones.LEFT KIDNEY: The left kidney measures 13.3 cm in length. Septated left renal cyst measures 2.8 x 2.3 x 2.5 cm. No hydronephrosis, masses, or stones.SPLEEN: The spleen measures 13.1 cm in length.OTHER: No ascites.", "output": "Findings consistent with hepatic steatosis or parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old male patient with cirrhosis. Evaluate for HCC. LIVER: The liver measures 18 cm in length and demonstrates coarsened, increased parenchymal echogenicity and is nodular in contour. 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 3 mm in diameter.PANCREAS: The pancreas is poorly visualized on this examination.RIGHT KIDNEY: The right kidney measures 11 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9 cm in length. No evidence of hydronephrosis.The spleen measures 12.5 cm in length.No ascites.", "output": "Nodular liver contour consistent with cirrhosis. No focal hepatic lesion is identified."}
{"instruction": "Generate impression based on findings.", "input": "Female, 49 years old. AKI. Evaluate for hydronephrosis. Exam again limited by patient body habitus and positioning.RIGHT KIDNEY: The right kidney measures 5.3 cm in length with increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.1 cm in length with increased cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The bladder is decompressed. Again noted is cirrhotic liver morphology and moderate to marked ascites.", "output": "1.Increased renal cortical echogenicity compatible with medical renal disease. No hydronephrosis.2.Cirrhotic liver morphology and ascites."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female with history of thyroid cancer status post surgery and I-131. Evaluate for abnormal masses. RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: No discrete nodules or masses are noted in the thyroidectomy bed. LEFT LOBE: No discrete nodules or masses are noted in the thyroidectomy bed. ISTHMUS: No discrete nodules or masses are noted in the thyroidectomy bed. PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right neck level 2 benign-appearing lymph node measures 6 mm x 4 mm x 8 mm. Left neck level 2 benign-appearing lymph node measures 0.8 cm x 0.3 cm x 1.5 cm. Additional left neck level 3 benign-appearing lymph node measures 0.4 cm x 0.3 cm x 1.6 cm.OTHER: No significant abnormality noted.", "output": "No evidence of recurrence in the thyroidectomy bed. No pathologic lymphadenopathy. "}
{"instruction": "Generate impression based on findings.", "input": "Female 34 years old; Reason: assess for gallstones, signs of cholecystitis History: RUQ tenderness LIVER: The liver measures 20.3 cm in length. There is normal 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 36.3 cm/s. There is trace ascites.GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 3 mm. No stones or sludge are seen within the gallbladder. No pericholecystic fluid. The common bile duct measures 4.6 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 11.8 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 13.2 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 12.9 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. No sonographic evidence of cholelithiasis or acute cholecystitis.2. Mild hepatomegaly with no focal hepatic lesions or intrahepatic ductal dilation. There is trace ascites.3. Bilaterally, the kidneys have increased echogenicity compatible with medical renal disease without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are breast MRI (3/23/15) performed at Presence Saint Joseph Medical Center. Family history of breast cancer in her sister. There is extreme amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.There is slowly enhancing small mass (8 mm) at 10:00 position in the right breast, corresponding to a benign mass seen on the ultrasound study.Scattered benign appearing foci are present in both breasts.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.", "output": "No MRI evidence of malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Cerebral infarction with hepatic and renal lesions on CT Examination limited by patient's inability to cooperate and overlying gasLIVER: The previously noted segment 2 left lobe lesion seen on the recent CT could not be visualized on the current examination due to overlying gas and the patient's inability to cooperate. Liver length 21.3 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: Not visualized due to overlying gasRIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. Right kidney 13.8 cm in lengthOTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. Left kidney 14.1 cm in length. Spleen 12.2 cm in length.", "output": "Due to technical limitations secondary to the patient's inability to cooperate and overlying gas, the previously noted lesion within the left lobe of liver seen on the recent CT could not be visualized. Hepatomegaly.Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "History of hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 6.3 x 2.2 x 2.2 cmLEFT LOBE MEASUREMENTS: 6.5 x 2.5 x 2.0 cmISTHMUS MEASUREMENTS: 6 mmRIGHT LOBE: The right thyroid lobe is homogeneous and normal in echogenicity without a discrete nodule.LEFT LOBE: The left thyroid lobe is homogeneous and normal in echogenicity without a discrete noduleISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Immediately inferior to the left thyroid lobe is a 1.4 x 0.9 x 1.0 cm hypoechoic nodule without significant hypervascularity.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.4 cm hypoechoic nodule immediately inferior to the left thyroid lobe may represent a parathyroid adenoma. Correlate with nuclear medicine study."}
{"instruction": "Generate impression based on findings.", "input": "Male, 64 years old. Rising Cr RIGHT KIDNEY: The right kidney measures 10.7 cm in length, with slightly increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.6 cm in length, with slightly increased cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The bladder is distended. No wall thickening.", "output": "Slightly increased renal cortical echogenicity, suggesting medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "History of renal failure on hemodialysis with mid epigastric/right upper quadrant pain. Rule out pancreatitis/cholecystitis. LIVER: The liver measures 15.4 cm in length. There is coarse increased echogenicity. The portal vein is patent with hepatopetal flow measuring 25.1 cm/s. A moderate amount of ascites is present. No worrisome masses are seen. There is no intrahepatic ductal dilation.BILIARY TRACT: The gallbladder is contracted. The gallbladder wall measures 0.4 cm. No stones, sludge, or signs of acute inflammation are seen. Negative sonographic Murphy sign. The common bile duct measures 0.5 cm.PANCREAS: The pancreas is not well-visualized due to bowel gas.SPLEEN: The spleen measures 8.4 cm in length. No significant abnormalities are noted.RIGHT KIDNEY: The right kidney is difficult to visualize, it measures 6.8 cm in length. It has significantly increased echogenicity. LEFT KIDNEY: The left kidney was unable to be visualized on this study as patient was unable to lie flat.", "output": "1. The gallbladder is contracted without stones, sludge, or signs of acute inflammation.2. There is coarse increased echogenicity within the liver compatible with fatty liver/parenchymal dysfunction. A moderate amount of ascites is present. 3 The pancreas is not well-visualized due to bowel gas.4. The right kidney has increased echogenicity compatible with known medical renal disease. The left kidney was unable to be visualized as patient was unable to lie flat."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old female complains of nausea and vomiting. Evaluate for hepatobiliary pathology. LIVER:The liver measures 13.8. There is normal echotexture of the liver. No masses or intrahepatic dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. The common bile duct measures 1.6 cm which may be related to cholecystectomy.PANCREAS: Evaluation the pancreas is limited due to bowel gas.SPLEEN: Spleen measures 10.8 cm.KIDNEYS: Left kidney measures 11.9 cm. It has normal echotexture. No shadowing calculi or hydronephrosis present. The right kidney measures 11.7 cm. It has normal echotexture. No shadowing calculi or hydronephrosis. ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Trace ascites noted. There are small bilateral pleural effusions.", "output": "1. Ascites and pleural effusions as above.2. Common bile duct dilated up to 16 mm, grossly stable from CT."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old female with hyperthyroidism. RIGHT LOBE MEASUREMENTS: 1.7 x 1.5 x 5 cmLEFT LOBE MEASUREMENTS: 1.8 x 1.4 x 5.4 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Heterogeneous with a giraffe pattern described in thyroiditis. No focal mass. Mildly hyperemic.LEFT LOBE: Heterogeneous with a giraffe pattern described in thyroiditis. No focal mass. Mildly hyperemic.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Findings supportive of thyroiditis. No focal nodule."}
{"instruction": "Generate impression based on findings.", "input": "36 year old female with history of nephrolithiasis. Presents with right upper quadrant pain. LIVER: The liver is normal in morphology, echogenicity and size, measuring 15.3 cm in craniocaudal length. An 8mm echogenic shadowing parenchymal calcification is noted. There is no suspicious focal hepatic lesion or intrahepatic biliary ductal dilatation. Normal hepatopetal portal venous blood flow at 30 cm/sec.GALLBLADDER, BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common bile duct measuring 3 mm. Normally distended gallbladder without wall thickening, pericholecystic fluid or cholelithiasis.PANCREAS: The visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: The right kidney appears slightly atrophic, measuring approximately 8.3 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident.LEFT KIDNEY: The left kidney is normal in size, measuring 12.6 cm without hydronephrosis, shadowing calculus or discrete lesion evident.SPLEEN: The spleen measures 12.6 cm in length without a focal lesion.AORTA: The aorta is ectatic without aneurysmal dilatation. The right and left iliac vessels are mildly ectatic measuring 1 and 1.1 cm, respectively.INFERIOR VENA CAVA: The visualized portions of the vena cava are patent.URINARY BLADDER: Partially distended urinary bladder. The left ureteral jet is visualized. OTHER: A right ovarian cyst measuring 2.6 x 2.1 cm is noted.", "output": "No hydroureteronephrosis or shadowing calculus. 2.6-cm right ovarian cyst. Mildly ectatic aorta without aneurysmal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Parathyroid adenoma RIGHT LOBE MEASUREMENTS: 5.3 x 2.0 x 1.8 cm. Normal in size with normal background echotexture and vascularity.LEFT LOBE MEASUREMENTS: 4.4 x 1.2 x 1.2 cm. Normal in size with normal background echotexture and vascularity.ISTHMUS MEASUREMENTS: 10 mm in AP dimensionRIGHT LOBE: There is a slightly hypoechoic 1.7 cm solid nodule in the superior pole. LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: A 1.3 x 0.8 x 1.3 cm hypoechoic nodule is noted posterior to the right inferior thyroid pole. A 4.2 x 2.6 x 1.7 cm hypoechoic nodule is noted posterior to the left inferior thyroid pole. These are similar to the prior ultrasound and correspond to areas of increased uptake on the prior nuclear medicine parathyroid study.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "1. Bilateral parathyroid adenomas, left larger than right. 2. 1.7 cm right intrathyroid nodule. This nodule is amenable to percutaneous biopsy."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male patient status OHT/OLT with persistent ascites fluid from JP. LIMITED ABDOMENLIVER: The liver measures 14.1 cm in length and demonstrates increased parenchymal echogenicity.BILIARY TRACT: There is no intra or extrahepatic biliary ductal dilatation. The common duct measures 4 mm in diameter.PANCREAS: Pancreas is not visualized on this examination secondary to overlying bowel gas.SPLEEN: The spleen measures 13.8 cm in length. KIDNEYS: The right kidney measures 11.4 cm and the left kidney measures 11.3 cm in length. No evidence of hydronephrosis.OTHER: A right pleural effusion is noted. Minimal ascites is present.", "output": "1. Patent portal veins. 2. Minimal ascites and right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old female who was called back at outside screening mammogram presents for additional views 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 heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. There is focal asymmetry at upper outer quadrant in both breasts, without significant changes from prior studies. There are no suspicious findings on spot compression views.Ultrasound study is performed for both breasts, targeting the focal asymmetry. There are no suspicious findings including solid or cystic masses in either breast.", "output": "No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Goiter. Status post right hemithyroidectomy due to multinodular goiter RIGHT LOBE MEASUREMENTS: Right hemithyroidectomy.LEFT LOBE MEASUREMENTS: 5.6 x 1.8 x 1.7 cm, similar to prior.ISTHMUS MEASUREMENTS: 3 mm in AP dimension, similar to prior.RIGHT LOBE: Right hemithyroidectomy.LEFT LOBE: Multiple heterogeneous nodules are noted, similar to prior. What was previously measured to be one nodule, appears as 2 nodules on the current examination. The larger of these measures 2.5 x 1.4 x 2.0 cm, unchanged compared to prior when measured similarly. A cystic nodule measures 1.2 x 1.1 x 0.4 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not identifiedLYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Unchanged multinodular goiter."}
{"instruction": "Generate impression based on findings.", "input": "Hemachromatosis. Evaluate for hepatocellular carcinoma. LIVER: Non-cirrhotic liver morphology. 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 gallbladderPANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney is 10.5 cm in length. The left kidney is 9.7 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 10.8 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.", "output": "Increased hepatic echogenicity, compatible with diffuse liver disease. No suspicious hepatic lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "Female 46 years old; Reason: Assess thyroid nodule History: Thyroid nodule RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 1.9 x 2.0 x 6.1 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 1.6 x 1.9 x 6.2 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.5 cm.RIGHT LOBE: Right lobe is heterogeneous. Posteriorly and inferiorly there is a round heterogeneously cystic/solid nodule measuring 2.0 cm x 1.0 cm x 1.3 cm. No internal microcalcifications are seen and there is a small amount of internal vascularity. LEFT LOBE: The left lobe is heterogeneous. There is a small subcentimeter hypoechoic nodule at the inferior portion of the left thyroid lobe that demonstrates comet tail artifact within.ISTHMUS: Within the isthmus there is a hypoechoic nodule with increased internal vascularity and areas of irregularly increased echogenicity within. This measures 1.9 cm x 0.7 cm x 1.4 cm.LYMPH NODES: No suspicious adenopathy noted.", "output": "1. The thyroid appears heterogeneous.2. There is a dominant hypoechoic nodule with increased internal vascularity visualized within the isthmus. A biopsy of this nodule could be performed as indicated. No suspicious adenopathy is seen.3. Dominant cystic/solid nodule is identified in the inferior/posterior portion of the right lobe. This nodule, as above, meets size criteria for biopsy if clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "CVA tenderness RIGHT KIDNEY: 10.5 cm in length. Normal renal parenchymal echogenicity. No focal lesions, stones, or hydronephrosis.LEFT KIDNEY: 10.2 cm in length. Normal renal parenchymal echogenicity. No focal lesions, stones, or hydronephrosis.OTHER: No significant abnormalities noted. No perinephric fluid collections are identified.", "output": "No specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Male; 30 years old. Reason: Evaluate for gallstones. History: ruq pain LIVER: The liver measures 12.0 cm in length. The liver capsule is smooth and the liver parenchyma demonstrates normal echogenicity. Within the right lobe of the liver is a 10 x 9 x 7 mm solid, hyperechoic lesion with no flow on color Doppler.The main portal vein is patent and demonstrates a normal direction of flow with a peak velocity of 20 cm/sec.BILIARY TRACT: The gallbladder is normal in appearance. There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The common bile duct measures 3 mm. There is no intrahepatic biliary ductal dilatation.PANCREAS: The visualized head of the pancreas is unremarkable. The body and tail are obscured by overlying bowel gas.SPLEEN: The spleen measures 10.1 cm in length.RIGHT KIDNEY: The right kidney measures 10.7 cm in length. There is no hydronephrosis. OTHER: The left kidney measures 12.0 cm in length. There is no hydronephrosis.", "output": "1.No cholelithiasis and no evidence of cholecystitis.2.1 cm hyperechoic liver lesion most compatible with hemangioma."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female patient with chronic generalized abdominal pain. Elevated alkaline phosphatase. LIVER: The liver measures 12.7 cm in length. 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 3 mm in diameter.PANCREAS: Near the pancreatic head/body junction, there is a 1.3 x 1.0 cm gently lobulated hypoechoic focus which does not demonstrate definite increased vascularity. This could correlate to a hypodense area on prior CT (axial image 98). There is no significant pancreatic ductal dilatation.RIGHT KIDNEY: The right kidney measures 11.3 cm in length. No evidence of hydronephrosis. There is a 0.1 x 1.2 x 0 cm septated cystic lesion within the right lower pole.OTHER: The left kidney measures 10.7 cm in length. No evidence of hydronephrosis.The spleen measures 8.0 cm in length.", "output": "1. Hypoechoic focus near the pancreatic head/body junction which could correlate to a hypodense region when compared to prior CT, and may represent a nonspecific cystic pancreatic neoplasm. Given the presence of an adjacent metal clip on the CT which could obscure a lesion on MRI, follow-up is recommended with ultrasound.2. Minimally complex right renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "Varices noted on endoscopy LIVER: Normal parenchymal echogenicity without mass. Noncirrhotic morphology. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 14 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 7.3 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 9.4 cm in lengthOTHER: Left renal cyst. Left kidney 8.3 cm in length. No ascites.", "output": "Normal hepatic morphology and echogenicity without mass or duct dilatation. No evidence for hepatobiliary abnormality. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "84-year-old female with history of intracystic capillary carcinoma on hormonal therapy. Follow-up study. Limited mobility of the patient, ultrasound performed in sitting position.A targeted right ultrasound was performed for the known cancer.At 9:00 position, 5 cm from the nipple, there is redemonstration of a isoechoic mass. The mass now measures 6 x 8 x 9 mm (previously 10 x 7 x 15 mm). There is mild internal vascularity.", "output": "Interval decrease in size of right breast cancer. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "62 year old female with pancreatitis evaluate for biliary dilatation, gallstones or ascites. LIVER: Liver is normal in size and echotexture without gross cirrhotic morphology. No focal mass.GALLBLADDER, BILIARY TRACT: The gallbladder contains dependent gallstones and sludge without gross wall thickening or pericholecystic fluid. The gallbladder is not distended. The common bile duct is normal in caliber although not cannot be followed beyond the porta. There is no gross intrahepatic delayed tract dilatation on today's studyPANCREAS: Pancreas is grossly abnormal and enlarged with central hypoechoic area consistent with necrosis versus abscess. Internal gas is identified. There is infiltrative change in the adjacent fat.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Limited views of the left kidney demonstrate no abnormality.Mild splenomegaly with focus of accessory splenic tissue.Right pleural effusion.", "output": "Findings of acute pancreatitis without ascites. Pancreatic necrosis.Gallstones without gross biliary dilatation or stone."}
{"instruction": "Generate impression based on findings.", "input": "HCV cirrhosis LIVER: Cirrhotic morphology without mass. Liver length 18.5 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: Subcentimeter pancreatic head cyst measuring 0.8 x 0.9 cm.RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 11.8 cm in lengthOTHER: Echogenic left renal parenchyma. Left kidney 10.4 cm in length. Trace ascites.", "output": "Cirrhotic morphology without mass or ductal dilatation. Trace ascites. Subcentimeter pancreatic head cyst. Echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Female 40 years old; Reason: eval thyroid nodules for interval change History: neck fullness RIGHT LOBE MEASUREMENTS: 6.5 x 1.9 x 1.7 cm.LEFT LOBE MEASUREMENTS: 5.0 x 1.6 x 1.6 cm.ISTHMUS MEASUREMENT: 0.7 cm.RIGHT LOBE: There are several nodules in the right lobe of the thyroid. Largest of these measures approximately 1.1 x 0.9 x 0.7 centimeters and appears to have changed since the prior exam and now appears mixed cystic-solid. A previously measured nodule in the inferior aspect of the right lobe appears stable since prior examination. There is a new approximately 0.3 x 0.3 round isoechoic lesion with a hypoechoic rim that was not seen on the prior examination.LEFT LOBE: Heterogeneous echotexture with multiple nodules most prominence of which is 1.1 x 0.5 x 0.7 cm is round, well-defined, hypoechoic. Appears stable since prior examination.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant adenopathy.OTHER: No significant abnormality noted.", "output": "1.Cystic degeneration of a right thyroid nodule.2.Heterogeneous multinodular thyroid.3.New thyroid nodule noted as described above; it is isoechoic with a hypoechoic rim measuring approximately 0.3 x 0.3 cm in the right mid thyroid."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male evaluated for epididymal masses with possible paraneoplastic polyneuropathy. RIGHT TESTIS: The right testicle measures 2.4 cm x 2.5 cm x 3.9 cm. The testicle is homogenous and no masses seen within the right testicle. Small hydrocele is seen on the right. Doppler flow is present and symmetrical throughout.LEFT TESTIS: The left testicle measures 3 cm x 2 cm x 4 cm. The testicles homogenous and no masses are seen. There is a small hydrocele. Doppler flow is present and symmetrical throughout.RIGHT EPIDIDYMIS: The right epididymis measures 1.3 cm x 1.5 cm x 1.8 cm. There is a hypoechoic area posterior to the epididymis measuring 1.1 cm x 1.0 cm x 1.5 cm.LEFT EPIDIDYMIS: The left epididymis measures 2.5 cm x 1.5 cm x 2.4 cm. There are multiple hypoechoic round lesions within the left epididymis. The largest measures 1.8 cm x 2.2 cm x 1.7 cm.", "output": "1. Bilaterally the testicles appear normal with no masses seen and symmetrical blood flow.2. Bilaterally hypoechoic areas within the epididymis likely represent epididymal cysts or spermatoceles.3. Small hydrocele seen bilaterally."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old male patient with right upper quadrant abdominal pain. Question of cholecystitis. LIVER: The liver measures 19.6 cm in length. The hepatic parenchyma is diffusely heterogeneous in echogenicity and increased. Main portal vein flow is hepatopetal and measures 0.27 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. Sonographic Murphy's sign is equivocal. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 4 mm in diameter.PANCREAS: The pancreas is not visualized on this examination secondary to overlying bowel gas.RIGHT KIDNEY: The right kidney measures 9.8 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.4 cm in length. No evidence of hydronephrosis.The spleen measures 14.7 cm in length.", "output": "1. No gallstones or sonographic evidence of acute cholecystitis. 2. Hepatosplenomegaly.3. Heterogeneous, increased hepatic parenchymal echogenicity of uncertain etiology, possibly representing parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Male 70 years old Reason: evaluate for HCC History: 70 M with hx of hep b, increased echogenicity on previous U/S LIVER: Hepatic parenchymal echogenicity is increased and coarsened. No focal hepatic lesions. Hepatic length measures 14.7 cm. Main portal vein is patent with hepatopedal flow and in peak velocity of 21 cm/s.BILIARY TRACT: The gallbladder is normal in appearance with a thin wall measuring 2 mm. Common bile duct is 2 mm. No cholelithiasis. No intrahepatic biliary ductal dilatation.PANCREAS: Pancreas is secured by bowel gas.SPLEEN: Spleen is normal in appearance measuring 10.3 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 11.2 cm. Left kidney measures 12.9 cm is. There is a anechoic unchanged left upper pole renal cyst measuring 3.3 x 2.6 x 2.6 cm. OTHER: No ascites.", "output": "1.Increased hepatic parenchymal echogenicity and coarsened echotexture compatible with hepatic parenchymal dysfunction, possibly related to patient's hepatitis B. No focal hepatic mass or ductal dilatation. 2.Stable left renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "83-year-old male patient with cirrhosis. Evaluate for HCC. LIVER: The liver measures 15.3 cm in length. No focal hepatic lesion is identified. Hepatic parenchymal echogenicity is coarsened. Main portal vein flow is hepatopetal and measures 0.1 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 6 mm in diameter.PANCREAS: The pancreatic duct is mildly dilated, measuring up to 2 millimeters in diameter, similar to the prior study. The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The native right kidney is not visualized secondary to bowel gas.OTHER: The native left kidney is not visualized secondary to bowel gas. The spleen measures 7.3 cm in length.The right iliac fossa transplant kidney measures 13.1 cm in length. No evidence of hydronephrosis.", "output": "1. Coarse liver echotexture, compatible with chronic liver disease, without focal hepatic mass.2. Nonspecific chronic mild dilatation of the pancreatic duct.3. No hydronephrosis of the transplant kidney."}
{"instruction": "Generate impression based on findings.", "input": "Declining renal function, evaluate for urinary obstruction. RIGHT KIDNEY: Kidney measures 13.0 cm in length. Normal echotexture. No hydronephrosis or shadowing calculus. Midpole exophytic simple cyst measuring 2.5 x 2.6 x 2.5 cm. LEFT KIDNEY: Kidney measures 13.1m in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.No hydronephrosis or nephrolithiasis. 2.Right renal simple cyst. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: History of renal transplant with worsening Cr and poor UOP. Please evaluate. History: As above, evaluate transplant concern for hydronephrosis RENAL TRANSPLANT:LOCATION: Left iliac fossa.PERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality noted..COLLECTING SYSTEM/URETER: Mild expected prominence of the collecting system, not significantly changed. No significant hydronephrosis.URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormality noted", "output": "No significant hydronephrosis of the transplant kidney. "}
{"instruction": "Generate impression based on findings.", "input": "19-year-old male with hematuria. Ultrasound guidance was provided for biopsy of the right kidney", "output": "Ultrasound guidance "}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female with right upper quadrant pain. LIVER: Normal in size, contour and echogenicity. No focal abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: The biliary tract is normal in caliber. The 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: No significant abnormalities noted.", "output": "Normal exam. No findings to explain the patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "New onset nephrotic syndrome RIGHT KIDNEY: Mildly echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Right kidney 12.2 cm in length.LEFT KIDNEY: Mildly echogenic renal parenchyma without worrisome mass, stone, or hydronephrosis. Left kidney 10.4 cm in length. Benign appearing left renal cyst.OTHER: Bladder nondistended.", "output": "Mildly echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for abscess/soft tissue source of infection in left leg History: Left leg pain, erythema, swelling. There is extensive subcutaneous edema and inflammation in the subcutaneous tissues of the left anteromedial lower extremity without focal fluid collection or abscess.", "output": "Extensive subcutaneous edema and inflammation, which can be seen in cellulitis. No focal fluid collection or abscess."}
{"instruction": "Generate impression based on findings.", "input": "Reason: tender swelling under the chin. Evaluate for abscess vs lymph node vs other. History: tender swelling under the chin There is a 1.5 x 0.6 x 1.6 cm prominent submental lymph node with a benign appearance and fatty hilum, corresponding to patient's region of discomfort. No other suspicious nodules or masses are identified.", "output": "Prominent submental lymph node with a benign appearance."}
{"instruction": "Generate impression based on findings.", "input": "Elevated liver enzymes, evaluate for cirrhosis, portal vein thromboses LIVER: Coarsened hepatic echotexture. There is a 1 cm cyst in the left hepatic lobe. The main portal vein is patent.GALLBLADDER, BILIARY TRACT: Gallbladder sludge without wall thickening. There is nonspecific pericholecystic fluid.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Measures 10.0 cm in length. No hydronephrosis or mass.OTHER: Left kidney measures 11.2 cm in length. The spleen measures 9.2 cm in length.", "output": "1.Coarsened hepatic echotexture without evidence of cirrhosis. 2.The main portal vein is patent. 3.Gallbladder sludge without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "77 year-old male with complex right renal cyst for follow-up. RIGHT KIDNEY: The right kidney measures approximately 11 cm in length. Echotexture is normal. There is no hydronephrosis or shadowing calculus. The patient's known mildly complex and exophytic cyst is not well-visualized but measures approximate 1.4 x 1.4 cm in transverse which is unchanged from prior CT.LEFT KIDNEY: The left kidney measures approximately 12.5 cm in length. Echotexture is normal. There is no hydronephrosis, shadowing calculus or mass.OTHER: Bladder is incompletely distended", "output": "Stable complex cyst, right kidney."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male patient with likely cirrhosis. Question of ascites, portal vein thrombus. LIVER: The liver measures 21.8 cm in length and demonstrates increased parenchymal echogenicity. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal but sluggish measuring 0.1 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is filled with sludge. No gallbladder wall thickening or pericholecystic fluid. Sonographic Murphy's sign is negative. 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 11.6 cm in length. No evidence of hydronephrosis. There is a 6 mm right lower pole renal stone.OTHER: The left kidney measures 11.8 cm in length. No evidence of hydronephrosis.The spleen measures 12.9 cm in length.A small amount of free fluid is noted in the pelvis.", "output": "1. Hepatomegaly and increased hepatic parenchymal dysfunction suggestive of hepatic steatosis/hepatic parenchymal dysfunction. 2. Biliary sludge. 3. Non-obstructing right nephrolithiasis. "}
{"instruction": "Generate impression based on findings.", "input": "HCV LIVER: Mildly echogenic liver parenchyma without mass. Liver length 16.9 cm.GALLBLADDER, BILIARY TRACT: Gallbladder absent. Mild dilatation of common bile duct with maximal diameter of 0.9 cm without obvious distal obstructing lesion or intrahepatic ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9 cm in lengthOTHER: Left kidney 9.2 cm in length. Spleen 9.9 cm in length. No ascites", "output": "Mildly echogenic liver parenchyma consistent with chronic liver disease without mass. Mild dilatation of common bile duct without obvious distal obstructing lesion or intrahepatic ductal dilatation status post cholecystectomy. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old female with creatinine of 3.7. Evaluate RIGHT KIDNEY: The right kidney measures 14.1 cm in length and is moderately echogenic.LEFT KIDNEY: The left kidney measures 14.4 cm and is moderately to severely echogenic.BLADDER: Foley catheter noted.", "output": "Bilateral echogenic kidneys consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal liver function test LIVER: Coarse echogenic and heterogeneous liver echotexture without worrisome mass. Stable left lobe hepatic cyst. Liver length 14.4 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: Not visualized due to overlying gasRIGHT KIDNEY: No significant abnormalities noted. 11.1 cm in lengthOTHER: Left kidney 11.2 cm in length. Spleen 10.8 cm in length. No ascites.", "output": "Coarse, echogenic, and heterogeneous liver suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Right testicular pain RIGHT TESTIS: 4.3 x 2.2 x 2.8 cm. No worrisome intratesticular mass. Benign ectasia of the rete testes. Bilaterally symmetric Doppler flow characteristics.LEFT TESTIS: 4.4 x 2.2 x 2.8 cm. No worrisome intratesticular mass. Bilaterally symmetric Doppler flow character 6.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Negative scrotal ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male with pelvic hematoma due to fall on prior ultrasound. Renal transplant patient. RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: On today's study, there is inferior to the transplant a fluid component of the prior collection measuring 1.6 x 1.5 x 2.2 cm. There may be a more echogenic component anteriorly which cannot be adequately visualized.KIDNEY: There is no hydronephrosis or parenchymal abnormality.COLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: Patient voided prior to procedure.OTHER: No significant abnormality noted", "output": "Small residual fluid portion of collection noted on 4/14/2016 ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "67 years old, Female, Reason: evaluate for HCC History: cirrhosis LIVER: The liver measures 14.2 cm in length. Nodular contour of the liver is consistent with cirrhosis. No focal hepatic lesion identified. The portal vein is patent demonstrating hepatopetal flow with a velocity of 0.1 m/s. Perihepatic ascites is noted.BILIARY TRACT: There is no evidence of cholelithiasis. The gallbladder is thickened and edematous, nonspecific and likely reactive in setting of cirrhosis/related to hypoalbuminemia. Per ultrasound technologist, 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: Pancreas is not well visualized due to overlying bowel gas.SPLEEN: The spleen is enlarged measuring 17.8 cm in length. Splenule noted adjacent to the spleen measuring 2.3 x 2.0 by 2.0 cm.RIGHT KIDNEY: Kidney measures 10.2 cm in length. Normal echotexture. Mild hydronephrosis on the right without shadowing calculus delineated, entirety of right ureter not seen due to overlying bowel gas.LEFT KIDNEY: Kidney measures 8.9 cm in length. Normal echotexture. No hydronephrosis or shadowing calculus. Previously noted inferior pole cyst is not seen on this exam.", "output": "1.Cirrhotic liver without evidence of focal hepatic lesion.2.Moderate amount of ascites and splenomegaly are present, likely secondary to cirrhosis. Thick-walled gallbladder as described."}
{"instruction": "Generate impression based on findings.", "input": "Ultrasound follow-up for a small palpable area in the left breast inferior breast. A targeted left ultrasound was performed for the patient\u2019s area of concern. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy. The patient will be following up in surgical clinic later today.BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Jaundice and elevated bilirubin. Status TAVR and right hip fixation. LIVER: The liver is mildly coarse in echotexture. It is normal in morphology. It measures 16.8 cm in length. No focal lesion or intrahepatic biliary ductal dilatation. The hepatic veins are dilated. Hepatopedal portal venous blood flow at 45 cm/s.BILIARY TRACT: The common duct measures up to 8 mm without a filling defect evident.Sludge within a normally distended gallbladder. The gallbladder wall measures 2 mm. Trace pericholecystic free fluid is nonspecific. No focal tenderness.PANCREAS: The visualized portions of the pancreatic head and body are unremarkable. The remainder is obscured by overlying bowel gas.SPLEEN: The spleen is normal in size measuring 7 cm. The left kidney measures 8.2 cm in length without hydronephrosis or shadowing nephrolithiasis.RIGHT KIDNEY: The right kidney is atrophic measuring 8.2 cm in length without hydronephrosis or shadowing nephrolithiasis. OTHER: No significant abnormalities noted.", "output": "Coarse liver parenchyma suggestive of parenchymal liver disease. Gallbladder sludge without specific evidence of acute cholecystitis.Atrophic kidneys compatible with chronic renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Hyperkalemia RIGHT KIDNEY: 9.8 cm in length. The renal parenchyma is echogenic. No hydronephrosis. Subcentimeter renal cysts noted. No suspicious lesions are noted.LEFT KIDNEY: 12.1 cm in length. The renal parenchyma is echogenic. No hydronephrosis. No suspicious lesions are noted.BLADDER: Distended, without significant abnormality noted.OTHER: Small amount of ascites identified. Right pleural effusion partially visualized.", "output": "1. Echogenic renal parenchyma, without hydronephrosis, compatible with medical renal disease.2. Small amount of ascites and right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain. Nausea. Loss of appetite. Family history of pancreatic cancer. History of left renal ablation. LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. 11 mm cyst noted in the left hepatic lobe. No suspicious hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Gallbladder wall adenomyomatosis noted. Otherwise unremarkable 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 10.7 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.The left kidney is 8.1 cm in length. There are two echogenic foci near the renal pelvis, which may represent calcification from prior ablation procedure. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 6.2 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid identified.", "output": "No specific findings to account for the patient's abdominal pain."}
{"instruction": "Generate impression based on findings.", "input": "Right-sided palpable mass and/or lymph node. Targeted grayscale and color Doppler ultrasound at the site of the patient's palpable abnormality of the right side of the neck demonstrates a normal morphology and mildly prominent lymph node measuring 2.5 x 1.3 x 0.7.", "output": "The patient's right neck palpable abnormality corresponds to a normal morphology and mildly prominent lymph node, likely reactive."}
{"instruction": "Generate impression based on findings.", "input": "Epigastric pain LIVER: No significant abnormalities noted. 18 cm in lengthBILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 11 cm in lengthRIGHT KIDNEY: Stable minimally complex cyst. Right kidney 9.2 cm in length.OTHER: Left kidney 9.8 cm in length. No ascites.", "output": "Cholelithiasis without acute inflammation or ductal dilatation. Liver size upper limits of normal without mass. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female with right upper quadrant pain. LIVER: Mild increased hepatic echogenicity without focal lesion.GALLBLADDER, BILIARY TRACT: Cholelithiasis without gallbladder wall thickening, pericholecystic fluid, or sonographic Murphy sign. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "1. Cholelithiasis without specific sonographic evidence of acute cholecystitis.2. Mildly increased hepatic echogenicity may represent hepatic steatosis or parenchymal disease."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodule seen on chest CT. Weight loss. RIGHT LOBE MEASUREMENTS: Best measurement of 6.2 x 2.0 x 3.1 cm, though the inferior aspect of the right lobe is substernal and incompletely visualized.LEFT LOBE MEASUREMENTS: 6.1 x 2.7 x 0.7 cm.ISTHMUS MEASUREMENTS: 4 mm in AP dimension.RIGHT LOBE: A large heterogeneous minimally hypoechoic nodule is noted extending from the inferior pole. The inferior margin is not visualized due to substernal extension, though this approximately measures 3.0 x 2.3 x 2.8 cm. The echotexture of this nodule along with areas of comet tail artifact suggest this to be an intrathyroidal nodule. A large cystic nodule inferior and posterior to this nodule is also incompletely visualized due to substernal location, though measures approximately 2.9 x 2.2 x 1.8 cm. This does not appear to arise from the thyroid gland. An additional homogeneous 9 mm minimally hypoechoic nodule is noted in the midpole.LEFT LOBE: Two large heterogeneous minimally hypoechoic nodules in the inferior pole measure 3.3 x 2.8 x 1.4 cm and 3.8 x 3.0 x 3.2 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Multiple large thyroid nodules in the inferior thyroid poles bilaterally, extending into the superior mediastinum on the right.2. Cystic nodule adjacent to the right thyroid lobe inferior pole is incompletely visualized though appears to be extrathyroidal extending into the superior mediastinum."}
{"instruction": "Generate impression based on findings.", "input": "Male 60 years old; Reason: HBV carrier on immune spression d/t renal transplant, eval for HCC History: HBV carrier LIVER: The liver measures 18.7 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 21.1 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.1 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 3.3 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 8.6 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 9.0 cm in length and appears atrophic. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.RIGHT ILIAC FOSSA TRANSPLANT KIDNEY: The transplant kidney measures 11.2 cm in length. No hydronephrosis. No perinephric fluid collections are seen.LEFT KIDNEY: Left kidney was not visualized.", "output": "1. There is coarse increased echogenicity of the liver compatible with fatty infiltration/hepatocellular disease. No new focal masses are seen within the liver.2. The transplant kidney the right iliac fossa is visualized without any abnormalities noted. No hydronephrosis or perinephric fluid collections."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old female partial right nephrectomy for clear cell renal cell carcinoma. RIGHT KIDNEY: Deformity due to prior partial nephrectomy. No gross, solid mass. No hydronephrosis or shadowing calculus. Kidney measures 11.3 cm in lengthLEFT KIDNEY: Kidney measures 11 cm in length. No hydronephrosis, shadowing calculus or mass.OTHER: No gross bladder abnormality", "output": "No ultrasound evidence for renal mass."}
{"instruction": "Generate impression based on findings.", "input": "56 years old, Female, Reason: Have thyroid nodules grown? Exam in February 2014 is scanned into EPIC for comparison. RIGHT LOBE MEASUREMENTS: The right lobe measures 4 x 2 x 2 cmLEFT LOBE MEASUREMENTS: Left lobe measures 4 x 1.5 x 1 cm.ISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Multiple simple cystic appearing cysts in the right lobe.LEFT LOBE: There is a colloid nodule in the left which is favored to have a benign etiology.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple cysts in the right thyroid lobe. Colloid nodule in the left thyroid lobe is favored to have a benign etiology. "}
{"instruction": "Generate impression based on findings.", "input": "79-year-old male with history of childhood radiation. RIGHT LOBE MEASUREMENTS: 3.4 x 1.9 x 1.6 cmLEFT LOBE MEASUREMENTS: 3.3 x 1.9 x 1.2 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: The right thyroid lobe is normal in morphology, echogenicity, and size without a discrete nodule.LEFT LOBE: The left thyroid lobe is normal in morphology, echogenicity and size without a discrete nodule.ISTHMUS: The isthmus is normal in morphology, echogenicity and size without a discrete nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Normal appearing thyroid."}
{"instruction": "Generate impression based on findings.", "input": "Reason: r/o pancreatitis, cholecystitis History: elevated lipase Examination limited due to constraints positioning patient as well as bandages.LIVER: The liver measures 20.6 cm in length. The liver is heterogeneous in echotexture which limits sensitivity for focal lesions. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.19 m/s.BILIARY TRACT: The gallbladder is contracted and contains stones and/or sludge. There is gallbladder wall thickening measuring up to 6 mm. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 5.6 mm in diameter.PANCREAS: There is a linear echogenic structure in the pancreatic neck and body compatible with a stent.SPLEEN: No significant abnormalities noted. The spleen measures 11.0 cm in length. RIGHT KIDNEY: Kidney measures 10.8 cm in length. Normal echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 8.9 cm in length. Normal echotexture. No hydronephrosis.OTHER: Ascites.", "output": "1.Limited exam.2.Heterogeneous appearance of the liver which is nonspecific. Underlying lesions cannot be excluded, and dedicated contrast-enhanced cross-sectional imaging is recommended for further evaluation when the patient is clinically able.3.Contracted gallbladder with cholelithiasis and gallbladder wall thickening. Chronic cholecystitis is not excluded and could be further evaluated with HIDA scan if clinically indicated. 4.Ascites."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old female patient with intermittent right upper quadrant pain, severe, worse after eating wings. Evaluate for gallstones. LIVER: The liver measures 15.9 cm in length. 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 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 10.3 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11 cm in length. No evidence of hydronephrosis.The spleen measures 9.8 cm in length.", "output": "No cholelithiasis or other specific finding to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old female with prior thyroidectomy for thyroid cancer. Evaluate for recurrent disease. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massLEFT LOBE: No massISTHMUS: No massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No abnormal-appearing lymph nodes. Reference node in the right neck measures 0.4 x 1 x 1.4 cm without significant change.OTHER: No significant abnormality noted.", "output": "Stable exam. No evidence for recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old male with hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 2.8 x 0.9 x 5.5 cmLEFT LOBE MEASUREMENTS: 2.5 x 1.2 x 3.7 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Posterior to the right lobe of the thyroid is a very large, primarily solid mass with cystic components. This measures 2.2 x 2.3 x 4.5 cm.Posterior to the left lobe of the thyroid is a large, predominantly cystic mass with partial septation and slight eccentric wall thickening measuring 2.2 x 2.2 x 3.1 cm.LYMPH NODES: No significant abnormality notedOTHER: No significant abnormality noted.", "output": "Normal thyroid.Large, bilateral extrathyroidal masses. Although the appearance is unusual, with the patient's history the findings are consistent with bilateral parathyroid adenomas."}
{"instruction": "Generate impression based on findings.", "input": "Rule out ascites. Bloating. Large volume ascites in both lower quadrants.", "output": "Large volume ascites in both lower quadrants."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old morbidly obese female with neutropenic fever, bacteremia and cutaneous abdominal abscesses. Evaluate for intra-abdominal fluid collection. The examination is extremely limited and inadequate due to body habitus. No gross intra-abdominal/pelvic fluid collection.", "output": "Limited exam without fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old female with transaminitis. Evaluate liver. LIVER:Measures 14.8 cm. Increased echogenicity. No focal mass, ascites, or intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. The wall measures 2.7 mm. No pericholecystic fluid, stones, or sludge. The common bile duct measures 2.8 mm.PANCREAS: Evaluation is limited due to overlying bowel gas.SPLEEN: Measures 8.4 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 9.4 cm. Left kidney measures 11.0 cm. Normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "1. Increased hepatic echogenicity consistent with fatty infiltration and chronic liver disease/parenchymal dysfunction. No mass or ascites."}
{"instruction": "Generate impression based on findings.", "input": "44 year old woman with history of calcifications seen on screening mammogram 1/23/15. Also complains of a palpable mass in right superolateral axilla. An ML view and two spot magnification 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. Regional, round calcifications are seen in the left superolateral breast. These are highly likely benign based on distribution and morphology.  ULTRASOUND", "output": "1. Regional round calcifications in the left superolateral breast are highly likely benign. Followup with unilateral diagnostic mammogram is recommended in 6 months. Recommendation was discussed with and provided to the patient in writing.2. Sebaceous cyst of the right axilla.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old female with history of stones. Evaluate for stones RIGHT KIDNEY: The right kidney measures 10.8 cm in length and is normal in echogenicity. There is an echogenic focus at the right upper pole measuring 7 mm, compatible with nephrolithiasis, which is stable.LEFT KIDNEY: The left kidney measures 12.2 cm in length with normal cortical echogenicity. There is a 2.8 cm minimally complex cyst which is mildly increased in size compared to the previous examination, previously measuring 2.3.BLADDER: No significant abnormalities noted.OTHER: Incidentally noted diffuse fatty hepatic infiltration.", "output": "1.Stable right nonobstructive nephrolithiasis. 2.No significant interval change in minimally complex left renal cyst.3.Hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "Heart transplant evaluation LIVER:No significant abnormality noted. 13.4 cm in length GALLBLADDER, BILIARY TRACT: No significant abnormality noted.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. 9.3 cm in lengthKIDNEYS: No significant abnormality noted. Right kidney 9 cm in length. Left kidney 10 cm in length. ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted. No ascites", "output": "Negative abdominal ultrasound without evidence for acute, inflammatory, or neoplastic process."}
{"instruction": "Generate impression based on findings.", "input": "Male 77 years old with elevated bili, fever/septic shock, assess for cholangitis LIMITED ABDOMENLIVER: The liver has a smooth contour, it measures 22.0 cm in length. The parenchyma is mildly coarse and echogenic . No focal liver lesion is identified. The main portal vein is patent and demonstrates hepatopetal flow with a velocity of 3.0 m/s. There is a small amount of perihepatic ascites.BILIARY TRACT: There is no cholelithiasis. The gallbladder wall is thickened at 1.2 cm, there is no pericholecystic fluid. Common duct measures 4 mm in diameter, there is mild thickening of the common bile duct wall. There is no intrahepatic biliary ductal dilatation or focal liver lesion.PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 13.2 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. The left kidney measures 12.7 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 11.9 cm. in length. There are scattered splenic calcifications.OTHER: Trace right pleural effusion.", "output": "1.Gallbladder wall edema and mild thickening of the common duct wall are non-specific findings that can be seen in cholangitis. 2.Hepatomegaly with mildly echogenic liver parenchyma compatible with hepatic steatosis/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female underwent recent diagnostic mammogram of the right breast on 8/12/15 which did not demonstrate any suspicious mass corresponding to the physician palpated area in the right breast 7:00 position. Donna Christian saw the patient today and felt a palpable mass at 7:00 position which she marked for targeted ultrasound. On physical examination, a soft vague subcentimeter masses palpated corresponding to the marked area on the skin. A targeted right ultrasound was performed for the palpable area of concern. There is no solid or cystic mass identified. Normal glandular tissue noted.", "output": "No sonographic evidence for malignancy corresponding to the palpable area in the right breast 7:00 position. Clinical correlation is recommended. If the palpable area is suspicious, FNA can be performed. Annual screening mammogram is recommended, due in May 20, 2016.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old male presents with right upper quadrant pain. LIVER:Measures 14.2 cm. Mild bilobar hepatic biliary dilation is noted without extrahepatic dilatation. No masses. Trace ascites. There is a prominence of the portal triads.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. Wall is 0.2 cm. No stones or sludge. Common hepatic duct measures 0.4 centers. Common bile duct measures 0.5 cm.PANCREAS: Evaluation the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 17.1 cm.KIDNEYS: Left kidney measures 9.8 cm. Right kidney measures 9.4 cm. Normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "1. Mild bilobar intrahepatic biliary dilation without extrahepatic biliary dilation is consistent with a cholestatic picture.2. Prominent triads the liver parenchyma which can be seen in the setting of hepatic edema which may be suggestive of hepatitis or diffuse infiltrative process .3. Trace ascites.4. Splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Cancer status post surgery and I-131 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: Not visualized.LYMPH NODES: A 5 x 3 x 2 mm left level III lymph node demonstrates abnormal morphology, with internal echogenic foci and convex contoursOTHER: No significant abnormality noted.", "output": "1. No evidence of residual disease in the postsurgical thyroid bed2. Abnormal left level III cervical lymph node identified"}
{"instruction": "Generate impression based on findings.", "input": "Male 62 years old Reason: hx of bilateral renal masses, evaluate for change in size or characteristics, notably for large left renal cyst with mural nodule History: see above RIGHT KIDNEY: Right kidney measures 11.3 cm. Again noted multiple cysts largest measuring 3.3 x 3.1 x 2.9 cm within the right kidney. Some of the cysts demonstrate septations. Echogenic kidney. No evidence of hydronephrosis.LEFT KIDNEY: Left kidney is also echogenic. Left kidney measures 11.3 cm. Multiple cysts in the left kidney largest measuring 2 x 1.9 x 1.2 cm. No hydronephrosis.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Bilateral echogenic kidneys. Bilateral renal cysts. Some of the right renal cyst are complicated with thick septations. No significant change from previous study."}
{"instruction": "Generate impression based on findings.", "input": "Hyperparathyroidism RIGHT LOBE MEASUREMENTS: 4.8 x 1.5 x 1.4 cmLEFT LOBE MEASUREMENTS: 4.2 x 1 x 1.5 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: 2.8 x 1.9 x 1.7 cm hypoechoic extrathyroidal lesion projecting inferior and posterior to the right thyroid gland. In addition, there is a 1.8 x 1.5 x 1.2 cm extrathyroidal hypoechoic lesion projecting posterior inferior to the left thyroid gland.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral hypoechoic extrathyroidal lesions as described consistent with bilateral parathyroid adenomas/hyperplasia. No thyroid nodule or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "51 year old female who was recalled from screening mammogram for focal asymmetry in the right breast . Mammogram: An ML 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 composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. Focal asymmetry in the right central breast with possible correlate in the superior breast disperses into normal breast tissue. Few benign calcifications are noted. Ultrasound: Targeted ultrasound in the right breast 12:00 position was obtained. No suspicious cystic or solid mass 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": "Fevers and chills. RIGHT KIDNEY: The right kidney measures 11.1 cm in length without hydronephrosis or shadowing nephrolithiasis. There is multifocal cortical thinning/scarring.LEFT KIDNEY: The left kidney measures 12.2 cm in length without hydronephrosis or shadowing nephrolithiasis. Multifocal cortical thinning/scarring.OTHER: The urinary bladder is collapsed with a Foley catheter in place.", "output": "No hydronephrosis or shadowing nephrolithiasis. Multifocal bilateral cortical thinning/scarring may reflect chronic reflux nephropathy and/or chronic infection."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old male. Patient with left testicular pain. Evaluate for torsion. RIGHT TESTIS: Normal echogenicity. No focal mass. 4.2 x 2.4 x 3.1 cm.LEFT TESTIS: Normal echogenicity. Small 2 mm hypoechoic focus in the central testicle which fills completely with flow on color Doppler images is likely a vessel. No suspicious testicular mass. 3.8 x 2.2 x 2.9 cm.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: Mild asymmetrically increased vascularity to the left epididymis raises the possibility of epididymitis.OTHER: Symmetric color Doppler flow and normal arterial waveforms of both testicular speaks against torsion.", "output": "No evidence of testicular torsion. Mild hyperemia to the left epididymis, raises possibility of mild epididymitis."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old woman recalled from screening mammogram for suspicious right breast microcalcifications. Patient indicated there is a possibility she may be pregnant. Ultrasound is being performed to assess for microcalcification. A targeted right ultrasound was performed for the mammographic area of concern. Unremarkable fibroglandular tissue is seen in the right breast central to nipple and in the outer quadrant near the 9:00 position. Fine segmentally distributed microcalcifications identified on the prior mammograms are not discretely seen.", "output": "Fine segmental distributed right breast microcalcifications are not seen on ultrasound. Serum beta hCG pregnancy test has been ordered. The patient will scheduled for stereotactic biopsy as soon as results are received. Findings and recommendations were discussed with the patient at the time of the exam.Bi-Rads below reflects this exam only. Please note that biopsy continues to be recommended based on the mammogram finding. BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess for cirrhosis, biliary tree abnormalities History: chronic hepatitis c with transaminitis LIVER: The liver measures 17.9 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: Cholelithiasis including stone in gallbladder neck. No 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.SPLEEN: No significant abnormalities noted. The spleen measures 8.6 cm in length. RIGHT KIDNEY: Kidney measures 10.0 cm in length. Increased parenchymal echogenicity is suggestive of medical renal disease/parenchymal dysfunction. No hydronephrosis or shadowing calculi. In the superior pole of the right kidney, there is a cystic structure with suggestion of fine internal septations.LEFT KIDNEY: Kidney measures 12.2 cm in length. Increased parenchymal echogenicity is suggestive of medical renal disease/parenchymal dysfunction. No hydronephrosis or shadowing calculi. Simple appearing cyst in the left kidney measuring 4.2 x 4.2 x 3.7 cm.OTHER: No significant abnormalities noted.", "output": "1.Cholelithiasis without sonographic evidence of acute cholecystitis or biliary ductal dilatation.2.Echogenic kidneys suggestive of medical renal disease.3.Minimally complex right renal cyst, with thin internal septations suggested."}
{"instruction": "Generate impression based on findings.", "input": "Rule out cholelithiasis right flank pain with radiation to right shoulder Suboptimal scan, large body habitus making penetration and visualization of structures difficult.LIVER: Liver measures 16.9 cm with moderate increased echogenicity consistent with hepatic steatosis. No focal lesions noted within the liver.No intrahepatic biliary ductal initiation. Portal vein demonstrates normal flow directionality and patency.BILIARY TRACT: Common bile duct at the porta measures up to 4 mm. Gallbladder is well-distended without any focal lesions or gallstones. No evidence of pericholecystic fluid. Sonographic Murphy sign is negative.PANCREAS: Not visualized due to overlying bowel gasSPLEEN: Spleen measures 8.2 cm, partially visualized due to patient body habitus and overlying bowel gasKIDNEY: Right kidney measures 12.6 cm and left kidney measures 11.3 cm. Both kidneys demonstrate cortical thinning and increased echogenicity suggestive of chronic medical renal disease. Nonobstructing left renal calculus in the midpole measuring up to 5 mm is redemonstrated.OTHER: No ascites", "output": "Bilateral echogenic kidneys consistent with chronic medical renal disease.Hepatic steatosis.No evidence of acute cholecystitis or cholelithiasis.Nonobstructing left renal calculus which is unchanged from prior examination."}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine Interval decrease in size of perinephric hematoma, now measuring 5.1 x 2.9 cm. No stone or significant hydronephrosis. OTHER: Bladder nondistended.", "output": "Interval decrease in size of perinephric hematoma. No significant hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Goiter RIGHT LOBE MEASUREMENTS: 5.6 x 2.2 x 2.7 cmLEFT LOBE MEASUREMENTS: 4.4 x 1.4 x 1.5 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: No significant change in diffusely heterogeneous echotexture with increased vascularity. Stable hyperechoic nodule measuring 1.3 x 0.9 x 1 cmLEFT LOBE: No significant change in diffusely heterogeneous echotexture with increased vascularity. No discrete nodule.ISTHMUS: No significant change in diffusely heterogeneous echotexture with increased vascularity. No obvious nodule appreciated within the isthmusPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No significant change in diffusely heterogeneous echotexture with increased vascularity consistent with known Graves' disease. Stable hyperechoic right thyroid nodule. Previously noted Isthmus nodule not appreciated. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Rising creatinine/AKI unclear etiology History: AKI RIGHT KIDNEY: The renal parenchyma appears hyperechoic with poor corticomedullary differentiation. The right kidney is 13.7 cm in length, previously 14.3 cm. No hydronephrosis.LEFT KIDNEY: The renal parenchyma appears hyperechoic with poor corticomedullary differentiation. The left kidney is 13.6 cm in length, previously 13.9 cm. No hydronephrosis.OTHER: The liver is also diffusely hyperechoic. The bladder is decompressed, limiting evaluation.", "output": "1. Hyperechoic renal parenchyma is nonspecific and can be seen in medical renal disease.2. Diffusely hyperechoic liver, consistent with hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "Left lower extremity thigh cellulitis. Evaluate for underlying abscess. Targeted ultrasound of the patient's left anterior thigh soreness/redness was performed. There is mild subcutaneous edema without a discrete fluid collection.", "output": "Mild subcutaneous edema without a discrete fluid collection to suggest an abscess."}
{"instruction": "Generate impression based on findings.", "input": "68 year old female with HCV. Evaluate for cirrhosis or HCC. LIVER: The liver is normal in morphology, echogenicity and size, measuring 16 cm in the craniocaudal dimension. The liver capsule is smooth. No intrahepatic biliary ductal dilatation or focal hepatic lesion is evident. There is normal hepatopetal portal venous blood flow at 19 cm/sec.BILIARY TRACT: A normally distended gallbladder is present without gallstones, wall thickening, pericholecystic fluid, or focal tenderness.No extrahepatic biliary ductal dilatation with the common bile duct measuring 5 mm.PANCREAS: The visualized pancreatic head is unremarkable. SPLEEN: The spleen measures 7.7 cm in length without a discrete lesion.RIGHT KIDNEY: The right kidney measures 12 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. OTHER: The left kidney measures 10.4 cm without hydronephrosis, shadowing calculus, or discrete lesion evident.", "output": "No focal hepatic lesion or specific stigmata of cirrhosis."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 8.5 cm in lengthLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 9.9 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": "Reason: Follow-up on history of hydronephrosis History: previous ultrasound with hydronephrosis BLADDER  Wall Thickness: Normal  Contents: Distended and normal. 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: 0 Left: 0  Length*** Right: 6.3 cm Left: 6.8 cm   Mean for age: 6.2 cm  Range for age: 5 - 7.6 cmADDITIONAL OBSERVATIONS: None.", "output": "Normal examination.*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": "29-year-old female. Evaluate kidney stones. ABDOMEN: Exam is not sensitive for solid organs or bowel to the lack of intravenous and oral contrast.LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Single 3-mm focus of nephrolithiasis midright kidney. No calcification seen along the course of the ureters. Kidney contour is normal. Perinephric fat is normal. No hydronephrosis.Left kidney is normal. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: Small soft tissue focus exophytic off anterior uterus abutting the abdominal wall, may represent a small fibroid in and much less likely portion of a urachal remnant.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": "Single punctate calcification right kidney. Uterine finding as above."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain, rule out cholelithiasis LIVER: Liver measures 18.3 cm with normal architecture. No focal lesions noted. Portal vein demonstrates normal flow directionality and patency.BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilatation. The common bile duct measures 0.4 cm. The gallbladder contains sludge and stones, and the gallbladder wall measures up to 4 mm in thickness. No pericholecystic fluid. Sonographic Murphy sign is a clearly localized this point as patient complains of pain also radiating to her back.PANCREAS: Head of the pancreas as visualized appears unremarkable. Body and tail of pancreas is not visualized due to overlying bowel gas.SPLEEN: Spleen measures 9.1 cm and appears unremarkable.RIGHT KIDNEY: Right kidney measures 10.8 cm and left kidney measures 10.8 cm. No hydronephrosis or focal lesions noted. Normal echotexture noted. OTHER: No ascites", "output": "Cholelithiasis and gallbladder wall thickening. No pericholecystic fluid. Acute cholecystitis is not excluded."}
{"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": "Male, 68 years old. Reason: baseline exam as part of evaluation for heart transplant History: none LIVER: The liver measures 17.7 cm, with heterogeneous increased echogenicity, and no focal lesion.The main portal vein is patent, with normal hepatopetal flow.GALLBLADDER, BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilatation. The common bile duct measures 0.3 cm. Gallbladder wall thickness is normal. No stones.PANCREAS: The pancreas is completely obscured by overlying bowel gas.SPLEEN: 11.9 cm in length, without focal lesion.RIGHT KIDNEY: 12.0 cm in length, with increased echogenicity. No focal lesion or hydronephrosis.LEFT KIDNEY: 11.4 cm in length, with increased echogenicity. No focal lesion or hydronephrosis.BLADDER: The bladder is incompletely distended, with minimal circumferential wall thickening and trabeculation.ABDOMINAL AORTA: The abdominal aorta is completely obscured by overlying bowel gas.INFERIOR VENA CAVA: The IVC is patent.OTHER: Right pleural effusion.", "output": "1.Echogenic liver compatible with fatty infiltration. Echogenic kidneys compatible with medical renal disease.2.Circumferential bladder wall thickening and trabeculation, likely related to prostate hypertrophy.3.Overlying bowel gas limits evaluation of deep abdominal structures, including the aorta."}
{"instruction": "Generate impression based on findings.", "input": "Follow-up gallbladder polyp; history cirrhosis LIVER: Stable cirrhotic morphology without mass.GALLBLADDER, BILIARY TRACT: Subcentimeter gallstone. No acute inflammation or ductal dilatation. No polyp identifiedPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.2 cm in lengthOTHER: Left kidney 13.4 cm in length. Spleen 17.3 cm in length. No ascites.", "output": "Cirrhotic liver morphology without mass or ductal dilatation. No ascites. Subcentimeter gallstone without evidence for acute inflammation; no gallbladder polyp identified."}
{"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: No significant abnormalities noted.", "output": "Nonobstructive left renal pelvis stone. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Male 71 years old; Reason: Characteristics of let lobe History: s/p partial thyroidectomy, enlarged left lobe RIGHT LOBE MEASUREMENTS: 2.0 x 1.3 x 1.3 cmLEFT LOBE MEASUREMENTS: 5.7 x 2.7 x 8.4 cmISTHMUS MEASUREMENT: Not visualized.RIGHT LOBE: Partial resection of the right thyroid lobe, with residual heterogenous remaining tissue in the right thyroid bed.LEFT LOBE: Enlarged heterogeneous left thyroid lobe, which was seen to extend into the chest and CT neck from 1/11/2016 and the full extent is not visualized on ultrasound examination.ISTHMUS: Not visualized.LYMPH NODES: Bilateral small lymph nodes are visualized.OTHER: No significant abnormality noted.", "output": "Patient status post partial right thyroidectomy, with enlarged heterogeneous left thyroid lobe and small residual right thyroid lobe."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Hepatomegaly. No mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 20.4 cm.BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 10.8 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 11.6 cm in lengthOTHER: Left kidney 12.4 cm in length. No ascites", "output": "Hepatomegaly without mass. Cholelithiasis without acute inflammation or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 87 years old Reason: RUQ u/s to eval for liver dysfunction History: elevated LFTs LIVER: Liver is nonspecific and unchanged, mildly increased echogenicity. Liver measures 19.3 cm in length. No focal mass. There is a shadowing focus in the right liver parenchyma. However there is no intrahepatic biliary ductal dilatation, suggesting this may represent a parenchymal calcification rather than a stone in the bile duct. Main portal vein is patent with normal directional flow and peak velocity of 32 cm/s.BILIARY TRACT: Gallbladder is filled with sludge and shadowing stones. Common duct is within normal limits for age measuring 7 mm. No intra or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are unremarkable.SPLEEN: Spleen is normal in appearance measuring 9.7 cm.RIGHT KIDNEY: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 9.7 cm. Left kidney measures 10.6 cm. OTHER: No significant abnormalities noted.", "output": "1.Gallbladder is filled with sludge and small stones. No intra or extrahepatic biliary ductal dilatation.2.Unchanged nonspecific mildly increased echogenicity of the liver."}
{"instruction": "Generate impression based on findings.", "input": "Recent screening mammogram performed on 8/16/2016 was within normal limits. Patient presents with right breast itching and pain. Personal history of bilateral breast reduction in 2012. Family history of breast cancer in a maternal aunt and a maternal cousin. A targeted right ultrasound was performed for the patient\u2019s area of concern. On physical examination, no discrete palpable mass noted in the right breast 3:00 position. No evidence of skin redness noted. Ultrasound demonstrates normal glandular tissue. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy corresponding to patient's area of pain in the right breast 3:00 position. Annual screening mammogram is recommended.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "67 years old, Male, History: amyloidosis c/b ESRD on HD and instetinal involvement requiring TPN, p/w GNR bacteremia, trying to find source LIVER: The liver measures 14.2 cm in length. Echogenicity of the liver parenchyma is within normal limits. No focal hepatic lesions to suggest abscess or other abnormality. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.3 m/s.BILIARY TRACT: Patient status post cholecystectomy. The common bile duct measures 4 mm in diameter.PANCREAS: The pancreas is not well visualized. No significant abnormalities noted in the visualized area of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 8.2 cm in length. RIGHT KIDNEY: Kidney measures 10.5 cm in length. Increased echogenicity of the renal parenchyma is consistent with known renal disease. No focal lesion to suggest abscess. No perinephric fluid collection. No evidence of hydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 10.1 cm in length. Increased echogenicity of the renal parenchyma is consistent with known renal disease. No focal lesion to suggest abscess. No perinephric fluid collection. No evidence of hydronephrosis or shadowing calculus.OTHER: No significant abnormalities noted.", "output": "1.No focal lesion to suggest abscess or visualized fluid collection to indicate a source of infection.2.Echogenic kidneys consistent with known medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old female patient with right breast pain. No palpable abnormality. Family history of breast cancer in maternal grandmother diagnosed in her 60s. A targeted right breast ultrasound was performed for the patient\u2019s area of concern in the right lower outer breast. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy. Breast pain should be managed clinically. Result and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "29 year-old female with hypertension and proteinuria. RIGHT KIDNEY: No significant abnormalities noted.LEFT KIDNEY: No significant abnormalities noted.OTHER: The bladder is incompletely distended, limiting evaluation.", "output": "Unremarkable ultrasound examination of the kidneys and urinary bladder."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old male 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 massLEFT LOBE: No massISTHMUS: No massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No evidence recurrent disease.72-year-old male with history of thyroid cancer post thyroidectomy. Evaluate for recurrence."}
{"instruction": "Generate impression based on findings.", "input": "Male 69 years old; Reason: r/o recurrence History: h/o thyroid cancer 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: The thyroid surgically absent without signs of recurrence.LEFT LOBE: The thyroid is surgically absent without signs of recurrence.ISTHMUS: The thyroid is surgically absent without signs of recurrence.LYMPH NODES: No suspicious adenopathy noted. OTHER: No significant abnormality noted.", "output": "1.Surgical changes of thyroidectomy without recurrence of disease."}
{"instruction": "Generate impression based on findings.", "input": "Short-term follow-up for area of presumed hematoma/fat necrosis. The patient can no longer appreciate any abnormality of the site. A targeted left ultrasound was performed for the previously palpable area of concern. There is no suspicious solid or cystic mass identified. There is faint hyperechoic residua of fat necrosis measuring only 7 mm at most.", "output": "Near complete resolution of hematoma/fat necrosis. As long as the patient's physical exam at this site and elsewhere remains unremarkable, a routine mammogram in 6 months would be reasonable for follow-up.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for renal stone. RIGHT KIDNEY: The right kidney measures 12.6 cm. The cortex is normal in echogenicity. There is no hydronephrosis or renal calculus. No suspicious lesion is identified.LEFT KIDNEY: The left kidney measures 8 cm. The cortex is normal in echogenicity. There is no hydronephrosis or renal calculus. No suspicious lesion is identified.URINARY BLADDER: No significant abnormalities noted.OTHER: The liver is mildly coarse and echogenic, unchanged from prior.", "output": "1.Left renal calculus no longer identified. No hydronephrosis, renal calculus or suspicious mass.2.Diffuse mildly coarse and echogenic liver, may be secondary to nonspecific parenchymal disease/fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "Female; 65 years old. Reason: r/o bleeding/trauma to abdominal organs History: s/p LVAD, pulsating abdomen No free fluid is seen within the abdomen and pelvis. The liver is echogenic. The right renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone. The left kidney is not visualized.", "output": "No free fluid within the abdomen and pelvis."}
{"instruction": "Generate impression based on findings.", "input": "Palpable thyroid enlargement RIGHT LOBE MEASUREMENTS: 5.1 x 1.9 x 2.3 cmLEFT LOBE MEASUREMENTS: 5.1 x 1.7 x 1.5 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Multiple right solid thyroid nodules. The largest is within the lower pole measuring 1.3 x 1 x 1.7 cm. A mid pole nodule measures 1.1 x 0.6 x 1.1 cmLEFT 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": "Multiple right solid nodules. The largest of these nodules is amenable to ultrasound-guided percutaneous biopsy. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "66 year old female who was recalled from screening mammogram for asymmetry in the right breast. No current breast complaints. MAMMOGRAM: Two standard views and one spot compression view 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. Oval asymmetry in the posterior inferior right breast persist only on the ML and spot MLO views and may represent a benign tortuous vessel. An ultrasound is recommended for further evaluation. ULTRASOUND:On physical exam, there is no visible or palpable abnormality.Targeted ultrasound was performed of the inferior right breast 3:00 through 6:00 through 9:00 positions for the mammographic area of concern. In the right breast 9:00 position 8 cm from nipple there is a 6 x 3 x 6 mm intramammary lymph node, could possibly correlate to the findings on mammogram. Incidental note is made of a 3 x 2 mm cyst in the right breast 9 o'clock position 6 cm from nipple. No suspicious masses identified.", "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: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for liver lesions History: Hx of HCV with advanced liver fibrosis LIVER: The liver measures 17.4 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 0.25 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 6 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 7.8 cm in length. RIGHT KIDNEY: Kidney measures 10.9 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.9 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: Porta hepatis lymph node measuring 1.4 x 1.1 x 0.7 cm, similar to prior.", "output": "No suspicious focal hepatic lesions identified."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for kidney stone RIGHT KIDNEY: The right kidney measures 9.3 cm in length. The cortex is normal echogenicity. There are no stones or hydronephrosis, there is no new worrisome mass seen.LEFT KIDNEY: Left kidney measures 9.8 cm. Within the inferior portion of the left kidney there is an area of hyperechogenicity measuring 2.3 cm x 2.2 cm. Additionally at the superior pole there is another area of increased echogenicity measuring 2.3 cm x 1.6 cm. These are not visualized on the prior ultrasound. No hydronephrosis or stones are seen.URINARY BLADDER: No significant abnormalities noted. Bilateral ureteral jets are visualized.", "output": "1. Two areas of increased hyperechogenicity are seen within the left kidney. This finding may represent a mass such as an angiomyolipoma, due to increased echogenicity, however ultrasound is nonspecific. Recommend contrast enhanced CT for further characterization of this mass."}
{"instruction": "Generate impression based on findings.", "input": "78-year-old male with thrombocytopenia evaluate for liver or splenic enlargement. LIVER:The liver measures 16.4 cm in length. No worrisome masses are seen. No intrahepatic ductal dilation. No ascites. The portal vein is patent with hepatopedal flow measuring 34.2 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is completely shadowed due to presumed the cholelithiasis. The gallbladder wall measures 2.5 mm. No pericholecystic fluid is seen. The common bile duct measures 3.4 mm.PANCREAS: The pancreas is partially obscured with bowel gas. No significant abnormality noted.SPLEEN: The spleen measures 13.9 cm in length. There is an anechoic cyst within the spleen measuring 2.2 cm x 2.3 cm x 2.2 cm.RIGHT KIDNEY: The right kidney measures 10.8 cm in length. At the right superior pole there is a anechoic cyst measuring 1.6 cm x 1.2 cm x 1.8 cm. No other significant abnormalities are noted. LEFT KIDNEY: The left kidney measures 12.7 cm in length. At the superior portion of the left kidney there is a anechoic cyst measuring 2.2 cm x 2.9 cm x 2.1 cm. No other significant abnormalities are noted.", "output": "1. The liver appears normal, however there is presumed cholelithiasis due to shadowing that fills the gallbladder fossa. No signs of acute cholecystitis are seen.2. The spleen is prominent with a simple cyst."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with history of hepatitis C virus. Evaluate for mass. LIVER: Liver is normal in size, contour with very slightly heterogeneous echogenicity. No focal hepatic mass is identified. Main portal vein is patent with appropriate flow direction.BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The visualized biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.SPLEEN: Normal in size.RIGHT KIDNEY: Small and highly echogenic with cysts. OTHER: Left kidney poorly visualized with cysts and probable cyst wall calcification which was present on prior CT. Kidney is small and echogenic.", "output": "Minimally heterogeneous echotexture of the liver without mass.Echogenic, small kidneys with cysts, at least one complex on the left."}
{"instruction": "Generate impression based on findings.", "input": "Reason: advanced heart failure with early satiety, assess liver/spleen, abdominal vasculature as transplant workup History: advanced HF, early satiety LIVER:The liver is normal in echogenicity and echotexture and measures 19 cm in length. No intrahepatic biliary duct dilatations. No focal mass. The portal vein demonstrates normal direction of flow and peak velocity of 27 cm/s.GALLBLADDER, BILIARY TRACT: 0.8 x 0.7 cm echogenic focus in the gallbladder with shadowing, suggestive of gallstone. Gallbladder wall is a thickness of 2 mm. No pericholecystic fluid. No evidence of extrahepatic biliary ductal dilatation. The common bile duct measures 3 mm in diameter.PANCREAS: Limited evaluation of the pancreas due to overlying bowel gas does not demonstrate any significant abnormality in the visualized portion of the pancreas.SPLEEN: Spleen is normal in echotexture and measures 9 cm in length.KIDNEYS: The right kidney demonstrates normal echogenicity and measures 10 cm in length. No hydronephrosis. Small anechoic focus in the right kidney measuring 0.5 x 0.3 x 0.5 cm is too small to characterize but likely represents a cyst.Left kidney measures 10.1 cm in length and demonstrates normal echogenicity. No hydronephrosis.ABDOMINAL AORTA: The abdominal aorta is normal in size and demonstrates a peak velocity of 97 cm/s. Iliac arteries are normal in diameter.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Echogenic shadowing focus in the gallbladder suggestive of a gallstone with no evidence of acute cholecystitis. Otherwise normal sonographic examination of the abdomen."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Mildly coarse echogenic liver parenchyma without mass. Liver length 15.3 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.1 cm in lengthOTHER: Left kidney 11.4 cm in length. Spleen 9.1 cm in length. No ascites", "output": "Mildly coarse echogenic liver parenchyma raises the possibility of parenchymal dysfunction/fatty infiltration without mass or ductal dilatation. Unremarkable gallbladder without stones or acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "65 years old, Male, Reason: Left thyroid mass on MRI and CT History: as above Technically difficult examRIGHT LOBE MEASUREMENTS: 6.6 x 2.2 x 2.5 cmLEFT LOBE MEASUREMENTS: 4.6 x 2.6 x 2.4 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Multiple subcentimeter hypoechoic nodules in the right thyroid lobe.LEFT LOBE: Left predominantly solid hypoechoic thyroid nodule measures 1.9 x 1.7 x 1.2 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Predominantly solid left thyroid nodule measuring up to 1.9 cm.2.Multiple subcentimeter hypoechoic nodules in the right thyroid lobe."}
{"instruction": "Generate impression based on findings.", "input": "Female; 18 years old. Reason: eval transplant kidney and native kidney, r/o pyelo (fat stranding, etc) History: fever, s/p renal transplant RENAL TRANSPLANT LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: The transplanted kidney measures 17.8 cm in length. There is no shadowing renal stone or worrisome renal mass.COLLECTING SYSTEM/URETER: There is minimal hydronephrosis.URINARY BLADDER: The bladder is not distended.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels The renal transplant inflow and outflow vessels are patent.OTHER: The native kidneys are atrophic and echogenic. The right native kidney measures 6.4 cm in length. The left native kidney measures 9.0 cm in length. No fluid collections surrounding the native kidneys.", "output": "1.Atrophic, echogenic native kidneys.2.Minimal hydronephrosis of the transplanted kidney. Patent renal transplant vasculature. 3.No evidence of pyelonephritis."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old with two recent right breast biopsies showing invasive mammary carcinoma and invasive lobular carcinoma. Postbiopsy mammograms. Three standard views of 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. Interval placement of a long biopsy clip at the 10:00 position in an area of previously noted distortion. An additional short biopsy clip is noted at the 11:00 position corresponding to the lesion seen on ultrasound overlying an area of dense tissue. The distance between clips is 22 mm.", "output": "Biopsy clips noted at the 11:00 and 10:00 positions.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "46 years Female with history of stepping on glass under fourth metatarsal head with right plantar forefoot pain/callus formation, evaluate for foreign body. Along the plantar aspect of the forefoot inferior to the fourth metatarsal head and immediately subjacent to the skin, there is a 0.8 x 0.3 x 0.8 cm well-defined oval-shaped isoechoic structure which seems to correspond to the area of signal abnormality described on recent MRI. This structure is nonspecific but could represent a retained foreign object.", "output": "An 8 mm isoechoic structure just deep to the skin along the plantar aspect of the fourth metatarsal head which is non-specific but could represent a retained foreign object versus sequela of prior soft tissue injury."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for whole breast ultrasound for dense breast screening. Personal history of benign left breast in 2004 for \"densely hyalinized breast tissue.\" 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. Stable macrolobulated mass of the left upper outer breast, compatible with previously benign biopsy. Additional round anechoic lesions are identified bilaterally, compatible with simple cysts. No suspicious cystic or solid mass is identified.This exam was interpreted by two radiologists.", "output": "Stable benign mass of the left breast. No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Follow-up thyroid nodule RIGHT LOBE MEASUREMENTS: 5.3 x 1.2 x 1.5 cm.LEFT LOBE MEASUREMENTS: 4.9 x 1.2 x 1.5 cm.ISTHMUS MEASUREMENTS: 0.1 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Stable predominantly solid lower pole left thyroid nodule measuring 1 x 0.8 x 1.3 cm. Internal echogenic foci again noted; favor benign old colloid over microcalcifications.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable solid lower pole left thyroid nodule. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "59 years old, Male, Reason: Liver cysts; gallstones History: elevated bilirubin LIVER: The liver measures 19.7 cm in length consistent with mild hepatomegaly. There is heterogeneous echotexture of the liver consistent with partial fatty infiltration. 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 0.3 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 8.8 cm in length. RIGHT KIDNEY: Kidney measures 11.6 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 11.3 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis. 2.Mild hepatomegaly. No focal liver lesions or masses."}
{"instruction": "Generate impression based on findings.", "input": "Reason: decreased renal function History: elevated creatinine RIGHT KIDNEY: The right kidney measures 9.5 cm in length. Unremarkable renal parenchyma. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.4 cm in length. Unremarkable renal parenchyma. Anechoic cyst in the midpole of the left kidney measures 1.0 x 0.9 x 0.7 cm. No shadowing stones or hydronephrosis.OTHER: Ureteral jets visualized bilaterally.", "output": "No acute renal abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Chronic hepatitis C LIVER: Coarse echogenic liver echotexture again noted without mass. Liver length 19.7 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation again noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.6 cm in length.OTHER: Left kidney 11.8 cm in length. Spleen 12.2 cm in length. No ascites.", "output": "No change in fatty infiltration of liver/parenchymal dysfunction without mass or ductal dilatation. Stable cholelithiasis without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Call back from screening mammogram for a focal asymmetry in the right breast 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 heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. An irregularly shaped focal asymmetry is seen at posterior upper outer quadrant in the right breast.Focused ultrasound of the right breast at upper outer quadrant is performed. There is an irregularly shaped hypoechoic mass measuring 8 x 4 mm with increased vascularity, corresponding to the mammographic findings.", "output": "Focal asymmetry at posterior upper outer quadrant in the right breast with sonographic correlate. Ultrasound-guided 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": "80-year-old female with history of fever, right upper quadrant pain, gallstones with gallbladder drain in place. There is also a history of treated hepatocellular carcinoma. LIVER: Cirrhotic liver morphology and increased hepatic echogenicity. The previously seen and treated hepatocellular carcinoma is not clearly visualized on this limited study. There are small focal hyperechoic areas in the right hepatic lobe measuring up to approximately 1.3 cm which are of uncertain etiology and may be iatrogenic in etiology related to prior procedures. There are no correlate lesions in these locations on recent MRI examinations.The portal vein is patent with predominantly antegrade flow measuring 30 cm/sec. However, there is focal prominence of the main portal vein with an area of \"to and fro\" bidirectional flow which likely represents turbulence in a focally ectatic vessel. GALLBLADDER, BILIARY TRACT: The gallbladder is partially collapsed with a cholecystostomy drain in place. Cholelithiasis is again identified. The bladder wall measures 0.3 cm in thickness. There is no significant pericholecystic fluid. PANCREAS: The pancreas is not clearly visualized due to patient bowel gas.KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "1. Cholelithiasis with cholecystostomy tube in place as described above, without specific evidence of acute superimposed inflammation. 2. Cirrhotic liver morphology with increased hepatic echogenicity consistent with chronic liver disease. Small echogenic areas in the right hepatic lobe without correlate lesions on recent MRI exams may be iatrogenic in etiology. Continued attention to this region is recommended on subsequent examinations. "}
{"instruction": "Generate impression based on findings.", "input": "36-year-old male for evaluation ascites. There is moderate volume ascites in all 4 quadrants.", "output": "1. Moderate volume ascites."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old male with right testicular pain. RIGHT TESTIS: Measures 3.4 x 2.3 x 4.6 cm. Normal echogenicity and vascularity.LEFT TESTIS: Measures 2.6 x 2.2 x 4.5 cm. Normal echogenicity and vascularity.RIGHT EPIDIDYMIS: Subcentimeter epididymal cyst, otherwise no significant abnormalities noted.LEFT EPIDIDYMIS: Subcentimeter epididymal cyst, otherwise no significant abnormalities noted.OTHER: Probable small varicoceles, slightly greater on the right.", "output": "1. No testicular torsion, mass, or fluid collection. 2. Probable small varicoceles, slightly greater on the right."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old male status post renal transplant with an anuria. LOCATION: Left iliac fossaRENAL TRANSPLANT: Renal transplant measures 10.3 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis seen, there are no stones.PERITRANSPLANT TISSUES: There is no perinephric fluid collection seen.URINARY BLADDER: The bladder was not visualized in this study.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels. The renal artery is patent with peak systolic velocities ranging between 102 and 190 cm/s between the anastomosis and the hilum. Restrictive indices range from 0.58-0.62. There is no area of focal stenosis. Interlobar and smaller distal arteries are patent with normal arterial waveform and resistive indices. The renal and iliac veins are patent.", "output": "1. Normal renal transplant ultrasound with Doppler. Patent renal vasculature without evidence for inflow or outflow compromise. No evidence of perinephric fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Elizabeth Kirkland is a 75 year old female with bilateral lumpectomies for breast cancer (left breast - 2011 for IDC, right breast - 2014 for DCIS) followed by radiation and hormonal therapy. Bilateral breast scars. Personal history of oophorectomy. She presents for ultrasound evaluation of the lymph nodes in her left lower neck palpated by her physician. She states that she is having symptoms of infection currently. On physical examination, no discrete large lymph node is palpated in her left lower neck.A targeted left neck ultrasound was performed for the palpable area of concern designated by patient. In the lower neck, adjacent to the left common carotid artery, there are 4-5 prominent lymph nodes with diffuse cortical thickening. The largest one measuring up to 1.9 cm. Ultrasound of the right lower neck is also performed comparison. There are 2-3 lymph nodes with cortical thickening measuring up to 1 cm.", "output": "Bilateral prominent lymph nodes in the lower neck with diffuse cortical thickening, left greater than right. These are likely reactive lymph nodes given patient's current infectious status. Patient is going to have palpation guided fine needle aspiration due to her personal history of breast cancer. If FNA confirms it to be benign, clinical follow up is recommended. Alternatively, patient can be followed up with ultrasound in one month. 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": "Female 61 years old; Reason: rule out change in nodules History: none RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 1.2 x 1.5 x 4.8 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 1.0 x 2.0 x 4.6 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.4 cm.RIGHT LOBE: Right lobe is heterogeneous. No nodules are identified.LEFT LOBE: The left lobe is heterogeneous. There is a hypoechoic nodule in the midportion of the left lobe measuring 0.3 cm x 0.2 cm x 0.3 cm. This was seen on prior ultrasound. No internal microcalcifications are seen. A larger hypoechoic nodule in the inferior portion of the left lobe visualized on prior ultrasound was not seen on this study.ISTHMUS: There is a heterogeneous spongiform nodule redemonstrated the right portion of the isthmus measuring 1.1 cm x 0.6 cm x 0.8 cm. No internal microcalcifications are seen.LYMPH NODES: No suspicious adenopathy noted.", "output": "There is a spongiform nodule redemonstrated between the right lobe and isthmus measuring 1.1 cm x 0.6 cm x 0.8 cm and appears stable in size from prior ultrasound. Additionally, there is a nodule in the midportion of the left lobe that is stable in size and appearance from prior ultrasound.No suspicious adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old female with right upper quadrant pain LIVER: Mildly increased hepatic echogenicity without discrete focal lesion.GALLBLADDER, BILIARY TRACT: No cholelithiasis. No gallbladder wall thickening, pericholecystic fluid, or biliary ductal dilation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: A splenule is noted in the splenic hilum. The spleen otherwise appears unremarkable.OTHER: No significant abnormalities noted.", "output": "1. No evidence of cholelithiasis or cholecystitis.2. Mildly increased hepatic echogenicity may represent hepatic steatosis or parenchymal disease."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Miller is a 24 year old female with a recent history of PE and left axillary adenopathy seen on recent CT study. She has no other medical problems. Targeted left axillary ultrasound is performed.In the left axilla, there is an enlarged abnormal morphology lymph node identified measuring 3.2 x 1.2 x 2.1 cm. There is no significant vascularity.", "output": "Abnormal morphology left axillary lymph node. An ultrasound-guided biopsy with clip placement is recommended for further evaluation. Of note, the patient does take Xarelto for her recently diagnosed PE.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Female 69 years old Reason: multinodular goiter History: eval and c/w prior thyroid US RIGHT LOBE MEASUREMENTS: Patient is status post right thyroidectomy.LEFT LOBE MEASUREMENTS: 6.0 x 1.6 x 1.5 centimetersISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Echogenic focus in the right thyroidectomy bed likely represents small amount of fat or scar.LEFT LOBE: In the left thyroid lobe there are multiple spongiform-appearing nodules which are unchanged in size. The superior nodule measures 1.5 x 1.1 x 0.6 cm. A mid lobe nodule measures 1.0 x 1.4 x 1.2 cm. Unchanged inferior nodule measures 2.3 x 1.8 x 0.9 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional lymphadenopathy. OTHER: No significant abnormality noted.", "output": "Unchanged spongiform nodules in the left thyroid lobe. No evidence of recurrent or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Mildly coarse echotexture without mass, stone, or hydronephrosis. Right kidney 13.5 cm in lengthLEFT KIDNEY: Mildly coarse echotexture without mass, stone, or hydronephrosis. Left kidney 11.7 cm in lengthOTHER: Bladder nondistended.", "output": "Mildly coarse renal echotexture suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis. Left nephrectomy. Cholecystectomy. LIVER: Cirrhotic liver morphology. Coarsened 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 15.1 cm in length, with a 1.5 cm simple appearing cyst at the inferior pole. No suspicious renal lesions are evident. No hydronephrosis is present. The left kidney is not present. SPLEEN: 11.6 cm in length, without focal lesions evident.OTHER: Right pleural effusion is partially imaged. No significant ascites identified.", "output": "1. Cirrhotic liver morphology, without suspicious hepatic lesion identified.2. Right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old male patient with history of melena. Evaluate for liver parenchyma for changes suggestive of cirrhosis. Evaluation limited secondary to patient body habitus.LIVER: The liver measures 17.9 cm in length and demonstrates coarsened hepatic echotexture. Main portal vein flow is hepatopetal and measures 0.6 m/sec. The hepatic veins are dilated.GALLBLADDER, BILIARY TRACT: The gallbladder contains biliary sludge. No gallbladder wall thickening or pericholecystic fluid is identified. There is no intra- or extrahepatic biliary ductal dilatation. The common bile duct measures 5 mm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 9.8 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.6 cm in length. No evidence of hydronephrosis.The spleen is poorly visualized.", "output": "1. Limited evaluation with coarsened hepatic echotexture suggestive of hepatic parenchymal dysfunction.2. Biliary sludge."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain and nausea. Evaluate for cholecystitis. LIVER: Non-cirrhotic liver morphology. Increased parenchymal echogenicity. 16.4 cm in length. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Distended gallbladder, without stones, 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 10.9 cm in length. The left kidney is 12.1 cm in length. The renal parenchymal echogenicity is increased bilaterally. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 9.7 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No significant upper abdominal free fluid is identified.", "output": "1. No evidence of cholecystitis.2. Increased hepatic echogenicity, compatible with parenchymal dysfunction.3. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "56 years old, Female, Reason: ultrasound of liver to eval for hcc in setting of HBV History: HBV LIVER: The liver measures 14.2 cm in length. Mildly coarse echogenicity of the liver. Unchanged small right liver cyst measuring 5 mm. No evidence of nodularity to the liver. 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. Patient's known 4-mm polyp is unchanged in size and appearance. 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 8.4 cm in length. RIGHT KIDNEY: Kidney measures 10.9 cm in length. Normal echotexture. Nohydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 10.2 cm in length. Normal echotexture. Nohydronephrosis or shadowing calculus.OTHER: No significant abnormalities noted.", "output": "Stable examination."}
{"instruction": "Generate impression based on findings.", "input": "History of laryngeal cancer with hypermetabolic thyroid seen on CT RIGHT LOBE MEASUREMENTS: 1.3 x 1.3 x 3.9 cmLEFT LOBE MEASUREMENTS: 1.7 x 1.7 x 3.7 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: 0.9 x 0.7 x 0.8 cm isoechoic solid nodule within the lower pole of the right thyroid gland. In retrospect, this nodule was probably present on the prior study but less conspicuous due to technical limitations.LEFT LOBE: Stable left thyroid nodules. Mid pole predominantly solid nodule measures 1.4 x 1.2 x 1.3 cm. Inferior solid nodule measures 0.6 x 0.5 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Interval decrease in size of mixed cystic and solid lesion right cervical neck level 4 now measuring 1.8 x 1 cm. The lesion demonstrates increase in solid component", "output": "Stable left thyroid nodules. Isoechoic subcentimeter right lower lobe thyroid nodule; in retrospect, this nodule was probably present on the prior study but less conspicuous due to technical limitations.Interval decrease in size of mixed cystic and solid lesion right cervical neck level 4. This lesion demonstrates increase in solid component; this change is of unclear clinical significance."}
{"instruction": "Generate impression based on findings.", "input": "Congestive heart failure; assess for ascites Moderate ascites observed throughout the abdomen and pelvis.", "output": "Moderate ascites throughout the abdomen and pelvis."}
{"instruction": "Generate impression based on findings.", "input": "Autoimmune hepatitis with cirrhosis. Evaluate for HCC. LIVER: Nodular liver contour and course echotexture compatible with chronic liver disease. The liver measures 17 cm in craniocaudal dimension. No suspicious focal lesion is identified. Normal hepatopedal portal venous blood flow at 19 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation with the common duct measuring 6 mm. Status post cholecystectomy.PANCREAS: The visualized portions of the pancreas are unremarkable. Main hepatic duct is normal in caliber.SPLEEN: The spleen measures 12.1 cm length without a focal lesion.RIGHT KIDNEY: The right kidney measures 9 cm in length with new mild pelviectasis. No shadowing nephrolithiasis. OTHER: The left kidney measures 9.1 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion evident.", "output": "1. Cirrhotic liver without a suspicious lesion evident.2. New mild right-sided pelviectasis."}
{"instruction": "Generate impression based on findings.", "input": "Female 63 years old; Reason: pt had L lobe enlargement back in 2008, reassess thyroid gland History: hypothryoidism RIGHT LOBE MEASUREMENTS: 4.7 x 1.6 x 1.4 cm.LEFT LOBE MEASUREMENTS: 4.0 x 1.6 x 1.8 cm.ISTHMUS MEASUREMENT: 0.2 cm.RIGHT LOBE: The right lobe is diffusely heterogenous. There are numerous cystic spaces. The thyroid appears hypervascular. No masses.LEFT LOBE: The parenchyma of the left lobe also appears diffusely heterogenous and hypervascular. There is an approximately 2.4 x 1.2 x 1.4 cm hypoechoic nodule. It has a heterogenous echotexture. There are foci of ringdown artifact suggestive of colloid. ISTHMUS: No significant abnormality noted.LYMPH NODES: There are several lymph nodes in levels III, IV, and V of the left neck, the largest of which measures 1.2 x 0.8 x 1.6 cm.OTHER: No significant abnormality noted.", "output": "1.Thyroid nodule as described above. Although we favor a benign etiology (colloid), given the asymmetric adenopathy consider biopsy."}
{"instruction": "Generate impression based on findings.", "input": "History of goiter RIGHT LOBE MEASUREMENTS: 3.2 x 0.9 x 1.6 cmLEFT LOBE MEASUREMENTS: 2.8 x 1 x 1.1 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Somewhat small gland without discrete nodule or increased vascularityLEFT LOBE: Somewhat small gland without discrete nodule or increased vascularityISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Somewhat small thyroid gland without discrete nodule or increased vascularity. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female with proteinuria for biopsy of right kidney. Ultrasound guidance was provided for biopsy of right kidney", "output": "Ultrasound guidance was provided for biopsy of right kidney"}
{"instruction": "Generate impression based on findings.", "input": "Male, 79 years old. Hematuria RIGHT KIDNEY: The right kidney measures 9.7 cm in length, with normal echotexture. No renal stones, mass, or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.0 cm in length with normal echotexture. No renal stones, mass, or hydronephrosis.OTHER: The bladder is incompletely distended. The prostate is enlarged.", "output": "1. No renal stones, mass, or hydronephrosis.2. Enlarged prostate."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female with abdominal pain and history of polycystic kidney disease and family. LIVER: Liver appears perhaps mildly echogenic without interval change. There is normal in size and echotexture without focal abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Gallbladder is poorly distended but appears unremarkable without gallstones, 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. No cysts.OTHER: No cysts involving the left kidney. Spleen appears unremarkable.", "output": "No cause of patient's abdominal pain identified. No evidence of polycystic kidneys."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old female with left upper quadrant pain and splenomegaly. Sjogren's syndrome. LIVER: Liver is relatively small but normal in echotexture. No focal hepatic abnormality.GALLBLADDER, 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 are normal. The tail is less well seen due to bowel gas.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Spleen is adequately visualized and is normal in size. The left kidney is incompletely visualized due to high position.", "output": "Normal spleen. Left kidney is poorly visualized due to position, if a renal abnormality is a consideration, would recommend CT or MR."}
{"instruction": "Generate impression based on findings.", "input": "Female 94 years old; Reason: 94 yo F w/ new onset signs of heart failure, please eval for ascites and liver pathology History: abdominal distension LIVER: The liver measures 15.6 cm in length. There is coarse and 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. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.8 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 5.8 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 8.5 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.4 cm in length. The cortex has mildly increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.0 cm in length. The cortex has mildly increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: Of note, this exam is limited by body habitus and inability to optimally position the patient.", "output": "1. Mildly echogenic kidneys consistent with diffuse renal parenchymal dysfunction.2. No fluid or ascites noted."}
{"instruction": "Generate impression based on findings.", "input": "Male 35 years old Reason: eval for torsion History: 2 d h/o R testicular pain/swelling RIGHT TESTIS: Right testis measures 4.2 x 2.5 x 2.4 cm. right testis is heterogeneous. Vascularity is slightly increased. These findings are compatible with mild orchitis.LEFT TESTIS: This measures 3.8 x 3.9 x 2.3 centimeters. No focal lesions. Normal vascularity.RIGHT EPIDIDYMIS: Right epididymis is diffusely thickened with increased vascularity compatible with right epididymitis.LEFT EPIDIDYMIS: Possible 3.5 x 2.4 cm left epididymal cyst versus localized varicocele.OTHER: No significant abnormalities noted.", "output": "Ultrasound findings compatible with right epididymoorchitis. Possible left epididymal cyst."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs. Evaluate for cholecystitis. Findings are limited by inability to reposition the patient and patient's inability to hold breath.LIVER: Non-cirrhotic liver morphology. Mildly coarsened parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction. A 5 x 4 x 4 cm complex collection posterior to the left hepatic lobe is identified.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Mild gallbladder wall thickening, which may be seen in the setting of ascites. No cholelithiasis or sonographic Murphy sign.PANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney is 8.5 cm in length. The left kidney is 8.8 cm in length. The renal parenchyma is echogenic bilaterally. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 12.5 cm in length, without focal lesions evident.OTHER: Moderate amount of complex ascites identified, with septations.", "output": "1. Coarsened hepatic echogenicity compatible with parenchymal dysfunction, without biliary ductal dilation.2. Moderate amount of complex septated ascites.3. 5 cm complex collection posterior to the left hepatic lobe. This is nonspecific in appearance and may represent loculated septated ascites, hematoma, or abscess.4. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "41 years old, Female, Reason: rule out change in nodules or worrisome features RIGHT LOBE MEASUREMENTS: 2.0 x 3.2 x 5.2 cm.LEFT LOBE MEASUREMENTS: 2.2 x 2.0 x 5.8 cm.ISTHMUS MEASUREMENTS: 0.44 cm.RIGHT LOBE: There are at least two right thyroid nodules more anterior of which is at least partially solid and has increased vascularity and measures 1.1 x 0.7 by 1.7 cm, which is increased from prior exam when it measured 0.8 x 0.5 x 0.8 cm. The larger right thyroid nodule is heterogeneous in appearance and is slightly increased in size measuring 1.8 x 2.8 x 3.2 cm. No definite microcalcifications are seen within these nodules.LEFT LOBE: Subcentimeter left thyroid nodule is not significantly changed in size measuring 0.7 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": "1.Hypervascular, at least partially solid right thyroid nodule which has increased in size. Recommend further evaluation with biopsy.2.The larger right thyroid nodule has also slightly increased in size."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female for evaluation of liver status on clinical trial. LIVER: Liver is normal in size. Liver is mildly and heterogeneously echogenic without change likely due to irregular fatty infiltration. There is no focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Post cholecystectomy. The biliary tract is normal in caliber.PANCREAS: Head and body are normal. The tail was not well seen.SPLEEN: Upper normal in size. Accessory splenic tissue noted. RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "No significant change. Likely mild fatty liver. Kidneys do not appear echogenic on today's exam."}
{"instruction": "Generate impression based on findings.", "input": "Acute right upper quadrant colicky pain for one month. LIVER: The liver measures 15.0 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: Cholelithiasis. No associated 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.SPLEEN: No significant abnormalities noted.The spleen measures 8.2 cm in length. RIGHT KIDNEY: Kidney measures 10.7 cm in length. LEFT KIDNEY: Kidney measures 11.1 cm in length. Subcentimeter simple cyst within the interpolar left kidney.OTHER: No significant abnormalities noted.", "output": "Cholelithiasis without sonographic evidence of acute cholecystitis or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Female; 63 years old. Reason: of biliary tree, mid-epigastric and right upper quadrant pain, evaluate biliary tree LIVER: The liver measures 15.9 cm in length. The liver contour is smooth, the parenchyma demonstrates a coarsened echogenicity. There is no focal hepatic lesion identified. The main portal vein is patent with hepatopetal flow and a peak velocity of 0.2 m/sec.BILIARY TRACT: The gallbladder is normal in appearance. There is no cholelithiasis, gallbladder wall thickening or pericholecystic fluid. The common duct measures 4 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gasSPLEEN: The spleen measures 7.2 cm in length.RIGHT KIDNEY: The right kidney measures 10.1 cm in length. Left kidney measures 10.8 cm in length. The cortex is increased in echogenicity. There is no hydronephrosis or shadowing renal stone. LEFT KIDNEY: Left kidney measures 10.8 cm in length. The cortex is increased in echogenicity. There is no hydronephrosis or shadowing renal stone. Two cysts are seen within the lower pole of the kidney. The largest measures 2.4 x 1.9 x 2.0 cm (previously measured 3.5 x 2.1 x 2.5 cm) and is minimally complex. The second cyst is simple in appearance and measures 1.3 x 1.2 x 1.1 cm.OTHER: No significant abnormalities noted.", "output": "1.Coarsened liver echotexture without focal hepatic lesion.2.No cholelithiasis or biliary ductal dilatation.3.Echogenic kidneys bilaterally compatible with medical renal disease.4.Minimally complex left lower pole kidney cyst measures smaller on the current study which may be to technical differences and the lobulated configuration of the lesion."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Upper abdomen/epigastric pain, recent transplant day +5. History: Upper abdominal pain, epigastric pain, some nausea LIVER: The liver measures 15.9 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 0.3 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 biliary ductal dilatation is present. The common bile duct measures 8-9 mm in diameter and tapers distally. No choledocholithiasis is visualized.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 12.7 cm in length. Normal cortical echotexture. No hydronephrosis, shadowing calculus, or mass.LEFT KIDNEY: Kidney measures 12.1 cm in length. Normal cortical echotexture. No hydronephrosis, shadowing calculus, or mass.OTHER: Trace abdominal ascites.", "output": "1.Mild prominence of the common bile duct which may simply reflect age-related ectasia but may be correlated with liver function tests. No evidence of intrahepatic biliary duct dilatation.2.Echogenic liver suggestive of parenchymal dysfunction/fatty infiltration.3.Trace abdominal ascites. "}
{"instruction": "Generate impression based on findings.", "input": "58 year old male with a history of ascites of unclear etiology. LIVER: The liver parenchyma is coarsened. It is normal in size, measuring 18.7 cm in craniocaudal dimension. The liver contour is smooth. There is no focal hepatic lesion or biliary ductal dilatation. Moderate volume perihepatic ascites. There is normal directional portal venous blood flow at 51 cm/sec.GALLBLADDER, BILIARY TRACT: Normally distended gallbladder with mild wall thickening, up to 4 mm, which is nonspecific in the setting of ascites. No cholelithiasis or focal tenderness. No extrahepatic biliary duct dilatation with common bile duct measuring 3 mm.PANCREAS: The visualized pancreatic body and head are normal.SPLEEN: The spleen is normal in size, measuring 11.5 cm.KIDNEYS: The right kidney measures 11.5 cm without hydronephrosis, shadowing nephrolithiasis, or discrete lesion evident. The left kidney measures 10.4 cm and is partially obscured, without hydronephrosis, shadowing nephrolithiasis or discrete lesion evident. The renal cortices are echogenic. ABDOMINAL AORTA: The visualized proximal aorta is normal in caliber, measuring 1.9 cm.INFERIOR VENA CAVA: The visualized inferior vena cava is patent. OTHER: Bilateral pleural effusions and moderate volume ascites.", "output": "1. Bilateral pleural effusions and moderate volume ascites. 2. Coarse hepatic parenchyma, compatible with parenchymal dysfunction. 3. Medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old male patient with history of myeloproliferative disorder, CHF, with acutely elevated INR. Evaluate portal flow, signs of embolic obstruction. LIVER: The liver measures 17.3 cm in length and has a coarsened echotexture. Main portal vein flow is hepatopetal and measures 0.2 m/s. The hepatic veins are dilated.GALLBLADDER, BILIARY TRACT: Numerous gallstones are noted within the neck of the gallbladder. There is no gallbladder wall thickening or pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common bile duct measures 3 mm in diameter.PANCREAS: The pancreas is not visualized.RIGHT KIDNEY: The right kidney measures 9.8 cm in length. Renal cortical echogenicity is increased. No evidence of hydronephrosis.OTHER: Left kidney measures 9.9 cm in length and contains a 2.9 x 3.2 cyst, similar to the prior study. Renal cortical echogenicity is increased. No evidence of hydronephrosis.The spleen is enlarged measuring 20.1 cm in length.A right pleural effusion is seen.", "output": "1. Cholelithiasis without sonographic evidence of acute cholecystitis.2. Patent portal vein with hepatopetal flow. Coarsened hepatic echotexture suggestive of hepatic parenchymal dysfunction.3. Splenomegaly.4. Medical renal disease. 5. Small right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "History of poor oral intake and acute kidney injury, evaluate for postrenal obstruction. Also history of Hb-SS. RIGHT KIDNEY: Kidney measures 9.5 cm in length. Increased parenchymal echogenicity. No hydronephrosis. No shadowing stones or masses identified.LEFT KIDNEY: Left kidney difficult to visualize. Kidney measures approximately 8.3 cm in length. Increased parenchymal echogenicity. No hydronephrosis. No shadowing stones or masses identified.URINARY BLADDER: Foley catheter present. OTHER: No significant abnormalities noted.", "output": "Increased renal echogenicity compatible with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female with acute kidney injury. Evaluate for obstruction. RIGHT KIDNEY: Measures 13.4 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 13.1 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: Left pleural effusion.", "output": "1. Increased renal echogenicity consistent with medical renal disease. No nephrolithiasis, hydronephrosis, or suspicious mass lesion. 2. Left pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "Female 27 years old; Reason: Nash, study us needed for research trial History: none LIVER: The liver measures 18.5 cm in length. There is 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 23.9 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.6 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 3.8 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 12.6 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 12.2 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 12.2 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "There is increased echogenicity within the liver which is compatible with fatty infiltration/hepatocellular dysfunction. No worrisome masses or intrahepatic ductal dilation are seen."}
{"instruction": "Generate impression based on findings.", "input": "Male 58 years old Reason: Pt has had 5 years of progressively enlarging R-sided solitary nodule. LAD vs lipoma. Now causing him pain on arm movement History: Pain on R arm motion In the right shoulder area there is a superficial, well circumscribed, mildly hyperechoic to muscle, oval mass measuring 4.2 x 2.7 cm. No abnormal vascular flow within this lesion.", "output": "Findings are most compatible with a lipoma."}
{"instruction": "Generate impression based on findings.", "input": "81-year-old male with Escherichia coli sepsis, anuric. RIGHT KIDNEY: Measures 11.1 cm in length. Markedly increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 11.2 cm in length. Markedly increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Collapsed with a Foley catheter in place.OTHER: 12.1 x 10.4 x 8.9 cm complex collection noted in the left upper quadrant, which in retrospect was present on recent CT from 9/7/2015 however was very difficult to visualize at that time given anasarca and appears retroperitoneal in location.Bilateral pleural effusions.", "output": "1. Large complex left retroperitoneal collection as described above, for which there is a wide differential diagnosis including hematoma and/or abscess, additionally a neoplasm cannot be excluded. Correlation with a contrast enhanced cross sectional study is recommended as feasible clinically. 2. Markedly increased renal echogenicity consistent with medical renal disease. 3. Bilateral pleural effusions. Findings discussed with Dr. Gregory Haman at 1100 on 9/9/15. "}
{"instruction": "Generate impression based on findings.", "input": "23 year old female with flank pain. Evaluate for urinary obstruction, lesions, stones or other abnormality. RIGHT KIDNEY: Normal echogenicity measuring 10.8 cm in length. No hydronephrosis or shadowing calculi are noted.LEFT KIDNEY: Normal echogenicity measuring 11.7 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Bladder is well distended with no significant abnormalities noted.", "output": "Unremarkable examination."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female gross hematuria, hypertension RIGHT KIDNEY: Measures 10.9 cm in length. Unremarkable echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 10.7 cm in length. Unremarkable echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.", "output": "No nephrolithiasis, hydronephrosis, or suspicious lesion. "}
{"instruction": "Generate impression based on findings.", "input": "BPH with renal insufficiency RIGHT KIDNEY: Normal echogenicity without worrisome mass or hydronephrosis. Benign-appearing renal cyst. Right kidney 9.4 cm in length.LEFT KIDNEY: Normal echogenicity without worrisome mass, stone, or hydronephrosis. Benign-appearing renal cyst. Left kidney 11 cm in length.OTHER: Bladder nondistended.", "output": "Normal renal echogenicity without worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Dixon is a 27-year-old female presenting with a 3 week history of left breast swelling, redness, tenderness. Patient was on a 1 week trial of Bactrim with no resolution of symptoms. Upon physical exam of the left breast, the breast is asymmetrically larger than the right breast, edematous and erythematous. There is a focal area of swelling/bulging in the medial left breast, adjacent to the nipple areolar complex.A targeted left breast ultrasound was performed for the patient\u2019s area of concern. In the left breast 9:00 location, approximately 2 cm from the nipple, there is an irregular mixed echogenic mass measuring 4.2 x 1.8 x 5.0 cm. There is marked vascularity associated with this mass along with internal heterogeneity, compatible with floating debris. Sonographic findings are compatible with a left breast abscess. Associated findings include marked skin thickening, measuring up to 0.8 cm.", "output": "Sonographic findings compatible with a 5 cm left breast abscess. Patient should have a surgical consultation for further evaluation. All results and recommendations were relayed to the patient and Dr. Claire Shappell. BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Suspected portal hypertension and GI lead LIVER: Coarse echogenic liver parenchyma without mass. Liver length 16.7 cm. Limited interrogation of main portal vein demonstrates patent main portal vein with normal directional flow. Main portal vein velocity 20 cm/s.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: Not visualized due to overlying gasRIGHT KIDNEY: No significant abnormalities noted. Right kidney 10.1 cm in length.OTHER: Left kidney 10.3 cm in length. Spleen 12.3 cm in length. No ascites.", "output": "Coarse echogenic liver parenchyma suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Limited interrogation of main portal vein demonstrates patent main portal vein with normal directional flow. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "44 years old, Male, Reason: 44yo with HTN, new diagnosed hyperthyroidism with new Afib. Requesting thyroid US for eval History: palipations, weakness, insomnia RIGHT LOBE MEASUREMENTS: 5.2 x 2.3 x 2.2 cmLEFT LOBE MEASUREMENTS: 5.7 x 2.2 x 2.2 cmISTHMUS MEASUREMENTS: 2.8 cmRIGHT LOBE: Mosaic echogenicity of the right thyroid lobe without discrete mass.LEFT LOBE: Mosaic echogenicity of the left thyroid lobe. The upper pole the left thyroid lobe is slightly more hypoechoic than the rest of the lobe and we cannot definitely excluded a nodule in this location. ISTHMUS: This this appears heterogeneous.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Mosaic echogenicity of the thyroid gland diffusely consistent with thyroiditis. 2.Hypoechoic area in the superior left lower lobe. We cannot definitely exclude a nodule in this area."}
{"instruction": "Generate impression based on findings.", "input": "84 year old female with outside ultrasound showing large nodules in the right lobe. RIGHT LOBE MEASUREMENTS: 9.7 x 5.0 x 4.2 cmLEFT LOBE MEASUREMENTS: 6.0 x 4.8 x 3.2 cmISTHMUS MEASUREMENTS: 2.1 cmRIGHT LOBE: Multinodular goiter. Dominant solid hyperechoic and hypoechoic nodule with small cystic spaces measures 6.0 x 3.2 x 4.8 cm. No obvious microcalcifications. LEFT LOBE: Heterogeneous left thyroid lobe with macrocalcifications. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Heterogeneous thyroid parenchyma with macrocalcifications and dominant right thyroid nodule as detailed above. "}
{"instruction": "Generate impression based on findings.", "input": "Palpable right testicular nodule RIGHT TESTIS: 3.9 x 2.2 x 1.5 cm. Multiple well-circumscribed anechoic peripheral cystic lesions associated with the right testis consistent with tunica cysts. The largest measures 1 x 0.9 x 1.1 cm.LEFT TESTIS: 4.2 x 2.8 x 1.9 cm. No intratesticular mass.RIGHT EPIDIDYMIS: Benign-appearing right epididymal cyst/spermatoceleLEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Multiple right benign tunica cysts. No worrisome intratesticular mass."}
{"instruction": "Generate impression based on findings.", "input": "Weight loss, extensive smoking history and elevated alkaline phosphatase LIVER: Mildly coarse liver echotexture without mass. Liver length 13.2 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 8.5 cm in lengthOTHER: Left kidney 8 cm in length. Mildly echogenic left renal parenchyma without mass, stone, or hydronephrosis. Spleen 8.5 cm in length. No ascites", "output": "Mildly coarse liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Reason: r/o recurrence. please compare to prior ultrasounds History: h/o thyroid cancer. 1 year follow up study. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: No specific evidence of recurrence.LEFT LOBE: No specific evidence of recurrence.ISTHMUS: No specific evidence of recurrence.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level 2 (previously labeled level 1B) lymph node measures 2.1 x 0.8 x 2.2 cm, previously 1.7 x 0.6 x 1.9 cm. Right level 1B lymph node measures 0.8 x 0.6 x 1.2 cm and demonstrates benign morphology.OTHER: No mass or abnormality demonstrated in the left lateral level 5 in the patient's palpable area of concern.", "output": "No evidence of recurrence."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old female with hepatitis B without delta agent. Evaluate for cirrhosis or mass. LIVER: Liver is normal in size and is mildly echogenic. Morphology is normal. There is no focal hepatic mass identified.BILIARY TRACT: Biliary tract is normal in caliber. The gallbladder appears unremarkable without cholelithiasis, wall thickening or pericholecystic fluid.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Mildly echogenic liver. Otherwise, normal exam."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic prostate cancer. Rising creatinine. RIGHT KIDNEY: 10.2 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 11.4 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones. Mild left hydronephrosis.BLADDER: No significant abnormality noted.OTHER: Left lower abdominal quadrant lymphadenopathy.", "output": "Mild left hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old asymptomatic woman with personal history of left breast biopsy demonstrating atypical lobular hyperplasia. Strong family history of breast cancer in her sister diagnosed at age 59, paternal grandmother diagnosed in her 70s, and paternal first cousin diagnosed at age 53. Three standard views of both breasts with tomosynthesis and with two right ML rolled views and three right breast spot compression views (11 images total) 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. A distortion in the right retroareolar breast on spot compression views appears to represent overlapping glandular tissue on tomosynthesis images.Stable calcifications in the right upper outer breast. A biopsy marker clip is present in the left posterior central breast. No suspicious microcalcifications in either breast. RIGHT BREAST ULTRASOUND", "output": "Questionable distortion versus overlapping glandular tissue in the right breast, without sonographic abnormality. Attention to this area should be paid on the patient's future scheduled screening MRI. In addition, a right unilateral diagnostic mammogram is recommended in 6 months, as long as the patient's physical examination remains normal. Results and recommendation 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": "Female 55 years old Reason: assess liver History: elevated lft, sickle cell crisis, elevated creatnine LIVER:The liver is coarse indicating fatty infiltration. The liver measures 17.6 cm. Main portal vein is patent with normal directional flow with a peak velocity of 26.5. GALLBLADDER, BILIARY TRACT: Common bile duct measures 6 mm. No intra or extra hepatic biliary ductal dilatation. Patient is status post cholecystectomy. PANCREAS: Tail the pancreas is obscured by overlying bowel gas. The pancreas is normal in appearance.SPLEEN: Spleen measures 7.7 cm and is not well-visualized.KIDNEYS: Right kidney measures 8.5 cm. No shadowing calculi or hydronephrosis bilaterally. Left kidney is difficult to visualize.ABDOMINAL AORTA: The abdominal aorta proximally measures 2.8 cm x 3.2 cm. The mid abdominal aorta measures 2.0 cm x 2.0 cm.INFERIOR VENA CAVA: There is an age-indeterminate nonocclusive thrombus in the infrahepatic, suprarenal IVC.OTHER: No ascites", "output": "1.Age indeterminate nonocclusive thrombus in the infrahepatic, suprarenal IVC. Discussed findings with ordering physician Dr. Chrapek at 3:10 PM on 9/15/2016.2.Fatty liver."}
{"instruction": "Generate impression based on findings.", "input": "78-year-old male with history of thyroid cancer who presents for evaluation for recurrence RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyPOSTOPERATIVE BED: No evidence of residual or recurrent disease.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy without evidence of residual or recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "34-year-old female presents with palpable concern in the left breast. A targeted left ultrasound was performed for the palpable area of concern behind the nipple. There is no solid or cystic mass identified. Normal breast tissue is noted at the site of palpable concern.", "output": "No sonographic evidence for malignancy corresponding to the patient's palpable area of concern. Routine screening mammogram at age of 40. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 69 yo with cirrhosis please screen for HCC LIVER: The liver measures 15.5 cm in length and is nodular in contour. The liver parenchymal echotexture demonstrates increased echogenicity. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.1 m/s. Recanalized umbilical vein.BILIARY TRACT: Gallbladder wall thickening is nonspecific but likely represents the sequela of chronic liver disease. Single 1 mm adherent stone versus tiny polyp. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common hepatic duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: Spleen is enlarged measuring 20.8 cm in length. Small splenule.RIGHT KIDNEY: Kidney measures 9.7 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 9.9 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: Large volume ascites, particularly in the pelvis.", "output": "1.Cirrhotic liver morphology and increased hepatic echogenicity consistent with chronic liver disease, without discrete lesion.2.Sequelae of portal hypertension including splenomegaly and ascites.3.Gallbladder wall thickening nonspecific but likely related to chronic liver disease."}
{"instruction": "Generate impression based on findings.", "input": "24-year-old female with a right breast palpable mass who presents for sonographic evaluation. On physical examination, there is a palpable, nontender, mobile mass in the right breast at approximately 11:00 position, 4 cm from the nipple.A targeted right ultrasound was performed for the palpable area of concern. There is a hypoechoic circumscribed mass measuring 3.5 x 1.9 x 3.7 cm with mildly increased vascularity and parallel orientation in the right breast at 11:00 position, 4 cm from the nipple.", "output": "Large hypoechoic mass at 11:00 position in the right breast as detailed above. Finding may represent a fibroadenoma; however, based on the large size, surgical consultation is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Chang is a 24 year old female with a history of a left breast mass seen on prior ultrasound. The patient reports that the palpable lump has gotten larger. No pain or nipple discharge. No family history of breast cancer. A targeted left breast ultrasound was performed. The area of palpable concern in the left breast 12:00 position, approximately 1 cm from the nipple, corresponds with a parallel-oriented oval, circumscribed, homogeneously hypoechoic mass measuring 1.3 x 0.5 x 1.5 cm, previously measuring 1.3 x 0.5 x 1.4 cm. These findings are again consistent with a benign fibroadenoma. No other suspicious cystic or solid masses are identified.", "output": "Stable benign fibroadenoma of the left breast. No sonographic evidence of malignancy. No additional imaging workup is recommended at this time. All results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Right quadrant pain LIVER: Non-cirrhotic liver morphology. 14.7 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. Status post cholecystectomy.PANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney is 9.9 cm in length. The left kidney is 9.7 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 9.7 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No upper abdominal fluid collections identified.", "output": "Mildly increased hepatic echogenicity, compatible with parenchymal dysfunction. Otherwise no specific findings to account for the patient's right upper quadrant pain."}
{"instruction": "Generate impression based on findings.", "input": "Male; 61 years old. Reason: Evaluate possible mets, testicular cancer History: HCC, HCV elevated AFP RIGHT TESTIS: The right testis measures 3.0 x 2.9 x 2.7 cm. It is is normal in echogenicity, no worrisome lesion is identified. Vascular flow is symmetric.LEFT TESTIS: The left testes measures 2.0 x 3.1 x 1.8 cm. It is normal in echogenicity. There is a 1 mm calcification within the left testicle. No worrisome lesion is identified. Vascular flow is symmetric.RIGHT EPIDIDYMIS: The right epididymis measures 0.7 x 0.9 x 0.7 cm and is normal in appearance.LEFT EPIDIDYMIS: The left epididymis measures 1.5 x 1.1 x 0.6 cm and contains a 0.7 x 0.9 x 0.7 cm simple cyst.OTHER: Bilateral hydroceles.", "output": "1.No worrisome testicular lesion is identified.2.Simple left epididymal cyst.3.Bilateral hydroceles."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules RIGHT LOBE MEASUREMENTS: 4.6 x 1.7 x 1.6 cmLEFT LOBE MEASUREMENTS: 3.4 x 1.2 x 1.4 cmISTHMUS MEASUREMENTS: 0.1 cmRIGHT LOBE: Diffusely heterogeneous gland again noted. Stable solid right lower pole thyroid nodule measuring 1 x 1 x 1 cmLEFT LOBE: Diffusely heterogeneous gland again noted. Stable left lower pole hyperechoic subcentimeter nodule measuring 0.5 x 0.5 x 0.5 cm.ISTHMUS: Diffusely heterogeneous gland again noted. 1 x 0.4 x 0.9 cm predominantly solid right isthmic nodule; in retrospect, this nodule was present on the prior study and unchanged in appearance.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable diffusely heterogeneous thyroid gland. Stable thyroid nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old man with history of renal cancer. Evaluate for recurrence. RIGHT KIDNEY: The right kidney measures 11.4 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.7 cm in length and shows normal echotexture. There is a 1.6 x 1.9 x 1.2 cm simple cyst within the cortex of the left midpole kidney which does not contain internal septations, debris or calcifications. No mass, stone or hydronephrosis.URINARY BLADDER: The urinary bladder is normal in appearance.OTHER: A round hyperechoic focus within the right lobe of the liver measures 1.5 x 1.5 x 1.4 cm.", "output": "1.Simple cyst within the cortex of the left midpole kidney without internal septations, debris or calcifications. No mass is seen of either kidney. No hydronephrosis.2.A round hyperechoic focus within the right lobe of the liver presumably represents a hemangioma described on previous imaging."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain and right upper quadrant tenderness LIVER: Coarse echogenic liver echotexture 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. 10 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 11.2 cm in lengthOTHER: Left kidney 11.8 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old man with nephrotic syndrome. RIGHT KIDNEY: The right kidney measures 10.5 cm in length and shows mildly increased echotexture. Well-circumscribed echogenic focus in the right midpole kidney measures 1.6 x 1.5 x 1.3 cm. No hydronephrosis. LEFT KIDNEY: The left kidney measures 12.3 cm in length and shows mildly increased echotexture. There is a simple appearing cyst within the left midpole kidney measuring 3.0 x 2.7 x 2.8 cm. No mass, stone or hydronephrosis.URINARY BLADDER: The urinary bladder is normal in appearance.OTHER: Mild ascites.", "output": "Mildly echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis. Well-circumscribed echogenic focus in the right midpole kidney, likely an AML. Mild ascites. "}
{"instruction": "Generate impression based on findings.", "input": "Thyroid cancer status post thyroidectomy. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy LEFT LOBE MEASUREMENTS: Status post thyroidectomy ISTHMUS MEASUREMENTS: Status post thyroidectomy RIGHT LOBE: The previously described hyperechoic tissue in the right thyroid bed is again seen, with linear hyperechoic focus likely representing a surgical clip.LEFT LOBE: The anechoic focus in the left thyroid bed is unchanged at 7 x 4 x 4 mm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "Stable examination, without evidence of recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "Female; 49 years old. Reason: 49 yo with HCV with GB polyps. LIVER: The liver measures 14.8 cm. Liver echogenicity is mildly increased. The liver capsule is smooth in contour. No mass lesion is identified within the liver. The main portal vein is patent with normal directional flow a peak velocity of 40 cm/sec.GALLBLADDER, BILIARY TRACT: Again seen is a small, echogenic, non-shadowing, non-mobile focus along the gallbladder wall which measures 5 x 5 x 4 mm.PANCREAS: Mild diffuse fatty infiltration the pancreas is again seen.SPLEEN: The spleen measures 9.5 cm in length.LEFT KIDNEY: Limited views of the left kidney show no hydronephrosis or shadowing renal calculus. The kidney measures 11.6 centimeters in length. At the superior pole of the left kidney is a 2.4 x 2.0 x 2.1 cm simple cyst.OTHER: No significant abnormalities noted.", "output": "Stable exam with no focal hepatic lesion."}
{"instruction": "Generate impression based on findings.", "input": "History of hepatitis C. Evaluate for HCC. LIVER: The liver measures 14 cm in length. The hepatic parenchyma is mildly coarse, but normal in morphology. The previously seen simple cyst was not identified on today's study. In the right hepatic dome there is a nonspecific 6 mm mildly echogenic lesion not seen on the prior study. Normal hepatopedal portal venous blood flow at 23 cm/s. BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation with the common duct measuring 3 mm. Normally distended gallbladder without wall thickening, gallstones pericholecystic fluid or focal tenderness. Nonmobile nodular focus measuring 5 x 4 x 5 mm; probable gallbladder polyp, unchanged.PANCREAS: The pancreas is obscured by overlying bowel gas shadowing and the patient's body habitus.SPLEEN: The spleen measures 9 cm in length without a focal lesion.RIGHT KIDNEY: The right kidney measures 11.5 cm with a superior pole 8.6 x 7.2 x 7.7 cm simple appearing cyst. No shadowing nephrolithiasis or hydronephrosis. OTHER: The left kidney measures 11.3 cm in length without shadowing nephrolithiasis, hydronephrosis or suspicious lesion.", "output": "Nonspecific 6 mm right hepatic dome mildly echogenic lesion statistically favors a hemangioma. However, given the history of HCV with no specific evidence of cirrhosis, attention to this lesion on surveillance imaging is recommended. If there is clinical concern an MRI may be of utility, although the lesion may be too small to characterize at this time. "}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female with history of renal masses and pulmonary cyst, evaluate for metastatic disease. RIGHT KIDNEY: Measures 10.8 cm in length. Solid mass in the right kidney measures 3.4 x 3.3 x 2.9 cm, correlating with the lesion seen on recent CT. No hydronephrosis.LEFT KIDNEY: Measures 11.9 cm in length. 3.9 x 4.2 x 4.0 cm left inferior pole cyst without septation or nodular component. Adjacent subcentimeter cyst also noted. No hydronephrosis or solid mass. Nonobstructive left renal calculi.URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.", "output": "Solitary solid right renal mass highly suspicious for renal cell carcinoma."}
{"instruction": "Generate impression based on findings.", "input": "52 year-old female with colicky abdominal pain for 2 months. LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: Note is made of a subcentimeter echogenic focus along the nondependent portion of the neck of the gallbladder without internal vascularity, measuring 5 mm in its largest diameter, most consistent with a gallbladder polyp. It should be noted that gallbladder polyps less than 6 mm in size require no follow-up examination. No gallstones are identified. No evidence of acute cholecystitis. Sonographic Murphy's is negative.PANCREAS: No significant abnormalities noted although the pancreas is partially obscured by overlying bowel gas.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "1. No sonographic findings to account for the patient's pain.2. 5 mm gallbladder polyp for which no follow-up examination is required."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 62M refractory ALL with septic shock, rule out acalculous cholecystitis History: as above LIVER: The liver measures 17.1 centimeters in length, indicating mild hepatomegaly. Course hepatic parenchymal echotexture, consistent with hepatic steatosis, parenchymal dysfunction, or cirrhosis. The portal vein is patent with normal directional hepatopedal portal venous blood flow, peak velocity 16.2 cm/s. No focal masses.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No biliary ductal dilatation. The proximal common bile duct measures 0.3 cm.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 11.4 cm in length. No evidence of hydronephrosis, masses, or shadowing calculi.LEFT KIDNEY: The left kidney measures 12.5 cm in length. No evidence of hydronephrosis, masses, or shadowing calculi.SPLEEN: The spleen measures 13.7 cm in length.OTHER: No significant abnormalities noted.", "output": "1. Mild hepatomegaly and coarse hepatic parenchymal echotexture, consistent with hepatic steatosis, parenchymal dysfunction, or cirrhosis.2. Status post cholecystectomy without biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "21-year-old female with hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 5.7 x 1.8 x 1.5 cmLEFT LOBE MEASUREMENTS: 5.6 x 1.4 x 1.7 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Heterogeneous parenchyma without discrete noduleLEFT LOBE: Heterogeneous parenchyma without discrete noduleISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Extrathyroidal circumscribed hypoechoic structure posterior to the right mid-inferior gland measures 1.3 x 1.6 x 0.7 cm, highly suspicious for parathyroid adenoma.LYMPH NODES: Scattered cervical lymph nodes with benign morphologic features.OTHER: No significant abnormality noted.", "output": "Suspected right parathyroid adenoma as described above. "}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female with enlarged thyroid. RIGHT LOBE MEASUREMENTS: 5.2 x 2.1 x 1.5 cmLEFT LOBE MEASUREMENTS: 4.8 x 1.9 x 2.3 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Mildly heterogeneous in echogenicity. Much of the anterior portion of the mid pole of the thyroid is occupied by poorly defined hypoechoic region with internal echogenic rounded small nodules. The appearance is unusual for a thyroid nodule and this may represent focal manifestation of thyroiditis. Within the posterior portion of the mid right lobe there is a 0.5 cm iso to mildly hypoechoic nodule with a full hypoechoic rim.LEFT LOBE: In the upper pole of the left lobe there is an area similar to the anterior aspect of the right lobe which is hypoechoic with internal rounded echogenic component measuring approximately 0.6 x 1.1 x 1.4 cm. Again this may be a focal manifestation of thyroiditis. In the inferior left lobe there is a solid iso to mildly hypoechoic nodule with a hypoechoic rim measuring 0.4 x 0.6 x 0.6 cm, similar to small nodule on the right.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Thyromegaly with bilateral poorly defined hypoechoic regions with internal rounded echogenic components. This may be related to thyroiditis.There are small, non--- specific solid nodules bilaterally."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old female with nausea and vomiting with abnormal liver function. Prior cholecystectomy. Mild hyperemesis gravidum LIVER: Normal in size and echogenicity. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: The biliary tract is normal in caliber. Patient has had a prior cholecystectomy.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Normal exam post cholecystectomy."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male with history of thyroid cancer. Evaluate for recurrence. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No masses in the thyroid bed.LEFT LOBE: No masses in the thyroid bed.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: At level 1B on the left, there are 2 rounded hypoechoic masses which are adjacent, one measuring 0.8 x 0.8 x 0.9 cm and the second 0.6 x 0.8 x 0.7 cm. These do not have normal nodal morphology and are rounded in nature, and therefore worrisome for nodal recurrence given the position. It is also possible that this represents a single lobulated mass. OTHER: No significant abnormality noted.", "output": "Abnormal lymph nodes left neck. No abnormality in the thyroid beds."}
{"instruction": "Generate impression based on findings.", "input": "Calf pain following injury The images demonstrate the presence of a focal hypoechoic defect of the distal medial portion of the medial head of the gastrocnemius along the aponeurosis at the interface with the soleus. This defect measures approximately 2 cm in length and is compatible with a hematoma at the site of a partial-thickness tear. There is no evidence of a full-thickness rupture. There is diffuse subcutaneous edema particularly of the medial calf. Lateral head of the gastrocnemius and Achilles tendon are unremarkable.", "output": "Small partial-thickness tear / hematoma of the medial head of the gastrocnemius as above with associated diffuse subcutaneous edema."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old male with a history of altered mental status and elevated bilirubin. LIVER: The liver echotexture is mildly coarsened. No focal hepatic lesion or biliary ductal dilatation. Normal hepatic size, measuring 18.8 cm in craniocaudal dimension. Perihepatic ascites. Pulsatile normally oriented portal venous blood flow up to 40 cm/sec. BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 4 mm. The gallbladder appears contracted and full of shadowing gallstones and sludge. No pericholecystic fluid. Evaluation for focal tenderness is limited by the patient's mental status.PANCREAS: Limited evaluation of the pancreatic head is unremarkable.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.9 cm in length without hydronephrosis, shadowing nephrolithiasis or focal lesion identified. OTHER: The spleen is normal in size measure 11.4 cm. It is partially obscured. The left kidney is partially obscured, measuring 10.2 cm without gross hydronephrosis.The urinary bladder is collapsed with a Foley. Pelvic ascites. Bilateral pleural effusions.", "output": "1. The gallbladder appears partially contracted with gallstones/sludge. No significant gallbladder wall thickening or pericholecystic fluid to suggest acute inflammation. Evaluation for focal tenderness is limited by the patient's mental state. 2. Pulsatile portal venous blood flow is unchanged.3. Ascites and pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodule RIGHT LOBE MEASUREMENTS: AbsentLEFT LOBE MEASUREMENTS: 6.1 x 2 x 1.7 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Surgically removedLEFT LOBE: Multiple mixed cystic and solid as well as spongiform nodules. The largest nodule within the lower pole measures 1.2 x 1 x 1.1 cm and has a spongiform appearance.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Status post resection of right thyroid lobe. Multiple mixed cystic and solid as well as spongiform left thyroid nodules; favor benign etiology. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: HCC screening History: Hep B LIVER: Echogenic, coarse hepatic parenchyma. The liver measures 11.3 cm in length. Hepatic cyst in the left lobe of the liver measures 1.1 x 0.6 x 1.0 cm, stable. There is no biliary ductal dilatation. The main portal vein is patent with normal directional hepatopedal portal venous flow, peak velocity 16.3 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is unremarkable. The gallbladder wall measures 0.2 cm. The common bile duct measures 0.4 cm. There is no biliary ductal dilatation. No shadowing gallstones are seen. There is no pericholecystic fluid.PANCREAS: Not visualized due to overlying bowel gas.RIGHT KIDNEY: The right kidney measures 11.0 cm in length. The left kidney measures 9.2 cm in length. The renal parenchymal echogenicity is unremarkable. There is no hydronephrosis or shadowing stones.OTHER: The spleen measures 8.47 m in length. A loculated fluid collection is seen at the is right lung base, measuring 2.0 x 2.6 x 1.8 cm, likely representing a persistent loculated pleural effusion.", "output": "1. No suspicious hepatic lesions identified.2. Persistent loculated fluid collection at the right lung base.3. Echogenic hepatic parenchyma, consistent with chronic liver dysfunction"}
{"instruction": "Generate impression based on findings.", "input": "67 year old female with history of acute renal failure. Evaluate right upper quadrant due to elevated bilirubin, and for renal obstruction. LIVER: The liver has a subtly nodular contour, and measures 15.5 cm in length. Heterogeneous echogenicity, suggestive of cirrhosis. Moderate amount of abdominal and pleural fluid.GALLBLADDER, BILIARY TRACT: No biliary dilatation, or other significant abnormality. History of cholecystectomy.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. The spleen measures 13.5 cm.KIDNEYS: No hydronephrosis or hydroureter, and no additional significant abnormality noted. The right kidney measures 13 cm, the left kidney measures 12.5 cm.ABDOMINAL AORTA: The abdominal aorta measures 2.4 cm in widest dimension.INFERIOR VENA CAVA: The IVC is not well visualized.OTHER: No significant abnormality noted.", "output": "Abdominal ascites and pleural effusions as above, without findings of biliary dilatation, or renal obstruction. Imaging findings suggestive of cirrhosis."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Ann Balling is a 61 year old female with personal history of left breast cancer, status post chemotherapy. She presents today for imaging evaluation of treatment response. A targeted left ultrasound was performed for the patient\u2019s area of concern, site of a known cancer. In the left breast, 2:00 position, 5 cm from the nipple, there is a subtle hypoechoic area measuring 10 x 12 mm, which could represent the residua of the known cancer and/or treated tissue. This mass previously measured 37 x 18 x 28 mm. A few lymph nodes are noted in the left axilla. The index lymph node now measures 11 x 9 mm versus 16 x 7 mm on the prior ultrasound.", "output": "Interval decrease in size of the left breast cancer and left axillary index lymph node as described above. Also refer to today's separately dictated MRI. Surgical consultation is recommended. Results and recommendations were discussed with the patient. BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "43 year old female who was recalled from screening mammogram for 17 mm focal asymmetry in the right breast 12 o'clock position . 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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. The focal asymmetry in question most likely represents glandular tissue on spot compression views Ultrasound: Targeted right breast upper outer quadrant ultrasound was performed. Normal glandular tissue noted on ultrasound. No suspicious cystic or solid mass seen.", "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": "30-year-old female with right anterior neck mass and new left posterior neck mass RIGHT LOBE MEASUREMENTS: 5.2 x 1.7 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.6 x 1.1 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: In the upper pole of the right lobe there is a rounded, solid and heterogeneously hyperechoic mass with a complete hypoechoic rim. Otherwise normal echotextureLEFT LOBE: Normal echotexture without mass.ISTHMUS: No massesPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Focused evaluation of the left posterior neck in the region of palpable abnormality as described the patient demonstrates no sonographically visible mass.", "output": "1. Solid right thyroid nodule. The appearance is not characteristic.2. No left neck mass identified."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old with LFTs elevation after allo-SCT and donor lymphocyte infusion LIVER: Liver measures 17.4 cm with normal echotexture. No intrahepatic biliary ductal dilatation. No focal lesions noted.BILIARY TRACT: Gallbladder is well distended and normal gallbladder wall thickness without pericholecystic fluid. No evidence of gallstones.PANCREAS: No significant abnormalities noted.SPLEEN: Mild splenomegaly, spleen, measures 13.3 cm, with normal echotexture.KIDNEY: Right measures 11.6 cm the left kidney measures 11.8 cm. Normal echotexture noted. No hydronephrosis. No focal lesions are noted.OTHER: No ascites", "output": "Mild splenomegaly. Normal echotexture of the liver. "}
{"instruction": "Generate impression based on findings.", "input": "right upper quadrant pain LIVER: Liver measures 14.8 cm with diffuse coarse heterogenous echotexture. There is no definite surface nodularity that is noted on today's imaging. No focal lesions noted.Multiple tortuous vessels were observed in the porta hepatis occupying the portal vein bed demonstrating hepatopedal flow suggestive of cavernous transformation of the portal vein.No definite intrahepatic biliary ductal dilatation.BILIARY TRACT: Status post cholecystectomy. Common bile duct measures up to 3 mm.PANCREAS: Head of the pancreas appears unremarkable. Body and tail of pancreas not visualized due to overlying bowel gas.SPLEEN: Spleen measures 8.3 cm with normal echotexture.KIDNEY: Right kidney measures 9.5 and left kidney measures 10.6 cm. No hydronephrosis. Normal echotexture noted. No focal lesions. OTHER: No ascites", "output": "Cavernous transformation of the portal vein occupying the portal vein bed at the porta hepatis. Diffuse coarse echotexture of the liver however not completely cirrhotic on ultrasound. Suggest further evaluation with CT liver protocol."}
{"instruction": "Generate impression based on findings.", "input": "18-year-old male with history of sickle cell anemia, right upper quadrant pain LIVER: Measures 17.9 in length. Unremarkable hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: The gallbladder is mildly distended and contains sludge as well as small stones. There is mild gallbladder wall thickening with reticulation of the pericholecystic fat. No sonographic Murphy sign was elicited during the examination. There is no biliary ductal dilation.PANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Markedly increased splenic echogenicity consistent with infarction and calcification.KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "1.No convincing evidence of acute cholecystitis, but cholelithiasis with mild gallbladder wall thickening and pericholecystic inflammatory changes raise the question of a chronic component of inflammation. 2.Splenic infarction and calcification consistent with sickle cell anemia."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old female with ascites. History of lupus and antiphospholipid syndrome. LIVER: Liver is normal in size and echotexture. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein. BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The visualized biliary tract is normal in caliber.PANCREAS: Head and body are normal. The tail was not well seen.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Moderately to markedly echogenic without hydronephrosis.OTHER: Left kidney is moderately to markedly echogenic without hydronephrosis.Ascites with largest collection in the right lower quadrant.Bilateral pleural effusions.", "output": "Mild to moderate ascites.Bilateral pleural effusions.Echogenic kidneys."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old male with right upper quadrant pain, evaluate for cholelithiasis. LIVER: The liver measures 18 cm in length. Mildly increased hepatic echogenicity without discrete focal lesion.GALLBLADDER, BILIARY TRACT: Numerous shadowing gallstones. The gallbladder is partially collapsed. There is no gallbladder wall thickening, pericholecystic fluid, or sonographic Murphy sign. No biliary ductal dilation.PANCREAS: Evaluation of the pancreas is limited due to bowel gas and shadowing from gallstones.KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "1.Cholelithiasis without specific evidence of acute cholecystitis.2.Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease."}
{"instruction": "Generate impression based on findings.", "input": "45 years old, Female, Reason: 45 yo female with h/o htn and GFR 60's. Please eval for obstruction History: ckd RIGHT KIDNEY: Kidney measures 10.8 cm in length. Normal echotexture. Nohydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 10.5 cm in length. Normal echotexture. Nohydronephrosis or shadowing calculus.Bladder: Nondistended", "output": "No significant abnormality seen on this ultrasound evaluation of the kidneys. No evidence of hydronephrosis as clinically questioned."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male patient with bruising abdomen status post PTC drain with AMS, hypertension. Evaluate for worsening obstruction of gallbladder or free fluid in abdomen. LIVER: The liver measures 16.4 cm in length and demonstrates increased, coarsened parenchymal echotexture. Main portal vein flow is hepatopetal and measures 0.14 m/sec.GALLBLADDER, BILIARY TRACT: Interval placement of a percutaneous cholecystostomy tube. The gallbladder is less distended and contains less debris. There is no intrahepatic biliary ductal dilatation. The common bile duct appears to contain some echogenic material which may represent sludge and measures 7 mm in diameter. PANCREAS: The pancreas is poorly visualized on this examination.RIGHT KIDNEY: The right kidney is poorly visualized.OTHER: The left kidney is not visualized on this examination.The spleen measures 11.6 cm in length.No ascites is identified. No discrete fluid collection is identified in the subcutaneous tissues near the cholecystostomy tube.", "output": "1. Less distended gallbladder.2. No ascites. "}
{"instruction": "Generate impression based on findings.", "input": "26-year-old female with out significant medical history presents with palpable mass in her posterior left neck. There is a approximately 1.2 x 1.1 x 0.3 cm reactive lymph node in the left posterior neck with benign morphology. It does not appear enlarged.", "output": "1. Normal-appearing lymph node as above."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male with diffuse goiter and FNA of right thyroid nodule at outside institution demonstrating FLUS. The patient was referred for biopsy of right lobe nodule. Limited scanning demonstrated spongiform/colloid nodules on the right and perhaps a small grouping of calcification without associated mass. Therefore, biopsy was not performed and this was discussed with Dr. Angelos service.", "output": "Suspicious nodule not identified. Biopsy not performed."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate right renal cyst RIGHT KIDNEY: Stable mildly complex lower pole right renal cyst measuring 1.8 x 1.8 x 1.5 cm. No stones or hydronephrosis. Right kidney 9.4 cm in length.LEFT KIDNEY: No significant abnormalities noted. 10.1 cm in length OTHER: Bladder nondistended", "output": "Stable mildly complex lower pole right renal cyst."}
{"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.This exam was double read and Dr. Kulkarni concurred with this report.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "History of cirrhosis with progressing ascites LIVER: Cirrhotic morphology again noted without mass. Liver length 15.7 cm.Limited Doppler interrogation of the main portal vein demonstrates a patent portal vein with normal directional flow. Main portal vein velocity 21.7 cm/sGALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 8.5 cm in lengthOTHER: Left kidney 8.9 cm in length. Spleen 11.8 cm in length. Moderate ascites.", "output": "Stable cirrhotic morphology without mass or ductal dilatation. Gallbladder sludge without acute inflammation. Limited Doppler interrogation of the main portal vein demonstrates a patent portal vein with normal directional flow. Moderate ascites."}
{"instruction": "Generate impression based on findings.", "input": "21-year-old female with history of thyroid cancer. Follow-up cervical lymph nodes. RIGHT LOBE MEASUREMENTS: Just inferior to the right thyroid bed there is a 0.2 x 0.2 x 0.4 cm likely solid nodule. This is not specific and could represent a lymph node.LEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massesLEFT LOBE: No massesISTHMUS: No massesPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: ,Ovoid homogeneous level 2-3 node on the right measuring 0.5 x 0.9 x 1.0 cm without change. Normal hilum not visualized with certainty. Smaller adjacent nodes as well.0.7 x 1.3 x 2.2 cm lymph node with normal hilum at level 2 in the left neck. 0.4 x 1.3 x 2.2 cm lymph node with normal architecture at level 2-3. 0.4 x 0.4 x 0.8 cm left level 3 node is unchanged.OTHER: No significant abnormality noted.", "output": "Increase in size of left cervical lymph nodes although not obviously morphologically abnormal."}
{"instruction": "Generate impression based on findings.", "input": "Female 62 years old Reason: AML patient with transaminitis- eval liver morphology- fatty liver vs. drugs vs. leukemic infiltration History: AML patient undergoing chemo- mobility LIMITED ABDOMENLIVER: Liver measures 22.4 cm. Echogenic liver parenchyma without focal lesion. The portal vein is patent with normal directional flow.BILIARY TRACT: No evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No intra or extrahepatic biliary ductal dilation. The common bile duct measures 7 mm.PANCREAS: No significant abnormality noted.KIDNEYS: The right kidney measures 10.2 cm. The left kidney measures 10.4 cm. No hydronephrosis or mass. SPLEEN: The spleen measures 10.4 cm in length.OTHER: No significant abnormalities noted.", "output": "Hepatomegaly and hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury RIGHT KIDNEY: Measures 10.7 cm. Echogenic parenchyma with thinning of the renal cortex. No hydronephrosis or mass.LEFT KIDNEY: Measures 10.4 cm. Echogenic renal parenchyma. Mild left hydronephrosis. No mass.OTHER: Foley catheter in a nondistended bladder.", "output": "Medical renal disease. Mild left hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female patient with continued trend in bilirubin. Assess for acalculous cholecystitis, SOS, and patency of liver vasculature. LIMITED ABDOMENLIVER: The liver measures 18.2 cm in length and demonstrates increased parenchymal echogenicity. No focal hepatic lesion is identified.BILIARY TRACT: The gallbladder is mildly contracted and contains sludge. No intra or extrahepatic biliary ductal dilatation is identified. The common duct measures 2 mm in diameter.PANCREAS: The pancreas is poorly visualized on this examination.SPLEEN: The spleen measures 12.2 cm in length. RIGHT KIDNEY: The right kidney measures 12.6 cm in length. No evidence of hydronephrosis.OTHER: The left kidney measures 11.7 cm in length. No evidence of hydronephrosis.There is ascites.", "output": "1. Non-visualization of the right portal vein. Otherwise, patent hepatic vasculature.2. Increased hepatic echogenicity which can be seen with hepatic parenchymal dysfunction.3. Biliary sludge without specific sonographic evidence of acute cholecystitis.4. Ascites."}
{"instruction": "Generate impression based on findings.", "input": "Evaluation for HCC, history of hepatitis B LIVER: Liver measures 13.5 cm, mild coarse echotexture without any focal lesions. Normal Flow directionality and patency of the portal vein.GALLBLADDER, BILIARY TRACT: Distended gallbladder with multiple small stones which are mobile in nature. No wall thickening or pericholecystic fluid is noted. Common bile duct measures within normal limits.PANCREAS: No significant abnormalities noted.KIDNEY: Right kidney measures 9.8 cm and left kidney measures 11.6 cm. Normal echotexture noted. No hydronephrosis. A 0.6 x 0.3 x 0.5 cm new renal calculus is identified in the midpole.OTHER: Spleen measures 9.9 cm without any focal lesions. No ascites", "output": "Coarse hepatic echotexture without any focal lesions.Cholelithiasis.New left renal midpole calculus without obstruction"}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male with acute kidney injury. Evaluate for hydronephrosis. RIGHT KIDNEY: Measures 10.7 cm. Cortex appears to be thin. Marked hydronephrosis with proximal hydroureter; distal ureter cannot be visualized on ultrasound. No focal mass or shadowing calculi.LEFT KIDNEY: Measures 14.9 cm. Cortex appears to be thin. Marked hydronephrosis with proximal hydroureter; distal ureter cannot be visualized on ultrasound. No focal mass or shadowing calculi.URINARY BLADDER: The bladder is mildly distended.OTHER: No significant abnormalities noted.", "output": "Bilateral hydronephrosis and hydroureter. Bladder appears distended. Findings discussed with the clinical service at the time of dictation."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B status post liver transplant LIMITED ABDOMENLIVER: Mildly coarse and echogenic liver echotexture without worrisome mass. Hepatic cyst unchanged. Liver length 17 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 11.2 cm in length RIGHT KIDNEY: Echogenic renal parenchyma again noted without worrisome mass, stone, or hydronephrosis. Right renal cyst. Right kidney 9.4 cm in lengthOTHER: Echogenic left renal parenchyma without worrisome mass, stone, or hydronephrosis. Left kidney 10.6 cm in length. No ascites", "output": "Mildly coarse and echogenic liver echotexture again noted without mass. Patent hepatic vessels with normal directional flow. No ascites. Echogenic renal parenchyma again noted consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 10.6 cm in lengthLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 10.6 cm in lengthOTHER: Bladder nondistended. Cholelithiasis incidentally noted", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction. Cholelithiasis incidentally noted."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old female with hepatitis B. Evaluate for HCC. LIVER: Measures 20.2 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: No hydronephrosis or nephrolithiasis. Focal contour abnormality of the lateral right kidney seen on limited views likely represents lobulation, but not definitively seen on prior studies, and a mass cannot be entirely excluded.OTHER: No significant abnormalities noted.", "output": "1. Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease, without discrete focal lesion. 2. Focal contour abnormality of the lateral right kidney seen on limited views most likely represents lobulation, but not definitively seen on prior studies, and a mass cannot be entirely excluded. Continued attention to this region is recommended on follow-up examinations, and if there is clinical concern a renal protocol CT or MR may be performed for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain LIVER: Mildly heterogeneous and echogenic liver without mass. Liver length 18.6 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: Pancreatic ductal prominence again noted.RIGHT KIDNEY: No significant abnormalities noted. Stable right renal cysts. Right kidney 9.9 cm in lengthOTHER: Stable left renal cysts. Left kidney 10.3 cm in length. Spleen 7.5 cm in length. No ascites.", "output": "Mildly heterogeneous and echogenic liver parenchyma suggestive for fatty infiltration/parenchymal dysfunction without worrisome mass or ductal dilatation. No ascites. Prominent pancreatic ductal prominence again noted"}
{"instruction": "Generate impression based on findings.", "input": "Female 31 years old Reason: Vague upper and LUQ pain. Exclude splenomegaly, pancreatic abnormalities LIVER: Normal, relatively homogeneous appearance of the liver parenchyma. No focal hepatic mass is visualized. Main portal vein is patent with normal directional flow and a peak velocity 26 cm/s.BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. Common bile duct measures up to 5 mm. No evidence of acute inflammation of the gallbladder. No gallstones. Gallbladder wall is within normal limits measuring 2 mm.PANCREAS: The visualized portions of the pancreas are normal.SPLEEN: Spleen is normal in appearance measuring 8.8 cm.RIGHT KIDNEY: Normal cortical echogenicity. No hydronephrosis or shadowing calculus. Right kidney measures 11.8 cm.LEFT KIDNEY: Per technologist the left kidney is somewhat inferiorly displaced and has a configuration that is somewhat altered, which may be seen in ptotic kidney. Visualized portions of the cortex of normal echogenicity. No hydronephrosis or shadowing calculus. Left kidney measures 9.3 cm. OTHER: No significant abnormalities noted.", "output": "The left kidney is somewhat inferiorly displaced and has a somewhat altered orientation, appearance may be seen in setting of ptotic kidney. If there is further clinical concern for anatomic abnormality causing patient's symptoms, contrast enhanced CT may be helpful for further evaluation (would provide improved evaluation of pancreas as well). No evidence of splenomegaly as clinically questioned. "}
{"instruction": "Generate impression based on findings.", "input": "Male, 57 years old. AKI. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 13.2 cm in length with increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 12.2 cm in length with increased cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The bladder is incompletely distended. Moderate ascites is again noted.", "output": "1.Increased renal cortical echogenicity compatible with medical renal disease. No hydronephrosis.2.Ascites."}
{"instruction": "Generate impression based on findings.", "input": "Male 70 years old Reason: Assess for fluid collection around SID History: SID infection Complex collection measures about 2 cm in longest dimension in the region of the transplant site. It is mostly echogenic with some hypoechoic to anechoic areas.", "output": "Complex collection measuring up to 2 cm drive line. Abscess cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": "Male 33 years old Reason: history of ex vivo transplant for metastatic rectal cancer, now s/p creation of colostomy for recurrent obstructive rectal cancer, please evaluate for hepatic venous flow VASCULAR: Status post right hepatectomy. Main portal vein patent with normal directional flow, velocity measures 30 cm/sec. Left portal vein not well evaluated.Patent common hepatic artery, peak systolic velocity measures 90 cm/sec and resistive index measures 0.54. Left hepatic artery not well assessed.Visualized IVC and hepatic veins patent.Visualized splenic vein patent.OTHER: Incompletely imaged relatively echogenic liver masses and pleural effusion formation. Common bile duct not well seen but no definite intrahepatic or extrahepatic biliary duct dilatation delineated.", "output": "1. Patent hepatic veins.2. Partially seen liver masses, metastatic disease a consideration. "}
{"instruction": "Generate impression based on findings.", "input": "69-year-old female patient with history of bone marrow transplant and CHF, now with worsening edema and CKD. Evaluate size, shape, and echogenicity of her kidneys and blood flow. ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures 9.7 cm in length and demonstrates mildly increased cortical echogenicity. No evidence of hydronephrosis.LEFT KIDNEY: The left kidney measures 10.3 cm in length and demonstrates mildly increased cortical echogenicity. No evidence of hydronephrosis. A 1 cm left midpole renal cyst is noted.OTHER:The bladder is decompressed.", "output": "1. Mildly echogenic kidneys which can be seen with medical renal disease. No hydronephrosis.2. Suboptimal evaluation of the renal ostia, however, no specific secondary signs of renal artery stenosis distally."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old female with acute kidney injury. RIGHT KIDNEY: The right kidney measures 10.1 cm in length. No hydronephrosis. Increased parenchymal echogenicity. No shadowing calculi or suspicious masses.LEFT KIDNEY: The left kidney measures 9.6 cm in length. No hydronephrosis. Echogenic renal parenchyma. No shadowing calculi or suspicious masses.URINARY BLADDER: The urinary bladder is partially distended and shows no acute abnormality.OTHER: No significant abnormalities noted.", "output": "Echogenic renal parenchyma suggestive of chronic medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female with anasarca, nephrotic proteinuria. Reason: Evaluate renal tissue. Ultrasound guidance was provided for right kidney biopsy. A total of four passes were made during the right kidney biopsy.", "output": "Guidance for right kidney biopsy."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female with right breast mass found on screening mammogram. DIGITAL DIAGNOSTIC RIGHT MAMMOGRAM:Three standard 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. The right upper outer breast mass persists on compression views. No associated calcifications were identified.RIGHT BREAST ULTRASOUND:A targeted right ultrasound was performed for the mammographic area of concern. A 1.5 x 1.2 x 1.5 cm, hypoechoic, ill-defined right breast mass with increased vascularity was identified at the 10 o'clock position 7 cm from the nipple.", "output": "Hypoechoic, ill-defined mass of the right breast is suspicious for malignancy. Ultrasound-guided biopsy of this lesion is recommended for further evaluation.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "49 years old, Female, Reason: assess for ascites, any intra-abd abnormalities, h/o dermatomyositis + ILD + pulm HTN History: abd distention, volume overload 2/2 right heart failure LIVER: The liver measures 18.7 cm in length. There are regional areas of increased parenchymal echogenicity consistent with focal fatty infiltration. A focal hyperechoic area adjacent to the porta hepatis measuring 1.7 x 1.8 x 1.5 cm most likely represents focal fatty infiltration. 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. Ringdown artifact from the gallbladder wall suggests cholesterol deposition. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 0.3 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 15.9 cm in length. RIGHT KIDNEY: Kidney measures 13.2 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 12.6 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "Regional areas of hepatic parenchymal fatty infiltration with a more focal hyperechoic focus adjacent to the porta hepatis which likely represents focal fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male with history of cirrhosis and sclerosing cholangitis who presents for baseline examination prior to heart transplant. LIVER:The liver is coarse and heterogeneous in echotexture with nodular contour and possible underlying hypoechoic lesions which are difficult to evaluate on this sonographic evaluation. The liver measures 21 cm in length. The main portal vein is patent with peak systolic velocity of 0.2 m/s.GALLBLADDER, BILIARY TRACT: Gallbladder wall measures 0.3 cm with the common bile duct measuring 0.7 cm in diameter.PANCREAS: No significant abnormality noted.SPLEEN: The spleen measures 18.4 cm in length and is homogeneous in echotextureKIDNEYS: The cortices of both kidneys are echogenic with the right kidney measuring 11.6 cm and the left kidney measuring 11.6 cm in length. There is a hypoechoic lesion in the right upper pole measuring 1.1 x 0.9 x 0.9 cm, likely a cyst.ABDOMINAL AORTA: Abdominal aorta is patent with the proximal abdominal aorta measuring 3.1 x 3.3 x 3.3 cm and the mid abdominal aorta measuring 2.2 x 2.3 x 2.3 cm.INFERIOR VENA CAVA: Inferior vena cava is patent.OTHER: Moderate volume ascites.", "output": "1.Cirrhotic liver morphology with possible underlying hypoechoic lesions. Further evaluation with dedicated liver MRI examination is recommended.2.Moderate volume ascites. 3.Echogenic renal cortices compatible with medical renal disease. "}
{"instruction": "Generate impression based on findings.", "input": "22 year old with right breast mass for 3 months and bilateral breast pain. A targeted right ultrasound was performed for the patient\u2019s area of concern. There is no solid or cystic mass seen in the area identified as palpable by the patient. At this site, and throughout the right upper inner quadrant, very dense breast tissue is noted.", "output": "No sonographic evidence for malignancy. Dense breast tissue at the site of concern. Clinical correlation is recommended to ensure that these results are concordant with physical exam. Clinical follow-up is also recommended for the patient's bilateral breast pain.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 57M s/p OLT now with concern for large amount of ascites in the setting of fever. History: Large amount of ascites There is large volume ascites with the largest apparent pocket noted in the left lower quadrant. Partially visualized right pleural effusion.", "output": "Large volume ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female, 23 years old. Previous ultrasound showing hydronephrosis. Now postpartum. Per service, ovaries/adnexa appeared normal on recent C-section. RIGHT KIDNEY: The right kidney measures 11.1 cm in length, with normal cortical echogenicity. No focal lesion or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.6 cm in length, with normal cortical echogenicity. An upper pole calyx is visualized. Otherwise, no hydronephrosis.OTHER: The bladder is incompletely distended. A heterogeneous cystic and solid appearing mass in the right adnexal region is noted, without significant internal vascularity.", "output": "1.Near complete resolution of previously seen bilateral hydronephrosis.2.A cystic and solid appearing right adnexal mass is nonspecific, but may reflect a hematoma, and can be evaluated with dedicated pelvic sonography or MRI as clinically indicated.Findings were discussed via telephone with Dr. Simon at 4:38 PM on 11/16/2015."}
{"instruction": "Generate impression based on findings.", "input": "41 years old, Female, Reason: R shoulder pain after eating, eval for cholecystitis History: R shoulder pain after eating, AIH LIVER: The liver measures 12.7 cm in length. Hepatic parenchymal echogenicity is within normal limits. Multiple anechoic foci within the liver of varying sizes the largest of which measures 1.9 x 1.4 x 2.0 cm and is located in the right hepatic lobe. These lesions are indeterminate by ultrasound but are favored to represent hepatic cysts. 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 11.2 cm in length. RIGHT KIDNEY: Kidney measures 9.9 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.2 cm in length. Normal echotexture. Nohydronephrosis. Nonobstructing shadowing calculus in the left kidney measures up to 6 mm.OTHER: No significant abnormalities noted.", "output": "1.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis.2.Nonobstructing shadowing calculus in the left kidney measures up to 6 mm.3.Multiple anechoic foci within the hepatic parenchyma are indeterminate on this ultrasound exam although are favored to represent cysts."}
{"instruction": "Generate impression based on findings.", "input": "Hit chin on desk 2 weeks ago now with tender palpable subcutaneous mass 1.9 x 2.1 x 1 cm mixed cystic and solid complex focus within the subcutaneous tissues of the anterior chin. This lesion demonstrates no increased vascularity", "output": "Mixed cystic and solid complex focus within the subcutaneous tissues of the anterior chin without increased vascularity. Favor benign process such as resolving hematoma."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain with elevated LFTs and lactic acidosis LIVER: Mildly heterogeneous echotexture without mass 19.8 cm in length. 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: Atrophic echogenic kidney without hydronephrosis. 8.9 cm in length OTHER: Spleen 13.3 cm in length no ascites.", "output": "Mild hepatomegaly with mildly heterogeneous echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites. Atrophic echogenic right kidney consistent with medical renal disease/parenchymal dysfunction without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Female 40 years old Reason: 39 y.o. F with PTC. History: PTC. Request intraoperative marking of skin. Several nodes or nodules were identified in the region of the thyroid bed, both to the right of midline, midline and to the left of midline. Location was reviewed with Dr. Angelos real-time. The skin was marked with indelible marker. Percutaneous injection was deemed unnecessary.", "output": "Multifocal lesions identified and the skin was marked."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Unremarkable echogenicity without mass. Liver length 16.9 cmGALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11 cm in lengthOTHER: Left kidney 10.1 cm in length. Spleen 8.2 cm in length. No ascites.", "output": "Unremarkable liver without mass or ductal dilatation. Gallbladder sludge without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Renal transplant. Question of pyelonephritis. Patient with weakness. The right iliac fossa transplant kidney measures 10 cm in length without shadowing nephrolithiasis. No peritransplant fluid collection. Color Doppler demonstrates symmetric blood flow. Note is made of a 1.3 cm simple cyst. There is mild pelviectasis.Normally distended urinary bladder.", "output": "Mild pelviectasis. No specific evidence of pyelonephritis as clinically questioned however ultrasound is very limited for making this diagnosis."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male with superficial abscess of the right scrotum with surrounding cellulitis. Evaluate for testicular abscess versus scrotal abscess RIGHT TESTIS: The right testis is normal in echotexture and vascularity and measures 3.2 x 1.7 x 4.2 cm.LEFT TESTIS: The left testis is normal in echotexture and vascularity measures 3.2 x 2.2 x 4.2 cmRIGHT EPIDIDYMIS: The right epididymis measures 1.2 x 0.8 x 3.3 cm and is normal in vascularity.LEFT EPIDIDYMIS: The left epididymis measures 1.3 x 0.8 x 2.4 cm and is normal in vascularity. Left epididymal hypoechoic lesion measures 0.2 x 0.2 x 0.3 cm, most likely a cyst.OTHER: There is mild right scrotal subcutaneous echogenicity consistent with edema.", "output": "1.Superficial right scrotal edema, consistent with stated history of cellulitis. 2.No evidence of testicular abscess as clinically questioned."}
{"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": "Acute renal insufficiency RIGHT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. Right kidney 10.6 cm in length.LEFT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. Left kidney 10.6 cm in length.OTHER: Bladder nondistended", "output": "Mildly echogenic renal parenchyma suggestive for medical renal disease/parenchyma dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Stated history of a thyroid nodule incidentally noted on MRI of the cervical spine. RIGHT LOBE MEASUREMENTS: 4.9 x 2.5 x 2.3 cmLEFT LOBE MEASUREMENTS: 5.0 x 2.3 x 1.9 cmISTHMUS MEASUREMENTS: 1.6 cmRIGHT LOBE: The right thyroid lobe is normal in morphology and echogenicity. There is a 1.2 x 1.2 x 0.8 cm interpolar well-defined predominantly solid nodule with small cystic components. No specific suspicious sonographic features.LEFT LOBE: The left thyroid lobe is normal in morphology and echogenicity. It contains several small colloid nodules. The largest is a 7 x 5 x 4 mm hypoechoic well-defined nodule. No specific suspicious sonographic features.ISTHMUS: The isthmus is thickened without a discrete nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral small thyroid nodules with the largest measuring 1.2 cm in the right thyroid lobe interpolar region without specific suspicious sonographic features. The subcentimeter left thyroid lobe nodules have characteristics of colloid cysts/nodules."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old male with history of ERCP. Evaluate for biliary pathology and fluid reaccumulation. LIVER: Patent portal vein with antegrade flow. Large fluid collection in the right hepatic lobe measures 19.6 x 14.6 cm, not significant changed. The more medial right hepatic lobe lesion seen on prior CT are not clearly visualized on this study.BILIARY TRACT: Interval placement of a biliary stent with intrahepatic biliary duct dilation is less conspicuous compared with recent CT allowing for differences in technique. Partially collapsed gallbladder without evidence of acute inflammation.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 ascites.", "output": "1.Interval placement of a biliary stent with intrahepatic biliary ductal dilation appearing less conspicuous compared with the prior CT.2.Large homogeneous fluid collection the right hepatic lobe without significant interval change since the prior study. No evidence of ascites.3.Other suspicious lesions in the medial right hepatic lobe are not clearly visualized on the study. Please see prior CT for comparison."}
{"instruction": "Generate impression based on findings.", "input": "Female 19 years old Reason: r/o abnormality in RLQ, appendicitis History: abd pain Scanning throughout lower quadrant identifies normal bowel loops with no evidence of free fluid. Dilated appendix cannot be identified.", "output": "Lack of ability to identify appendix likely implies no evidence of appendicitis. No free fluid is seen. Peristalsing bowel is identified."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old male patient status post completion thyroidectomy, papillary microcarcinoma evident on pathology. RIGHT LOBE: The remaining right thyroid tissue measures approximately 0.8 x 1.0 x 1.9 cm. Multiple subcentimeter hypoechoic solid and cystic nodules are noted. The largest nodule, which is cystic, measures approximately 0.6 x 0.3 x 0.4 cm. LEFT LOBE: Status post thyroidectomy without residual tissue identified.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Status post partial right thyroidectomy with multiple subcentimeter nodules.2. Status post left thyroid lobectomy without evidence of residual tissue."}
{"instruction": "Generate impression based on findings.", "input": "Reason: primary hyperparathyroidism localization please History: hypercalcemia RIGHT LOBE MEASUREMENTS: 6.3 x 2.0 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.2 x 1.6 x 1.2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Heterogeneous thyroid parenchyma. No focal nodules or masses are identified.LEFT LOBE: Heterogeneous thyroid parenchyma. No focal nodules or masses are identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: A 0.9 x 0.5 x 0.3 cm extrathyroidal isoechoic lesion posterior to the right common carotid artery is favored to represent a small cervical lymph node. A nondescript hypoechoic extrathyroidal lesion inferolateral to the inferior pole of the left thyroid lobe is indeterminate and may represent parathyroid tissue or a cervical lymph node.LYMPH NODES: Right level 2 lymph node measures 1.1 x 0.9 x 0.3 cm. Left level 2 lymph node measures 0.9 x 0.7 x 0.4 cm.OTHER: No significant abnormality noted.", "output": "Nondescript extrathyroidal lesion inferior to the inferior pole of the left thyroid lobe is indeterminate may represent parathyroid tissue or a cervical lymph node."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female patient with posterior thoracic soft tissue mass just below the base of the neck. Targeted ultrasound performed in the patient's palpable region of interest in the posterior neck demonstrates no discrete, discernible mass within the subcutaneous soft tissues.", "output": "No discernible subcutaneous mass is identified. Ultrasound is insensitive for the detection/characterization of subcutaneous lesions; if clinically concern for a mass persists, MRI may be considered. "}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female with abnormal thyroid function. History of nodules. RIGHT LOBE MEASUREMENTS: 6.5 x 2.1 x 1.3 cmLEFT LOBE MEASUREMENTS: 6.2 x 2.6 x 1.5 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Spongiform nodule in the right lobe adjacent to the isthmus measuring 0.3 x 0.6 x 0.6 cm without change.There is a second, hypoechoic and poorly defined nodule in the lower pole measuring 0.4 x 0.4 x 0.6 cm. This is also unchanged from prior studyLEFT LOBE: Within the midportion of the left lobe there are 3 small spongiform nodules. Previously measured nodule is unchanged measuring 0.4 x 0.5 x 0.8 cm. In the lower pole there is a somewhat spongiform-appearing nodule which has been previously biopsied measuring 0.8 by 1.3 x 1 cm, decreased in size in the interim. The second, more medially placed partly cystic, partly solid nodule as described on the prior study appears changed in morphology on today's exam, being hypoechoic and poorly defined. This measures approximately 1 x 1.1 x 1.8 cm.ISTHMUS: Small spongiform nodule identifiedPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral thyroid nodules. The majority of these are little changed in the interim many with a benign appearance. However, a nodule on the left has changed in appearance on today's exam, and biopsy may be indicated."}
{"instruction": "Generate impression based on findings.", "input": "Reason: new AKI on CKD RIGHT KIDNEY: The right kidney measures 11.1 cm in length. Markedly echogenic renal parenchyma. No hydronephrosis or shadowing stones.LEFT KIDNEY: The left kidney measures 10.6 cm in length. Markedly echogenic renal parenchyma. No hydronephrosis or shadowing stones.OTHER: The urinary bladder is decompressed by Foley catheter, precluding evaluation. Renal jets not visualized. Small volume of free fluid in the pelvis.", "output": "1. Markedly echogenic renal parenchyma, consistent with medical renal disease or parenchymal dysfunction.2. Small volume of free fluid in the pelvis."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 11 cm in length.LEFT KIDNEY: Poorly visualized left kidney. Echogenic parenchyma without mass, stone, or hydronephrosis. 11.9 cm in length.OTHER: Bladder nondistended; moderately severe ascites.", "output": "Echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis. Moderately severe ascites."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old woman with questioned physician palpated a pea-sized mass in the left breast 5:00 position about 8 cm away from the areolar. The patient complains of left breast pain at the same site, intermittent for the past few months. On physical exam, there is no visible or palpable abnormality of the left breast.A targeted left ultrasound was performed for the patient\u2019s area of concern. Normal fibroglandular tissue is seen in the left breast 5:00 position 8 cm from nipple and in the adjacent breast parenchyma. There are no solid or cystic masses or other abnormality identified.", "output": "Unremarkable fibroglandular breast tissue is seen in the left breast 5:00 position at the site of clinical concern. Clinical correlation and follow-up is recommended for the breast pain. The findings and recommendations were discussed with the patient at the time of the exam.BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Female 37 years old; Reason: intraabdominal bleed History: dropping hemoglobin postop LIVER: Limited views of the liver were obtained. There is increased echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. GALLBLADDER/BILIARY TRACT: Debris/sludge is seen within the gallbladder. There is no pericholecystic fluid or wall thickening.OTHER: No free intra-abdominal fluid.", "output": "No sonographic evidence of an intra-abdominal fluid collection. Although only limited views of the liver were obtained, there appears to be increased echogenicity within the liver compatible with fatty infiltration/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Male 53 years old; Reason: RIGHT UPPER QUADRANT TO EVAL FOR GALLBLADDER PATHOLOGY AND TO EVAL FLOW THROUGH TIPS History: acute on chronic liver failure, hyperbilirubinemia LIVER: The liver measures 14.5 cm in length. There is increased coarse echogenicity of the liver parenchyma with a nodular appearance. No focal hepatic lesions. No intrahepatic ductal dilation is seen. Pleural effusion is seen above the liver as well as ascites.GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 6.1 mm. There is layering sludge within the gallbladder. Edema around the gallbladder is seen. No stones are seen. The common bile duct measures 5.1 mm in diameter. Negative sonographic Murphy sign.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 13.8 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.9 cm in length. The cortex has heterogeneously increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.6 cm in length. The cortex has heterogeneously increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.DOPPLERS:PORTAL VEIN:The main portal vein is patent with hepatopetal flow measuring 31.0 cm/s. The left portal vein is patent with hepatofugal flow measuring 22.4 cm/s. Right portal vein was not well visualized.INFERIOR VENA CAVA: The inferior vena cava is patent with hepatofugal flow. This is measured at 69.5 cm/s.HEPATIC VEINS: The main hepatic vein is patent with hepatofugal flow measuring 42.3 cm/s. The left hepatic vein is patent and hepatofugal in flow measuring 70.0 cm/s. The right hepatic vein is patent with hepatofugal flow measuring 32.3 cm/s.HEPATIC ARTERIES: The hepatic artery is patent with hepatopedal flow and peak systolic velocity measurements ranging from 228.4 cm/s to 260.8 cm/s, and RI 0.6. The left hepatic artery is patent with hepatopetal flow with peak systolic velocity measured at 31.6 cm/s, RI 0.6. The right hepatic artery is patent with hepatopetal flow and peak systolic velocity measuring 45.1 cm/s and RI of 2.0. TIPS: The TIPS is patent with hepatofugal flow measuring 223.9 cm/s at the proximal limb, 265.8 cm/s at the midportion, and 176.6 cm/s to 134.1 cm/s at the distal portion.SPLENIC ARTERY: The splenic artery is patent with anterior grade flow to the spleen with peak systolic velocity measured at 68.4 cm/s and RI of 0.8.SPLENIC VEIN: The splenic vein is patent with retrograde flow from the spleen measuring 20.6 cm/s.", "output": "1. Flow within the TIPS is concerning for proximal stenosis with increased velocity through the more proximal portion of the TIPS.2.The gallbladder wall is thickened with layering sludge and there is edema around the gallbladder likely due to volume overload/ascites. Right pleural effusion and ascites is present.3.The liver has coarse echogenicity consistent with cirrhotic morphology. No discrete masses are seen or intrahepatic ductal dilation. There is splenomegaly.4. Heterogeneously increased kidney parenchyma suggestive of medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with history of right breast asymmetry on screening mammography. Personal history of benign right biopsy in 2009. No reported family history of breast cancer. Three standard views of the right breast with additional 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, unchanged in pattern and distribution. A few subcentimeter round circumscribed masses are seen in the right upper medial breast which do not disperse on compression imaging.Ultrasound: A targeted right breast ultrasound was performed in the area of mammographic abnormality in the upper inner right breast. A few tiny scattered simple cysts were seen. The largest measured 7 x 5 x 5 mm. There is no increased vascularity associated with any of these cysts. These lesions were concordant with mammographic findings.", "output": "A few tiny benign cysts in the right inner upper breast concordant with mammographic abnormalities. No evidence of malignancy. As long as the patient's physical exam remains unchanged, annual screening mammography is recommended. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "71 year old female patient with history of thyroid cancer. Evaluate for recurrence. RIGHT LOBE: Status post thyroidectomy. There is a 0.2 x 0.2 x 0.3 cm hypoechoic nodule with an echogenic center within the right thyroid bed. LEFT LOBE: Status post thyroidectomy. There is are two benign morphology lymph nodes noted within the superior and mid left thyroidectomy bed.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-morphology lymph nodes are present bilaterally.OTHER: No significant abnormality noted.", "output": "Hypoechoic nodule with an echogenic hilum within the right thyroidectomy bed likely represents a lymph node; this can be followed on subsequent studies. Additional benign morphology lymph nodes are noted in the left thyroid bed."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old male with abdominal pain. Evaluate for gallstone pancreatitis. LIVER: Measures 21.8 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: Enlarged measuring 18.9 cm.KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "1.No evidence of cholelithiasis or cholecystitis.2.Hepatomegaly with increased echogenicity consistent with steatosis or parenchymal disease.3.Splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Right thyroid nodule RIGHT LOBE MEASUREMENTS: 6.9 x 2.2 x 2.1 cm.LEFT LOBE MEASUREMENTS: 6.2 x 2.3 x 1.5 cm.ISTHMUS MEASUREMENTS: Up to 0.3 cm in thickness.RIGHT LOBE: Numerous nodules are present within the right lobe of the thyroid, the majority of which are partially solid/cystic. There is a dominant nodule within the upper pole measuring 3.6 x 1.5 x 2.9 cm which is predominantly solid, slightly hypoechoic, contains internal vascularity, and lacks definite suspicious microcalcifications. Overall, the nodule is of intermediate suspicion for neoplasm.LEFT LOBE: Normal background parenchymal echotexture. No suspicious nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No cervical lymphadenopathy identified.OTHER: No significant abnormality noted.", "output": "Multiple nodules within the right thyroid. Right upper pole dominant nodule measuring up to 3.6 cm of intermediate suspicion for neoplasm and would be amenable to fine needle aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: No significant abnormalities noted. 14.9 cm in lengthGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.3 cm in lengthOTHER: Left kidney 11.2 cm in length. Spleen 8.4 cm in length. No ascites", "output": "Cholelithiasis without acute inflammation or duct dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Male 59 years old Reason: patient with hepatomegaly on exam increased LFT's History: above LIVER: Liver parenchyma is within normal limits. Liver measures 14.0 cm in length. No focal hepatic lesion. Main portal vein is patent with normal directional flow.BILIARY TRACT: No intra-axial hepatic biliary ductal dilatation. The gallbladder is collapsed. Common bile duct measures up to 5 mm.PANCREAS: The visualized portions of the pancreas are normal in appearance.SPLEEN: Spleen is normal in appearance measuring 9.5 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. OTHER: Mild ascites is present. Bilateral small pleural effusions.", "output": "1.Mild ascites and bilateral small pleural effusions.2.Normal echogenicity of the liver with a patent portal vein. Liver is not enlarged by ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Ventura is a 27 year old female presenting with a right axillary lump/tenderness. Targeted right axillary ultrasound is performed.In the right axilla, three normal axillary lymph nodes are identified, the largest one of which measures 1.8 x 0.5 cm. All three lymph nodes demonstrate normal hilar vascular flow.No suspicious cystic or solid mass is identified.", "output": "Three normal right axillary lymph nodes. No sonographic evidence of 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: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter. "}
{"instruction": "Generate impression based on findings.", "input": "Female 65 years old Reason: r/o concerning lesions, adenopathy History: had right lobectomy and found to have microscopic thyroid cancer RIGHT LOBE MEASUREMENTS: Patient is status post right thyroidectomy.LEFT LOBE MEASUREMENTS: 1.6 x 1.7 x 5.5 cm. Previously 1.9 x 1.3 x 4.7 cm.ISTHMUS MEASUREMENTS: The SVC measures approximately 5 mm.RIGHT LOBE: In the inferior right thyroidectomy bed there is a hypoechoic nodule which may represent a lymph node measuring 0.6 x 0.5 x 0.9 cm. LEFT LOBE: Multiple nodules are present on the left. The entire left lobe is hyperemic which may represent underlying thyroiditis.Left mid thyroid nodule has peripheral hypodensity and centrally isoechoic to normal thyroid measures 0.9 x 0.8 x 1.4 cm, previously 0.6 x 0.7 x 1.1 cm. This nodule is vascular. This first nodule has been biopsied.Left mid nodule adjacent to the isthmus measures 0.8 x 0.8 x 1.4 cm is heterogeneous internally with possible colloid. This previously measured 0.9 x 0.7 x 1.0 cm. This nodule is vascular. Unclear if this nodule has been biopsied.Another left mid lobe nodule adjacent to the isthmus measures 1.3 x 0.8 x 1.2 cm, previously 0.9 x 0.7 x 1.0 cm. This nodule has definitely been biopsied. A fourth nodule in the left inferior lobe measures 0.7 x 0.8 x 0.8 cm. This is predominantly a hypoechoic nodule. This nodule was likely present on the prior exam and is unchanged.ISTHMUS: There is a predominantly hypoechoic nodule in the isthmus which measures 0.7 x 0.6 x 1.0 cm which was not definitely present on prior outside exam.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.4 nodules on the left, 3 of which measure slightly increased in size compared to the prior exam. At least 2 of these nodules have been previously biopsied. 2.The entire left lobe is hyperemic which may represent underlying thyroiditis.3.There is a hypoechoic nodule in the isthmus, which was not definitely present on the outside exam.4.Hypoechoic nodule in the right thyroidectomy bed may represent a lymph node."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old female presents with right upper quadrant pain and tenderness. LIVER:Evaluation limited due to an inability to optimally position the patient and due to body habitus. Again noted are right lobe are widespread metastases. Unable to accurately measure liver length. Mild ascites. No intrahepatic biliary dilation. Portal vein is patent with hepatopedal flow.GALLBLADDER, BILIARY TRACT: Evaluation of gallbladder and biliary tract is limited due to inability to optimally position the patient due to body habitus. Common duct measures 0.3 cm.PANCREAS: Evaluation of the pancreas limited due to overlying bowel gas.SPLEEN: Evaluation limited. Spleen not seen on this study.KIDNEYS: Evaluation of the kidneys is limited and unable to accurately measure. No gross hydronephrosis. OTHER: Small left pleural effusion.", "output": "1. Study severely limited due to an inability to optimally position the patient and due to body habitus.2. Widespread bilobar hepatic metastases better seen on prior CT abdomen.3. No gross hydronephrosis, though evaluation of the kidneys is limited."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain. Known fatty liver. LIVER: 18.5 cm in length. Non-cirrhotic liver morphology. Coarsened parenchymal echogenicity, compatible with known steatosis. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Possible 1 to 2 mm gallstones. Otherwise unremarkable appearance of the gallbladder.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 10.2 cm in length. The left kidney is 11.0 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 10.2 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": "Acute kidney injury. RIGHT KIDNEY: The right kidney measures 9.6 cm in length without hydronephrosis or shadowing nephrolithiasis. The renal cortex is hyperechogenic.LEFT KIDNEY: The left kidney measures 10 cm in length without hydronephrosis or shadowing nephrolithiasis. The renal cortex is hyperechogenic.URINARY BLADDER: Normal distended urinary bladder.OTHER: Ascites.", "output": "1. Hyperechogenic kidneys compatible with medical renal disease. No hydronephrosis.2. Ascites."}
{"instruction": "Generate impression based on findings.", "input": "Fevers and chills for one week. Bilateral palpable axillary lymphadenopathy, now decreasing, with pain. Bilateral axillary ultrasound examinations were performed. Prominent though normal morphology lymph nodes were identified. The largest of these, in the left axilla, measures 15 x 10 mm. A sebaceous cyst was noted in the left axilla, measuring 6 x 4 mm. There is no solid or cystic mass identified. No suspicious abnormality corresponding to patient's area of pain in bilateral axillary region.", "output": "Prominent normal morphology lymph nodes. Left axillary sebaceous cyst. No suspicious abnormality corresponding to patient's area of pain in bilateral axillary region. No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "50 years, Male, pain for 10 years. RIGHT TESTIS: 3.9 x 2.0 x 3.1 cm. Normal echotexture and vascularity. No intratesticular mass evident.LEFT TESTIS: 3.3 x 2.1 x 2.0 cm. Normal echotexture and vascularity. No intratesticular mass evident.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Small bilateral hydroceles and small left-sided varicocele", "output": "Small bilateral hydroceles and small left-sided varicoceleI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Call back from screening mammogram for masses in both breasts. 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 heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. Multiple circumscribed masses are seen in the right breast at upper outer quadrant and an oval shaped mass seen at 3:00 position in the left breast.In the ultrasound, there are 2 simple cysts at 9:00 position and a small simple cyst at 10:00 position in the right breast. The largest cyst is located at 9:00 position measuring 21 x 10 mm. There is a circumscribed hypoechoic mass measuring 9 x 6 mm at 8:00 position in the right breast, likely a complicated cyst.In the left breast, there are 2 simple cysts at 3:00 position; the larger one measures 22 x 11 mm.", "output": "High probability benign complicated cyst at 8:00 position in the right breast, for which ultrasound follow-up is recommended in 6 months. Multiple simple cysts in both breasts. 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": "26-year-old female with hyperthyroidism RIGHT LOBE MEASUREMENTS: 6.1 x 2.2 x 2.0 cmLEFT LOBE MEASUREMENTS: 5.4 x 1.8 x 1.7 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Diffusely increased vascularity without discrete nodule.LEFT LOBE: Diffusely increased vascularity without discrete nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Enlarged heterogeneous thyroid gland with increased vascularity can be seen in thyroiditis. No discrete nodules. "}
{"instruction": "Generate impression based on findings.", "input": "86 years old, Male, Reason: 86 yo with cirrhosis please screen for HCC History: none LIVER: The liver has a cirrhotic morphology. No focal hepatic lesions or masses are identified. No significant ascites is present. The liver measures 8.6 cm in length. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.1 m/s.BILIARY TRACT: There is minimal intra-and mild extrahepatic ductal dilatation. There is a stone or sludge in the area of the neck of the gallbladder without gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. The common bile duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: 1 cm hypodensity in the spleen is again noted and unchanged since CT dated 6/7/14. The spleen measures 9.5 cm in length. RIGHT KIDNEY: Kidney measures 10.2 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.7 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Cirrhotic morphology of the liver without focal hepatic lesion identified.2.Mild intra-and extra hepatic biliary ductal dilatation is present."}
{"instruction": "Generate impression based on findings.", "input": "Nausea vomiting and elevated alkaline phosphatase LIVER: Mildly coarse liver echotexture without mass. Liver length 14.3 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.9 cm in length.OTHER: Left kidney 8 cm in length. Spleen 7.3 cm in length. No ascites.", "output": "Mildly coarse liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or duct dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "41 years old, Female, Reason: history of cervical cancer /p robotic radical hysterectomy/LND and pelvic radiation in 2010 with urinary retention requiring intermitent self catheterization, now with bilateral flank pain History: bilateral flank pain, worsening urinary retention RIGHT KIDNEY: Kidney measures 10.8 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 11.1 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "Normal ultrasound examination of the kidneys."}
{"instruction": "Generate impression based on findings.", "input": "Male 24 years old Reason: assess for gallstones, hepatomegaly History: RUQ pain for last month, + Murphy's sign, associated with meals, mild scleral icterus LIVER: Increased echogenicity of the liver suggestive of fatty infiltration. Liver measures 15.5 cm. No focal hepatic mass. Main portal vein is patent with a normal direction of flow and peak velocity of 24 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Common bile duct is normal measuring 3 mm. Minimal sludge is present in the gallbladder neck. No shadowing gallstones. No pericholecystic fluid or gallbladder wall thickening. Negative sonographic Murphy's sign.PANCREAS: The visualized portions of the pancreas are normal.SPLEEN: Spleen is normal in appearance measuring 9.4 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 10.3 cm. The left kidney measures 10.6 cm. OTHER: No significant abnormalities noted.", "output": "1.Increased echogenicity of the liver suggestive of fatty infiltration or diffuse hepatic dysfunction. 2.Small amount of gallbladder sludge without evidence of shadowing gallstones or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Follow-up left thyroid nodule RIGHT LOBE MEASUREMENTS: 3.7 x 1.2 x 1.3 cm.LEFT LOBE MEASUREMENTS: 3.9 x 1.4 x 1.5 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant change in size of left thyroid nodule now measuring 1.3 x 1.3 x 2.1 cm; a new central cystic component of this nodule is appreciatedISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No significant change in size of left thyroid nodule. This nodule now demonstrates a new central cystic component. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "52 year old female with enlarged thyroid RIGHT LOBE MEASUREMENTS: 4.8 cm x 1.5 cm x 1.7 cmLEFT LOBE MEASUREMENTS: 3.8 cm x 1.3 cm x 1.6 cmISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: Normal echogenicity of the right thyroid lobe. Mixed predominantly solid cystic nodule at the mid to upper pole measures 5 mm x 3 mm x 3 mm with no internal vascularity or definite microcalcifications.LEFT LOBE: Normal echogenicity of the left thyroid lobe. There is inferior extension of the thyroid measuring 1.0 cm x 0.3 cm x 0.6 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Left neck it is level 2 lymph node measures 2.0 cm x 0.8 cm x 1.0 cm. Additional left neck level 5 lymph node measures 1.4 cm x 0.3 cm x 0.8 cm.OTHER: No significant abnormality noted.", "output": "Benign appearing subcentimeter nodule in the right thyroid lobe. Inferior extension of the left thyroid lobe is noted. "}
{"instruction": "Generate impression based on findings.", "input": "Oliguric. Evaluate for obstruction. RIGHT KIDNEY: The right kidney measures 10.3 cm in length without hydronephrosis, shadowing nephrolithiasis or suspicious lesion. There is a 5 cm simple appearing superior pole cyst and a 1.7 cm interpolar cyst. Color Doppler demonstrates hilar blood flow. The renal cortex is mildly echogenic.LEFT KIDNEY: The left kidney measures 10.7 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow. The renal cortex is mildly echogenic.URINARY BLADDER: The urinary bladder is collapsed by a Foley catheter, limiting evaluation.OTHER: No significant abnormalities noted.", "output": "No hydroureteronephrosis. Right renal simple appearing cysts. Echogenic renal cortices suggestive of medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for fluid surrounding LVAD drive line No evidence for loculated fluid collection associated with LVAD drive line", "output": "No evidence for loculated fluid collection associated with LVAD drive line "}
{"instruction": "Generate impression based on findings.", "input": "Female 43 years old; Reason: r/o cystic structure. assess size. r/o adenopathy, growth of lesion History: h/o thyroid cancer. Had small cystic structure in neck, biopsied and mostly drained. Low Tg level, but atypical cells seen. This is a follow up study to see if cyst still visible, and for any other changes RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENT: Status post thyroidectomy.RIGHT LOBE: Subcentimeter hypoechoic focus in the right thyroid bed measures 0.4 x 0.3 x 0.2 cm (previous 0.3 x 0.3 x 0.3 cm).LEFT LOBE: No evidence of disease recurrence.ISTHMUS: No evidence of disease recurrence.LYMPH NODES: Hypoechoic focus in the left lateral neck level IV region which was previously aspirated is redemonstrated and currently measures 0.3 x 0.2 x 0.3 cm (previously 0.6 x 0.6 x 0.6 cm).", "output": "1.Persistent cystic structure in the left level IV region is smaller in size than on the prior ultrasound. Again, adequate tissue sampling would be difficult due to the cystic composition.2.No evidence of recurrence in the thyroid bed."}
{"instruction": "Generate impression based on findings.", "input": "Male 7 years old; Patient with vasculopathy renal artery stenosis status post repair and the left renal auto-transplant with stent in place presents with with painless gross hematuria. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. 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: 2 Left: 0  Length*** Right: 7.9 cm Left: 7.93 cm   Mean for age: 8 cm  Range for age: 6.8 - 9.2 cmADDITIONAL OBSERVATIONS: The left kidney is a pelvic kidney and a ureteral stent is present.", "output": "Grade 2 hydronephrosis in the right kidney.*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": "Male 49 years old Reason: 49 year old male with history of ulcerative colitis and abnormal LFTs, evaluate for biliary ductal dilation/PSC or changes in liver architecture. History: abnormal LFTs LIVER: Liver measures 17.5 cm, enlarged. Echogenicity of the liver is slightly increased. IVC and hepatic veins are dilated likely secondary to heart failure.BILIARY TRACT: Cholelithiasis. Contracted gallbladder. No evidence of fracture or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 9.4 cm.RIGHT KIDNEY: Shadowing hyperechoic focus in the lower pole of the left kidney likely represents a small stone. No evidence of hydronephrosis. Right kidney measures 11.5 cm. Left kidney measures 11.7 cm.OTHER: No significant abnormalities noted.", "output": "Cholelithiasis without evidence of biliary dilatation. Right nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old female with right upper quadrant pain. LIVER: Limited without focal abnormality.GALLBLADDER, BILIARY TRACT: Gallbladder contains gallstones with posterior acoustical shadowing. No gallbladder wall thickening or pericholecystic fluid.PANCREAS: The head and body are normal. The tail was not well seen.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Gallstones without complication."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate evidence of liver fibrosis. History: Hep C LIVER: The liver measures 15.8 cm in length. Coarse, echogenic hepatic parenchymal echotexture. Normal morphology with a smooth contour. The portal vein is patent with normal directional hepatopedal flow, peak velocity of 31.2 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. No intraluminal stones or sludge. The common bile duct measures 0.2 cm. The gallbladder wall measures 0.2 cm. No biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.4 cm in length. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.2 centers in length. No shadowing stones or hydronephrosis.OTHER: The spleen measures 8.7 cm in length. No ascites.", "output": "Coarse, echogenic hepatic parenchyma, consistent with parenchymal dysfunction or chronic liver disease. No evidence of cirrhosis or ascites."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with laboratory findings of primary hypogonadism. Testicular tenderness on exam. RIGHT TESTIS: Normal in size, contour and echogenicity. Prominent rete testes which is normal variant.LEFT TESTIS: Normal in size, contour and echogenicity.RIGHT EPIDIDYMIS: Several small epididymal cysts, the largest in the head measuring 4 mm.LEFT EPIDIDYMIS: Left epididymal cyst in the head measuring 4 mmOTHER: Small tunica cyst on the left measuring 4 mm.Bilateral, complex small to moderate hydroceles with septation.", "output": "1. Normal testes.2 bilateral epididymal cystic masses.3. Bilateral complex hydroceles.4. Small left tunica cyst."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old male with transaminitis and and symptoms of new or failure. LIVER:The liver measures 19 cm in length. The liver is coarse with increased echogenicity. No new worrisome masses are seen. There is no intrahepatic ductal dilation. No ascites. The portal vein is patent with hepatopetal flow measuring 17.1 cm/s.GALLBLADDER, BILIARY TRACT: There is sludge seen within the gallbladder. The gallbladder wall measures 0.3 cm, this is normal. Negative sonographic Murphy sign. The common bile duct measures 0.3 cm.PANCREAS: The pancreas is not well-visualized due to bowel gas.SPLEEN: No significant abnormality noted.RIGHT KIDNEY: The right kidney measures 12.2 cm in length. The cortex has normal echogenicity. There is no hydronephrosis, stones, or new worrisome masses seen. LEFT KIDNEY: The left kidney measures 12.2 cm in length. The cortex is of normal echogenicity. There is no hydronephrosis, stones, or new worrisome masses noted within the left kidney.OTHER: There is a small right pleural effusion noted.", "output": "1. Mild hepatomegaly will coarse increased echogenicity within the liver which is compatible with fatty liver/parenchymal dysfunction. No worrisome masses. No intrahepatic ductal dilation, and no ascites is seen.2. Sludge is seen within the gallbladder without signs of cholelithiasis or acute cholecystitis.3. Small right pleural effusion is visualized."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old male with HCV. Evaluate for hepatocellular carcinoma. LIVER: Normal in size and mildly to moderately echogenic without change. No gross cirrhotic morphology. No evidence for hepatic mass. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Biliary tract is normal in caliber. The patient has had a cholecystectomy.PANCREAS: Mildly hypoechoic but otherwise normal.SPLEEN: No significant abnormalities noted. RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "No change in echogenic liver without mass."}
{"instruction": "Generate impression based on findings.", "input": "Female 42 years old; Reason: r/o biliary duct stone History: right upper quadrant pain s/p cholecystetomy 2013 LIVER: The liver measures 13.4 cm in length. There is normal 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 19.7 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is surgically absent. The common bile duct measures 6.8 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 7.3 cm and no significant abnormalities are noted. Increased echogenicity inferior to the spleen that is likely perisplenic fat or shadowing from the bowel.RIGHT KIDNEY: The right kidney measures 10.6 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": "1. No evidence of a biliary duct stone or intrahepatic or extrahepatic ductal dilation. The gallbladder surgically absent.2. There is an area of increased echogenicity inferior to the spleen that likely represents perisplenic fat or visualized bowel."}
{"instruction": "Generate impression based on findings.", "input": "55 years old, Female, Reason: Primary HPT please assess for parathyroid adenoma. RIGHT LOBE MEASUREMENTS: 5.6 x 2.5 x 2 cmLEFT LOBE MEASUREMENTS: 6.2 x 2.1 x 1.7 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Multiple subcentimeter cysts and nodules are seen in the right thyroid lobe the largest of which measures 0.9 x 0.8 x 0.7 cm. No evidence of parathyroid adenoma or parathyroid hyperplasia.LEFT LOBE: Multiple subcentimeter cysts and nodules are also seen in the left thyroid lobe. Largest of these nodules measures 0.7 x 0.8 x 0.4 cm. No evidence of parathyroid adenoma or parathyroid hyperplasia.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No evidence of parathyroid adenoma or parathyroid hyperplasia.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.No evidence of parathyroid adenoma or hyperplasia.2.Multiple bilateral subcentimeter thyroid nodules and cysts"}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: Mildly coarse liver echotexture without mass. Liver length 18.9 cmBILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation.OTHER: No ascites", "output": "Mildly coarse liver echotexture suggestive for parenchymal dysfunction/chronic liver disease without mass. Gallbladder sludge without acute inflammation or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules RIGHT LOBE MEASUREMENTS: 6 x 1.5 x 1.2 cm LEFT LOBE MEASUREMENTS: 5.4 x 1.2 x 0.7 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Solid lower pole nodule with coarse internal calcifications. Nodule measures 2.1 x 1 x 1.2 cm.LEFT LOBE: Hypoechoic subcentimeter nodule measuring 0.4 x 0.2 x 0.47 m.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Dominant solid nodule with internal coarse calcifications lower pole right thyroid gland. This nodule is amenable to ultrasound guided percutaneous biopsy. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Right Testicular pain RIGHT TESTIS: 2.9 x 2 x 2 cm, heterogenous echotexture, normal vascularity notedLEFT TESTIS: 2.7 x 2.6 x 2.5 cm, heterogenous echotexture, normal vascularity notedRIGHT EPIDIDYMIS: 1.3 x 1.3 x 1 cm, normal echotexture and vascularity. Septated cyst noted in the head measuring 1 x 1.2 x 0.9 cm.LEFT EPIDIDYMIS: 1.3 x 1.2 x 1.4 cm. Normal echotexture and vascularity noted. No solid lesion noted.OTHER: No evidence of hydrocele or rectocele noted.", "output": "Heterogeneous echotexture of the testes bilaterally most likely related to atrophy. No evidence of intratesticular mass"}
{"instruction": "Generate impression based on findings.", "input": "Left testicular lesion RIGHT TESTIS: 4.2 x 2.2 x 2.9 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristicsLEFT TESTIS: 4.3 x 2.1 x 2.8 cm. Bilaterally symmetric Doppler flow characteristics.There is a 0.6 x 0.5 x 0.4 cm well circumscribed mixed cystic and solid lesion inseparable from the left inferior mediastinum. This lesion demonstrates no appreciable vascularity. This lesion has not changed in its appearance when compared to 7/14/2014.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Well-circumscribed mixed cystic and solid subcentimeter lesion inseparable from the left inferior mediastinum. This lesion demonstrates no appreciable vascularity and has not changed in appearance compared to 7/14/2014. An ultrasound report from 2002 provided by the patient documents the presence of a cystic lesion arising from the same left inferior mediastinum.Given this lesion's temporal stability from the prior study and a report from 2002 mentioning a cystic focus arising from the same the left inferior mediastinum location, a benign etiology is favored (such as a post inflammatory/fibrotic lesion.) The very minimal increase in size from 2002 and the presence of a complex mixed cystic and solid appearance compared to the cystic description in 2002 does not preclude a benign etiology and may represent expected evolution of a post inflammatory lesion. However, would recommend annual ultrasound surveillance monitoring of this lesion."}
{"instruction": "Generate impression based on findings.", "input": "76 year old female with history of metastatic lung cancer. Elevation of LFTs. Evaluate for obstruction. LIVER: The liver is minimally coarsened. No discrete mass lesion is identified; this may be better characterized with CT/MRI as clinically warranted, given the presence of metastatic lesions on the CT from 05/16/2014. The liver measures 16.1 cm in craniocaudal dimension. No intrahepatic biliary ductal dilatation is identified. Normal hepatopetal portal venous blood flow at 30 cm/sec.BILIARY TRACT: The common bile duct is dilated up to 10 mm and tapers smoothly to the hepatic hilum. A normally distended gallbladder is present. There is focal fundal hyperechoic thickening with associated ring-down artifact, likely representing focal adenomatosis. No gallstones, focal tenderness or pericholecystic fluid.PANCREAS: The visualized portions of the pancreatic body and head appear grossly normal.SPLEEN: The visualized portions of the spleen are unremarkable. It measures 7.6 cm in length.RIGHT KIDNEY: The right kidney measures 12.7 cm in length without hydronephrosis or shadowing calculus. 3.0-cm simple the inferior pole cyst. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 11 cm in length without hydronephrosis or shadowing calculus. 1.5-cm simple appearing interpolar cyst, better characterized on prior CT.", "output": "1. Common bile duct dilatation up to 10 mm is decreased compared to the prior CT from 12/5/2014. No intrahepatic biliary ductal dilatation is evident.2. No discrete liver mass lesion is identified; this may be better characterized with CT/MRI as clinically warranted, given the presence of metastatic lesions on the CT from 05/16/2014. 3. Focal gallbladder fundal adenomyomatosis, of no clinical significance."}
{"instruction": "Generate impression based on findings.", "input": "Male 19 years old Reason: ?RAS, CKD History: elevated bp ULTRASOUND KIDNEYSRIGHT KIDNEY: 11 cm in length. Normal echogenicity. No hydronephrosis.LEFT KIDNEY: 11 cm in length. No hydronephrosis.OTHER:Bladder collapsed.", "output": "No evidence of renal artery stenosis. Morphologically normal kidneys."}
{"instruction": "Generate impression based on findings.", "input": "81 year-old female who is recalled from screening for further evaluation of focal asymmetry with calcifications in the retroareolar right breast. No current breast complaints. RIGHT BREAST DIGITAL DIAGNOSTIC MAMMOGRAM: Right breast ML and two 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, unchanged in pattern and distribution. The right retroareolar focal asymmetry with calcifications partially disperses with spot compression.RIGHT BREAST ULTRASOUND: On physical examination, no palpable masses were present of the right breast. Targeted right breast ultrasound at the 9 o'clock position demonstrates no suspicious solid or cystic mass.", "output": "High probability benign focal asymmetry in the right retroareolar region. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (6 Months)."}
{"instruction": "Generate impression based on findings.", "input": "Assess for renal artery stenosis; hypertension and acute renal insufficiency RENAL TRANSPLANT: LOCATION: Left iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality noted. 10.8 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 transplant vasculature without evidence for inflow or outflow compromise.OTHER: No significant abnormality noted", "output": "Patent renal transplant vasculature without evidence for inflow or outflow compromise."}
{"instruction": "Generate impression based on findings.", "input": "Status post LVAD, transaminitis LIVER: Liver measures 17.5 cm with coarse echotexture suggestive of chronic liver disease or fatty infiltration. No intrahepatic biliary ductal dilatation noted. Portal vein demonstrates normal flow directionality and patency. GALLBLADDER, BILIARY TRACT: The common bile duct measures 4 mm in diameter. There is no cholelithiasis or findings to suggest acute cholecystitis.PANCREAS: The pancreas is entirely obscured by bowel gas.SPLEEN: The spleen measures 10. 8 cm in length.RIGHT KIDNEY: Right kidney measures 11 cm and left kidney measures 10.8 cm. No hydronephrosis. Normal echotexture noted. No focal lesion.OTHER: No ascites", "output": "Coarse hepatic echotexture suggestive of chronic medical renal disease or fatty liver."}
{"instruction": "Generate impression based on findings.", "input": "Male 15 years old; Reason: Evaluate asymmetry of the testicles. History: Possible history of testicular torsion. RIGHT TESTIS: No significant abnormalities noted and measured 4.1 x 1.7 x 2.2 cm.LEFT TESTIS: No significant abnormalities noted and measured 2.8 x 1.3 x 1.6 cm.RIGHT EPIDIDYMIS: No significant abnormalities noted and measures 0.9 x 0.9 x 0.9 cmLEFT EPIDIDYMIS: Left epididymal cyst and measures 1.7 x 1.2 x 1.1 cm.OTHER: No significant abnormalities noted.", "output": "Left epididymal cyst."}
{"instruction": "Generate impression based on findings.", "input": "88-year-old female with left breast mass detected on recent CT. Due to limitations of the patient's movement, mammogram was not performed.There is a firm palpable mass in the left breast at 12:00 position. Focused ultrasound shows an ill-defined hypoechoic mass measuring 40 x 25 mm at 12:00 position with increased blood flow.", "output": "Suspicious mass at 12:00 position in the left breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Male, 71 years old. BPH. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 6.6 cm in length, with significantly increased cortical echogenicity. No hydronephrosis or perinephric fluid.LEFT KIDNEY: The left kidney measures 11.3 cm in length with mild increased cortical echogenicity. No hydronephrosis or perinephric fluid.OTHER: The bladder is distended. The prostate measures 6.1 x 5.8 x 4.3 cm. Post void residual volume is approximately 446 mL.", "output": "1.Atrophic right kidney and increased renal cortical echogenicity, compatible with medical renal disease. No hydronephrosis.2.Enlarged prostate and significant post-void residual volume."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female with hepatitis B. Evaluate for HCC. LIVER: Measures 16.7 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: Absent status post splenectomy.KIDNEY: Atrophic right kidney with cortical scarring and thinning. No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "No significant interval change. Increased hepatic echogenicity consistent with parenchymal liver disease, without discrete focal lesion. Atrophic, scarred right kidney"}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain. LIVER: Non-cirrhotic liver morphology. 13.9 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 gallbladderPANCREAS: The pancreas is obscured by bowel gas.KIDNEYS: The right kidney is 9.8 cm in length. The left kidney is 10.5 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 12 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.", "output": "Mildly increased hepatic echogenicity, compatible with parenchymal dysfunction. Otherwise, no specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old woman with history of renal stone and hydronephrosis. RIGHT KIDNEY: The right kidney measures 11.7 cm in length. The renal cortex is thinned but normal in echogenicity. There is moderate to severe right hydronephrosis slightly increased from the prior study. No shadowing renal stone or worrisome renal mass is identified.LEFT KIDNEY: The left kidney measures 11.9 cm in length. The cortex is normal in echogenicity. A 5 mm calcification is again seen in the midpole. The lower pole calcification was not identified on today's exam.OTHER: The bladder is decompressed and incompletely evaluated.", "output": "1.Moderate to severe right hydronephrosis has slightly increased.2.Nonobstructing left renal calculus."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain nausea and vomiting BILIARY TRACT: Cholelithiasis again noted without acute inflammation or ductal dilatation. Negative Murphy's sign.OTHER: Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow", "output": "Cholelithiasis again noted without acute inflammation or ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Painful nodule posterior right thigh No evidence for mass or loculated fluid collection", "output": "No evidence for mass or loculated fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "Elevated bilirubin LIVER: Non-cirrhotic liver morphology. Increased parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No intrahepatic biliary ductal dilation. Mild prominence of the common bile duct is within normal limits for the patient's age. There is gallbladder sludge and cholelithiasis, without specific evidence of cholecystitis. No sonographic Murphy's sign.PANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney is 9.5 cm in length. The left kidney is 10.7 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 11.2 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites.", "output": "1. Increased hepatic echogenicity compatible with parenchymal dysfunction and/or steatosis, without biliary ductal dilation.2. Cholelithiasis without specific evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "15-year-old male evaluated for left axillary lymphadenopathy No lymph nodes or masses are identified in the left axilla.", "output": "No lymph nodes were identified sonographically in the left axilla."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain for one month. LIVER: The liver is normal in morphology and size measuring 16 cm in craniocaudal dimension without a focal lesion or biliary ductal dilatation. It is mildly echogenic in echotexture. Normal hepatopedal portal venous blood flow 0.3 m/s.BILIARY TRACT: No biliary ductal dilatation with the common duct measuring 4 mm. Mildly distended gallbladder without wall thickening, pericholecystic fluid, gallstones or focal tenderness.PANCREAS: Evaluation of the pancreas is limited by overlying bowel gas.SPLEEN: The spleen is normal in size measuring 6.5 cm without a focal lesion.RIGHT KIDNEY: The right kidney is normal in size measuring 11.2 cm without hydronephrosis, shadowing nephrolithiasis or focal lesion. OTHER: The left kidney measures 9.2 cm the hydronephrosis, shadowing nephrolithiasis or focal lesion.", "output": "No evidence of acute cholecystitis.Non-specific mildly echogenic liver parenchyma may represent fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "Female 75 years old Reason: 74F hx Bosniak IIF right renal cyst. Allergy to contrast. Evaluate for change in size. RIGHT KIDNEY: Right kidney has normal cortical echogenicity and measures 10.7 cm. Right inferior pole renal cyst is unchanged in appearance with a small septation measuring 3.1 x 2.4 x 2.8 cm, previously 3.0 x 2.5 x 3.4 cmLEFT KIDNEY: Left kidney has normal cortical echogenicity and measures 10.0 cm. Small cyst present in the superior left kidney measuring 1.4 x 1.0 x 1.2 cm, unchanged.BLADDER: Bladder is distended and normal in appearance", "output": "Right renal Bosniak 2F cyst is unchanged in size and sonographic appearance."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Johnson is a 51 year old female with a recent diagnosis of metastatic adenocarcinoma of the left axillary lymph node, concerning for breast primary. She presents today for further evaluation to locate the breast primary. Given patient's body habitus and limited mobility, a breast mammogram was not able to be performed today. Therefore, a whole left breast ultrasound was performed.In the left breast 2:00 location, approximately 10 cm from the nipple, there is an irregular hypoechoic mass identified measuring 1.5 x 0.7 x 0.9 cm. There is moderate associated vascularity.This mass is located approximately 3.3 cm inferolateral to the recently biopsied left axillary lymph node.", "output": "1.5 cm suspicious mass in the left upper outer breast, likely representing patient's breast primary. An ultrasound-guided biopsy with clip placement can be attempted if clinically warranted. All 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": "50-year-old male with sarcoidosis and abnormal liver function. Evaluate for liver disease. LIVER: Liver is normal in size. Slightly heterogeneous increased echogenicity likely due to mild irregular fatty liver. No focal hepatic abnormality. Limited spectral and color Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The very tract is normal in caliber.PANCREAS: Head and body are normal. The tail was not well seen.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Small right renal cyst. OTHER: 2.4 cm left renal cyst.", "output": "Mildly heterogeneous liver likely due to irregular fatty infiltration.Renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "21-year-old male with elevated LFTs and jaundice. LIVER: Echogenicity of the hepatic parenchyma is increased. The liver measures 16.9 centimeters in length. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts.The main portal vein is patent with normal direction of flow towards the liver and velocity of 32.3 cm/s.GALLBLADDER, BILIARY TRACT: Debris is noted within the gallbladder.. There is no pericholecystic fluid or gallbladder wall thickening. Tthe common bile duct measures 0.3 cm in diameter. OTHER: There is no free or loculated fluid.", "output": "Debris within the gallbladder without ductal dilatation. Fatty infiltration of the liver."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old male with acute on chronic congestive heart failure, preheart transplant and LVAD. LIVER:Normal in size and echotexture. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The visualized biliary tract is normal in caliber.PANCREAS: Poorly evaluated due to bowel gas.SPLEEN: No significant abnormality noted.KIDNEYS: The right kidney measures 10.6 cm in length and the left 9.9 cm. Echotexture is normal. No hydronephrosis, shadowing calculus or mass. ABDOMINAL AORTA: Only the proximal to mid aorta is adequately visualized and is normal in caliber. Remainder is obscured by bowel gas.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Normal examination with inadequate visualization of the pancreas and mid to distal aorta."}
{"instruction": "Generate impression based on findings.", "input": "Alcohol use with transaminitis LIVER: Mildly echogenic and heterogeneous liver echotexture without mass. Liver length 21.2 cmGALLBLADDER, BILIARY TRACT: Gallbladder removed. Minimal intrahepatic and extrahepatic ductal prominence. Maximal common bile duct diameter 0.9 cm.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.4 cm in lengthOTHER: Left kidney 11.7 cm in length. Spleen 8.8 cm in length. Mild ascites. Bilateral pleural effusions.", "output": "Hepatomegaly associated with mildly echogenic and heterogeneous liver echotexture consistent with fatty infiltration/parenchymal dysfunction without mass. Minimal intrahepatic and hepatic ductal dilatation status post cholecystectomy without obvious distal obstructing lesion. Mild ascites. Bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Female 83 years old Reason: rule out obstruction, hydronephrosis, stone History: elevated AKI Exam is somewhat limited by patient inability to change positions or hold breath.RIGHT KIDNEY: Marked echogenicity of the right kidney, suggesting atrophy or scarring. No hydronephrosis. Small cyst in the right kidney measures 1.2 x 0.9 x 1.4 cm. Right kidney measures 8.6 cm.LEFT KIDNEY: Difficult visualization of the left kidney. However, the cortex appears normal in echogenicity. Multiple large stones are identified in the left kidney. No hydronephrosis. Left kidney measures 8.47 m.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "1.Marked cortical echogenicity of the right kidney suggesting atrophy or scarring. No right hydronephrosis.2.Multiple large stones are identified in the left kidney. No left hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Female, 54 years old. Kidney stone RIGHT KIDNEY: The right kidney measures 11.1 cm in length, with normal echotexture. A nonobstructing lower pole stone measures 0.6 x 0.5 x 0.5 cm. No hydronephrosis. No perinephric collection.LEFT KIDNEY: The left kidney is not well visualized due to patient positioning. A lower pole stone measures 1.2 x 0.9 x 0.7 cm. No obvious hydronephrosis.OTHER: The bladder is distended, without significant wall thickening.", "output": "Nonobstructing 6 mm right renal stone. No hydronephrosis. Poor visualization of the left kidney with an approximately 1 cm left renal stone."}
{"instruction": "Generate impression based on findings.", "input": "Male 38 years old; Reason: Evaluate for recurrence of thyroid cancer History: hx of thyroid cancer The patient is status post total thyroidectomy for papillary cancer.RIGHT THYROIDECTOMY BED: There is a lobular hypoechoic focus seen within the right thyroidectomy bed measuring 0.4 cm x 0.4 cm x 0.4 cm. There is some mild internal complexity. This does not appear to have any internal vascular flow. No discrete microcalcifications are seen.LEFT THYROIDECTOMY BED: No suspicious lesions for recurrence.LYMPH NODES: No suspicious adenopathy noted.", "output": "There is a hypoechoic focus within the right thyroidectomy bed, as above. No prior ultrasounds are available for comparison, however if this is a new finding this may be concerning for a possible recurrence. No suspicious regional adenopathy is identified."}
{"instruction": "Generate impression based on findings.", "input": "Pancreatitis. Evaluate for cholelithiasis. Please note that this examination was limited due to poor acoustic penetration.LIVER: Non-cirrhotic liver morphology. Mildly 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. Biliary sludge noted within the gallbladder. No cholelithiasis identified.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. The body and tail are obscured by bowel gas.KIDNEY: The right kidney is 9.1 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present. The left kidney is not well visualized.SPLEEN: Not well visualized.OTHER: No significant abnormalities noted. No significant ascites identified.", "output": "No cholelithiasis identified."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female patient with hepatitis C. Evaluate for evidence of cirrhosis. LIVER: The liver measures 13.9 cm in length. No focal hepatic lesion is identified. Hepatic parenchymal echogenicity is slightly coarsened. 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 9.4 cm in length. No evidence of hydronephrosis. There is a subcentimeter midpole renal cyst.OTHER: The left kidney measures 9.8 cm in length. No evidence of hydronephrosis.The spleen is not visualized on this examination.", "output": "1. Mildly coarsened hepatic echotexture which can be seen with hepatic parenchymal dysfunction, but no focal hepatic lesion.2. Subcentimeter right renal cyst. "}
{"instruction": "Generate impression based on findings.", "input": "Biceps injury There is full-thickness rupture of the distal tendon of the right biceps with proximal retraction of the tendon to the level of the humeral condyles. There is perhaps a small residual stump of fibers emanating from the tubercle of the proximal radius; however no definite fibers are seen between the retracted tendon and this stump. There is a small hypoechoic collection adjacent to the retracted tendon, likely representing a small hematoma and there is generalized hypervascularity of the soft tissues anterior to the radius. The brachialis muscle and insertion are intact and the brachial artery appears normal. The remaining soft tissues are also unremarkable.", "output": "Distal right biceps tendon rupture with retraction of the tendon to the level of the humeral condyles."}
{"instruction": "Generate impression based on findings.", "input": "Male 45 years old Reason: U/S for pt w apparent CKD (creatinine 1.6, BUN 20, GFR mid 40s). He has borderline BP and A1C but no prior dx of HTN, DM History: as above RIGHT KIDNEY: The right kidney measures 11.4 cm. There is no hydronephrosis or shadowing stones. The renal cortex is mildly echogenic suggestive of medical renal disease.LEFT KIDNEY: The left kidney measures 11.1 cm. There is no hydronephrosis or shadowing stones. The renal cortex is mildly echogenic, suggestive of medical renal disease.URINARY BLADDER: The bladder is incompletely distended at time of imaging.", "output": "The renal cortex is bilaterally mildly echogenic consistent with medical renal disease. No hydronephrosis or shadowing stones."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female patient with history of right breast cancer and bilateral neck adenopathy including submandibular area. Received chemotherapy. Assess bilateral supraclavicular, cervical, and submandibular nodes. Targeted ultrasound of the bilateral neck demonstrates benign morphology lymph nodes within the right level two station measuring 1.6 x 0.2 x 0.5 cm and the left level two station measuring 1.4 x 0.3 x 0.5 cm. An additional benign morphology left level three lymph node measures 1.9 x 0.4 x 0.9 cm.Incidental note of a hypoechoic, spongiform nodule within the lower pole of the left thyroid measuring 1.8 x 1.1 x 1.3 cm. An additional smaller mostly solid hypoechoic nodule within the midpole measures 0.9 x 0.5 x 0.7 cm.", "output": "1. Benign morphology bilateral neck lymph nodes.2. Incidental note of left thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "14-year-old female with breast painVIEWS: Chest AP/lateral (two views) 3/3/15 16:55 The cardiothymic silhouette is normal. The cardiac apex, aortic arch and stomach are left-sided. Note is made of a soft tissue mass overlying the left breast, better evaluated on recent ultrasound.", "output": "No acute cardiopulmonary abnormality. Soft tissue mass within the left breast is better evaluated on prior ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Mildly heterogeneous liver without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 19 cmBILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 10.6 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 11.5 cm in lengthOTHER: Left kidney 9.6 cm in length. No ascites.", "output": "Cholelithiasis without acute inflammation or ductal dilatation. Mildly heterogeneous liver raises the possibility of fatty infiltration/parenchymal dysfunction without mass. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for changes in known thyroid nodules History: Thyroid nodules, history of neck radiation, history of chronic lymphocytic thyroiditis RIGHT LOBE MEASUREMENTS: 5.4 1.3 x 1.6 cm.LEFT LOBE MEASUREMENTS: 1.4 x 1.3 x 4.5 cm.ISTHMUS MEASUREMENTS: 0.2 cm in the AP dimension.RIGHT LOBE: Diffusely heterogeneous appearing gland.Right upper pole nodule: Solid appearing, demonstrating minimal internal vascularity but without microcalcifications, measures 1.0 x 0.7 x 0.6 cm, previously 0.7 x 0.5 x 0.8 cm.Right lower pole nodule: Solid with a more heterogeneous appearance, demonstrating minimal internal vascularity and a questionable shadowing hyperechoic focus which may represent a calcification, measures 1.1 x 1.0 x 0.7 cm, previously 1.7 x 1.2 x 1.2 cm.LEFT LOBE: Diffusely heterogeneous appearing gland.Left lower pole nodule: Solid appearing, demonstrating some internal vascularity but without microcalcifications, measures 1.0 x 1.5 x 0.9 cm, previously 1.3 x 1.7 x 1.7 cm.ISTHMUS: Heterogeneous gland.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Left level 4 cervical lymph node measures 0.7 x 0.7 x 0.4 cm with a visualized fatty hilum.OTHER: No significant abnormality noted.", "output": "Stable dominant nodules on background of thyroiditis without significant interval change."}
{"instruction": "Generate impression based on findings.", "input": "44 year old woman with history of calcifications seen on screening mammogram 1/23/15. Also complains of a palpable mass in right superolateral axilla. An ML view and two spot magnification 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. Regional, round calcifications are seen in the left superolateral breast. These are highly likely benign based on distribution and morphology.  ULTRASOUND", "output": "1. Regional round calcifications in the left superolateral breast are highly likely benign. Followup with unilateral diagnostic mammogram is recommended in 6 months. Recommendation was discussed with and provided to the patient in writing.2. Sebaceous cyst of the right axilla.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "Worsening LFTs LIMITED ABDOMENLIVER: Coarse echogenic liver echotexture consistent with chronic liver disease again noted. No mass. Liver length 18 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. RIGHT KIDNEY: Echogenic parenchyma without mass or stone or obstruction. Right kidney 10.9 cm in lengthOTHER: Mild to moderate ascites again noted.", "output": "Coarse echogenic liver parenchyma again seen consistent with chronic liver disease without mass or ductal dilatation. Mild to moderate ascites again noted. Patent hepatic vessels with normal directional flow.Echogenic right kidney consistent with medical renal disease/parenchymal dysfunction without obstruction."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male patient with HCV, bridging fibrosis. Evaluate for HCC. LIVER: The liver measures 14.0 cm in length. There is mild coarseness and increased echogenicity of the hepatic parenchyma. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is contracted; the patient reported recently eating. There is no significant pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 2 mm in diameter.PANCREAS: The pancreas is largely obscured by overlying bowel gas. RIGHT KIDNEY: The right kidney measures 11.3 cm in length. No evidence of hydronephrosis. There is a 7 mm stone within the right lower pole.OTHER: The left kidney measures 11.3 cm in length. No evidence of hydronephrosis.The spleen measures 8.1 cm in length.No ascites.", "output": "1. Coarse liver, likely related to chronic liver disease/hepatic steatosis. No focal hepatic lesion identified.2. Non-obstructing right nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old male with umbilical hernia. Grayscale and color ultrasound of the anterior abdominal wall soft tissues demonstrates a fat-containing umbilical hernia which does not significantly change with Valsalva maneuver, and does not contain bowel. The hernia defect measures approximately 1.5 cm in diameter.", "output": "Fat-containing umbilical hernia as described above."}
{"instruction": "Generate impression based on findings.", "input": "Rule out hydronephrosis, AKI Limited evaluation due to body habitus and patient positioningRIGHT KIDNEY: Upper pole and midpole the right kidney is visualized with mild increased echogenicity consistent with chronic medical renal disease. Lower pole of the right kidney is not visualized due to overlying bowel gas. No hydronephrosis.LEFT KIDNEY: Left kidney is not visualized due to overlying bowel gas and patient positioning.OTHER: Foley catheter noted within the bladder", "output": "Incompletely visualized left kidney and lower pole of the right kidney. Mild increased echogenicity of the visualized right kidney consistent with chronic medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 63 yo with multiple co-morbidities. May have CKD, unclear. Creatinine rising. Evaluate for hydronephrosis History: urinary incontinence ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures 12.3 cm in length. Echogenic renal parenchyma. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.5 cm in length. Echogenic renal parenchyma. No shadowing stones or hydronephrosis.OTHER:The bladder wall is thickened symmetrically, measuring up to 0.7 cm.", "output": "Echogenic renal parenchyma, consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "51 year-old female with large left forearm IV infiltration. Assess size of infiltrate, rule out hematoma. In the left upper extremity there is infiltrating edema in the subcutaneous soft tissues diffusely from the level of the biceps to the wrist.Mild infiltrating edema in the subcutaneous tissues in the right elbow.No loculated fluid collection is noted.", "output": "Infiltration edema in the bilateral upper extremity soft tissues, left greater than right as described above. Correlation with clinical history is suggested to exclude cellulitis. No loculated fluid collection or a collection that would be amenable to drainage is noted. "}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female presents for evaluation of a known thyroid nodule. RIGHT LOBE MEASUREMENTS: 5.1 x 2.2 x 2.6 cm.LEFT LOBE MEASUREMENTS: 4.9 x 1.7 x 1.7 cm.ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: There is a well-defined dominant hypoechoic nodule measuring approximately 2.4 x 2.1 x 2.1 cm with some spongiform components in the right mid pole of the thyroid. Otherwise, the parenchyma on the right appears mildly heterogeneous. LEFT LOBE : Mildly heterogeneous parenchyma without mass or nodule.ISTHMUS: Mildly heterogeneous parenchyma without mass or nodule.LYMPH NODES: No adenopathy noted.OTHER: No significant abnormality noted.", "output": "1. Nodule in the right lobe as described above. Although there are some spongiform characteristics, it is largely uniformly hypoechoic and amenable to biopsy.2. Mildly heterogeneous parenchyma raises the possibility of chronic thyroiditis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: r/o adenopathy, recurrence History: h/o thyroid cancer. RIGHT LOBE MEASUREMENTS: Interval status post thyroidectomy.LEFT LOBE MEASUREMENTS: Interval status post thyroidectomy.ISTHMUS MEASUREMENTS: Interval status post thyroidectomy.RIGHT LOBE: No evidence of residual disease or recurrence.LEFT LOBE: No evidence of residual disease or recurrence.ISTHMUS: No evidence of residual disease or recurrence.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level 2 lymph node measures 1.5 x 0.5 x 2.2 cm with suggestion of a fatty hilum. Left level 2 lymph node measures 0.8 x 0.5 x 1.4 cm, nonspecific. OTHER: No significant abnormality noted.", "output": "No evidence of residual disease or recurrence. Nonspecific small left level 2 lymph node. "}
{"instruction": "Generate impression based on findings.", "input": "47-year-old male patient with history of lymphoma, papillary thyroid cancer for thyroidectomy, lymph node mapping. RIGHT LOBE MEASUREMENTS: 5.4 x 2.1 x 2.2 cm, previously 6.0 x 2.5 x 2.0 cm.LEFT LOBE MEASUREMENTS: 4.8 x 1.9 x 1.7 cm, previously 5.3 x 1.8 x 1.7 cm.ISTHMUS MEASUREMENTS: 3 mm in thickness.RIGHT LOBE: The right thyroid lobe is diffusely heterogeneous in echotexture. Again seen is a complex cystic mass in the mid to inferior right lobe measuring approximately 1.2 x 1.3 x 1.3 cm. This has internal round calcifications as well debris.LEFT LOBE: The left thyroid lobe is diffusely heterogeneous in echotexture without a dominant thyroid mass.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Numerous enlarged lymph nodes are noted in the neck bilaterally including the submandibular regions.A right submandibular region lymph node measures 3.0 x 0.8 x 2.6 cm. A right level two lymph node measures 2.0 x 0.7 cm. Multiple additional right level three and level four lymph nodes are seen. These lymph nodes appear to have normal morphology.An enlarged lymph node within the left submandibular region measures 1.7 x 1.3 x 1.4 cm and is abnormal in morphology. A left level two lymph node measures 1.5 x 0.6 cm. Additional lymph nodes are noted within the left three and four stations.OTHER: No significant abnormality noted.", "output": "1. Dominant right thyroid nodule, previously biopsied demonstrating papillary thyroid cancer.2. Enlarged bilateral submandibular and neck lymph nodes, many of which demonstrate normal morphology except for a left submandibular region node. "}
{"instruction": "Generate impression based on findings.", "input": "Male 74 years old Reason: pre op History: pre op LIVER:Liver measures 16 cm. Normal echogenicity. No focal liver lesions.GALLBLADDER, BILIARY TRACT: No significant abnormality noted. No evidence of intra or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: No significant abnormality noted.KIDNEYS: Echogenic kidney. Right kidney measures 10.1 cm. Simple appearing cyst measuring 4.9 cm involving the right kidney. Echogenic left kidney. Left kidney measures 11.1 cm. There is a simple cyst measuring 3.3 cm in diameter. ABDOMINAL AORTA: No significant abnormality noted. No evidence of abdominal aortic aneurysm.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Enlarged prostate.", "output": "Bilateral echogenic kidneys compatible with medical renal disease. Bilateral simple appearing renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "Female 25 years old; Reason: Liver pathology History: Acutely elevated AST/ALT, c/f acute liver injury LIVER: The liver measures 16.5 cm in length. There is normal echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. There is a hyperechoic lesion seen within the left lower of the liver measuring 2.3 cm x 1.3 cm x 2.0 cm. This has no internal vascularity. The main portal vein is patent with normal hepatopetal flow measured at 25.2 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.1 mm. No stones are seen. No pericholecystic fluid. Negative sonographic Murphy's sign. The common bile duct measures 3.3 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 11.7 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 12.3 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: A left pleural effusion is identified. No ascites.", "output": "1. There is a hyperechoic lesion identified in the left lobe of the liver. While this may represent a benign hemangioma, this lesion is incompletely characterized on ultrasound and recommend cross-sectional imaging for further characterization.2. Bilaterally the kidneys have increased echogenicity compatible with medical renal disease.3. A left pleural effusion is identified."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female patient with left thyroid nodule. Evaluate for changes. RIGHT LOBE MEASUREMENTS: 5.7 x 2.0 x 1.2 cm, previously 5.8 x 2.1 x 1.1 cm.LEFT LOBE MEASUREMENTS: 5.2 x 2.0 x 0.9 cm, previously 5.0 x 1.9 x 0.9 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: The right thyroid lobe is homogeneous in echogenicity without dominant thyroid nodule.LEFT LOBE: The left thyroid lobe contains two nodules. A mid pole complex nodule measures 1.0 x 0.8 x 0.5 cm, not significantly changed in size. An additional left inferior pole mostly solid, hypoechoic nodule measures 0.6 x 0.4 x 0.2 cm, not significantly changed in size.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology lymph nodes are noted in the neck.OTHER: No significant abnormality noted.", "output": "No significant change in size or appearance of left thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "24-year-old female with swelling and pain in the region of the right submandibular gland The submandibular gland is homogeneous without evidence for calcification, site atelectasis, fluid collection or mass. There is at least one large but morphologically normal lymph node in the region of the patient's discomfort measuring 0.7 x 2.2 x 2.6 cm. Limited images of the parotid gland demonstrate no abnormality. There is no adenopathy in the neck.", "output": "Normal submandibular gland on the right with adjacent prominent but morphologically normal lymph node."}
{"instruction": "Generate impression based on findings.", "input": "80 yo female with past history of left breast cancer, has benign feeling mass in the right breast. Prior ultrasound on 7/24/2014 demonstrated no mass in the palpable area of abnormality in the 3 o'clock position of the right breast. A targeted right ultrasound was performed for the palpable area of concern, previously denoted as the 3 o'clock position. There is no solid or cystic mass identified 4 cm from the nipple, the previous location examined sonographically. In the 3 o'clock position, 2 cm from the nipple, there is a small simple cyst, measuring 3 x 1 x 3 mm.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Male, 61 years old. Acute on chronic kidney disease. RIGHT KIDNEY: The right kidney measures 12.3 cm, with increased cortical echogenicity. An upper pole simple cyst measures 2.3 x 2.2 x 1.8 cm. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 12.6 cm, with increased cortical echogenicity. An upper pole cyst measures 3.5 x 3.1 x 2.4 cm, with thin nonvascular septations.OTHER: The bladder is decompressed.", "output": "1.Increased renal cortical echogenicity, compatible with medical renal disease. No hydronephrosis.2.Bilateral renal cysts, including a 3 cm minimally complex left cyst."}
{"instruction": "Generate impression based on findings.", "input": "Male 29 years old Reason: ? Nodules or abnormal nodes History: Family history papillary carcinoma RIGHT LOBE MEASUREMENTS: 5.1 x 1.6 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.8 x 1.4 x 1.6 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Normal appearance of the right thyroid lobe. Normal echogenicity. No nodules.LEFT LOBE: Normal appearance of the left thyroid. Normal echogenicity. No nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted. No suspicious lymph nodes.OTHER: No significant abnormality noted.", "output": "Normal appearance of the thyroid."}
{"instruction": "Generate impression based on findings.", "input": "70 year-old female with autoimmune hepatitis and cirrhosis, evaluate for HCC. LIVER: The liver parenchyma is coarsened and mildly nodular, compatible with cirrhosis. No focal hepatic lesion is evident. It is normal in size, measuring 18 cm in the craniocaudal dimension. There is normal hepatopetal portal venous blood flow with velocity measure 25 cm/sec.GALLBLADDER, BILIARY TRACT: A normally distended gallbladder is present with minimal sludge and mild diffuse wall thickening, but no reported focal tenderness or pericholecystic fluid.No extrahepatic biliary duct dilatation with the common bile duct measuring up to 5 mm at the porta hepatis.PANCREAS: The poorly visualized pancreatic body and head are grossly unremarkable.RIGHT KIDNEY: The right kidney measures 10.1 cm in length without hydronephrosis.OTHER: Note is made of a small echogenic shadowing focus, in the region of the anterior wall of the splenic vein at the level of the pancreatic body head junction, of uncertain clinical significance. The left kidney measures 8 cm in length without hydronephrosis.The poorly visualized spleen measures approximately 8 cm.", "output": "1. Cirrhotic liver morphology without definite focal lesion. 2. Gallbladder sludge without specific evidence of acute inflammation."}
{"instruction": "Generate impression based on findings.", "input": "66 years old, Male, Reason: r/o cholecystitis History: abd pain LIVER: The liver is enlarged measuring 21.1 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 0.3 m/s.BILIARY TRACT: There is gallbladder sludge without evidence of gallbladder wall thickening or pericholecystic fluid. Sonographic Murphy's sign could not be assessed due to patient's clinical status. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 5 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 12.5 cm in length. RIGHT KIDNEY: Kidney measures 10.4 cm in length. Normal echotexture. Nohydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 11.4 cm in length. Normal echotexture. Nohydronephrosis or shadowing calculus.OTHER: No significant abnormalities noted.", "output": "1.Gallbladder sludge without evidence of acute cholecystitis.2.Hepatomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Secondary hyperparathyroidism RIGHT LOBE MEASUREMENTS: 4.7 x 1.8 x 1.3 cmLEFT LOBE MEASUREMENTS: 4.1 x 2 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: 1.5 x 1.9 x 2.5 cm hypoechoic focus arising the superior aspect of the left thyroid gland; it is unclear whether not this lesion is separate from our arising from the left thyroid gland.1.4 x 0.9 x 0.8 cm hypoechoic extrathyroidal focus projecting inferior and posterior to the left thyroid gland.1.3 x 0.9 x 0.9 cm mixed echogenicity focus right level 4 which does not morphologically correspond to a normal lymph nodeLYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Hypoechoic extrathyroidal focus projecting inferior and posterior to the left thyroid gland suspicious for clinically suspected parathyroid hyperplasia/adenoma. Larger hypoechoic focus arising from the superior aspect of the left thyroid gland; it is unclear whether not this lesion arises from the left thyroid gland or is separate and extrathyroidal; a large parathyroid adenomas/hyperplasia cannot be excluded.An additional mixed echogenicity focus right level 4 which is not morphologic correspond to normal lymph node; a parathyroid adenoma focus cannot be excluded.No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "59 year old female with chronic hepatitis B carrier. Evaluate for malignancy, cirrhosis, portal hypertension. LIVER: Normal echogenicity of the liver measuring 10.1 cm in length. Cyst measures 7 mm x 4 mm x 4 mm. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. The common duct measures 5 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: Normal echogenicity of the right kidney measuring 9.1 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Spleen is not well visualized.Normal echogenicity of left kidney measuring 9.4 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "Probable subcentimeter cyst in the right hepatic lobe. "}
{"instruction": "Generate impression based on findings.", "input": "31-year-old female patient with elevated AST/ALT postpartum. Evaluate for liver parenchymal disease, obstruction. LIVER: The liver measures 19.7 cm in length. Hepatic parenchymal echogenicity is slightly 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. 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 10.5 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.8 cm in length. No evidence of hydronephrosis.The spleen measures 10.5 cm in length.", "output": "1. Increased hepatic parenchymal echogenicity which can be seen with hepatic steatosis/hepatic parenchymal dysfunction.2. No intra- or extrahepatic biliary ductal dilatation. "}
{"instruction": "Generate impression based on findings.", "input": "26-year-old female with transaminitis and MDS/MPN, evaluate liver size and pathology, spleen size. LIVER: Measures 16.4 cm in length. Increased hepatic echogenicity without discrete focal lesion. The main portal vein demonstrates antegrade flow of 0.5 m/s, slightly elevated. BILIARY TRACT: No significant abnormalities noted.PANCREAS: The distal pancreas is not well-visualized due to bowel gas. The visualized portions of the pancreas appear unremarkable.SPLEEN: Measures 18.1 cm in length without focal lesion.KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "1. Marked splenomegaly and mild hepatomegaly with increased hepatic echogenicity consistent with diffuse parenchymal disease or hepatic steatosis.2. Mildly elevated velocity of the main portal vein. "}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Mildly coarse liver echotexture without worrisome mass. Right lobe minimally complex hepatic cyst. Liver length 13.9 cm.GALLBLADDER, BILIARY TRACT: 0.6 x 0.8 x 0.5 nonmobile soft tissue focus within the gallbladder. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.9 cm in lengthOTHER: Left kidney 10.5 cm in length. Spleen 9.4 cm in length. No ascites.", "output": "Mildly coarse liver echotexture suggestive for chronic liver disease without worrisome mass or ductal dilatation. Gallbladder polyp; would pay special attention to this polyp on future surveillance scans. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "The patient submitted outside mammogram dated 3/25/2014, 10/20/2013, 10/7/2013 and ultrasounds dated 3/25/2014 and 10/22/2013, from Mercy Hospital. Submitted outside study was compared to the current mammogram dated 3/4/2015. There is no significant change between these two studies.Ultrasound images submitted for comparison only, no official interpretation will be performed.", "output": "No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Palpable mass along the superior aspect of the right shoulder. Per the patient is has been present for many years and more recently became tender with palpation. At the site of the patient's palpable tender abnormality there is a 2.0 x 0.9 x 1.7 cm heterogeneous hypoechoic solid lesion demonstrating mild internal vascularity. This appears deep to the musculature.", "output": "Nonspecific 2.0 cm hypoechoic solid lesion at the site of the patient's chronic palpable mass. Further evaluation of the lesion and it's origin can be performed by CT of the right shoulder."}
{"instruction": "Generate impression based on findings.", "input": "Renal transplant. Acute kidney injury. Transplant kidney identified in the right hemipelvis. Two percutaneous biopsies performed", "output": "Ultrasound guidance for percutaneous renal biopsy."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old female with history of fibromyalgia and seronegative arthritis with borderline bilateral enlarged lymph nodes. History of right breast cyst excision. Family history of breast cancer in paternal grandmother. MAMMOGRAM: Three standard views of both breasts were performed with additional spot compression views of the left breast 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 a new, oval, focal asymmetry in the left lower inner breast, posterior depth, best seen on the CC view measuring 13 mm. On spot compression CC view, this lesion persists. It is not well seen on spot compression ML view.The right breast is unremarkable.There are partially imaged prominent bilateral axillary lymph nodes.ULTRASOUND: A targeted left breast ultrasound performed in the area of the patient's mammographic abnormality. No suspicious masses or cysts were appreciated.", "output": "New asymmetry in the left lower inner breast, posterior depth best seen on CC view with most likely benign morphology and without sonographic correlate. A diagnostic mammogram of the left breast is recommended in 6 months. Results and plan 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": "Reason: 83M with soft mass on LLQ area, ? Spigelian hernia History: soft LLQ abdominal mass In the left inguinal region, there is an apparent defect in the abdominal wall which appears to contain peristaltic bowel compatible with an inguinal hernia.", "output": "Findings compatible with left inguinal hernia. CT abdomen/pelvis with intravenous and enteric contrast may be considered for additional evaluation as clinically warranted.Findings discussed with patient and daughter. Patient not currently experiencing acute obstructive symptoms and was counseled to seek care at the emergency department if symptoms worsen."}
{"instruction": "Generate impression based on findings.", "input": "Status post thyroidectomy for follicular carcinoma with increased uptake on PET/CT within left thyroid bed, right supraclavicular space, and left cervical chain RIGHT LOBE: Status post thyroidectomy without mass.LEFT LOBE: Status post thyroidectomy. 0.7 x 0.7 x 1 cm hypoechoic nodular focus within the left thyroid bed.ISTHMUS: 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. Hypoechoic nodular focus within the left thyroid bed. This focus will be biopsied today. No regional adenopathy. Specifically, no abnormality appreciated within the right supraclavicular region or left cervical nodes."}
{"instruction": "Generate impression based on findings.", "input": "Acute on chronic renal insufficiency RIGHT KIDNEY: Echogenic parenchyma again noted without mass, stone, or hydronephrosis. 10 cm in lengthLEFT KIDNEY: Echogenic parenchyma again noted without mass, stone, or hydronephrosis. 9.3 cm in lengthOTHER: Bladder nondistended", "output": "Echogenic renal parenchyma again noted consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction"}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female with chronic kidney disease, stage IV and sarcoidosis. Ultrasound guidance was provided for biopsy of the patient's native right kidney.", "output": "Ultrasound guidance."}
{"instruction": "Generate impression based on findings.", "input": "81-year-old male with a history of newly diagnosed hepatitis C, and thrombocytopenia. Evaluate for cirrhotic liver morphology. LIVER: The liver parenchyma is minimally coarsened. It is normal in size, measuring 15.0 cm in craniocaudal dimension. The liver contour, and capsule are smooth. 1.3-cm coarse calcification in the right hepatic dome, seen on prior CT. No suspicious focal hepatic lesion, or intrahepatic biliary ductal dilatation. Normal hepatopetal portal venous blood flow at 23 cm/sec.GALLBLADDER, BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common bile duct measuring 3 mm. Normally distended gallbladder without cholelithiasis, wall thickening or pericholecystic fluid.PANCREAS: The pancreas is obscured by overlying bowel gas shadowing.RIGHT KIDNEY: The right kidney measures 9.8 cm in length without hydronephrosis, shadowing nephrolithiasis, or discrete lesion evident.OTHER: The spleen is normal in size, measuring 7.9 cm. The left kidney is difficult to see, measuring 8.6 cm, without hydronephrosis.", "output": "Mildly coarse hepatic parenchyma, compatible with parenchymal dysfunction. Otherwise, normal hepatic morphology without discrete lesion. "}
{"instruction": "Generate impression based on findings.", "input": "71 years old, Female, Reason: rule out progression in size of nodules - please comment on substernal extension - seen on 7/2012 US but not mentioned on 3/2013 US History: dysphagia RIGHT LOBE MEASUREMENTS: 5.0 x 2.3 x 1.7 centimetersLEFT LOBE MEASUREMENTS: 7.1 x 5.6 x 4.7 cm.ISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Stable right thyroid nodules which are spongiform in appearance and likely represent colloid nodules. The largest spongiform right thyroid nodule measures 1.1 x 0.6 x 0.8 cm, previously measuring 1.1 x 0.8 x 0.7 cm.LEFT LOBE: There are two left thyroid nodules. The more superior medial nodule is spongiform in appearance measuring 1.9 x 1.7 x 1.8 cm. Interval increase in size of dominant solid left thyroid nodule which measures 5.9 x 5.1 x 4 .5 cm, previously measuring 5.4 x 4.6 x 4.07 m. Retrosternal extension of the left thyroid lobe. ISTHMUS: There is a mixed solid-cystic nodule measuring 2.2 x 1.3 x 1.2 cm which is not significantly changed in size.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing right level 2 lymph node measures 1.5 x 1.3 x 0.5 cm. Left level 2 benign-appearing lymph node in measures 0.9 x 0.6 x 0.8 cm.OTHER: No significant abnormality noted.", "output": "1. Dominant solid left thyroid nodule has increased in size and is indeterminate on this examination.2. Stable spongiform thyroid nodules which are likely colloid nodules.3. Stable mixed solid cystic left thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for routine screening mammography. She has a history of bilateral benign breast biopsies. She has a family history of breast cancer in her twin sister diagnosed at age 28, and in another sister, diagnosed at age 39, who also was diagnosed with ovarian cancer. Two standard digital views of both breasts were performed with tomosynthesis 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. Linear scar markers overlying both breasts. Distortion underneath the right breast scar marker is questionably increased this year, and spot compression views and ultrasound are recommended. Distortion the left breast is stable. Bilateral benign calcifications are stable.", "output": "Distortion underneath the right breast scar marker is questionably increased this year, and spot compression views and ultrasound are recommended.Screening breast MRI could also be considered based on her strong family history and the limitations of her mammogram due to her breast density and postsurgical changes.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EC - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "Female 32 years old Reason: emesis throughout pregnancy, evaluate for liver etiologies History: nausea, vomiting LIVER: Liver measures 17.2 cm in length. There is increased echogenicity of the liver suggesting fatty infiltration or diffuse hepatic dysfunction. No focal hepatic mass. Main portal vein is patent with normal directional flow and a peak velocity of 19.2 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Gallbladder is normal in appearance. No gallstones. No gallbladder wall thickening. No evidence of acute inflammation. Common bile duct measures up to 6 mm, within normal limits.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 9.5 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Minimal fullness of the left renal pelvis. Right kidney measures 10.8 cm. Left kidney measures 12.2 cm.OTHER: No significant abnormalities noted.", "output": "Increased echogenicity of the liver suggesting fatty infiltration or diffuse hepatic dysfunction. No gallstones or acute inflammation of the gallbladder."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old female with family history of renal cysts. RIGHT KIDNEY: The right kidney measures 10.5 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 10.6 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.OTHER: Bladder is decompressed.", "output": "Normal kidneys."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are diagnostic mammograms and ultrasounds (7/7/16) along with post procedural mammograms (7/13/16) performed at Northwestern Lake Forest Hospital. Three standard views of both breasts were obtained along with spot compression and spot magnification views of the bilateral breasts. Subsequent ultrasound was also performed. The breast parenchyma is heterogeneously dense.Right:Three areas of concern are described on the right:1. Loosely scattered calcifications are seen in the lower, inner quadrant. These calcifications span 3.4 cm on the MLO spot magnification view. Few benign coarse calcifications are noted within this cluster. On corresponding ultrasound, within the right lower, inner quadrant a corresponding 10 x 7 x 3 mm mass is demonstrated that was subsequently biopsied and consistent with benign fibroadenoma which is concordant. A coil shaped clip is present adjacent to the coarse and other loosely scattered calcifications. Specimen radiograph were not obtained to confirm calcifications but the post procedure mammogram shows that a few calcifications were removed at the time of biopsy. 6 month follow up mammogram is recommended of this area of calcifications to confirm stability. 2. A benign subcentimeter intramammary lymph node is identified in the right upper-outer quadrant with a correlate seen on ultrasound subsequently.Left:Four areas of concern are described on the left:1. Patient palpable mass at the 5:00 position does not show any abnormality on mammogram or targeted ultrasound.2. A cluster of calcifications within the left axillary tail measures up to 8 mm on mammogram. This area was biopsied, marked by a heart shaped clip that has been medially displaced about 3 cm. Pathology corresponds to focal ALH at this area. This is concordant. Specimen radiograph shows cores with calcifications. 3. A tight cluster of calcifications measuring 4 mm is seen at the 6:00 position. This area was subsequently biopsied marked by an x= shaped clip and was consistent with fibroadenoma with fibrocystic change. This is concordant. Specimen radiograph shows cores with calcifications. 4. Within the posterior depth at 12:00 position a 14 mm mass with associated calcifications is identified best on MLO views (partially visualized on CC view). This area was unable to be biopsied secondary to depth and overlying vasculature. A correlate was not found on ultrasound.", "output": "On the right, six-month follow-up is recommended for the loosely scattered calcifications adjacent to the coil clip with benign results. On the left, ultrasound is recommended to further characterize the mass within the posterior depth of the breast.Surgical consultation is recommended for the left axillary tail calcifications that showed focus of ALH. Heart shaped clip is medially displaced by 3 cm. No definite residual calcifications are seen. No abnormality noted corresponding to the palpable area of concern in the left breast. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female with right sided abdominal pain. LIVER: Liver is normal in echotexture and upper normal in size. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: The biliary tract is normal in caliber. The gallbladder is well-visualized and appears unremarkable.PANCREAS: There is mild dilatation of the pancreatic duct without obstructing mass or calculus identified.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Echogenic with significant parenchymal thinning and cysts as previously identified. No hydronephrosisOTHER: Left kidney is echogenic with parenchymal thinning and cysts as previously identified.. No hydronephrosis.", "output": "1. Normal gallbladder.2. Mild dilatation pancreatic duct of uncertain significance.3. Echogenic kidneys with parenchymal thinning and cysts."}
{"instruction": "Generate impression based on findings.", "input": "59 year old male patient status post OLT. Evaluate vessel patency. LIMITED ABDOMENLIVER: The liver measures 15.4 cm in length.", "output": "Patent hepatic vessels though the right and left hepatic arteries are not visualized on this examination."}
{"instruction": "Generate impression based on findings.", "input": "Alpha 1 antitrypsin cirrhosis, evaluate for HCC LIVER: Cirrhotic morphology without focal hepatic lesions.GALLBLADDER, BILIARY TRACT: The gallbladder appears normal without evidence of gallstones or wall thickening. No biliary ductal dilation. The portal vein is patent.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Measures 12.1 cm. No hydronephrosis or mass.OTHER: The left kidney measures 13.6 cm. No hydronephrosis or mass. Splenomegaly measuring 23.4 cm. No ascites.", "output": "1.Cirrhosis without focal hepatic lesions. 2.Splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old female. Right upper quadrant pain. Evaluate for cholecystitis. LIVER: Normal echogenicity and echotexture of the liver. The liver is 14 cm in length. No focal hepatic lesion. Hepatopetal portal venous flow.GALLBLADDER, BILIARY TRACT: No cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. Common duct is 4 mm in caliber, within normal limits.PANCREAS: Pancreas is obscured by bowel gas.KIDNEYS: Right kidney is 9.6 cm in length. Left kidney is 10.4 cm in length. No hydronephrosis.OTHER: Spleen is 8 cm in length.", "output": "No evidence of acute cholecystitis or cholelithiasis."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old female with history of stable complex renal and simple cysts bilaterally. Surveillance exam. RIGHT KIDNEY: The right kidney measures 10.2 cm in length. No hydronephrosis. The known minimally complex septated cyst measuring 2.6 x 2.3 x 2.8 cm (prior 2.3 x 1.9 x 2 cm in 2015 and 2.6 x 1.8 x 1.9 cm in 2014) is grossly stable in size accounting for changes in technique. No hydronephrosis.LEFT KIDNEY: The left kidney measures 12.1 cm in length. No hydronephrosis. Large simple cyst of the left lower renal pole measuring 7.6 x 9.4 x 3.6 cm (prior 8.6 x 7.5 x 2.9 cm in 2015 and 6.8 x 6.7 x 2.5 cm in 2014).URINARY BLADDER: Normal distention of the urinary bladder without acute abnormality.OTHER: No significant abnormalities noted.", "output": "1. Grossly stable minimally complex right renal cyst given changes in technique. 2. Slightly increased size of a simple left lower pole renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "Recurrent UTI. Evaluate for obstruction PREVOID BLADDER: The prevoid bladder measures 203 mL in volume. No significant abnormalities noted.POST VOID BLADDER: The post void bladder is contracted and measures 12 mL in volume. OTHER: No significant abnormalities noted.", "output": "No significant post void residual noted in the bladder."}
{"instruction": "Generate impression based on findings.", "input": "Reason: RUQ pain concern for cholecystitis vs liver pathology. LIVER: The liver measures 16.4 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 hepatopetal flow with a velocity of 0.47 m/s.BILIARY TRACT: No definite gallstones. No 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 10.3 cm in length. RIGHT KIDNEY: Kidney measures 10.5 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.1 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.No sonographic evidence of acute cholecystitis or biliary ductal dilatation.2.Mildly echogenic liver raising the possibility of parenchymal dysfunction/fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "Septic shock with history of tubular interstitial nephritis RIGHT KIDNEY: Mildly echogenic renal parenchyma without discrete mass, stone, or hydronephrosis. Right kidney 11.7 cm in lengthLEFT KIDNEY: Mildly echogenic renal parenchyma without discrete mass, stone, or hydronephrosis. Left kidney 10.2 cm in length.OTHER: Bladder nondistended. Mild ascites.", "output": "Mildly echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or obstruction. Mild ascites."}
{"instruction": "Generate impression based on findings.", "input": "38 year old female with history of multinodular goiter. RIGHT LOBE MEASUREMENTS: 5.6 x 1.9 x 1.5 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.4 x 1.8 cmISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: Heterogeneous thyroid with multiple nodules. Well defined heterogeneous hypoechoic nodule, measuring 0.9 x 0.8 x 0.9 cm compared to 1.2 x 9 x 9 cm previously. Predominantly hypoechoic well-defined 1.4 x 0.7 x 0.8 cm mid thyroid nodule compared to 1.2 x 0.5 x 0.8 cm previously. No suspicious calcifications.LEFT LOBE: Heterogeneous thyroid with multiple nodules. The largest measure nodule is well defined and hypoechoic measuring 7 x 7 x 7 mm compared to 9 x 7 x 4 mm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Heterogeneous thyroid with multiple nodules bilaterally. The reference nodules are stable in size. No specific suspicious sonographic features are evident."}
{"instruction": "Generate impression based on findings.", "input": "Epiglottic cancer and a colovesicular fistula with abnormal FDG activity right kidney and spleen LIVER: No significant abnormalities noted. 16.4 cm in lengthGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Specifically, no evidence for worrisome renal mass, stone, or hydronephrosis. 11.4 cm in lengthOTHER: Left kidney 11.2 cm in length. Spleen 11.4 cm in length. No ascites.", "output": "Unremarkable right upper quadrant ultrasound. Specifically, no evidence for worrisome right renal mass or splenic abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Female 48 years old Reason: Change in nodules History: nodular goiter RIGHT LOBE MEASUREMENTS: 5.1 x 1.7 x 1.4 cmLEFT LOBE MEASUREMENTS: 5.6 x 2.0 x 2.0 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Normal background echogenicity of the thyroid. Again seen are multiple nodules bilaterally. Right thyroid nodule in the inferior pole with a cystic component measures 0.4 x 0.4 x 0.4 cm, decreased in size compared to prior exam. A mid thyroid nodule measures 0.8 x 0.3 x 0.7 cm, unchanged from the prior exam. Another nodule in the superior lateral right thyroid lobe has heterogeneous mixed echogenicity measures 1.3 x 0.5 x 0.6 cm, not significantly changed.LEFT LOBE: The superior left thyroid lobe there is a predominantly cystic nodule with internal septations, measuring 1.8 x 0.8 x 0.3 cm, not significantly changed. An adjacent spongiform, heterogeneous nodule measures 0.6 x 0.6 x 0.7 cm, not significantly changed.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No abnormal lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Multiple thyroid nodules bilaterally are not significantly changed and likely benign. No local lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "46 year-old male with history of clinical trial participant, evaluate for hepatocellular carcinoma. LIVER: Mildly increased liver parenchyma echogenicity. Smooth liver contour. No biliary dilatation, no focal mass. The liver measures 16 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. The right kidney measures 11.4 cm.OTHER: No significant abnormalities noted. The left kidney measures 11.1 cm.", "output": "Mildly increased liver parenchyma echogenicity, may be seen in setting of hepatic steatosis/parenchymal dysfunction, without suspicious mass or biliary dilatation."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old female status post adrenalectomy. Please assess renal and IVC vasculature. ULTRASOUND KIDNEYSRIGHT KIDNEY: Right kidney appears echogenic without evidence of hydronephrosis or renal stone. It measures 13.0 cm.LEFT KIDNEY: The left kidney appears echogenic without evidence of hydronephrosis or renal stone. Left kidney measures 10.5 cm.OTHER: No significant abnormalities noted.", "output": "Bilateral echogenic kidneys consistent with medical renal disease. No evidence to suggest thrombosis of the renal vasculature or IVC."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old male patient with abnormal LFTs, history of complete situs inversus. Evaluate for liver abnormalities, organ placement. LIVER: The liver measures 14.7 cm in length and is left-sided in location. 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. The gallbladder is within the left upper quadrant. 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 9.2 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.7 cm in length. No evidence of hydronephrosis.The spleen measures 12.6 cm in length and is on the right side of the abdomen.The aorta is to the right of the spine. The IVC is to the left of the spine. Catheter tubing is noted within the IVC.", "output": "1. Findings compatible with abdominal situs inversus.2. No acute sonographic abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Acute liver failure LIMITED ABDOMENLIVER: Coarse echogenic liver echotexture without mass. Liver length 23.3 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 11 cm in length RIGHT KIDNEY: No significant abnormalities noted. 14.2 cm in lengthOTHER: 3.5 by 5 x 3.8 cm solid hypoechoic mass arising from the midpole of the left kidney. Left kidney 11.9 cm in length. Trace ascites. Right pleural effusion.", "output": "Hepatomegaly with coarse echogenic parenchyma consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Patent hepatic vessels with normal directional flow. Trace ascites.Worrisome mass lesion arising from midportion of left kidney. A neoplastic lesion cannot be excluded. This lesion is also appreciable on the noncontrast outside CT. Would recommend correlation with dedicated renal CT."}
{"instruction": "Generate impression based on findings.", "input": "Preop for LVAD LIVER:Liver measures 15.5 cm with diffuse coarse echotexture. No focal lesions noted within the liver. No intrahepatic biliary ductal dilatation.GALLBLADDER, BILIARY TRACT: Gallbladder is well distended with multiple gallstones within it. Gallbladder wall appears slightly thickened, reaching upper limit of normal up to 3 mm. Minimal fluid noted in the pericholecystic space. Common hepatic duct measures up to 3 mm.Negative sonographic Murphy signPANCREAS: Head and body of pancreas visualized appears unremarkable. Tail of pancreas not visualized due to overlying bowel gas.SPLEEN: Spleen measures 10.3 cm, normal echotexture.KIDNEYS: Right kidney measures 9 cm and left kidney measures 9.4 cm. Simple cyst identified in both kidneys, largest cyst in the right kidney measures 2.7 x 2.4 x 1.7 cm. No hydronephrosis. ABDOMINAL AORTA: Proximal aorta measures 1.7 x 2.2 x 1.3 cm. No evidence of aneurysmal dilatation or atherosclerotic changes. Mid aorta measures 1.6 x 2 x 1.6 cm and distal aorta measures 1.4 x 1.6 x 1.5 cm. The proximal right and left iliac arteries also demonstrate normal caliber.INFERIOR VENA CAVA: PatentOTHER: Mild right pleural effusion.", "output": "Distended gallbladder with gallstones and mild gallbladder wall thickening reaching upper limit of normal and minimal pericholecystic fluid. Findings are equivocal for acute cholecystitis however if clinically suspicious, HIDA scan can be performed for further evaluation.Mild right pleural effusion.Bilateral simple renal cysts.Findings conveyed to pager 1467, Dr. Lauren feld at the time of dictation 1:18 p.m, 4/28/16."}
{"instruction": "Generate impression based on findings.", "input": "87-year-old female with right upper quadrant pain. LIVER: Liver is normal in size but heterogeneous in echotexture consistent with irregular fatty infiltration of the liver area no focal hepatic abnormality.Portal vein is patent with appropriate flow direction.GALLBLADDER, BILIARY TRACT: Fundus is not well visualized due to bowel gas but no gross wall thickening, pericholecystic fluid or gallstones. Visualized portions of the biliary tract are normal for age.PANCREAS: Pancreatic duct is prominent but no obstructing mass or calculus identified.RIGHT KIDNEY: 1 cm right renal cyst. No hydronephrosis.OTHER: No hydronephrosis involving the left kidney. Splenic size normal.", "output": "No evidence for cholecystitis.Mild prominence of the pancreatic duct, likely within normal limits given negative lipase."}
{"instruction": "Generate impression based on findings.", "input": "Renal stones RIGHT KIDNEY: Normal parenchymal echogenicity without worrisome mass or hydronephrosis. Benign renal cyst. Right kidney 11 cm in length.Multiple subcentimeter echogenic foci within the lower pole of the right kidney with posterior shadowing consistent with nonobstructing subcentimeter renal stonesLEFT KIDNEY: AbsentOTHER: Bladder nondistended. Enlarged prostate", "output": "Multiple subcentimeter nonobstructing lower pole right renal stones. No worrisome mass or obstruction. Left kidney absent. Enlarged prostate."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male with history of BPH. Evaluate for obstruction. RIGHT KIDNEY: The right kidney measures 10.6 cm in length and shows diffusely increased echogenicity. No mass, stone or hydronephrosis. A right upper pole minimally complex cyst measures 1.7 x 1.6 x 1.4 cm. Normal color flow Doppler.LEFT KIDNEY: The left kidney measures 10.5 cm in length and shows diffusely increased echogenicity. No mass, stone or hydronephrosis. Normal color flow Doppler.BLADDER: Incompletely distended. OTHER: No significant abnormalities.", "output": "Increased echogenicity of both kidneys which can be seen in medical renal disease/parenchymal dysfunction without hydronephrosis. "}
{"instruction": "Generate impression based on findings.", "input": "36 year-old female with renal cysts. RIGHT KIDNEY: The right kidney measures 11.7 cm in length. Echotexture within normal limits. There is a 2.8 x 3.5 x 2.9 cm cyst in the midpole the right kidney with a smaller, adjacent smaller cyst or a septated component. This is unchanged or minimally increased compared are seen. No hydronephrosis, shadowing calculus or solid mass.LEFT KIDNEY: Left kidney measures 11.2 cm in length and appears unremarkable. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "Right renal cysts as previously noted either unchanged or minimally larger not requiring follow up."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old male with gallbladder mass identified on outside preemployment ultrasound. LIVER: Evaluation of the liver is very limited by high position. There is some heterogeneity involving the left lobe of the liver although a defined mass cannot be seen with certainty.BILIARY TRACT: Within the gallbladder fossa there is a round area of mixed echogenicity measuring 5.1 x 5.3 x 6.3 cm which does not obviously change in appearance with change in patient position, although no normal gallbladder lumen with fluid is identified. The adjacent liver appears mildly hypoechoic as well. Although a gallbladder with significant sludge could potential he have this appearance, given that the patient is asymptomatic, findings are highly worrisome for a gallbladder carcinoma.There is, however, no intrahepatic ductal dilatation. Common duct is mildly enlarged for age.PANCREAS: Incompletely visualized due to bowel gas. Pancreatic body is normal.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: Limited views of left kidney demonstrate no abnormality.Evaluation of the retroperitoneum demonstrates evidence for para-aortic retroperitoneal adenopathy. The largest node visualized by ultrasound measures 2.7 cm in greatest diameter.", "output": "Findings of large mass in the gallbladder fossa with adjacent liver altered echogenicity which may be due to invasion by gallbladder carcinoma. There is also heterogeneity of the lateral left lobe of the liver and small mass cannot be excluded.Given the constellation of findings above, would recommend CT for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Dermatomyositis. Evaluate hepatic architecture. LIVER: Coarsened hepatic echogenicity with minimally nodular contours. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Status post cholecystectomy.PANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney is 10.1 cm in length. The left kidney is 10.1 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 11.3 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites identified.", "output": "Coarsened hepatic echogenicity with minimally nodular contours compatible with chronic liver disease."}
{"instruction": "Generate impression based on findings.", "input": "67 years old, Female, Reason: evaluate for L and/or R femoral abscess History: previous central line access; fungemia No evidence of fluid collection or abscess at sites of clinical concern.", "output": "No evidence of soft tissue edema or abscess as clinically questioned."}
{"instruction": "Generate impression based on findings.", "input": "Male; 50 years old. Reason: hep C eval for lesions History: hep c LIVER: The liver measures 18.0 cm in length. The liver contour is smooth, the parenchyma is diffusely increased in echogenicity and coarsened in echotexture is which limits the identification of focal lesions. Within this limitation, no suspicious lesion is identified. Within the right lobe near the capsule is a 4 x 4 x 5 mm hypoechoic lesion with posterior acoustic enhancement and a single thin septation.The portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.3 m/sec.BILIARY TRACT: Multiple shadowing gallstones are seen within the gallbladder. There is no gallbladder wall thickening or pericholecystic fluid. The common duct measures 3 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: Head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 10.0 cm in length.KIDNEYS: The right kidney measures 11.1 cm in length, the left kidney measures 11.4 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": "1.Hepatomegaly and echogenic, coarse liver compatible with hepatic steatosis/parenchymal dysfunction.2.5-mm hypoechoic right liver lesion is too small to accurately characterize but likely represents a minimally complex cyst.3.Cholelithiasis. No evidence obstruction or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Status post kidney transplant with likely urosepsis, mild AKI. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No significant abnormality noted.KIDNEY: The transplant kidney measures 12.1 cm in length.COLLECTING SYSTEM/URETER: No evidence of hydronephrosis.URINARY BLADDER: The bladder is distended with fluid.OTHER: No significant abnormality noted", "output": "No evidence of hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Male, 57 years old. Kidney stone. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 11.1 cm in length, with mildly increased increased cortical echogenicity. A punctate echogenic focus in the mid upper pole parenchyma is nonspecific. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 12.7 cm in length, with mildly increased cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The bladder is nondistended.", "output": "A punctate echogenic focus in the right renal parenchyma is nonspecific. No shadowing stones or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male undergoing evaluation prior to LVAD. LIVER: The liver measures 21 cm. There is coarse and heterogeneous echotexture of the liver parenchyma. No focal mass or ascites appreciated.BILIARY TRACT: The common bile duct measures 0.5 cm. No stones or pericholecystic fluid.PANCREAS: Evaluation limited by bowel gas.SPLEEN: The spleen measures 13.4 cm. No significant abnormalities noted. RIGHT KIDNEY: No significant abnormalities noted.LEFT KIDNEY: No significant abnormalities noted.ABDOMINAL DOPPLER: Color and spectral Doppler were performed on inflow and outflow vessels. All vessels are patent and there is normal hepatopedal flow.OTHER: No significant abnormalities noted.", "output": "Hepatomegaly with coarse echotexture consistent with chronic liver disease/parenchymal dysfunction. No masses or ascites."}
{"instruction": "Generate impression based on findings.", "input": "Chronic hepatitis with acute renal insufficiency RIGHT KIDNEY: Echogenic kidney without mass, stone, or hydronephrosis. 6.2 cm in lengthLEFT KIDNEY: Echogenic kidney without mass, stone, or hydronephrosis. 9.2 cm in lengthOTHER: Bladder collapsed. Trace ascites", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with history of thyroid cancer. Evaluate for recurrent disease. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massLEFT LOBE: No massISTHMUS: No massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Morphologically normal lymph nodes at levels two and three on the right and level five on the left. Left submandibular region was scanned due to patient stating palpable abnormality. In this location there is a morphologically normal 1.7 x 1.5 x 1.6 cm lymph nodeOTHER: No significant abnormality noted.", "output": "No evidence for recurrent disease. Results discussed with the patient at his request."}
{"instruction": "Generate impression based on findings.", "input": "50 year old female, baseline exam as part of heart transplant evaluation. LIVER: Coarse echotexture of the liver measuring 16.1 cm in length with no focal hepatic lesions.GALLBLADDER, BILIARY TRACT: Cholelithiasis and sludge within the gallbladder. No pericholecystic fluid. Gallbladder wall measures 2 mm in thickness, within normal limits. Sonographic Murphy's sign is negative. No intra or extra hepatic biliary ductal dilatation. Common duct measures 2 mm in caliber, within normal limits.PANCREAS: The tail of the pancreas is obscured by overlying bowel gas. The remaining visualized portions are normal in echogenicity. No pancreatic ductal dilatation.SPLEEN: Normal echogenicity of the spleen measuring 10.0 cm in length.KIDNEYS: The right kidney measures 10.8 cm in length and is normal in echogenicity. No hydronephrosis or nephrolithiasis. The left kidney measures 9.9 cm in length and is lobular in contour with normal echogenicity. No hydronephrosis or nephrolithiasis.ABDOMINAL AORTA: The proximal aorta measures 1.6 cm x 1.8 cm x 1.7 cm, the mid aorta measures 1.4 cm x 1.5 cm x 1.5 cm, and the distal aorta measures 1.3 cm x 1.6 cm x 1.4 cm.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Coarse echotexture of the liver with no focal hepatic lesions. 2. Cholelithiasis with no evidence of cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "Weight loss and upper abdominal pain LIVER: No significant abnormalities noted. Bilobar hepatic cysts again noted. 0.7 x 0.6 cm subcentimeter echogenic focus within the peripheral aspect of the right lobe of the liver; a benign etiology such as hemangioma is favored. Liver length 18.8 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.1 cm in length OTHER: Left kidney 11.9 cm in length. Left renal cysts again noted, unchanged. No ascites", "output": "Mild hepatomegaly without mass or ductal dilatation. Cholelithiasis without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female, 70 years old. Hx of hydronephrosis, evaluate for stricture. RIGHT KIDNEY: The right kidney measures 11.4 cm in length, with normal echotexture. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.5 cm in length, with normal echotexture. No shadowing stones or hydronephrosis.OTHER: The urinary bladder is not seen, likely decompressed.", "output": "No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter RIGHT LOBE MEASUREMENTS: 2.7 x 2.3 x 6.8 cmLEFT LOBE MEASUREMENTS: 1.7 x 2.5 x 4.5 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Diffusely heterogeneous gland again noted. Stable multiple thyroid nodules. Reference upper pole hypoechoic nodule again measures 1.1 x 1 cm. Previously noted lower pole nodule appears on today's exam to represent overall heterogeneity of the gland and not a discrete nodule.LEFT LOBE: Diffusely heterogeneous gland again noted. Stable multiple thyroid nodules. Reference upper pole mixed cystic and solid nodule measures 1.6 x 1.2 x 1 cm.ISTHMUS: Diffusely heterogeneous gland again notedPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable bilateral thyroid nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "46 year old female with history of left breast benign core biopsy (fibroadenoma) with increasing size of right-sided breast mass and focal asymmetry in the left upper outer breast. Patient is currently asymptomatic. No personal or family history of breast cancer. DIAGNOSTIC MAMMOGRAM", "output": "Circumscribed mass in the right breast 10 o'clock position is compatible with a benign cyst. Normal breast parenchyma in the left upper outer breast. No 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": "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": "Status post left ureteral reimplant RIGHT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 11.2 cm in lengthLEFT KIDNEY: Normal echogenicity without worrisome mass, stone, or hydronephrosis. Benign-appearing cyst. Left kidney 10.7 cm in length.OTHER: Bladder nondistended", "output": "Negative renal ultrasound without evidence for worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Crawl is a 20-year-old female presenting with a palpable lump in the right breast for the past two years. Per patient, this mass has increased in size of the past one month. She denies any history of trauma, fever/chills, or skin thickening. Upon physical exam at the patient's area of concern, a soft, mobile mass is appreciated in the right upper outer breast.A targeted right breast ultrasound was performed for the patient\u2019s area of concern. In the right breast 10 o'clock location (approximately 2 cm from the nipple), there is a lobulated, hypoechoic solid mass measuring 3.0 x 1.3 x 2.3 cm. There is a moderate amount of vascularity associated with this lesion. Findings are highly suggestive of a fibroadenoma.", "output": "Sonographic findings highly suggestive of a fibroadenoma. However, due to the recent growth of this mass per patient, a surgical consultation is recommended. Patient is scheduled to see Dr. Chhablani after the radiology appointment.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "History of cirrhosis. On clinical trial. Evaluate for HCC. LIVER: The liver is markedly coarse in echotexture. It is shrunken and nodular. It measures 13.9 cm in length. Redemonstrated 1.5 cm right hepatic lobe simple cyst. No suspicious lesion. No intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 0.3 m/s.BILIARY TRACT: Status post cholecystectomy. No extrahepatic biliary ductal dilatation with the common duct measuring 3 mm.PANCREAS: Poorly visualized pancreatic head is unremarkable.SPLEEN: Mild splenomegaly measuring 15.4 cm in length.RIGHT KIDNEY: The right kidney measures 10.1 cm in length without hydronephrosis. OTHER: The left kidney measures 9.7 cm in length without hydronephrosis.", "output": "1. Cirrhotic liver morphology without suspicious lesion.2. Mild splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Bilateral findings from screening presents for further evaluation. ML views 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, unchanged in pattern and distribution. Asymmetry in the right outer breast disperses with spot compression. Mass in the left upper inner breast persists partially with spot compression but has an appearance more of focal breast tissue rather than a true mass. ULTRASOUND", "output": "Highly likely benign findings on today's mammogram and ultrasound. It would be best if stability could be proven for this finding by comparison to prior mammograms. The patient has signed paperwork so that her studies from Mercy Hospital can be submitted. If for some reason these cannot be submitted, then a short-term 6 month follow-up mammogram should be performed. If the old studies are submitted and the finding is stable, then a return to routine screening would be reasonable.BIRADS: 3 - Probably benign finding.RECOMMENDATION: O - Old Study For Comparison."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female with history of renal cysts. RIGHT KIDNEY: The right kidney is normal in size, measuring 11.1 cm without hydronephrosis, shadowing nephrolithiasis or suspicious lesion. There is a 2-cm interpolar simple appearing cyst.LEFT KIDNEY: The left kidney is normal in size, measuring 11.5 cm without hydronephrosis, shadowing nephrolithiasis, or suspicious lesion. There is a 5.9-cm interpolar simple appearing cyst.OTHER: No significant abnormalities noted.", "output": "Bilateral simple cysts."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female with acute kidney injury, hyponatremia RIGHT KIDNEY: Measures 9.8 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 9.6 cm in length. 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. "}
{"instruction": "Generate impression based on findings.", "input": "Elevated liver enzymes, history of gallbladder carcinoma. Exam mildly limited by inability to optimally position patient.LIVER: The liver measures 15.9 cm in length. The known previously described liver lesion adjacent to the gallbladder fossa measures 4.9 x 3.6 x 4.6 cm, increased in size from approximately 2.4 x 2.3 cm on recent CT. Previously described portacaval reference mass now measures approximately 3.1 x 3.3 x 3.3 cm, measured approximately 2.7 x 4.7 cm on recent CT. The portal vein is attenuated at the porta hepatis and is patent within the liver with a velocity of 0.25 m/s.BILIARY TRACT: A large stone is present within the gallbladder. The gallbladder wall is not thickened. The sonographic Murphy's sign is negative. There is mild intrahepatic biliary ductal dilatation. The common bile duct measures 3 mm in diameter.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.The spleen measures 10.3 cm in length. RIGHT KIDNEY: Kidney measures 10.8 cm in length. The parenchymal echogenicity is increased. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 9.5 cm in length. The parenchymal echogenicity is increased. No hydronephrosis, shadowing calculus or mass.OTHER: Bilateral pleural effusions and ascites.", "output": "1.Interval increase in size of hepatic mass adjacent to gallbladder. Mild intrahepatic biliary ductal dilatation, similar to prior. 2.Persistent ascites and pleural effusions.3.Echogenic kidneys suggesting medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female patient with right upper quadrant abdominal pain. LIVER: The liver measures 15.8 cm in length and demonstrates a mildly coarsened echotexture. 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. 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 11.1 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.3 cm in length. No evidence of hydronephrosis.The spleen measures 8.8 cm in length.", "output": "1. Mildly coarsened hepatic echotexture which can be seen with hepatic parenchymal dysfunction.2. Otherwise, no acute sonographic abnormality in the abdomen."}
{"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. A couple of subcentimeter benign morphology cyst identified in the right upper inner quadrant. There is no suspicious solid or cystic mass identified.This exam was double read by Dr. Abe.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with hepatocellular carcinoma status post ablation. LIVER: The liver measures 13.7 cm in length. The parenchyma is coarse and echogenic, compatible with known cirrhosis. The ablation zone in the right hepatic lobe is similar in appearance and measures 2.9 x 1.9 cm, previously 2.6 x 1.6 cm. No new lesions are seen. The portal vein is patent with normal directional flow and velocity. GALLBLADDER, BILIARY TRACT: Cholelithiasis without sonographic evidence of cholecystitis. No biliary ductal dilation.PANCREAS: No significant abnormalities noted in the visualized pancreatic head. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 8.6 cm. The cortex is echogenic. No shadowing calculus or hydronephrosis is identified.The left kidney measures 10.1 cm. The cortex is echogenic. No shadowing calculus or hydronephrosis is identified.OTHER: The spleen measures 9.6 cm. No ascites is seen.", "output": "1. Stable sonographic appearance of the posttreatment changes in the right hepatic lobe.2. Cholelithiasis.3. Echogenic renal cortices, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Male 63 years old Reason: evaluation of bladder wall thickening in pt with hx of urothelial carcinoma History: hematuria, bladder wall thickening on CT Foley catheter is in place. Bladder was initially collapsed. It was then irrigated. After irrigation, an echogenic lesion is seen in the inferior aspect of the bladder estimated in size at 6.6 x 4.6 cm.", "output": "Mass in the urinary bladder."}
{"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": "Right upper quadrant abdominal pain. Status post remote cholecystectomy. LIVER: Non-cirrhotic liver morphology. Increased parenchymal echogenicity, compatible with steatosis. 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 9.5 cm in length. The left kidney is 10.2 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9.9 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid identified.", "output": "Increased hepatic echogenicity, compatible with steatosis. Otherwise no specific findings to account for the patient's acute symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Male 45 years old; Reason: Evaluate for parathyroid adenoma History: Secondary hyperparathyroidism RIGHT LOBE MEASUREMENTS: 5.4 x 2.2 x 2.0 cm.LEFT LOBE MEASUREMENTS: 5.0 x 1.9 x 2.1 cm.ISTHMUS MEASUREMENT: 0.6 cm.RIGHT LOBE: There is a nodule in the inferior right lobe measuring approximately 2.2 x 1.1 x 1.8 cm. It is solid with some cystic spaces and it has poorly defined borders and mixed echogenicity. Otherwise the parenchyma of the right lobe is homogenous.LEFT LOBE: There is a nodule in the inferior left lobe measuring approximately 1.4 x 1.0 x 1.4 cm. It is predominately solid with some spongiform components, well-defined, with mixed echogenicity. Otherwise parenchyma and left lobe is homogenous.ISTHMUS: Homogenous parenchyma.LYMPH NODES: No suspicious adenopathy noted. OTHER: Round hypoechoic nodule measuring approximately 1.0 x 0.5 x 0.6 cm with well-defined borders located posterior and inferior to the right thyroid is a candidate for a parathyroid adenoma.", "output": "1.Multinodular thyroid as described above. Amenable to biopsy.2.Round hypoechoic nodule as described above is candidate for right inferior parathyroid adenoma."}
{"instruction": "Generate impression based on findings.", "input": "Liver transplant LIMITED ABDOMENLIVER: Stable coarse liver echotexture without mass. Liver length 21 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 12.7 cm in length RIGHT KIDNEY: No significant abnormalities noted. 7.7 cm in lengthOTHER: Left kidney 9.6 cm in length. No ascites.", "output": "Patent hepatic vessels with normal directional flow. No hepatic mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "53 years old, Female, Reason: 53 yr old female with Stage IIIC Ovarian Cancer; known gastohepatic, mesenteric, periaortic, and retroperitoneal lymph nodes. Assess for cancer related symptoms vs. other GI etiology History: Upper abdominal fullness, acid reflux, LUQ pain, along with elevated LFT's and rising CA125. LIVER: The liver measures 19.1 cm in length. The liver parenchyma is mildly echogenic suggesting fatty infiltration. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of .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 5 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: History of splenectomy.RIGHT KIDNEY: Kidney measures 12.7 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 11.8 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Hepatic steatosis.2.No specific findings to account for the patient's left upper quadrant pain."}
{"instruction": "Generate impression based on findings.", "input": "Female 34 years old; Reason: Patient with thyroid nodules, f/u prior to surgery. RIGHT LOBE MEASUREMENTS: 5.6 x 1.7 x 1.2 cmLEFT LOBE MEASUREMENTS: 6.1 x 3.3 x 3.4 cmISTHMUS MEASUREMENT: 0.25 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Again noted is complex, partly cystic and partly solid well-defined nodule in the inferior left lobe measuring 4.4 x 3.3 x 3.4 cm as compared to 3.7 x 2.2 x 2.6 cm on the prior exam, increased in size. No microcalcifications identified.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Interval increase in size of complex nodule in the inferior left lobe of the thyroid as described above."}
{"instruction": "Generate impression based on findings.", "input": "Female; 41 years old. Reason: S/p stem cell transplant, now w/ sharp rise in LFTs and abdominal pain, concern for cholecystitis, gall stones, pancreatitis History: Abdominal pain LIVER: The liver measures 17.5 cm in length. No focal hepatic lesion is identified. The main portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.4 m/sec.BILIARY TRACT: The gallbladder is mildly distended. No gallstones are identified. There is no gall bladder wall thickening or pericholecystic fluid. The common duct is prominent measuring 7 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head of the pancreas is unremarkable. The body and tail are obscured by overlying bowel gas.SPLEEN: The spleen measures 14.5 cm in length.KIDNEY: The right kidney measures 12.0 cm in length, the left kidney measures 13.9 cm. The renal parenchyma is normal in echogenicity bilaterally. There is no hydronephrosis or shadowing renal stone. OTHER: No significant abnormalities noted.", "output": "1. Borderline hepatomegly. 2. Splenomegaly..3.Mildly distended gallbladder and prominent common bile duct but no gallstones, evidence of acute cholecystitis, or intrahepatic biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "45 year old male patient with cirrhosis. Screening HCC. LIVER: The liver measures 16.8 cm in length and demonstrates coarsened hepatic echotexture. The liver contour is nodular. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.4 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 12.3 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 12.6 cm in length. No evidence of hydronephrosis.The spleen measures 13.3 cm in length.", "output": "Findings consistent with chronic liver disease without focal hepatic lesion."}
{"instruction": "Generate impression based on findings.", "input": "Female 65 years old; Reason: primary hyperparathyroidism, evaluate parathyroid glands History: primary hyperparathyroidism RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.8 x 1.2 x 1.3 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.8 x 2.5 x 2.0 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.1 cm.RIGHT LOBE: The right lobe is heterogeneous. There is a nodule in the right mid thyroid that is isoechoic to slightly hyperechoic measuring 0.9 cm x 0.9 cm x 1.7 cm. There is internal vascular flow. No internal microcalcifications are seen.LEFT LOBE: The left lobe is heterogeneous. At the mid/lower pole there is a hyperechoic spongiform solid/cystic nodule measuring 2.2 cm x 1.9 cm x 2.9 cm. This has internal vascularity. No internal microcalcifications are seen.ISTHMUS: A hypoechoic nodule is seen within the isthmus measuring 0.6 cm x 0.5 cm x 1.0 cm. There is internal vascular flow. No internal microcalcifications are seen.LYMPH NODES: No suspicious adenopathy noted. OTHER: Inferior and posterior to the right lobe, there is a hypoechoic extrathyroidal round nodule measuring 0.9 cm x 0.5 cm x 0.3 cm which may represent a parathyroid gland.", "output": "1. Inferior/posterior to the right thyroid lobe, there appears to be an extrathyroidal nodule which may represent a parathyroid gland. Correlation can be made with a nuclear medicine study.2. There is a dominant nodule in the mid right thyroid measuring 0.9 cm x 0.9 cm x 1.7 cm. This has internal vascular flow and is amenable to biopsy.3. At the mid/lower pole of the left thyroid gland there is a spongiform nodule measuring 2.2 cm x 1.9 cm x 2.9 cm this is also amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "74 year old female with asymmetric swelling and tenderness of the right lower portion of the neck. Evaluate for thyroid enlargement. RIGHT LOBE MEASUREMENTS: 3.0 x 1.2 x 1.3 cmLEFT LOBE MEASUREMENTS: 3.6 x 1.5 x 1.2 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: The right thyroid lobe is normal in morphology, echogenicity, and size without a discrete nodule.LEFT LOBE: The left thyroid lobe is normal in morphology, echogenicity, and size without a discrete nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Normal thyroid examination."}
{"instruction": "Generate impression based on findings.", "input": "Assess for ascites, portal vein thrombosis, patient with abdominal pain LIVER: Liver is enlarged in size measures 22.6 cm with a large heterogenous mixed echogenic irregular mass arising from the left lobe of liver, it appears very indistinct and difficult to measure but within these limitations the mass approximately measures 8.3 x 5.2 x 8 cm.Background liver parenchyma appears heterogenous, coarse with mild ascites around it.Portal vein demonstrates very slow flow without typical waveform, underlying portal vein thrombosis cannot be ruled out.Common duct is not dilated.BILIARY TRACT: No intrahepatic or extra hepatic biliary ductal dilatation.Gallbladder is distended with sludge and a few stones within it. Gallbladder wall is not thickened.PANCREAS: Not significantly visualized due to overlying bowel gas.SPLEEN: Mild splenomegaly noted, spleen measures 13.5 cm.RIGHT KIDNEY: Right kidney measures 11.8 cm and left kidney measures 11.9 cm. No evidence of hydronephrosis or focal lesions. OTHER: Ascites noted.", "output": "Heterogenous large 8.3 cm mass arising from the left lobe of liver with a background of coarse heterogenous liver.Slow flow within the portal vein without difficulty form, underlying portal vein thrombosis cannot be ruled out.Mild splenomegaly and ascites"}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter RIGHT LOBE MEASUREMENTS: 6.0 x 2.7 x 1.9 cm, not significantly changed.LEFT LOBE MEASUREMENTS: 5.8 x 1.9 x 1.8 cm, not significantly changed.ISTHMUS MEASUREMENTS: 5 mm in AP dimension, not significant changed.RIGHT LOBE: Unchanged size of the slightly hyperechoic predominantly solid nodule with cystic components nodule in the inferior pole measuring 2.7 x 1.7 x 2.3 cm, with slightly decreased cystic elements.LEFT LOBE: Unchanged size and appearance of the homogeneous slightly hyperechoic solid nodule in the inferior pole measuring 1.2 x 1.4 x 1.3 cm.ISTHMUS: Unchanged size and appearance of the solid nodule with hypoechoic rim measuring 0.5 x 0.5 x 0.4 cm.PARATHYROID GLANDS: Not identified.LYMPH NODES: Benign morphology cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "Unchanged size of three thyroid nodules, without development of new suspicious features."}
{"instruction": "Generate impression based on findings.", "input": "Reason: ? Obstruction History: Cr trending up RIGHT KIDNEY: The right kidney measures 10.2 cm in length. Small anechoic right renal cyst measures 0.8 x 1.0 x 1.3 cm. No hydronephrosis or stones.LEFT KIDNEY: The left kidney measures 9.0 cm in length. 0.5 by 0.6 x 0.5 cm nonobstructive renal calculus. No hydronephrosis.OTHER: The bladder is underdistended, limiting evaluation.", "output": "0.6 cm nonobstructive right renal calculus. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic colon cancer with liver metastases with worsening right upper quadrant pain LIVER: Multiple liver metastasis again noted and not largely changed from prior CT exam. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 18.4 cm.BILIARY TRACT: No ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9.7 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.3 cm in lengthOTHER: Left kidney 11.1 cm in length. No ascites.", "output": "No significant change in multiple hepatic metastatic lesions. No ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 72 years old; Reason: gall bladder evaluation History: elevated bilirubin LIVER: The liver measures 17.0 cm in length. There is coarse echogenicity of the liver parenchyma. No focal hepatic lesions. Mild intrahepatic ductal dilation is seen which has progressed since the prior CT though the common bile duct is normal in caliber. The main portal vein is patent with normal hepatopetal flow. GALLBLADDER/BILIARY TRACT: The gallbladder wall is distended and asymmetrically thickened measuring up to 5mm. No stones are seen but the gallbladder is partially filled with sludge. No pericholecystic fluid. The common bile duct measures 1.3 mm in diameter. Negative sonographic Murphy's sign.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 8.9 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 11.5 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.", "output": "1. Asymmetrical gall bladder wall thickening is nonspecific. If the clinical service has high suspicion of tumor invasion, this could be further investigated with MRCP. We cannot rule out acute cholecystitis though this would be atypical. 2. Mild intrahepatic biliary duct dilation which has progressed since recent CT"}
{"instruction": "Generate impression based on findings.", "input": "History of elevated AST/ALT. Question of cirrhosis. LIVER: The liver is mildly coarse and echogenic. There is subtle mild left lobe hypertrophy, however the capsule is smooth. The liver measures 21 cm in craniocaudal dimension. No focal lesion is identified. No intrahepatic biliary ductal dilatation.BILIARY TRACT: Normally distended gallbladder with sludge. No gallbladder wall thickening, gallstones, pericholecystic fluid or focal tenderness. No extrahepatic biliary ductal dilatation with the common duct measuring 3 mm.PANCREAS: The visualized portions of the pancreatic head and body are unremarkable. The remainder is obscured by overlying bowel gas shadowing.SPLEEN: The spleen is normal in size, measuring 11.4 cm length without a focal lesion.RIGHT KIDNEY: The right kidney measures 11.7 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 11.6 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.", "output": "Mildly coarse and echogenic liver may represent parenchymal dysfunction and/or fatty infiltration. Possible early changes of chronic liver disease without definite changes of cirrhosis or portal hypertension. No suspicious liver lesion."}
{"instruction": "Generate impression based on findings.", "input": "Congestive hepatic disease LIVER: Mildly heterogeneous liver echotexture without mass. Liver length 20.1 cmGALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.2 cm in length.OTHER: Left kidney 11.5 cm in length. Spleen 13 cm in length. No ascites.", "output": "Hepatomegaly with mildly heterogeneous liver echotexture. No hepatic mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "History lung cancer with inferior right renal lesion seen on recent chest CT RIGHT KIDNEY: Examination technically limited due to overlying gas and body habitus. The previously noted right renal lesion could not be visualized; however this is most probably due to technical limitations of ultrasound. No gross hydronephrosis.LEFT KIDNEY: Examination technically limited due to overlying gas and body habitus. No gross hydronephrosisOTHER: Bladder nondistended", "output": "Examination technically limited due to overlying gas and body habitus. The previously noted right renal lesion seen on recent CT could not be visualized; however this is most probably due to technical limitations of the exam. Would not recommend ultrasound to follow or characterize the suspected right renal lesion."}
{"instruction": "Generate impression based on findings.", "input": "27 years old, Male, Reason: assess for perinephric abscess History: MRSA UTI RIGHT KIDNEY: Kidney measures 12.0 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.3 cm in length. A focal space occupying lesion in the superior anterior portion of the left kidney which appears to extend beyond the expected contours of the kidney. There is blood flow to portions of this space occupying lesion indicating it is at least partially intrarenal with distention of the renal capsule and possible extrarenal extension. This hypoechoic focus measures approximately 4.4 x 2.5 by 7.0 cm and highly suspicious for a renal and perirenal infection given the clinical history. However a malignancy cannot be fully excluded on this ultrasound examination.Bladder: There is echogenic debris in the bladder which is partially mobile when patient's position is changed. There is no significant bladder wall thickening or evidence of emphysematous cystitis.", "output": "1.Hypoechoic space-occupying lesion in the left kidney which likely represents intrarenal infection with possible extrarenal extension. However a malignancy cannot be fully excluded on this ultrasound examination. Dedicated cross-sectional renal imaging is recommended to further characterize if clinically warranted.2.Echogenic debris within the bladder."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B LIVER: Normal parenchymal echogenicity without mass. 15.4 cm in lengthGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.2 cm in lengthOTHER: Left kidney 10.3 cm in length. Spleen 9.2 cm in length. No ascites.", "output": "Stable negative examination. No hepatic mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Male 65 years old; Reason: eval for liver disease, obstruction History: new uptrending LFTs, cholestatic pattern LIVER: The liver measures 16.8 cm in length. There is coarse increased echogenicity of the liver parenchyma. There is a anechoic cyst at the superior left portion of the liver measuring 1.9 cm x 2 cm x 2.4 cm. This corresponds to prior CT. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 27.4 cm/s. There is a small volume of ascites.GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 9.2 mm and appears contracted with sludge. No stones are seen. No pericholecystic fluid. The common bile duct measures 6.3 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 12.4 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.2 cm in length. The cortex has increased echogenicity. Renal stent is visualized, no hydronephrosis. There is a round isoechoic lesion seen along the midportion of the right kidney measuring 3.3 cm x 2.9 cm x 3.9 cm. This was visualized on prior CT. No stones or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.6 cm in length. The cortex has increased echogenicity. Renal stent is visualized with mild hydronephrosis. No stones or worrisome masses are seen.OTHER: No significant abnormality noted.", "output": "1. The liver appears coarsely echogenic which is compatible with fatty infiltration/hepatocellular dysfunction. No worrisome masses are seen. There is a small volume of ascites.2. Bilateral renal stents are visualized with mild hydronephrosis seen on the left. Both kidneys demonstrate increased echogenicity which is compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Male 79 years old with AKI and history of hydronephrosis. Assess for worsening hydronephrosis. RIGHT KIDNEY: Measures 8.8 cm in length. Normal echogenicity. Previous leak seen mild right hydronephrosis has improved, there is only mild persistence of the right renal pelvis. There is no nephrolithiasis or solid mass. A nephroureteral stent is seen within the collecting system.LEFT KIDNEY: Measures 9.2 cm in length. Normal echogenicity without hydronephrosis, nephrolithiasis, or solid mass. A nephroureteral stent is seen within the collecting system.URINARY BLADDER: Incompletely distended. Two nephroureteral stents are visualized in the bladder.", "output": "1.Mild prominence of the right renal pelvis without significant hydronephrosis. No left hydronephrosis.2.Bilateral nephroureteral stents."}
{"instruction": "Generate impression based on findings.", "input": "73 year old female who was recalled from screening mammogram for 7 mm focal asymmetry in the right upper outer quadrant. Patient on estradiol for the past 2 years. Mammogram: An ML view and four 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. Focal asymmetry in the right upper-outer quadrant persist only on the ML and MLO view. It is not definitely seen on the cc view. A benign morphology partially circumscribed slightly hyperdense mass is identified in the central breast on CC spot magnification view.Ultrasound: Targeted superior right breast ultrasound was performed. Multiple simple, complex and septated cysts with milk of calcium identified in the superior right breast, largest simple cyst measuring 7 x 5 mm. No suspicious solid mass noted.", "output": "High probability benign morphology asymmetry in the superior right breast and multiple simple and complex cysts in the superior right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram and ultrasound is recommended in 6 months. Results and recommendation 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": "41 years old, Female, Reason: RUQ US for rule out stones History: RUQ pain LIVER: The liver measures 18.1 cm in length. Echogenicity of the liver is within normal limits. 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: The gallbladder is not visualized, suspect prior cholecystectomy. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 5 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 12.1 cm in length. Normal echotexture. Nohydronephrosis.LEFT KIDNEY: Kidney measures 11.9 cm in length. Normal echotexture. Nohydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.The gallbladder is not visualized. Suspect prior surgery.2.The common bile duct is within normal limits. No evidence of choledocholithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Worsening renal function RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 10.1 cm in lengthLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 10.5 cm in length.OTHER: 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": "Female 85 years old Reason: low TSH, please check for nodules History: low TSH RIGHT LOBE MEASUREMENTS: 5.9 x 1.7 x 2.3 cmLEFT LOBE MEASUREMENTS: 2.9 x 2.6 x 3.1 cmISTHMUS MEASUREMENTS: 9 mmRIGHT LOBE: There are several nodules in the right lobe of the thyroid. Largest solid nodules in the inferior pole and measures 2.4 x 1.8 x 1.7 cm.LEFT LOBE: Left lobe is larger compared to the right side and there are numerous nodules in the left lobe. Largest solid left lobe nodule measures 2.9 x 2.6 x 3.1 cm. Inferior aspect of the left lobe cannot be seen due to mediastinal extension.ISTHMUS: There is a left-sided isthmic nodule measuring 1.6 x 1.7 x 0.9 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multinodular goiter, more prominent on the left side. The thyroid extending to the mediastinum on the left side."}
{"instruction": "Generate impression based on findings.", "input": "42 years old, Female, Reason: 42F with ARDS, oliguria and Hx of ARF History: oliguria RIGHT KIDNEY: Kidney measures 12.4 cm in length. Increased echogenicity is right kidney consistent medical renal disease. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Limited evaluation of the left kidney. Kidney measures 10.2 cm in length. Increased echogenicity the left kidney consistent medical renal disease. No definite evidence of hydronephrosis.Bladder: The bladder is decompressed with a Foley.", "output": "1.Bilaterally increased echogenicity of the kidneys consistent with medical renal disease.2.No evidence of hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine RIGHT KIDNEY: 12.2 cm in length. The renal parenchyma is mildly echogenic. There are no focal lesions or hydronephrosis.LEFT KIDNEY: 11.1 cm in length. The renal parenchyma is mildly echogenic. There are no focal lesions or hydronephrosis.BLADDER: Contracted.OTHER: No significant abnormalities noted.", "output": "Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old male with pancreatitis. Evaluate for hepatobiliary pathology. LIVER:The liver is normal echotexture. No masses, ascites, or intrahepatic biliary dilation.GALLBLADDER, BILIARY TRACT: The gallbladder appears normal; it is nondistended, wall thickness measures 0.2 cm, no stones or sludge common bile duct measures 0.3 cm proximally and 0.6 cm distally. No pericholecystic fluid.PANCREAS: Evaluation the pancreas is limited by overlying bowel gas.SPLEEN: Was not evaluated on this study.KIDNEYS: Right kidney measures approximately 11.4 cm. The cortex has normal echogenicity. No shadowing calculi, hydronephrosis, or worrisome mass. Left kidney was not evaluated on study. OTHER: No significant abnormality noted.", "output": "1. Normal ultrasound of abdomen without evidence of gallbladder pathology."}
{"instruction": "Generate impression based on findings.", "input": "85-year-old female. Evaluate for portal vein thrombosis. Cirrhosis progression. Renal status. Acute on chronic renal failure. Decompensated liver. LIVER: Nodular contour of the liver with coarsened echotexture consistent with cirrhosis. The liver is 15.7 cm in length. No suspicious focal mass. Hepatoportal venous flow with a normal velocity.GALLBLADDER, BILIARY TRACT: No biliary ductal dilatation. The common duct is 4 mm, within normal limits. Dense shadowing in the gallbladder fossa, likely due to gallbladder packed with stones.PANCREAS: VIsualized portions of the pancreatic head and neck are normal in echogenicity. Remainder of pancreas is obscured by bowel gas.SPLEEN: No focal lesion. Spleen is 12.7 cm in length.KIDNEYS: Right kidney is 10.7 cm in length and contains a cyst with a thin septation. No hydronephrosis. Left kidney is surgically resected.ABDOMINAL AORTA: Normal in caliber measuring up to 2.6 cm in the proximal aorta and 2.3 cm in the mid aortaINFERIOR VENA CAVA: Patent.OTHER: Small amount of abdominal ascites.", "output": "Small amount of ascites. Cirrhosis. Patent portal vein. No hydronephrosis. Cholelithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Female 72 years old Reason: Change in abnormal node History: Thyroid cancer MEASUREMENTS: Patient is status post thyroidectomy.RIGHT RESECTION BED: In the mid right thyroid bed there is a small hypoechoic nodule with internal hyperechogenicity measuring 0.3 x 0.4 x 0.3 cm, possibly representing a small lymph node. In the superior right thyroid bed there is a another small hypoechoic nodule measuring 0.4 x 0.3 x 0.3 cm.LEFT RESECTION LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: The previously noted left level 3 lymph node is not definitely identified on this exam. However, there is a left level 4 lymph node with punctate internal hyperechogenic foci which may represent calcifications. This lymph node measures 0.8 x 0.5 x 0.3 cm. OTHER: No significant abnormality noted.", "output": "Left level 4 lymph node with suspicious features. There are also 2 new subcentimeter hypoechoic nodules in the right thyroidectomy bed; recurrent disease cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female with sickle cell pain crisis. Abdominal tenderness and guarding. Pain on the left side. Rule out free fluid. LIVER: Partial visualization of the hepatic parenchyma demonstrates stable appearance of echogenic coarse hepatic echotexture.OTHER: No ascites identified in the 4 abdominal quadrants. Fluid distended bowel in the left lower quadrant and fluid distention of the stomach.", "output": "1. No ascites.2. Fluid distended small bowel in the left lower quadrant (area of pain)."}
{"instruction": "Generate impression based on findings.", "input": "Female 32 years old Reason: bilateral fibroadenomas, evaluate for changes History: biopsy proven, palpable fibroadenoma in right breast Targeted bilateral breast ultrasound was performed. At the 12 o'clock position in the right breast redemonstration of an oval, parallel orientated hypoechoic mass consistent with a proven fibroadenoma, measuring 1.5 x 2.1 x 2.5 cm (previously 27 x 29 x 23 mm). A marker clip is identified within this mass. At 9:00 position, there is a stable mass measuring 15 x 9 x 13 mm (previously annotated as 8:00 position, 14 x 7 x 13 mm). In the left breast at the 11:00 position there is an oval, parallel oriented hypoechoic mass measuring 8 x 4 x 9 mm (previously 7 x 4 x 8 mm), also consistent with fibroadenoma.", "output": "Benign morphology masses in both breasts consistent with fibroadenomas as noted above. Follow-up bilateral breast research MRI is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old female patient with history of thyroidectomy for benign disease. Question of residual tissue. RIGHT LOBE: Status post thyroidectomy without residual tissue identified.LEFT LOBE: Status post thyroidectomy without residual tissue identified.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology lymph nodes are noted in the bilateral neck.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy without residual tissue identified."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain. CHF. LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. No focal hepatic lesions. Pulsatile portal venous flow, which may be seen in the setting of CHF. 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 11.9 cm in length. The left kidney is 13.0 cm in length. The renal parenchymal echogenicity is increased bilaterally. No suspicious renal lesion evident. No hydronephrosis is present.SPLEEN: 12.3 cm in length, without suspicious lesions evident. A splenule is noted.OTHER: Bilateral pleural effusions identified. Trace perihepatic ascites.", "output": "1. Bilateral pleural effusions.2. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease.3. Otherwise, no specific findings to account for the patient's right upper quadrant abdominal pain."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old female with lymphoma and growing right neck mass which is hot on PET CT. RIGHT LOBE MEASUREMENTS: 2.5 x 3.6 x 7.1 cm. Incompletely measured. See below.LEFT LOBE MEASUREMENTS: 1.1 x 1.3 x 4.3 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: There is marked, bulbous enlargement of the inferior right lobe of the thyroid corresponding to the mass extending into the substernal region on outside PET and prior CT. This cannot be measured in its entirety by ultrasound due to access. There is at least one focus of dense calcification at the superior margin of this mass. Complex cystic mass in the midportion of the right lobe measuring 0.8 x 1.2 x 1.4 cm. Smaller cystic focus is present as well.LEFT LOBE: Spongiform nodule in the midportion of the left lobe with comet tail artifact measuring 0.4 x 0.9 x 1.1 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bulbous enlargement of the inferior right lobe of the thyroid likely representing a solid, isoechoic nodule extending into the mediastinum.Bilateral, benign-appearing smaller thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "Patient presents for short-term follow-up of highly likely benign findings in the left axillary region. The area is unchanged to the patient. A targeted left ultrasound was performed for the palpable area of concern. Again seen is a mixed echogenicity mass, not significantly changed in size, measuring 8 x 7 mm. This remains highly likely benign, probably a small lymph node with adjacent fat necrosis.", "output": "No significant change in highly likely benign finding in the left axillary region. As long as there is no change in physical exam findings, the area could be evaluated at the time of her next mammogram, due in September 2016. If there is any change in the interim, then reevaluation with ultrasound should be performed.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old female with sickle cell anemia, abdominal pain. Evaluate for cholelithiasis. LIVER: The liver is enlarged measuring 22 cm in length. No discrete hepatic lesions are identified.GALLBLADDER, BILIARY TRACT: Cholelithiasis without gallbladder wall thickening or pericholecystic fluid. No sonographic Murphy sign was elicited during the examination. There is no biliary ductal dilation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.SPLEEN: Measures 9.4 cm in length without focal lesion.OTHER: No significant abnormalities noted.", "output": "1.Cholelithiasis without evidence of acute cholecystitis.2.Hepatomegaly."}
{"instruction": "Generate impression based on findings.", "input": "54 years old, Male, Reason: r/o masses, cirrhosis History: abdominal pain LIVER: The liver is enlarged measuring 21.6 cm in length. Coarse heterogeneous liver could be indication of chronic liver disease. 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: Patient is status post cholecystectomy. The common bile duct measures 6 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: The spleen is difficult to visualize on this exam. The visualized spleen measures approximately 6.6 cm in length. RIGHT KIDNEY: Kidney measures 11.7 cm in length. Echogenic right kidney indicating medical renal disease without evidence of hydronephrosis. Simple appearing right renal cyst measures 1.2 x 1.2 x 1.3 cm.LEFT KIDNEY: Kidney measures 13.0 cm in length. Increased echogenicity of the left kidney is consistent medical renal disease. No evidence of hydronephrosis. Left renal cyst measures 1.5 x 1.4 x 1.0 cm.OTHER: No significant abnormalities noted.", "output": "1.Hepatomegaly with coarse heterogeneous liver which can be consistent with chronic liver disease. No hepatic mass.2.Increased echogenicity of the kidneys without hydronephrosis is consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old female with recurrent UTIs. RIGHT KIDNEY: 11.9 cm in length. No hydronephrosis or focal lesion.LEFT KIDNEY: 13.37 m in length. No hydronephrosis or focal lesion.URINARY BLADDER: Partially collapsed which limits evaluation.OTHER: No significant abnormalities noted.", "output": "No evidence of abscess, stone, or hydronephrosis. "}
{"instruction": "Generate impression based on findings.", "input": "Neoplasm of uncertain behavior of skin. 17-year-old woman with 1 cm nodule in the occipital area which is intermittently tender. Lipoma versus cyst versus bony abnormality. The palpable area in the occiput appears to originate from the bone and cannot be further evaluated using ultrasound. There is no evidence of a lipoma or cyst in the subcutaneous tissues which were able to be evaluated.", "output": "Palpable abnormality is within bone and could be better evaluated using CT or MRI. Ultrasound revealed no abnormality in the overlying soft tissues."}
{"instruction": "Generate impression based on findings.", "input": "55 year-old female with metastatic colon cancer for potential biopsy of liver. LIVER: The patient's known metastatic disease to the liver is very poorly visualized by ultrasound and not approachable for biopsy", "output": "Inadequate visualization of hepatic metastatic disease for biopsy. This was discussed with the patient and research coordinator."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male with abdominal pain, evaluate biliary dilation. LIVER: Measures 17.7 in length. Markedly 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": "1. Markedly increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease, without discrete focal lesion. 2. No evidence of biliary dilation as clinically questioned. "}
{"instruction": "Generate impression based on findings.", "input": "The patient submitted outside mammogram dated 5/11/11, 4/13/10, from 2525 S. Michigan Ave, Chicago 60616. Submitted outside study was compared to the current mammogram dated 3/18/15. Multiple masses in both breasts appear new from prior studies and ultrasound is recommended for further evaluation. Small cluster of calcifications in left upper outer quadrant is progressing in a benign fashion. The right axillary lymph node appears prominent but stable from prior exams.", "output": "Multiple masses in both breasts appear new from prior studies and ultrasound is recommended for further evaluation. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "57 year old female who was recalled from screening mammogram for right breast mass. No family history of breast cancer. Right Breast Diagnostic 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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Within the medial slightly upper right breast, there is redemonstration of a circumscribed mass measuring approximately 0.4 cm which persists on spot compression imaging.Right Breast Ultrasound: On physical examination, no palpable abnormality is identified.A targeted right ultrasound was performed for the mammographic area of concern. At the two o'clock radian of the right breast, 4 cm from the nipple, there is a clustered cyst measuring 0.5 x 0.4 x 0.9 cm, corresponding to the mass visualized on mammogram.", "output": "Clustered cyst at the two o'clock position in the right breast, corresponding to the mass visualized on prior mammogram. Left unilateral diagnostic mammogram and ultrasound is recommended in 6 months to assess stability. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain, tenderness to palpation in right upper quadrant LIVER: The liver measures 14.5 cm in length. Unremarkable hepatic parenchyma and echotexture. The portal vein is patent with normal directional hepatopetal blood flow, peak velocity 22.7 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. No cholelithiasis. Negative sonographic Murphy's sign. The gallbladder wall measures 0.1 cm. The common hepatic duct measures 0.2 cm. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 10.37 m in length. No hydronephrosis or shadowing stones.LEFT KIDNEY: The left kidney measures 11.1 cm in length. No hydronephrosis or shadowing stones.OTHER: No ascites.", "output": "No acute abnormality. No findings to account for patient's abdominal pain."}
{"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. In the right breast at 8 - 9 o'clock near the nipple, there is an indeterminate hypoechoic lesion, measuring 8 mm. There is no solid or suspicious lesion identified in the left breast.", "output": "Indeterminate hypoechoic lesion at 8 - 9 o'clock near the nipple in the right breast. Diagnostic ultrasound study is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "Alcoholic cirrhosis LIVER: Cirrhotic morphology again noted without mass. Liver length 20.5 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.4 cm in lengthOTHER: Left kidney 12.5 cm in length. Spleen 14.6 cm in length. No ascites.", "output": "Stable cirrhotic morphology without mass or ductal dilatation. Cholelithiasis without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B LIVER: Coarse echogenic liver echotexture without mass; liver length 14.8 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis again noted without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.3 cm in lengthOTHER: Left kidney 9.8 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Stable cholelithiasis without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Polycythemia vera with elevation in liver enzymes LIMITED ABDOMENLIVER: Mildly echogenic and coarse liver echotexture without mass. The liver length 16.9 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: Spleen 15.2 cm in length RIGHT KIDNEY: No significant abnormalities noted. 11 cm in lengthOTHER: Left kidney 11.9 cm in length. No ascites", "output": "Mildly coarse and echogenic liver parenchyma suggestive for parenchymal dysfunction/fatty infiltration without mass or ductal dilatation. No ascites. Mild splenomegaly.Patent hepatic vessels with normal directional flow."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female status post left needle localization for left breast lumpectomy in January 2016 (left sentinel lymph node biopsy not performed as patient's original path showed diagnosis of DCIS), assess left axilla for nodal involvement A targeted left axillary ultrasound was performed. 3 adjacent lymph nodes are identified out of which the middle lymph node appears abnormal in morphology with thickened cortex and nonhilar blood flow, which measures 1.3 x 0.8 x 1.2 cm. The other 2 lymph nodes demonstrate normal morphology.", "output": "Abnormal left axillary lymph node, ultrasound-guided core biopsy can be performed.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male with history of thyroid cancer post surgery. 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 interval change. No evidence for recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "Concern for pancreatitis. LIVER: The liver is normal in morphology, echogenicity and size, measuring 16 cm in craniocaudal dimension. No focal lesion or intrahepatic ductal dilatation. Normal hepatopedal portal venous blood flow at 0.3 cm/s.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 3 mm. Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid or focal tenderness.PANCREAS: The pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 8.8 cm in length. RIGHT KIDNEY: The right kidney measures 10.6 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. OTHER: The left kidney measures 10.1 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion.", "output": "Normal gallbladder without gallstones. No biliary ductal dilatation. The pancreas is obscured by overlying bowel gas shadowing."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 38F with ALL, p/w nausea/vomiting, elevated lipase. Evaluate for stones, hepatin vein thrombus. LIVER: The liver measures 18.3 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 0.4 m/s. The hepatic veins appear patent.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 2 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 10.7 cm in length. RIGHT KIDNEY: Kidney measures 13.2 cm in length. Cortical echogenicity perhaps mildly increased. No hydronephrosis.LEFT KIDNEY: Kidney measures 14.1 cm in length. Cortical echogenicity perhaps mildly increased. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.No evidence of acute cholecystitis or biliary ductal dilatation. Patent hepatic veins.2.Possible mildly increased renal echogenicity raising possibility of medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Padilla is a 19 year old female with questionable lesion identified on outside ultrasound exam. She presents today for a repeat ultrasound study. Per patient, she has had a palpable lesion for the past 4 months, which has been decreasing in size. She denies any history of trauma, fever, chills. On physical exam at the palpable area of concern, dense nodular tissue is appreciated. No discrete mass is appreciatedA targeted right breast ultrasound was performed for the palpable area of concern. In the right breast 10:00 position, approximately 6 cm from the nipple, dense fibroglandular tissue is apparent. There is no suspicious cystic or solid mass identified.", "output": "No sonographic evidence for malignancy. Patient should follow-up with her primary physician as warranted. All results and recommendations were relayed to the patient and her mother.BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "History of hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 6.5 x 2.2 x 2.5 cm.LEFT LOBE MEASUREMENTS: 6.0 x 2.2 x 2.6 cm.ISTHMUS MEASUREMENTS: 0.4 cm in thicknessRIGHT LOBE: Normal echotexture without discrete nodules.LEFT LOBE: Normal echotexture without discrete nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: There is an oval-shaped hypoechoic structure posterior to the inferior pole of the right lobe of the thyroid measuring approximately 1.2 x 0.5 x 1.3 cm which is nonspecific but is a candidate for parathyroid adenoma.LYMPH NODES: Several benign morphology cervical lymph nodes are noted.OTHER: No significant abnormality noted.", "output": "Candidate for parathyroid adenoma posterior to the inferior pole of the right thyroid lobe."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid cancer status post surgery. Palpable left neck lymph node. RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomy ISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified. The palpable periauricular lymph node is benign in morphology and unchanged, measuring 6 mm in short axis. OTHER: No significant abnormality noted.", "output": "No evidence of disease recurrence"}
{"instruction": "Generate impression based on findings.", "input": "Male 65 years old Reason: Is there metastatic papillary thyroid carcinoma to the cervical lymph nodes bilaterally History: Papillary thyroid carcinoma LYMPH NODES: Patient has known, previously biopsied papillary thyroid carcinoma in the left thyroid lobe. Multiple small, benign-appearing lymph nodes are again seen. These lymph nodes are all subcentimeter with normal fatty hila. Based on small size and benign appearance of lymph nodes, biopsy of these lymph nodes is felt to be unnecessary. Discussed with patient and ordering physician.Incidental note is made of a tardus parvus waveform in the right common carotid.OTHER: No significant abnormality noted.", "output": "1.Multiple small benign-appearing lymph nodes, all of which are subcentimeter in short axis. Discussed with patient and Dr. Grogan.2.Tardus parvus waveform in the right common carotid. Recommend dedicated carotid duplex."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old male patient with thyromegaly. Evaluate for nodules or other abnormalities. RIGHT LOBE MEASUREMENTS: 5.2 x 1.9 x 2.4 cm.LEFT LOBE MEASUREMENTS: 4.8 x 1.6 x 2.1 cm.ISTHMUS MEASUREMENTS: 3 mm in thickness.RIGHT LOBE: The right thyroid lobe is homogeneous in echogenicity and contains a 0.3 x 0.2 cm cyst with likely colloid.LEFT LOBE: The left thyroid lobe is homogeneous in echogenicity without dominant thyroid lesion.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No dominant thyroid lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "Chronic kidney disease RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 9.8 cm in length.LEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 10.2 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": "Provided history of toxic nodular goiter. RIGHT LOBE MEASUREMENTS: 5.9 x 2.7 x 2.5 cmLEFT LOBE MEASUREMENTS: 6.7 x 2.3 x 2.5 cmISTHMUS MEASUREMENTS: 6 mmRIGHT LOBE: The right lobe is enlarged and heterogeneous in echogenicity containing several small cystic nodules. No discrete solid right thyroid lobe nodule.LEFT LOBE: The left lobe is enlarged and heterogeneous in echogenicity containing several small cystic nodules. In the mid portion of the lobe there is a 1.0 x 0.6 x 1.2 cm spongiform-appearing nodule consistent with a colloid nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Enlarged heterogeneous thyroid with a 1.2 cm left mid lobe colloid nodule."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old male with lump on medial buttock. Evaluate for perirectal abscess. Limited scan was performed over the visible helpful abnormality. In this location in the subcutaneous tissues there is a poorly marginated, but ovoid hypoechoic region measuring 2.5 x 5.6 x 5.4 cm. This has no fluid component to suggest abscess, and therefore this could represent a somewhat atypical appearing lipoma or other mass.", "output": "Masslike area in the subcutaneous tissues of the right buttock without obvious fluid component to suggest abscess. If abscess remains suspected or further soft tissue characterization is required, CT would be useful."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old male with testicular swelling. Given antibiotics one week ago with increased pain and swelling. RIGHT TESTIS: The right testis measures 4.3 x 3.4 x 2.4 cm. There demonstrable color and spectral Doppler flow. Normal parenchymal echotexture and vascularity. There is a moderate hydrocele.LEFT TESTIS: The left testis measures 4.0 x 3.5 x 3.2 cm. There demonstrable color and spectral Doppler flow. Normal parenchymal echotexture and vascularity. There is a small hydrocele with septations.RIGHT EPIDIDYMIS: The right epididymis is enlarged and demonstrates increased vascularity. The right epididymis measures 3.9 x 2.0 x 2.6 cm.LEFT EPIDIDYMIS: The left epididymis measures 4.0 x 2.6 cm. There is heterogeneity and the epididymis is mildly enlarged.OTHER: There is an ill-defined area of hypoechogenicity posterior to the left testicle corresponding to region of rim enhancing hypoattenuation.", "output": "1.Right epididymitis and right hydrocele.2.Complicated left hydrocele and probable epididymitis. Ill-defined area of hypoechogenicity posterior to the left testicle corresponding to a region of rim enhancing hypoattenuation on same-day CT. A phlegmon/abscess cannot be excluded.3.No evidence of torsion."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old male with acute kidney injury. RIGHT KIDNEY: Measures 11.8 cm. Echogenic renal parenchyma without discrete focal lesion or hydronephrosis.LEFT KIDNEY: Measures 11.5 cm. Echogenic renal parenchyma without discrete focal lesion or hydronephrosis.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Echogenic renal parenchyma consistent with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "50 year old female with history of right upper quadrant pain. Evaluate gallbladder and liver. LIVER: The liver is within normal limits, measuring 17 cm in length. No biliary dilatation or focal masses.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. No cholelithiasis or gallbladder wall thickening.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right kidney measures 9.6 cm.OTHER: No significant abnormalities noted. Left kidney measures 10.6 cm.", "output": "Normal right upper quadrant ultrasound, with no findings to explain the patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old male with mild thyroid enlargement on exam. RIGHT LOBE MEASUREMENTS: 5.9 x 2.7 x 2.0 cmLEFT LOBE MEASUREMENTS: 5.2 x 2.0 x 1.4 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Mildly heterogeneous thyroid echotexture without discrete nodule.LEFT LOBE: Mildly heterogeneous thyroid echotexture without discrete nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Mildly heterogeneous thyroid echotexture without discrete nodule."}
{"instruction": "Generate impression based on findings.", "input": "Female 73 years old Reason: Kidney stone? History: Hyperparathyroidism RIGHT KIDNEY: Slightly echogenic kidney. No focal lesions or hydronephrosis. Right kidney measures 9 cm.LEFT KIDNEY: Left kidney measures 9.6 cm. Slightly echogenic kidney. No focal lesions or hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Bilateral slightly echogenic kidneys. No evidence of stones, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Female 38 years old; Reason: RUQ pain History: pain LIVER: The liver measures 14.0 cm in length. There is 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 26.9 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.4 mm. A shadowing echogenic foci is seen within the gallbladder and tumefactive sludge is seen. A positive sonographic Murphy's sign was present. No pericholecystic fluid. The common bile duct measures 3.2 mm in diameter. No common bile duct stones are visualized.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 12.5 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 12.5 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. Cholelithiasis without overt sonographic evidence of acute cholecystitis. Due to the positive Murphy's sign, early or occult acute inflammation cannot be excluded. No ductal dilatation.2. The liver has increased echogenicity which is compatible with fatty infiltration/hepatocellular dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old male with history of gastric ulcer, hypoechoic liver focus on prior ultrasound. LIVER: Measures 14.3 cm in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. Anechoic structure in the right hepatic lobe measuring 1.1 x 1.0 cm with increased through transmission consistent with a benign cyst, unchanged.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": "Simple cyst in the right hepatic lobe unchanged since the prior study."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal LFTs LIVER: Mildly coarse echogenic liver echotexture without mass. Liver length 14.4 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 8.5 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.9 cm in lengthOTHER: Left kidney 10.9 cm in length. No ascites.", "output": "Mildly coarse liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 39 years old Reason: r/o recurrence, adenopathy History: h/o thyroid cancer, s/p lobectomy RIGHT LOBE MEASUREMENTS: Patient is status post right thyroidectomyLEFT LOBE MEASUREMENTS: 1.6 x 1.0 x 5.6 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Patient is status post right thyroidectomy. No residual or recurrent thyroid tissue.LEFT LOBE: The thyroid is normal echogenicity. No new nodules are present.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No local lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Unchanged, post right thyroidectomy, appearance of the thyroid. No evidence of recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male with congestive heart failure and abnormal liver function. LIVER: Liver parenchyma appears mildly coarsened in echotexture which is not specific and consistent with parenchymal disease. Overall hepatic size is within normal limits. No definite cirrhotic morphology. Within the superior aspect of the left lobe is a well-demarcated rounded and echogenic mass consistent with hemangioma, measuring 3.4 x 3.2 x 4.0 cm. No other focal abnormality.BILIARY TRACT: Gallbladder appears unremarkable without cholelithiasis, wall thickening or pericholecystic fluid. 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": "Coarsened echotexture of the liver without gross evidence for cirrhosis.Findings of hepatic hemangioma."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old male with AKI and transaminitis. LIVER:The liver measures 15.5 cm.GALLBLADDER, BILIARY TRACT: There is debris in the gallbladder. No stones. Gallbladder wall is within normal limits. No pericholecystic fluid. The common bile duct measures 2.8 mm.PANCREAS: Difficult to asses as pancreas is obscured by bowel gas.SPLEEN: The spleen measures 10.4 cm. No significant abnormalities noted.KIDNEYS: The right kidney measures 10.4 cm. The left kidney measures 10.7 cm. The kidneys have normal echogenicity. No shadowing calculi, hydronephrosis, or masses. ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: The IVC is patent without evidence of thrombus.OTHER: No significant abnormality noted.", "output": "1. Gallbladder debris without sonographic evidence of acute cholecystitis.2. Normal ultrasound of the kidneys without stones, hydronephrosis, or masses.3. Normal ultrasound of the liver without evidence of sonographic evidence of parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old female with history of left AML. Status post embolization of hematoma. RIGHT KIDNEY: The right kidney is normal in size, measuring 10.4 cm and contains several simple and minimally complex cysts, the largest of which measures 3.1 cm in the upper pole, minimally increased in size. No hydronephrosis.LEFT KIDNEY: The left kidney measures approximately 13.1 cm in length without hydronephrosis. Demonstrated again is a heterogeneous, hypoechoic mass at the left upper pole, which is difficult to accurately measure but does not appear significantly changed in size, measuring approximately 6.1 x 6.3 x 6.0 cm.OTHER: No significant abnormalities noted.", "output": "Left upper pole renal heterogeneous mass compatible with known angiomyolipoma is not appreciably changed in size. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 75 yo F with EtOH abuse presents with acute onset thrombocytopenia, evaluate for cirrhosis/liver pathology. Examination mildly limited by patient motion.LIVER: The liver measures 15.5 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 0.23 m/s.BILIARY TRACT: Gallbladder sludge and cholelithiasis without associated wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3 mm in diameter.PANCREAS: Not well visualized.SPLEEN: No significant abnormalities noted. The spleen measures 6.7 cm in length. RIGHT KIDNEY: Kidney measures 10.2 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 11.1 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No ascites.", "output": "1.Increased hepatic echogenicity suggestive of parenchymal dysfunction/fatty infiltration.2.Cholelithiasis without evidence of acute cholecystitis or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Status post sleeve gastrectomy now with nausea and vomiting LIVER: Coarse echogenic liver echotexture again noted.BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation", "output": "Gallbladder sludge without acute inflammation or ductal dilatation. Fatty infiltration of the liver."}
{"instruction": "Generate impression based on findings.", "input": "Female 32 years old; Reason: Primary hyperparathyroidism. Please evaluate for parathyroid adenoma RIGHT LOBE MEASUREMENTS: 5.3 x 1.3 x 1.7 cmLEFT LOBE MEASUREMENTS: 5.3 x 1.5 x 1.3 cmISTHMUS MEASUREMENT: 0.3 cmRIGHT LOBE: 0.5 x 0.5 x 0.4 cm solid, hypoechoic mid pole nodule is not well defined. It does not contain calcification or demonstrate increased vascularity on color Doppler.LEFT LOBE: At least two subcentimeter cysts are noted.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No evidence of parathyroid adenoma.", "output": "1.Small left lobe colloid cysts and 0.5 cm non-descript right thyroid nodule.2.No evidence of parathyroid adenoma."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Hepatitis C, evaluate for cirrhosis and splenomegaly. LIVER: The liver measures 19.2 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 0.18 m/s.BILIARY TRACT: Cholelithiasis without associated 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 within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 10.1 cm in length. RIGHT KIDNEY: Kidney measures 11.1 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 11.3 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Cirrhotic liver morphology without suspicious focal mass. No ascites. Cholelithiasis without acute inflammation. "}
{"instruction": "Generate impression based on findings.", "input": "History of left renal cell carcinoma status post partial nephrectomy in 2008. Evaluate for recurrence. RIGHT KIDNEY: The right kidney measures 12.3 cm in length without hydronephrosis or shadowing nephrolithiasis. 3.6 x 2.8 x 2.3 cm lower pole simple appearing cyst is not significantly changed in size. The adjacent smaller cyst measures 1.5 x 1.2 x 1.6 cm with thin septations, unchanged. Color Doppler demonstrates hilar blood flow. LEFT KIDNEY: The left kidney measures 10.0 cm in length without hydronephrosis or shadowing nephrolithiasis. The superior pole cyst/postprocedural fluid collection with thin septations measures 4.5 x 4.5 x 4.6 cm, unchanged. Color Doppler demonstrates hilar blood flow.OTHER: Normal distended urinary bladder.", "output": "1. Stable appearance of the residual loculated fluid collection/septated cyst in the superior pole of the left kidney. No suspicious lesion is evident.\\2. Simple appearing and minimally complex right renal cysts are unchanged in size."}
{"instruction": "Generate impression based on findings.", "input": "80-year-old female with metastatic renal cell carcinoma, pancreatic head mass, elevated LFTs. Evaluate for bile duct dilation. LIVER:The liver measures 17.2 cm in length. The liver is coarsely echogenic. No new worrisome masses are noted within the liver. There is no intrahepatic ductal dilation. No ascites. The portal vein is patent with hepatopetal flow measuring 21.4 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is surgically absent. The common bile duct measures 0.9 cm. This is stable from prior CT.PANCREAS: Hypoechoic mass noted in the head of the pancreas measuring 0.6 cm.SPLEEN: The spleen is surgically absentRIGHT KIDNEY: The right kidney measures 12.4 cm in length. The cortex is normal in echogenicity. There is no hydronephrosis, and there are no stones. There is a mass that is isoechoic to the kidney cortex measuring 3.1 cm x 2.8 cm x 3.2 cm. This corresponds with known mass seen on prior CT, and appears stable in size. No new worrisome masses are seen.", "output": "1. There is coarse increased echogenicity within the liver compatible with fatty liver/parenchymal dysfunction. No new worrisome masses are visualized within the liver.2. The common bile duct is enlarged, however this is stable from prior CT. There is no intrahepatic ductal dilation seen.3. Right upper pole renal mass is again visualized as seen on prior CT. This appears stable in size from prior CT."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female presents for evaluation of thyroid. She is status post left-sided thyroidectomy. RIGHT LOBE MEASUREMENTS: 5.8 x 1.7 x 1.8 cm.LEFT LOBE MEASUREMENTS: The left lobe is absent.ISTHMUS MEASUREMENTS: 0.4 cm.RIGHT LOBE: Unremarkable echogenicity of the parenchyma. Again seen are two subcentimeter well-defined nodules that appear unchanged since the prior study.LEFT LOBE: The left lobe is absent.ISTHMUS: Unremarkable echogenicity of the parenchyma.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Stable thyroid nodules. Surgical changes related to left-sided thyroid lobectomy. No significant adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "53 year old female who was recalled from screening mammogram for a circumscribed mass in the posterior right lower inner breast seen on 9/11/2015. 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 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. The subcentimeter circumscribed mass in the right lower inner breast persists on spot compression images. No suspicious microcalcifications are identified. RIGHT BREAST ULTRASOUND", "output": "Highly likely benign subcentimeter complicated cyst in the right inner medial breast. Short term follow up is recommended. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram and possible ultrasound is recommended in 6 months. Results and recommendation 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": "Reason: evaluate liver to r/o masses vs cirrhosis History: elevated transaminases LIVER: The liver measures 20.6 cm in length. The liver parenchymal echotexture is normal. No focal hepatic lesions or masses are identified, including at the site of the segment 3 subcentimeter hypoattenuating lesion described on 2014 CT. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.26 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. There is mild proximal intrahepatic biliary ductal dilatation as well as dilation of the common bile duct up to 12 mm which tapers distally and appears grossly similar in configuration to the 2014 CT. PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures approximately 9 cm in length. RIGHT KIDNEY: Kidney measures 10.7 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": "1.Mild hepatomegaly. No focal hepatic lesions identified. 2.No evidence of acute cholecystitis.3.Prominence of the proximal intrahepatic ducts and common bile duct appearing grossly similar in configuration to 2014 CT. If there is clinical concern for biliary obstruction, additional imaging (such as MRCP) may be considered as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Cholelithiasis? History: Abdominal pain Examination mildly limited due to body habitus.LIVER: The liver measures 18.6 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: Cholelithiasis without 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: Not well-visualized.SPLEEN: No significant abnormalities noted. The spleen measures 11.8 cm in length. RIGHT KIDNEY: Kidney measures 12.4 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 13.5 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Cholelithiasis without sonographic evidence of acute cholecystitis or biliary ductal dilatation.2.Mild hepatomegaly and increased hepatic echogenicity raising possibility of parenchymal dysfunction/fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old male patient status post OKT 2004 now with acute renal failure. Evaluate for obstruction, evidence of rejection. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No perinephric fluid collection is identified.KIDNEY: The transplant kidney measures 11.8 cm in length and demonstrates increased cortical echogenicity.COLLECTING SYSTEM/URETER: No evidence of hydronephrosis.URINARY BLADDER: The bladder is distended.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels. Transplant renal artery anastomosis: Peak systolic velocity of 144 cm/s, RI 0.79.Proximal transplant renal artery: Peak systolic velocity of 104 cm/s, RI of 0.85.Mid transplant renal artery: Peak systolic velocity of 112 cm/s, RI of 0.77.Distal transplant renal artery: Peak systolic velocity of 122 cm/s, RI of 0.77.Transplant renal artery hilum: Peak systolic velocity 105 cm/s, RI of 0.78.Segmental artery resistive indices range from 0.67-0.73.Arcuate artery resistive indices range from 0.58-0.61.The transplant renal vein is patent.OTHER: No significant abnormality noted.", "output": "1. Patent transplant renal vasculature with intrarenal resistive indices within normal limits.2. Echogenic kidney compatible with medical renal disease/parenchymal dysfunction. No evidence of hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "HCC status post resection LIVER: Severely coarse and echogenic liver parenchyma. Interval appearance of multiple subcentimeter right lobe low-attenuation foci. The previously noted hypoechoic region adjacent to the resection site is un-changed consistent with postoperative finding. Liver length 19 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.8 cm in lengthOTHER: Left kidney 10.8 cm in length. Left renal cyst. Spleen 11.2 cm in length. No ascites.", "output": "Interval appearance of multiple subcentimeter right lobe hypoechoic foci. It is unclear whether or not this represents focal sparing from the patient's fatty infiltration or new neoplastic foci. Would strongly recommend correlation with dedicated liver CT.Markedly echogenic and coarse liver echotexture consistent with chronic liver disease/fatty infiltration. No ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Male 62 years old Reason: HCC surveillance History: HCV cirrhosis LIVER: Liver measures 18.4 cm in length. Increased echogenicity and coarse echotexture of the liver. No focal hepatic mass. Portal vein is patent with normal direction of flow and velocity of 20 cm/s.BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. Small amount sludge is present within the gallbladder. No gallbladder wall thickening or pericholecystic fluid.PANCREAS: The visualized portions of the pancreas are normal in appearance. Pancreatic duct measures 1 mm. Nonspecific peripancreatic lymph node measures 0.7 x 1.4 x 2.1 cm.SPLEEN: Spleen is normal in appearance measuring 11.1 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 10.3 cm. Left kidney measures 11.9 cm. Unchanged scar in the inferior pole of the left kidney. OTHER: No ascites.", "output": "Increased echogenicity and coarse echotexture of the liver compatible with diffuse hepatic dysfunction. No hepatic mass."}
{"instruction": "Generate impression based on findings.", "input": "Male 89 years old Reason: eval multinodular goiter History: multinodular goiter seen on CT chest RIGHT LOBE MEASUREMENTS: 6.3 x 1.9 x 1.5 cmLEFT LOBE MEASUREMENTS: 5.7 x 4.3 x 3.6 cmISTHMUS MEASUREMENTS: 0.8 cmRIGHT LOBE: 2 nodules are present in the right thyroid lobe. In the superior right thyroid lobe there is a 1.6 x 0.8 x 0.4 cm nodule which is mildly hypoechoic compared to background thyroid parenchyma. The inferior portion of the right thyroid lobe there is a hypoechoic nodule measuring 0.7 x 0.7 x 0.9 cm.LEFT LOBE: The left thyroid lobe extends inferiorly to the substernal area, which is unable to visualize by ultrasound. Total size of this left thyroid lobe is better evaluated by recent CT. Part solid, part cystic left thyroid nodule measures approximately 5.1 x 4.2 x 3.9 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 goiter with a large left thyroid lobe extending posterior to the sternum and incompletely visualized on this exam."}
{"instruction": "Generate impression based on findings.", "input": "Renal stones; history partial right nephrectomy for resection of papillary renal cell carcinoma RIGHT KIDNEY: Contour defect again noted consistent with partial nephrectomy. No worrisome mass. Benign inferior pole cyst unchanged. No stone or hydronephrosis. Right kidney 11 cm in length.LEFT KIDNEY: Stable mid/lower pole angiomyolipoma measuring 2.5 x 2.7 x 2.8 cm. At least two nonobstructing renal stones. An upper pole stone measures 0.9 x 0.6 x 1 cm; a lower pole stone measures 0.9 x 1.2 x 1.1 cm. No hydronephrosis. Left kidney 11.6 cm in length.OTHER: Bladder non-distended", "output": "At least two nonobstructing left renal stones. Stable left renal angiomyolipoma. Stable contour defect right kidney consistent with partial nephrectomy without worrisome mass, stone, or hydronephrosis on the right."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old female with persistent hydronephrosis, left ureteral stone. RIGHT KIDNEY: Measures 9.3 cm in length. Mildly increased cortical echogenicity without hydronephrosis, nephrolithiasis, or solid mass. Subcentimeter right renal cysts without septation or solid component.LEFT KIDNEY: Limited examination of the left kidney due to patient body habitus. Measures 9.6 cm in length. Mild-moderate hydronephrosis does not appear significantly changed compared with the prior CT allowing for differences in modality. There is redemonstration of a left lower pole renal calculus. Evaluation of the proximal ureter is very limited without stone identified.URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.", "output": "1.Limited examination of the left kidney and ureter as described above, with mild-moderate hydronephrosis, the degree of which appears similar to the prior CT from August 20, 2015. Nonobstructive left renal calculus.2.Mildly increased right renal echogenicity suggests medical renal disease. "}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female patient with nausea/vomiting. Evaluate for gallstones, pancreatitis. LIVER: The liver measures 14.3 cm in length. 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 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 11.6 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.3 cm in length. No evidence of hydronephrosis.The spleen measures 8.7 cm in length.", "output": "No specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old male presents for evaluation of a possible left hydrocele. RIGHT TESTIS: Measures 3.7 x 3.2 x 3.3 cm. Parenchyma has normal homogenous echogenicity without focal mass. Normal vascular flow without evidence of torsion.LEFT TESTIS: Measures 3.5 x 2.7 x 3.7 cm. Parenchymal has normal homogenous echogenicity without focal mass. Normal vascular flow without evidence of torsion.RIGHT EPIDIDYMIS: Measures 0.6 x 1.0 x 0.9 cm. No radiographic abnormalities.LEFT EPIDIDYMIS: Measures 0.6 x 0.6 x 1.4 cm. No radiographic abnormalitiesOTHER: Large amount of simple appearing fluid area the left testicle and enlarging the scrotum compatible with a hydrocele. Small anechoic area surrounding the right testicle suggestive of a hydrocele.", "output": "1. Large left-sided hydrocele and small right-sided hydrocele. No sonographic evidence of torsion, focal mass, or infection."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. This additional preventive test was performed due to the level of density in the patient's breast tissue. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. Multiple simple cysts are seen in both breasts. In the left breast at 6:00 position, there is a questionable solid mass, for which repeat ultrasound study is recommended.", "output": "In the left breast at 6:00 position, there is a questionable solid mass, for which repeat ultrasound study is recommended. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "Palpable mass in the lateral right breast. Personal history of Ewings sarcoma and acute lymphocytic leukemia. On physical examination, a 2 cm soft mobile palpable mass is present in the lateral right breast. A bilateral whole breast ultrasound was performed. At the 9 o'clock position of the right breast, 3 cm from the nipple, a 2.6 x 1.6 x 2.6 cm lobulated hypoechoic parallel mass is present with minimal internal vascularity. At the 6 o'clock position of the right breast, 2 cm from the nipple, a 1.2 x 0.9 x 1.5 cm lobulated hypoechoic mass is present with mild internal vascularity. No additional masses are present in either breast.", "output": "Two similarly appearing masses in the right breast, one at 9 o'clock and one at 6 o'clock. Statistically, these are most likely fibroadenomata. However, given the patient's clinical history, referral to the breast clinic for possible FNA based on palpability is recommended. Results and recommendations were discussed with the patient. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female presents as a callback for left breast asymmetry on screening mammogram. No current breast complaints. Three standard views of the left breast and spot compression views of the central 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. A 5 mm asymmetry persists with spot compression, and additionally ultrasound was performed.ULTRASOUND", "output": "Small left breast mammographic asymmetry without sonographic correlate. A six month follow-up diagnostic left mammogram is recommended to confirm stability. These recommendations were discussed with the patient at the time of examination.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "Coagulation defect with rising total bilirubin LIVER: No significant abnormalities noted. 15.9 cm in length. 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: Echogenic parenchyma without mass, stone, or hydronephrosis. 7.3 cm in length.OTHER: Left kidney 11.3 cm in length. Echogenic left renal parenchyma without mass, stone, or hydronephrosis. Spleen 11.3 cm in length. Bilateral pleural effusions. Trace ascites.", "output": "No hepatobiliary abnormality noted. Trace ascites. Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: abnormal masses? History: thyroid cancer status post surgery, papillary thyroid carcinoma RIGHT LOBE: Status post total thyroidectomy without new suspicious lesions in the thyroidectomy bed.LEFT LOBE: Status post total thyroidectomy without new suspicious lesions in the thyroidectomy bed.ISTHMUS: Status post total thyroidectomy without new suspicious lesions in the thyroidectomy bed.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted. No cervical lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Status post total thyroidectomy without evidence of recurrence."}
{"instruction": "Generate impression based on findings.", "input": "year old female who was recalled from screening mammogram for area of pleomorphic microcalcifications in segmental distribution in the left lower central breast with few focal asymmetries. Mammogram: An ML view and two spot magnification 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 are pleomorphic grouped microcalcifications in segmental distribution with associated focal asymmetries in the left lower outer quadrant approximately spanning 7 cm on the cc view, reaching up to the nipple. A small 4 mm cluster of calcification in the left upper-outer quadrant also has similar morphology on spot magnification views.Ultrasound: Targeted left lower outer quadrant ultrasound and axillary ultrasound was performed.Multiple irregular hypoechoic areas with calcifications identified in the left breast 4 to 6:00 position spanning approximately 3.3 cm in maximum contiguous fashion. Located posteriorly, 5 cm from the nipple is a hypoechoic area with few calcifications that measures 6 x 5 x 8 mm. Located anteriorly close to the nipple is a similar hypoechoic area with calcifications that measures 6 x 4 x 8 mm. All these areas demonstrate increased vascularity. In the left upper-outer quadrant a normal morphology intramammary lymph node is identified measuring 1.1 x 0.4 cm. No definite correlate is identified to the small cluster of calcifications in the left upper outer quadrant. Normal morphology left axillary lymph nodes were identified.", "output": "Pleomorphic grouped segmental distribution of calcifications in the left breast 4 to 6:00 position with sonographic correlate needs further evaluation with ultrasound-guided core biopsy (of 2 sites preferably at the anterior and posterior most site).Normal morphology left axillary and intramammary lymph node.4 mm cluster of calcifications in the left upper outer quadrant can be biopsied if additional tissue sampling is needed. This will be based on the pathology results of the ultrasound guided biopsy of the left lower outer quadrant.Findings were conveyed to the patient and her orthopedic surgeon Dr. Arvind Athiviraham, pager 6082 at the time of dictation. Patient was scheduled for an elective knee replacement surgery on 10/2/2015 which has been rescheduled until further notice after discussion with Dr. Arvind Athiviraham, BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old male with history of elevated creatinine. A right iliac fossa transplant kidney is visualized. Two passes were performed. Post-biopsy imaging demonstrates nonspecific increased echogenicity adjacent to the transplant kidney which is nonspecific. There is a 2.2 cm cyst in the transplant kidney with internal septations.", "output": "1. Technical assistance provided for renal biopsy.2. Possible peritransplant collection is incompletely characterized. If further imaging evaluation is warranted clinically, at CT is recommended for further evaluation. 3. Transplant renal cyst with thin internal septations. "}
{"instruction": "Generate impression based on findings.", "input": "54 year old male patient with a left thyroid nodule noted on OSH CT scan. RIGHT LOBE MEASUREMENTS: 5.4 x 1.8 x 2.1 cm.LEFT LOBE MEASUREMENTS: 4.7 x 2.4 x 1.9 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: The right thyroid lobe is homogeneous in echogenicity without focal lesion.LEFT LOBE: The left thyroid lobe is homogeneous in echogenicity and contains a 4.7 x 2.4 x 1.8 cm solid, heterogeneously hypoechoic nodule with a hypoechoic rim within the inferior pole. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is a 1.8 x 0.8 x 0.8 cm left level three lymph node.OTHER: No significant abnormality noted.", "output": "Solid left thyroid nodule which is amenable to biopsy. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Wassenhove is an 87 year old female with a personal history of left breast cancer on neoadjuvant therapy. She needs ultrasound evaluation to evaluate imaging response. On physical exam, there is a 1.5-cm palpable mass at the two o'clock position of the left breast. A targeted left breast ultrasound was performed for the palpable area of concern. In the left breast 2 o'clock location, approximately 5 cm from the nipple, a 1.4 x 1.2 x 1.4 cm irregularly shaped hypoechoic mass is identified with hyperechoic halo. This mass previously measured 1.5 x 1.3 x 1.8 cm in 12/2014.", "output": "Little interval change in size of known left breast cancer.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Female; 67 years old. Reason: usg of liver, cirrhosis, screen for hcc, also f/u GB polyps LIVER: Liver is normal in size measuring 15.1 cm in length. Parenchyma diffusely echogenic with a coarse echotexture. A 1.1 x 1.2 x 1.1 cm simple cyst is seen in the right lobe of the liver, unchanged. No worrisome focal hepatic lesion evident. There is no ascites. The main portal vein is patent with normal hepatopetal flow and a peak velocity of 0.1 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is normal in appearance with a 5 x 4 x 1 mm gallbladder polyp, without significant change. No evidence of cholelithiasis, gallbladder wall thickening or pericholecystic fluid. The common bile duct measures 3 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 12.0 cm in length. The renal cortex is echogenic. No evidence of hydronephrosis or hydroureter. No shadowing caliculi evident.LEFT KIDNEY: The left kidney measures 11.2 cm in length. The renal cortex is echogenic. No evidence of hydronephrosis or hydroureter. No shadowing caliculi evident.SPLEEN: The spleen measures 8.9 cm in length.", "output": "1.Cirrhotic liver, no worrisome hepatic mass.2.Gallbladder polyp.3.Echogenic kidneys suggestive of medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Reason: s/p Renal transplant History: elevated Cr Ultrasound guidance was provided for a transplant kidney biopsy by the nephrology service. Two passes were performed.", "output": "Ultrasound guidance provided for transplant kidney biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine RIGHT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. Right kidney .47 m in length.LEFT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. Left kidney 11.1 cm in length.OTHER: Bladder collapsed.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal function without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "End-stage renal disease with multiple renal cysts RIGHT KIDNEY: Echogenic parenchyma with multiple minimally complex cysts again noted. The largest cyst arising from the mid pole measures 3.2 x 3.1 x 2.6 cm. No hydronephrosis. Right kidney 13.6 cm in lengthLEFT KIDNEY: Echogenic parenchyma with multiple minimally complex cysts again noted. The largest cyst within the lower pole measures 7.1 x 5.1 x 6.4 cm. This cyst demonstrates somewhat more conspicuous peripheral nodularity without increased vascularity. No hydronephrosis. Left kidney 12.4 cm in length.OTHER: Bladder nondistended.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction. No hydronephrosis. Multiple bilateral minimally complex cysts. The largest cyst arising from the lower pole left kidney demonstrates somewhat more conspicuous peripheral nodularity. A contrast enhanced MR or CT would be helpful for further characterization of this cyst; however if intravenous contrast cannot be tolerated by the patient, continued surveillance ultrasound scans with special attention to this cyst is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate mass in left groin History: hard mass in left groin, possible lymph node At the site of palpable abnormality in the superficial tissues of the left inguinal region, there are 2 structures which are compatible with abnormal morphology enlarged lymph nodes. The larger measures 1.6 x 1.2 x 0.9 cm. An additional normal morphology lymph node is identified in the deeper soft tissues.", "output": "Abnormal morphology lymph nodes in the left inguinal region corresponding to the palpable abnormality. Continued follow-up is recommended."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old male patient with abdominal distention. LVAD work up. LIVER: The liver measures 18.3 cm in length. No focal hepatic lesion is identified. The main portal vein is patent with hepatopetal flow. GALLBLADDER, BILIARY TRACT: There is no intra or extrahepatic biliary ductal dilatation. The common bile duct measures 4 mm in diameter. There is echogenic shadowing material within the gallbladder without definite visualization of the gallbladder wall, which is likely contracted and filled with gallstones. Sonographic Murphy's sign is negative.PANCREAS: The pancreas is poorly visualized secondary to overlying bowel gas. SPLEEN: The spleen measures 11.3 cm in length.KIDNEYS: The right kidney measures 11.4 cm in length and the left kidney measures 12.1 cm in length. Renal cortical echogenicity is within normal limits. No evidence of hydronephrosis. ABDOMINAL AORTA: The proximal aorta measures 2.0 x 1.6 cm in diameter and the mid-aorta measures at least 1.6 cm in the AP dimension. The distal abdominal aorta and iliac vasculature is not visualized secondary to overlying bowel gas. INFERIOR VENA CAVA: Flow is identified within the proximal inferior vena cava with an echogenic structure distally, which is compatible with an IVC filter.OTHER: There is a small amount of ascites and bilateral pleural effusions.", "output": "1. No acute abdominal findings. 2. Cholelithiasis and probable contracted gallbladder.3. Bilateral pleural effusions and small amount of ascites. "}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain LIVER: Mildly coarse echogenic liver echotexture without mass. Liver length 15.1 cmGALLBLADDER, BILIARY TRACT: Extensive cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.2 cm in lengthOTHER: Left kidney 11.1 cm in length. Spleen length 16.3 cm", "output": "Mildly coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Extensive cholelithiasis without acute inflammation."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female patient with history of multinodular goiter. RIGHT LOBE MEASUREMENTS: 6.6 x 1.5 x 2.3 cm.LEFT LOBE MEASUREMENTS: 7.2 x 3.0 x 2.3 cm.ISTHMUS MEASUREMENTS: 5 mm in thickness.RIGHT LOBE: No discrete thyroid nodule is identified.LEFT LOBE: A predominantly solid nodule replacing the mid to lower pole of the left thyroid gland measures 3.5 x 2.8 x 3.9 cm, previously 3.4 x 2.4 x 3.8 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable predominately solid dominant left thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "58 year old male patient with persistent MRSA bacteremia. Evaluate left upper arm near graft site for abscess. Targeted ultrasound performed over the patient's left upper arm arteriovenous graft demonstrates an elongated 2.7 x 0.5 x 1.2 cm area of subcutaneous heterogeneity superficial to the AVG with a small amount of insinuating fluid. A region of hypoechogenicity also extends from this to the posterior surface of the AVG along one side. There is no significant increased vascularity of this region on color Doppler imaging. Flow is identified within the graft.", "output": "Heterogeneity of the subcutaneous tissues with a small amount of fluid anterior to the AVG favored to represent a small complex hematoma given patient's history; no surrounding hypervascularity visualized but superimposed infection not entirely excluded, correlate with patient's laboratory values/physical exam. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: Please evaluate left inguinal abscess and popliteal area cyst. Examination limited by patient motion.Ultrasound images of the left inguinal area reveal benign morphology lymph nodes without evidence of abnormal fluid collection or abscess.Ultrasound images of the left popliteal fossa demonstrate a predominantly anechoic structure measuring 2.5 x 3.7 x 1.1 cm with minimal internal complexity but without internal blood flow. No definitive neck is identified.", "output": ".1.Left inguinal lymph nodes without evidence of left inguinal abscess as clinically questioned.2.Cystic structure in left popliteal fossa which is nonspecific but favor benign etiology such as a popliteal cyst."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old male with abscess. Again seen is diffuse edema in skin thickening of the subcutaneous tissues of the inner thigh. A small phlegmon/abscess measuring 1.0 x 0.7 x 0.4 cm is not significant change since the prior study.", "output": "No significant interval change in small abscess/phlegmon and subcutaneous edema."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for whole breast ultrasound for dense breast screening. She has a family history of breast cancer in her sister (diagnosed at the age of 26) and paternal grandmother. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. Few scattered simple cysts of the right breast. No suspicious cystic or solid mass is identified.This exam was interpreted by two radiologists.", "output": "No sonographic evidence for malignancy. Given her strong family history, a consultation with the high risk clinic/genetic counselor is advised.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "SLE with swelling in abdominal pain LIVER: Coarse echogenic liver echotexture without mass. Liver length 13.6 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.1 cm in lengthOTHER: Left kidney 10.5 cm in length. Spleen not visualized. No ascites", "output": "Coarse echogenic liver echotexture suggestive for parenchymal dysfunction/fatty infiltration without mass or ductal dilatation. Cholelithiasis without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Lower abdominal pain and tenderness with progression of chronic renal disease RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: Increased parenchyma echogenicity again noted. Multiple cysts stable.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 Interval improvement in systolic wave form upstroke now without evidence for delay. No change in diastolic dampening with increased resistive indices again noted. Resistive index of the renal arteries range from 0.8 to 0.9.OTHER: No significant abnormality noted", "output": "No change in echogenic renal parenchyma. No evidence for worrisome mass, perinephric collection, or obstruction.Interval improvement in systolic wave form upstroke now without evidence for delay. No change in diastolic dampening consistent with increased parenchymal resistance pattern."}
{"instruction": "Generate impression based on findings.", "input": "Epigastric pain LIVER: Normal parenchymal echogenicity without mass. Liver length 13.1 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 9.8 cm in length. Spleen 9.6 cm in length. No ascites.", "output": "Negative right upper quadrant ultrasound. No hepatobiliary abnormality."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old male with symptoms of renal failure, evaluate for flow and hydronephrosis ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures 13.7 cm in length. There is increased echogenicity within the cortex. There is no hydronephrosis or stones seen. No new worrisome masses.LEFT KIDNEY: Left kidney was not visualized due to heart assistance device, tubing, and bandages.OTHER:No significant abnormalities noted within the bladder. The Foley catheter is in place within the bladder. Small amount of fluid seen superior to the bladder.", "output": "1. No hydronephrosis, stones, or worrisome masses are seen within the right kidney. The right kidney has increased echogenicity within the cortex consistent with medical renal disease. The left kidney was not visualized due to tubing, bandages, and heart assistance device.2. Small amount of fluid seen superior to the bladder."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis LIVER: Cirrhotic morphology again noted without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 16 cm.BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 20 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 12.9 cm in lengthOTHER: Left kidney 12.8 cm in length. No ascites.", "output": "Stable cirrhotic morphology without mass or ductal dilatation. No ascites. Cholelithiasis without acute inflammation."}
{"instruction": "Generate impression based on findings.", "input": "Liver failure LIMITED ABDOMENLIVER: Coarse echogenic liver echotexture without mass. Mildly irregular contour. Liver length 16.6 cm.BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. RIGHT KIDNEY: No significant abnormalities noted. 11.9 cm in lengthOTHER: Left kidney 11.2 cm in length. Spleen 12.6 cm in length. Trace ascites; right pleural effusion.", "output": "Coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Mildly irregular liver contour raises the possibility of cirrhosis. Patent but hepatofugal portal venous flow. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old male patient with history of choledocholithiasis. LIVER: The liver measures 15.4 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopedal and measures approximately 0.2 m/s.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. No intra or extrahepatic biliary ductal dilatation is identified. The common bile duct measures approximately 2 mm in diameter.PANCREAS: The head of the pancreas demonstrates normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 9.5 cm in length. No evidence of hydronephrosis.OTHER: The left kidney measures 9.2 cm in length. No evidence of hydronephrosis.The spleen measures 6.5 cm in length.", "output": "No intra or extrahepatic biliary ductal dilatation or specific evidence of obstructing stone."}
{"instruction": "Generate impression based on findings.", "input": "Male 64 years old Reason: eval thyroid nodule seen on CT of chest RIGHT LOBE MEASUREMENTS: 5.2 x 2.2 x 1.3 cm.LEFT LOBE MEASUREMENTS: 5.4 x 2.1 x 1.1 cm.ISTHMUS MEASUREMENTS: 0.6 cm.RIGHT LOBE: Within the right thyroid lobe there is a linear, shadowing calcification. Background echogenicity of the right thyroid lobe is mildly heterogeneous.LEFT LOBE: Mildly heterogeneous background echogenicity. No nodules or significant abnormality.ISTHMUS: Solid, hypoechoic nodule in the right isthmus with mildly increased vascularity and a hypoechoic rim measures 1.5 x 1.0 x 1.8 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing left level 3 lymph node measures 0.7 x 0.5 x 0.8 cm.OTHER: No significant abnormality noted.", "output": "Hypoechoic, predominantly solid nodule in the right isthmus is amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "NASH with altered mental status LIVER: Cirrhotic morphology again noted. Estimated liver length 11.2 cm. No obvious discrete lesion seen; however technical limitations limit comprehensive evaluation. Limited Doppler interrogation of the hepatic vessels again demonstrate a patent but attenuated main portal vein with reversal of portal venous flow.GALLBLADDER, BILIARY TRACT: Gallbladder absent. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.4 cm in lengthOTHER: Spleen 14.8 cm in length. Mild ascites.", "output": "Cirrhotic morphology again noted. No obvious discrete lesion seen; however technical limitations limit comprehensive evaluation. Limited Doppler interrogation of the hepatic vessels again demonstrate a patent but attenuated main portal vein with reversal of portal venous flow; this reversal of main portal flow presumably secondary to extensive portosystemic collaterals seen on the recent MR. Mild ascites"}
{"instruction": "Generate impression based on findings.", "input": "Pregnant patient with pyelonephritis. Evaluate for obstruction. RIGHT KIDNEY: Right kidney measures 15.3 cm. Mild right hydronephrosis that persists after voiding. No renal calculus or mass identified.LEFT KIDNEY: Small left kidney measures 10.3 cm, unchanged. No left hydronephrosis, suspicious lesion or renal calculus identified.URINARY BLADDER: Minimal residual fluid post void. Unremarkable urinary bladder.OTHER: No significant abnormalities noted.", "output": "Mild right hydronephrosis that persists after voiding. Given history, concern for obstructing pyelonephritis. No renal calculus or mass identified."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male with upper limit of normal calcium and parathormone. Evaluate for parathyroid adenoma. RIGHT LOBE MEASUREMENTS: 4.6 x 1.6 x 1.5 cmLEFT LOBE MEASUREMENTS: 3.5 x 1.5 x 1.6 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Normal echotexture. There is a single, very small cystic nodule measuring less than 3 mm in diameterLEFT LOBE: Normal echotexture. The left lobe extends below the clavicle and therefore the lower pole is not well visualized.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No definite mass although visualization left lower pole is limited.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Small and benign-appearing cystic nodule on the right.No definite parathyroid adenoma although visualization of the left lower pole is limited."}
{"instruction": "Generate impression based on findings.", "input": "79-year-old female with metastatic breast cancer and abnormal liver function. LIVER: Hepatic size is normal upper normal. There is diffuse replacement of hepatic parenchyma by metastatic disease. BILIARY TRACT: The patient has had a cholecystectomy. There is no obvious, focal biliary tract dilatation and the common bile duct is normal in caliber.PANCREAS: Poorly visualized due to bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: Spleen not visualized. Patient has had a left nephrectomy.", "output": "Diffuse metastatic replacement of hepatic parenchyma without biliary abnormality."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old male with a provided history of left-sided thyroid nodule and papillary thyroid cancer. RIGHT LOBE MEASUREMENTS: 1.9 x 2.1 x 5.6 cmLEFT LOBE MEASUREMENTS: 1.7 x 1.9 x 5.1 cmISTHMUS MEASUREMENTS: 1 mmRIGHT LOBE: The right thyroid parenchyma is normal in morphology, echogenicity, and size.LEFT LOBE: Seen again in the inferior left thyroid lobe is a 1.4 x 1.2 x 1.5 cm hypoechoic nodule with associated coarse and micro-calcifications, posterior shadowing and lobulated margins. In the medial aspect of the inferior left thyroid lobe is a 6 x 4 x 6 mm very hypoechoic nodule without significant vascularity or definite calcifications.In the lateral aspect of the inferior left lobe is a 5 x 4 x 4 mm hypoechoic nodule without significant vascularity or definite calcifications.The background thyroid parenchyma is normal in echogenicity.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is a suspicious left level 4 lymph node measuring 9 x 7 x 9 mm with a round morphology, mild vascularity and possible non-shadowing microcalcifications.Right level 4 lymph node measuring 8 x 3 x 5 mm is oval shaped with a probable fatty hilum.Right level 2 lymph node measuring 6 x 3 x 5 mm, is oval-shaped with a probable fatty hilum although underlying non-shadowing microcalcifications cannot be entirely excluded.", "output": "1. 1.5 cm left thyroid nodule with features consistent with provided history of papillary thyroid carcinoma. Additional left indeterminate subcentimeter nodules. 2. Left level 4 lymph node is suspicious for nodal metastatic disease. 3. Right sided lymph nodes, with benign-favoring appearance, see above."}
{"instruction": "Generate impression based on findings.", "input": "History of left breast benign biopsy 2007, patient presents with palpable lump in her left breast.Recent mammogram from May 2016 was within normal limits. A targeted left ultrasound was performed for the patient\u2019s area of concern at 11:00 position 6 cm from the nipple. On physical examination, no discrete palpable mass noted. Patient complains of tenderness over that area. There is no solid or cystic mass identified. Normal glandular tissue noted.", "output": "No sonographic evidence for malignancy corresponding to patient's palpable area of concern in the left breast 11:00 position.Routine diagnostic mammogram is recommended due in May 20, 2017BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "History of kidney stones, evaluate for hydronephrosis RIGHT KIDNEY: Measures 10.3 cm. No hydronephrosis or mass. Scattered nonobstructive stones in the renal pelvis measure up to 0.6 cm. 0.6 cm mid pole cyst.LEFT KIDNEY: Measures 9.3 cm. No hydronephrosis or mass. Scattered nonobstructive stones in the renal pelvis measure up to 0.4 cm.BLADDER: No significant abnormalities noted.", "output": "Bilateral nonobstructive renal pelvis stones."}
{"instruction": "Generate impression based on findings.", "input": "80-year-old male with microscopic hematuria RIGHT KIDNEY: Measures 10.2 cm in length. Increased renal echogenicity without hydronephrosis. 1.5 cm inferior pole right renal cyst without septation or solid component.LEFT KIDNEY: Measures 10.2 cm in length. Increased renal echogenicity without hydronephrosis. 1.7 cm upper-mid left renal cyst without septation or solid component. URINARY BLADDER: Incompletely distended. No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "1. Increased renal echogenicity consistent with medical renal disease. 2. No hydronephrosis or nephrolithiasis. "}
{"instruction": "Generate impression based on findings.", "input": "Male 69 years old; Reason: Pt with thyrotoxicosis, eval for thyroid nodules and/or hyperemia History: Thyrotoxicosis RIGHT LOBE MEASUREMENTS: 3.9 x 1.6 x 3.1 cm.LEFT LOBE MEASUREMENTS: 3.5 x 1.5 x 2.1 cm.ISTHMUS MEASUREMENT: 0.5 cm.RIGHT LOBE: Heterogeneous echotexture without focal mass. No increased vascularity.LEFT LOBE: Heterogenous echotexture without concerning mass. No increased vascularity. There is a subcentimeter hypoechoic round lesion consistent with a benign colloid cyst measuring 0.4 x 0.4 x 0.3cm.ISTHMUS: Heterogeneous echotexture without focal mass. No increased vascularity.LYMPH NODES: No adenopathy noted. OTHER: No significant abnormality noted.", "output": "1.Diffuse heterogenous echotexture of thyroid suggestive for chronic thyroiditis without acute increased vascularity. No worrisome mass or adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. 10.7 cm in lengthLEFT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. 10 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": "Right upper quadrant pain and leukocytosis LIVER: Coarse echogenic liver echotexture without mass. Liver length 7.2 cm.GALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.8 cm in length.OTHER: 2.3 x 1.6 x 2.1 lesion arising from the midportion of the left kidney with heavily calcified rim. Left kidney 12.1 cm in length. Spleen not visualized. No ascites.", "output": "Echogenic liver suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Cholelithiasis without acute inflammation.Left renal lesion with heavily calcified rim of unclear significance. Given the patient's body habitus and inability to have a CT exam, would recommend surveillance follow-up via ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "Hypokalemia; there is clinical a concern for an adrenal mass. RIGHT ADRENAL: Not well visualized; no obvious masses are noted in the suprarenal space.LEFT ADRENAL: Not well visualized; no obvious masses are noted in the suprarenal space.RIGHT KIDNEY: No significant abnormalities noted, specifically no mass, stones, or hydronephrosis.LEFT KIDNEY: No significant abnormalities noted, specifically no mass, stones, or hydronephrosis.URINARY BLADDER: Visualization is limited due to patient's body habitus.OTHER: No significant abnormalities noted.", "output": "No adrenal masses evident on this study; however, the sensitivity of ultrasound to detect a suprarenal mass is limited. If a suprarenal/adrenal mass is clinical suspected, would recommend cross-sectional imaging such is CT or MR.Negative renal ultrasound without evidence for mass, stone, or hydronephrosis"}
{"instruction": "Generate impression based on findings.", "input": "Female 97 years old; Reason: epigastric pain, r/o pathology History: pain in epigastrum LIVER: The liver measures 12 point cm in length. There is normal 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 14.5 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.9 mm. Small shadowing echogenic foci are seen within the gallbladder along with minimal sludge. Negative sonographic Murphy sign. 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 8.2 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 8.5 cm in length. The cortex has slightly increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen. At the superior pole a renal cyst is seen measuring 2.9 cm x 3.4 cm x 3.0 cm.LEFT KIDNEY: The left kidney measures 8.8 cm in length. The cortex has slightly increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. Cholelithiasis without evidence of acute cholecystitis. No intrahepatic ductal dilation is seen.2. Bilaterally the kidneys have slightly increased echogenicity compatible with medical renal disease. No evidence of hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "48 years, Female, Reason: Lymph node mapping for PTC History: Lymph node mapping for PTC. RIGHT LOBE MEASUREMENTS: 1.7 x 1.1 x 3.8 cmLEFT LOBE MEASUREMENTS: 1.3 x 1.4 x x 4 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Heterogeneous, predominantly hypoechoic solid hypovascular lesion in the left mid pole containing calcifications compatible with patient's known papillary thyroid carcinoma measures 1.2 x 1.5 x 2.1 cm.ISTHMUS: Hypoechoic lesion in the isthmus measuring 0.6 x 0.3 x 0.6 cm with increased through transmission likely represents a cyst.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Left level 3 node measures 0.7 x 0.3 x 0.8 cm, but has an abnormal morphology and contains a calcification.OTHER: No significant abnormality noted.", "output": "1.Left lower pole lesion corresponding to patient's known papillary thyroid carcinoma.2.Subcentimeter left level 3 node with abnormal morphology and calcification."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 9.2 cm in lengthLEFT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 10.8 cm in length.OTHER: Bladder nondistended.", "output": "Mildly echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Johnson is a 62-year-old female with a personal history of left breast lumpectomy in 2008 for DCIS status post adjuvant radiation therapy. In clinic today, Dr. Chhablani palpated a possible enlarged right axillary lymph node. She presents today for ultrasound evaluation. Upon physical exam at the area marked by Dr. Chhablani, no discrete mass is appreciated. There are several enlarged superficial veins identified in the axillary and upper arm area.A targeted right axillary ultrasound was performed for the palpable area of concern. Three normal axillary lymph nodes identified in the area marked by Dr. Chhablani. No suspicious cystic or solid mass is identified.", "output": "Normal axillary lymph nodes in the right axilla. No sonographic evidence of malignancy. All findings relayed to Dr. Chhablani in person at time of dictation.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Male; 51 years old. Reason: Increasing kidney function tests in setting of OLT RIGHT KIDNEY: The right kidney measures 10.1 cm in length. Renal parenchyma is normal in echogenicity. There is no hydronephrosis or shadowing renal stone.LEFT KIDNEY: Evaluation of the left kidney is somewhat limited. The left kidney measures 11.9 cm in length. Renal parenchyma is normal in echogenicity. A few simple appearing cysts are seen within the kidney, the largest measures 1.2 x 0.9 x 1.1 cm. There is no hydronephrosis or shadowing renal stone.URINARY BLADDER: The bladder is decompressed which limits evaluation for focal lesions. Free fluid is seen superior to the bladder.OTHER: Adjacent to the liver, in the right upper quadrant there is a complex, loculated fluid collection likely representing postoperative fluid/hematoma..", "output": "1.No hydronephrosis.2.2.1 cm simple appearing left renal cyst.3.Heterogeneous collection in the right upper quadrant is of uncertain significance. "}
{"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": "Male; 59 years old. Reason: nephrology rec History: AKI RIGHT KIDNEY: The right kidney measures 11.6 cm in length. The cortex demonstrates normal echogenicity. There is no hydronephrosis, shadowing renal stone, or concerning mass identified.LEFT KIDNEY: The left kidney measures 12.8 cm in length. The cortex demonstrates normal echogenicity. There is no hydronephrosis, shadowing renal stone, containing mass identified.URINARY BLADDER: The bladder is decompressed by Foley catheter.OTHER: No significant abnormalities noted.", "output": "1.No hydronephrosis. Normal ultrasound of the kidneys."}
{"instruction": "Generate impression based on findings.", "input": "Female 65 years old; Reason: Pt c/o minor abdominal pain and distension. Desire to r/o Ascites, and potentional umbilical hernia History: distention, peri-umbilical tenderness LIVER: Limited views of the liver obtained however the liver is coarsely echogenic.RIGHT KIDNEY: The right kidney measures 10.3 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney is partially visualized and appears to have increased echogenicity. A renal cyst is seen along the midpole.OTHER: There is a fluid containing umbilical hernia noted measuring 1.2 cm x 1.5 cm x 1.5 cm. There is no definite connection between this collection and the abdomen.", "output": "1. A fluid collection is seen within the umbilicus, however no definite connection is seen with the abdomen. No definite umbilical hernia is visualized.2. No intra-abdominal ascites is visualized.3. The liver appears coarse and echogenic compatible with fatty infiltration/hepatocellular dysfunction. Only limited views of the liver in this study.4. Bilaterally the kidneys have increased echogenicity compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Microhematuria RIGHT KIDNEY: No mass, stone, or hydronephrosis. Right kidney 12.7 cm in length.LEFT KIDNEY: No mass, stone, or hydronephrosis. Left kidney 13.3 cm in length.OTHER: Bladder nondistended", "output": "No renal mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old male with renal cysts, evaluate stability, size, mass or suspicious lesion. History of weight loss, fatigue. RIGHT KIDNEY: Measures 10.8 cm in length. Increased renal echogenicity. 2.2 x 2.1 x 1.9 cm renal cyst with a prominent solid component is indeterminate and warrants further investigation. An adjacent cyst measuring 1.7 x 1.9 x 1.8 cm demonstrates no septation or solid component. No hydronephrosis.LEFT KIDNEY: Measures 11.4 cm in length. Multiple left renal cysts measuring up to 2.3 cm without septation or solid component. Increased echogenicity without hydronephrosis.URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.", "output": "1. Right renal inferior pole cyst with a prominent solid component is indeterminate and warrants further investigation with a dedicated renal protocol contrast enhanced MRI or CT. Additional renal cysts are without suspicious features. 2. Increased renal echogenicity consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Suspected umbilical hernia. Targeted grayscale and color Doppler ultrasound was performed of the umbilical and left periumbilical region corresponding to the patient's reported site of palpable abnormality. No fluid collection or evidence of a hernia is evident. The peri-umbilical soft tissues were symmetric", "output": "No hernia or fluid collection was visualized."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal distention abdominal pain No abdominal ascites", "output": "No abdominal pelvic ascites"}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with cirrhosis presents for evaluation of mass. LIVER:The liver measures 16.5 cm. The parenchyma is coarse and increased with a nodular contour and cirrhotic morphology. No focal lesions to suggest hepatocellular carcinoma. No ascites. No intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Gallbladder is absent.PANCREAS: No significant abnormality noted.SPLEEN: Measures 13.5 cm. No sonographic abnormalities.KIDNEYS: The right kidney measures 11.4 cm. The left kidney measures 11.4 cm. No shadowing calculi, or worrisome mass, or hydronephrosis. The cortices has normal echogenicity. OTHER: No significant abnormality noted.", "output": "1. Increased and coarse echogenicity of liver consistent with chronic liver disease/parenchymal dysfunction. Cirrhotic morphology noted. No focal lesions to suggest hepatocellular carcinoma. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Fever, transaminitis LIVER: Measures 19.2 cm. No focal hepatic masses. The portal vein is patent.GALLBLADDER, BILIARY TRACT: Gallbladder sludge without wall thickening or biliary dilation.PANCREAS: No significant abnormality noted.SPLEEN: Measures 11.9 cm.KIDNEYS: Right kidney measures 13.4 centers. Left kidney measures 14.0 cm. No hydronephrosis or mass.", "output": "Gallbladder sludge without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Episodic right upper quadrant pain LIVER: No significant abnormalities noted. 15.2 cm in length GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.9 cm in lengthOTHER: Left kidney 12 cm in length. Spleen 7.9 cm in length. No ascites", "output": "Negative right upper quadrant ultrasound. Specifically, no evidence for hepatobiliary abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Microhematuria RIGHT KIDNEY: Benign renal cysts again noted. Normal echogenicity without worrisome mass, stone, or hydronephrosis. Right kidney 10.9 cm in length.LEFT KIDNEY: Benign cysts again noted. Normal echogenicity without worrisome mass, stone, or hydronephrosis. Left kidney 11.3 cm in length.OTHER: Bladder nondistended", "output": "Stable bilateral renal cysts. Normal parenchymal echogenicity without worrisome mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old female post thyroidectomy for thyroid cancer. 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": "29-year-old male patient with ascites. Evaluate ascites. There is a moderate amount of abdominal ascites with the majority of fluid located around the liver.", "output": "Moderate ascites, mostly in a perihepatic location."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with chronic lymphocytic thyroiditis. RIGHT LOBE MEASUREMENTS: 6.9 x 3 x 2.3 cmLEFT LOBE MEASUREMENTS: 7.3 x 2.6 x 3.4 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Diffusely heterogeneous with echogenic and interspersed more hypoechoic areas. No dominant nodule other than one very small cystic area.LEFT LOBE: Diffusely heterogeneous with echogenic and interspersed more hypoechoic areas. No dominant nodule.ISTHMUS:Diffusely heterogeneous with echogenic and interspersed more hypoechoic areas. No dominant nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Thyromegaly with appearance consistent with chronic thyroiditis. No dominant mass."}
{"instruction": "Generate impression based on findings.", "input": "Male 30 years old; Reason: Elevated transaminases, eval liver, gall bladder, pancreas History: None LIVER: The liver measures 19.4 cm in length. There is 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 23.6 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 3.0 mm. No stones or sludge are seen. No pericholecystic fluid. The common bile duct measures 2.6 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 13.1 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.0 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.7 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.", "output": "1. There is increased echogenicity of the liver compatible with fatty infiltration/hepatocellular dysfunction. No focal hepatic lesions are seen.2. Mild hepatomegaly is present, the spleen size is at the upper limits of normal.3. No evidence of cholelithiasis or acute cholecystitis are seen."}
{"instruction": "Generate impression based on findings.", "input": "62 year old female with multinodular goiter. Evaluate for change in nodules. RIGHT LOBE MEASUREMENTS: 6.9 cm x 3.0 cm x 2.0 cmLEFT LOBE MEASUREMENTS: 8.4 cm x 3.9 cm x 2.7 cmISTHMUS MEASUREMENTS: 3 mm in thicknessRIGHT LOBE: Heterogeneous in echotexture with multiple nodules similar to prior study. Small right lower pole nodule with coarse calcification measures 4 mm x 4 mm x 4 mm, previously 3 mm x 4 mm x 5 mm.LEFT LOBE: Heterogeneous in echotexture with multiple nodules similar to prior study. Dominant nodule in the midpole measures 3.5 cm x 3.3 cm x 2.3 cm previously measured 3.3 cm x 3.3 cm x 2.2 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Multiple bilateral lymph nodes, although few mildly prominent, benignity favored given fatty hila, may be reactive in etiology. Left benign appearing lymph node measures 1.5 cm x 0.9 cm x 0.5 cm. Multiple benign appearing lymph nodes are seen in the right neck, one which measures 1.0 cm x 0.6 cm x 1.7 cm. OTHER: No significant abnormality noted.", "output": "Heterogeneous nodular thyroid compatible with multinodular goiter not significantly changed."}
{"instruction": "Generate impression based on findings.", "input": "Hyperparathyroidism history of thyroid cancer status post thyroidectomy 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 mass or regional adenopathy"}
{"instruction": "Generate impression based on findings.", "input": "Female 49 years old Reason: r/o recurrence History: h/o thyroid cancer MEASUREMENTS: Patient is status post thyroidectomy.RIGHT LOBE: No significant residual thyroid tissue is present. No abnormal nodules or masses.LEFT LOBE: No significant residual thyroid tissue is present. No abnormal nodules or masses.ISTHMUS: Post thyroidectomyPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No abnormal lymph nodes are present. A small benign-appearing lymph node is measured on the left at level 3 measuring 1.5 x 0.4 x 0.4 cm.OTHER: No significant abnormality noted.", "output": "No evidence of recurrent or locally metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "26 year old with history of surgical excision of a right breast fibroadenoma in June 2012, and biopsy proven fibroadenoma in both breasts. Whole breast ultrasound was performed for both breasts. There is a proven fibroadenoma at 11:00 position in the left breast measuring 19 x 11 x 14 mm (previously 22 x 12 x 17 mm), and at 6:00 position in the right breast measuring 19 x 19 x 16 mm (previously 18 x 10 x 19 mm). There are additional benign appearing masses in both breasts, at least 8 masses in right breast and 5 masses in the left breast in total. All masses appear to be fibroadenomata.", "output": "Stable biopsy proven fibroadenoma in both breasts with multiple fibroadenomata. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Palpable area of concern in the left breast marked by the clinical service. A targeted left ultrasound was performed for the areas marked by the clinical service. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy. Continued correlation with physical exam is recommended, and if the area continues to be of concern, follow-up ultrasound could be considered.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Palpable thyroid nodule RIGHT LOBE MEASUREMENTS: 4.8 x 1.6 x 1.2 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.5 x 0.9 cmISTHMUS MEASUREMENTS: 0.2 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": "Negative thyroid ultrasound. Specifically, no evidence for thyroid nodule or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Kahn is a 27 year old female with a personal history of mildly painful right breast lump that has resolved. Targeted grayscale and Doppler ultrasound of the right breast was performed.There are no masses or other suspicious findings identified within the area of concern of the right breast. Normal fibroglandular tissue is visualized within the breast. Mild pain is noted to deep pressure with ultrasound probe.", "output": "No ultrasonographic evidence of breast pathology. Given mild pain to deep pressure with ultrasound probe, pain may be musculoskeletal in etiology. Instructions to follow-up with primary physician if needed were given to patient. BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "HCV LIVER: Echogenic coarse liver echotexture without mass. Liver length 15.6 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.9 cm in lengthOTHER: Left kidney 11.2 cm in length. Spleen 7.2 cm in length. No ascites.", "output": "Echogenic coarse liver echotexture consistent with chronic liver disease without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Reason: familial adenomatous polyposis; increased risk of thyroid cancer. RIGHT LOBE MEASUREMENTS: 6.1 x 2.1 x 2.2 cm.LEFT LOBE MEASUREMENTS: 4.9 x 2.0 x 1.5 cm.ISTHMUS MEASUREMENTS: Measures up to 0.2 cm in thickness.RIGHT LOBE: Normal background parenchymal echotexture without discrete nodules.LEFT LOBE: Normal background parenchymal echotexture without discrete nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No suspicious cervical lymphadenopathy identified.OTHER: No significant abnormality noted.", "output": "No worrisome thyroid nodule or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Male 24 years old Reason: Intermittent LUQ pain, assess for splenomegaly/hepatomegaly History: Intermittent LUQ pain, assess for splenomegaly/hepatomegaly LIVER: Liver parenchyma is normal. No focal mass. Liver measures 16 cm, within normal limits. Main portal vein is patent with normal directional flow and a peak velocity of 29 cm/s.BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. Common bile duct measures 3 mm. Gallbladder is normal in appearance. No gallstones.PANCREAS: Visualized portion of the pancreas are normal.SPLEEN: Spleen is normal in appearance measuring 11.5 cm.RIGHT KIDNEY: Normal cortical echogenicity. No hydronephrosis or shadowing stone. Right kidney measures 11.5 cm. LEFT KIDNEY: Normal cortical echogenicity. No hydronephrosis or shadowing stone. Left kidney measures 11.8 cm.OTHER: No significant abnormalities noted.", "output": "Normal appearance of the liver and spleen. No specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Chronic renal disease RIGHT KIDNEY: Mildly echogenic renal parenchyma without mass, stone, or hydronephrosis. 10 cm in lengthLEFT KIDNEY: Mildly echogenic renal parenchyma without mass, stone, or hydronephrosis. 11.2 cm in lengthOTHER: Bladder not visualized", "output": "Mildly echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female with anterior abdominal wall pain. Evaluate for periumbilical hernia. There is no defect seen in the anterior abdominal wall. No herniation of fat or bowel.", "output": "No ultrasound evidence for periumbilical hernia."}
{"instruction": "Generate impression based on findings.", "input": "59 year old female with history of bilateral papillary renal cancer post partial nephrectomies. Evaluate for recurrence. Polycystic kidney disease. RIGHT KIDNEY: Kidney is grossly enlarged measuring at least 18.3 cm in length. Multiple simple and complex cysts throughout the right kidney as well as calcification. No obvious solid mass. Detection of small solid masses in this patient by ultrasound would be limited. No hydronephrosis.LEFT KIDNEY: Kidney is grossly enlarged measuring at least 19.9 cm in length. Multiple simple and complex cysts throughout the right kidney as well as calcification. No obvious solid mass. Detection of small solid masses in this patient by ultrasound would be limited. No hydronephrosis.OTHER: Bladder incompletely distended.", "output": "Polycystic kidneys with simple and complex cystic masses. No gross change."}
{"instruction": "Generate impression based on findings.", "input": "Papillary thyroid carcinoma 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 mass or regional adenopathy"}
{"instruction": "Generate impression based on findings.", "input": "Ms. Slavik is a 60-year-old female presenting for a short-term 6 month follow-up for complicated cysts of the right breast. She has no current breast related complaints. On physical exam at the mammographic areas of concern, no discrete masses are palpated.A targeted right breast ultrasound was performed for the mammographic areas of concern. -In the right breast 6:00 location, approximately 1 cm from the nipple, there is revisualization of a round anechoic mass measuring 0.3 x 0.2 x 0.3 cm, previously measuring 0.4 x 0.3 x 0.3 cm. Sonographic findings are compatible with a simple cyst.-In the right breast 10:00 location, approximately 2 cm from the nipple, there is revisualization of a round anechoic mass measuring 0.4 x 0.3 x 0.4 cm, previously measuring 0.4 x 0.2 x 0.4 cm. Sonographic findings are compatible with a simple cyst.", "output": "Simple cysts of the right breast. No sonographic evidence for malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually, due next in May 2016. All results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs status post stem cell transplant. Nodule lymphoma and myelodysplastic disease LIVER: Coarse echogenic liver parenchyma without mass. Liver length 19.4 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Renal cysts. Right kidney 13.1 cm in lengthOTHER: Limited evaluation of the main portal vein demonstrates a patent portal vein with hepatopedal flow. Main portal vein velocity 22 cm/s. Left renal cyst. Left kidney 11.9 cm in length. Spleen 9.2 cm in length. No ascites.", "output": "Hepatomegaly with coarse echogenic liver parenchyma consistent with parenchymal dysfunction/fatty infiltration without worrisome mass or ductal dilatation. No ascites. Patent main portal vein with normal directional flow."}
{"instruction": "Generate impression based on findings.", "input": "75-year-old male with history of alcohol abuse and hematemesis. Reason: Assess hepatic anatomy and vasculature. LIVER: Course echogenic liver echotexture without mass. The liver measures 16.2 cm in length.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 11.3 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 12 cm. The cortex is of normal echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: No significant abnormalities noted.OTHER: No ascites.", "output": "1. Coarse echogenic liver parenchyma suggestive of parenchymal dysfunction/fatty infiltration without mass or ductal dilatation.2. Patent hepatic vessels with normal directional flow.3. No significant ascites."}
{"instruction": "Generate impression based on findings.", "input": "Male, 71 years old. BPH. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 6.6 cm in length, with significantly increased cortical echogenicity. No hydronephrosis or perinephric fluid.LEFT KIDNEY: The left kidney measures 11.3 cm in length with mild increased cortical echogenicity. No hydronephrosis or perinephric fluid.OTHER: The bladder is distended. The prostate measures 6.1 x 5.8 x 4.3 cm. Post void residual volume is approximately 446 mL.", "output": "1.Atrophic right kidney and increased renal cortical echogenicity, compatible with medical renal disease. No hydronephrosis.2.Enlarged prostate and significant post-void residual volume."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old male patient with primary hyperparathyroidism. Evaluate for thyroid nodules, size, location, and parathyroid adenomas. RIGHT LOBE MEASUREMENTS: 6.3 x 2.4 x 2.1 cm.LEFT LOBE MEASUREMENTS: 6.3 x 2.3 x 1.9 cm.ISTHMUS MEASUREMENTS: 3 mm in thickness.RIGHT LOBE: The right thyroid lobe is slightly heterogeneous in echogenicity without dominant thyroid nodule. There are a few scattered subcentimeter cysts.LEFT LOBE: There is a 1.7 x 1.5 x 1.4 cm well-circumscribed, relatively hypoechoic solid nodule within the left midpole. This nodule demonstrates mild peripheral vascularity and has a hypoechoic rim. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: There is a 3.0 x 1.7 x 1.8 cm well-circumscribed, hypoechoic nodule posterior and inferior to the right lower pole with an internal cystic component.LYMPH NODES: Benign morphology lymph nodes are noted in the right neck.OTHER: No significant abnormality noted.", "output": "1. Parathyroid adenoma candidate posterior and inferior to the right lower pole.2. Solid hypoechoic nodule within the left midpole of thyroid gland; this would be amenable to percutaneous biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Palpable goiter RIGHT LOBE MEASUREMENTS: 7.4 x 4.3 x 3.3 cmLEFT LOBE MEASUREMENTS: 8.9 x 4 x 5.6 cm ISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Enlarged and diffusely heterogeneous gland. Lower pole mixed cystic and solid nodule measuring 5 x 3.7 x 3.2 cm.LEFT LOBE: Enlarged diffusely heterogeneous gland. Lower pole mixed cystic and solid nodule measuring 5.6 x 3.5 x 5.3 cm.ISTHMUS: Multiple predominantly cystic isthmic nodules, the largest measuring 1 x 0.6 x 0.8 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Enlarged and diffusely heterogeneous gland. Bilateral dominant mixed cystic and solid nodules; favor benign etiology. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old female with pancreatitis. Evaluate for gallstones. LIVER:Measures 14.4 cm. Unremarkable echogenicity. No ascites, or intrahepatic biliary dilation. Portal vein is patent with hepatopedal flow.GALLBLADDER, BILIARY TRACT: Gallbladder is nondistended with an anechoic lumen. Wall measures 0.2 cm. No pericholecystic fluid, stones, or sludge. Common bile duct measures 0.4 cm.PANCREAS: Evaluation the pancreas is limited due to inability to tolerate exam and overlying bowel gas.SPLEEN: Measures 11.4 cm without sonographic abnormality.KIDNEYS: Right kidney measures 11.1 cm. Left kidney measures 12.3 cm. Unremarkable echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "Normal ultrasound of the abdomen."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male with chronic hepatitis C. LIVER: Measures 14.5 in length. Increased hepatic echogenicity without discrete focal lesion. Two hepatic cysts in the right hepatic lobe measure 1.2 and 1.0 cm. Patent portal vein with antegrade flow. BILIARY TRACT: Cholelithiasis without 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. 1.6 x 1.5 cm right and 0.8 x 0.8 cm left renal cysts without septation or solid component.OTHER: No significant abnormalities noted.", "output": "Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease, without discrete focal lesion. "}
{"instruction": "Generate impression based on findings.", "input": "83-year-old female prethyroidectomy for multinodular goiter with right parotid mass. Within the mid portion of the right parotid gland is a 0.7 x 1.0 x 1.2 cm mass. Although this appears mildly complex cystic on this exam, configuration is suggestive of lymph node. On the prior CT, the appearance was consistent with a lymph node. Incidentally noted is a 0.5 x 0.8 x 1 cm probable cyst in the right submandibular gland.", "output": "Right parotid mass which by ultrasound appears to be complex cystic although still could represent a lymph node.CLINICAL INFORMATION AND PRE-OPERATIVE DIAGNOSIS: Right parotid massPOST-OPERATIVE DIAGNOSIS : SameCOMPARISON: Outside CT neck from 11/27/2015 and outside ultrasound of the thyroid from 9/25/2015OPERATORS: Doctors: I, the attending physician, Dr. Paushter, performed the entire procedure.TECHNIQUE: Following a discussion of the procedure with the patient and her daughter, including its risks, benefits, alternatives and steps to prevent infection, an informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure.Localizing US demonstrated 0.7 x 1.0 x 1.2 cm right parotid mass which may be complex cystic.. The skin over the target area was cleansed with chlorhexidine. Transducer was sterilely sheathed. Local anesthesia was obtained using 1% lidocaine, superficially and at depth. Using aseptic technique, and continuous ultrasound guidance, the lesion was sampled using 25 gauge needles. 3 fine needle aspirations were performed.Cytology was present to confirm specimen adequacy. Specimen was handed to cytology. The patient tolerated the procedure well without immediate complications. Routine post procedure instructions were communicated to the patient.COMPLICATIONS: NoneESTIMATED BLOOD LOSS: Less than 5 cc. An adhesive bandage was placed on the patient\u2019s skin."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury, in setting of chronic stage V kidney disease. Evaluate for medical renal disease and hydronephrosis. RIGHT KIDNEY: The right kidney measures 11.4 cm. The renal parenchyma is markedly echogenic. No suspicious lesion is identified. There is an unchanged right upper pole cyst with a thin septation measuring 4.1 x 2.5 x 3.8 cm. There is no hydronephrosis or renal calculus.LEFT KIDNEY: The left kidney measures 9.0 cm. The renal parenchyma is markedly echogenic. No suspicious lesion is identified. There is no hydronephrosis or renal calculus.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Echogenic renal parenchyma, consistent with medical renal disease/parenchymal dysfunction. No worrisome mass, stone or hydronephrosis."}
{"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 40. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. Multiple round anechoic lesions are identified bilaterally, consistent with bilateral cysts. No suspicious solid or cystic mass is identified.", "output": "Bilateral breast cysts. No sonographic evidence for malignancy.BIRADS: 2 - Benign.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney failure. Evaluate for obstruction. Lack of urine. RIGHT KIDNEY: Right kidney measures 11.0 cm. The cortex is mildly echogenic. No hydronephrosis or renal calculi are identified.LEFT KIDNEY: Left kidney measures 10.3 cm. The cortex is mildly echogenic. No hydronephrosis or renal calculi are identified.URINARY BLADDER: A Foley catheter is identified within a collapsed bladder.OTHER: No significant abnormalities noted.", "output": "Echogenic kidneys, compatible with medical renal disease. No hydronephrosis or renal calculi."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Collins is a 60 year old female with a personal history of leukemia who presents for evaluation of a persistently palpable right axillary mass which was previously shown to represent a benign lymph node as recently as 10/15/2015. On physical exam at the patient's area of concern, a small movable mass is identified in the right axillary region.Targeted right breast ultrasound was performed in the right axillary region. A single normal appearing lymph node is noted with normal hilar vascular flow, measuring 1.3 x 0.5 cm.", "output": "Single normal-appearing lymph node in right axillary region. No sonographic evidence for malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually, due next in April 2017. All results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Female 76 years old Reason: patient with gram negative bacteremia, getting renal US, please also US belly History: abdominal pain, bacteremia LIVER: 14.9 cm in length. No focal lesions. Normal echogenicity.GALLBLADDER, BILIARY TRACT: Sludge possibly small gallstones in the gallbladder. No evidence of tenderness to compression. No gallbladder wall thickening or pericholecystic fluid.No intrahepatic or extra hepatic biliary dilatation. Common hepatic duct measures 0.6 cm in diameter. Common bile duct 0.8 cm in diameter.PANCREAS: Limited visualization.RIGHT KIDNEY: Echogenic kidneys bilaterally consistent with medical renal disease. No evidence of hydronephrosis or hydroureter.OTHER: Tortuous aorta noted.Left pleural effusion noted.", "output": "No findings to explain bacteremia. No evidence of cholecystitis although it may be gallstones and sludge in the gallbladder. Echogenic kidneys. Left pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "62 year old female. History of thyroid cancer with new positive TG antibodies. Also biochemical evidence of hyperparathyroidism. Please assess thyroid bed lymph nodes and parathyroids. Thyroid has been surgically resected. Echogenic soft tissue focus just inferior to the left thyroid bed in the supraclavicular region is 0.9 x 0.7 x 0.5 cm, previously 1.1 x 0.7 x 0.5 cm, unchanged. No internal vascularity in this lesion on Doppler exam.PARATHYROID GLANDS: No lesions suspicious for a parathyroid adenoma are identified.LYMPH NODES: Benign-appearing left level 3 lymph node is 1.9 x 1.1 x 0.6 cm. No suspicious or enlarged lymph nodes are identified.OTHER: No significant abnormality noted.", "output": "Stable echogenic soft tissue focus in the left supraclavicular region. Benign-appearing left level 3 lymph node. No new masses or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "90-year-old female with elevated creatinine. Rule out obstruction/hydronephrosis. RIGHT KIDNEY: The right kidney measures 9.6 cm in length. Echogenic renal parenchyma unchanged from prior exam. No hydronephrosis or shadowing calculus.LEFT KIDNEY: The left kidney measures 8.9 cm in length. Echogenic renal parenchyma unchanged from prior exam. No hydronephrosis or shadowing calculus.URINARY BLADDER: Partially distended urinary bladder is not well evaluated.OTHER: Gallbladder contains dependent stones and sludge. No gross wall thickening or pericholecystic fluid.", "output": "1. No hydronephrosis.2. Echogenic renal parenchyma compatible with medical renal disease.3. Dependent gallstones and sludge within the gallbladder."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old female patient with known right thyroid nodule. Evaluate for interval increase in size. Occasional dysphagia. RIGHT LOBE MEASUREMENTS: 6.0 x 3.2 x 2.7 cm.LEFT LOBE MEASUREMENTS: 4.1 x 0.8 x 1.6 cm.ISTHMUS MEASUREMENTS: 3 mm in thickness.RIGHT LOBE: The right thyroid lobe contains an inferior pole heterogeneous nodule with mixed solid and cystic components measuring approximately 4.1 x 4.3 x 2.8 cm, previously 4.0 x 4.2 x 2.6 cm.LEFT LOBE: There is a 0.5 x 0.5 x 0.5 cm hypoechoic solid nodule within the left inferior pole.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology lymph nodes are noted bilaterally.OTHER: No significant abnormality noted.", "output": "Dominant complex right thyroid nodule, which is similar in size to the prior study."}
{"instruction": "Generate impression based on findings.", "input": "26 year old female with history of recurrent anorexia, nausea vomiting, evaluate for cholecystitis or cholelithiasis. LIVER: No biliary dilatation, abnormal hepatic parenchyma echogenicity or other significant abnormality. The liver is 12 cm in length.BILIARY TRACT: The gallbladder is relatively collapsed, and the gallbladder wall measures 2 mm. No pericholecystic fluid or other findings of cholecystitis. Small amount of gallbladder sludge is noted. No biliary dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen measures 8 cm in length, without significant abnormality.RIGHT KIDNEY: The right kidney measures 10.2 cm, and is within normal limits. OTHER: The left kidney is within normal limits, and measures 10.1 cm.", "output": "No evidence of cholecystitis or choledocholithiasis. Small amount of sludge within a contracted gallbladder."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Peterson is a 27 year old female presenting with bilateral nontender palpable masses for the past 2 years. Bilateral targeted ultrasound was performed for the patient's palpable areas of concern.In the right breast 10:00 location, approximately 3 cm from the nipple, no suspicious cystic or solid mass is identified.In the left breast 7:00 location, approximately 3 cm from the nipple, no suspicious cystic or solid mass is identified.In the left breast 2:00 location, approximately 3 cm from the nipple, no suspicious cystic or solid mass is identified.", "output": "No sonographic evidence of malignancy. The patient should follow up with her primary care physician as clinically warranted, presuming these results are concordant with the physical exam findings. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually, starting at the age of 40. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate cause of aki RIGHT KIDNEY: The right kidney measures 9.5 cm in length. Normal parenchymal echogenicity and echotexture. No hydronephrosis or shadowing renal calculi.LEFT KIDNEY: The left kidney measures 6.9 cm in length and is small in size. Normal parenchymal echogenicity and echotexture. No hydronephrosis or shadowing renal calculi.OTHER: The bladder is poorly visualized and decompressed by a Foley catheter.", "output": "Small left kidney. No other acute findings."}
{"instruction": "Generate impression based on findings.", "input": "59 year old female who was recalled from screening mammogram for right upper outer quadrant mass . 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 heterogeneously dense, which may obscure small masses(BiRads Density Category C) and, unchanged in pattern and distribution. 5 mm oval circumscribed mass persist on spot compression views in the right upper-outer quadrant. Ultrasound was subsequently performed.Ultrasound: Ultrasound demonstrates a 5 x 4 mm simple cyst at the 9:00 position of the right breast. This corresponds to the mammographic abnormality. No suspicious abnormality noted.", "output": "5 mm simple cyst on mammogram and ultrasound in the right breast 9:00 position. 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": "Unknown past medical history with seizure hypertensive emergency RIGHT KIDNEY: Markedly echogenic parenchyma without mass, stone, or hydronephrosis. 10 cm in lengthLEFT KIDNEY: Markedly echogenic parenchyma without mass, stone, or hydronephrosis. 9.5 cm in length.OTHER: Bladder nondistended. Bilateral pleural effusions.", "output": "Markedly echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Assess liver and gallbladder History: vomiting LIVER: Diffusely echogenic hepatic parenchyma. The liver measures 14.0 cm in length. The portal vein is patent with normal portal venous hepatopedal blood flow, peak velocity 20.6 cm/s.GALLBLADDER, BILIARY TRACT: Several echogenic stones are noted within the gallbladder neck. No evidence of pericholecystic inflammation. The gallbladder wall measures 0.2 cm. The common hepatic duct measures 0.2 cm. No biliary ductal dilatation. Negative sonographic Murphy's sign.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 10.5 cm in length. Echogenic renal parenchyma. No hydronephrosis, masses, or stones.LEFT KIDNEY: The left kidney measures 10.0 cm in length. Echogenic renal parenchyma. No hydronephrosis, masses, or stones.OTHER: No ascites. The spleen measures 8.8 cm in length.", "output": "1. Echogenic renal parenchyma, consistent with medical renal disease or parenchymal dysfunction.2. Echogenic hepatic parenchyma, consistent with hepatic steatosis or parenchymal dysfunction.3. Cholelithiasis without evidence of acute inflammation."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old male with hepatitis. LIVER:The liver measures 20.0 cm. There is coarse echotexture of the liver. No masses, ascites, or intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder appears to be contracted. There is echogenic shadowing foci consistent with cholelithiasis. No acute inflammation. The common bile duct measures 6.5 mm. The gallbladder wall measures 2.6 mm. No pericholecystic fluid.PANCREAS: Evaluation the pancreas is limited by overlying bowel gas.SPLEEN: Spleen measures 11.5 cm without sonographic abnormalities.KIDNEYS: The right kidney measures 10.8 cm. The cortex has normal echotexture. No shadowing calculi, mass, or hydronephrosis. The left kidney measures approximately 10.9 cm. The cortex has normal echotexture. No shadowing calculi, mass, or hydronephrosis. OTHER: No significant abnormality noted.", "output": "1. Coarse echotexture of liver consistent with chronic liver disease/parenchymal dysfunction. No mass or ascites.2. Cholelithiasis as described above without evidence of acute inflammation or ductal dilatation.3. Hepatomegaly."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female with abnormal liver function history of right upper quadrant pain. LIVER: Liver is normal in size and is moderately to markedly echogenic. This is nonspecific. No focal hepatic abnormality is identified.BILIARY TRACT: Gallbladder is normal without cholelithiasis, 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": "Echogenic liver. Normal gallbladder and biliary tract."}
{"instruction": "Generate impression based on findings.", "input": "Left thyroid nodule detected on outside CT RIGHT LOBE MEASUREMENTS: 4.7 x 1.4 x 1.7 cmLEFT LOBE MEASUREMENTS: 5 x 1.5 x 1.7 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Diffusely heterogeneous gland without discrete nodule.LEFT LOBE: Diffusely heterogeneous gland. 2.1 x 1.1 x 1.1 cm solid hypoechoic nodule arising from the lower pole of thyroid gland.ISTHMUS: Diffusely heterogeneous gland without discrete nodulePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Dominant solid hypoechoic nodule arising from the lower pole left thyroid gland. This lesion is amenable to ultrasound guided percutaneous biopsy"}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female patient with previous large subcapsular hematoma resolving in August, but now with pain and liver enlargement. Reevaluate status. LIVER: The liver measures 17.6 cm in length and demonstrates mildly coarsened, increased parenchymal echogenicity. A previously demonstrated perihepatic collection is smaller in size measuring approximately 7.4 x 1.9 cm. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. 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 12.5 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 12.9 cm in length. No evidence of hydronephrosis.The spleen is not visualized.", "output": "Decreased size of the perihepatic collection."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male with hepatitis C. LIVER: Coarse echotexture of the liver measuring 15.8 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: Normal echogenicity of the gallbladder. No pericholecystic fluid. No gallbladder wall thickening. Common duct measures 2 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Pancreatic tail is obscured by overlying bowel gas. Remaining portions of the visualized pancreas are unremarkable.RIGHT KIDNEY: Measures 10.9 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Spleen measures 9.9 cm in length and is normal in echogenicity.Left kidney measures 11.4 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "Coarse echotexture of the liver suggestive of proximal dysfunction/fatty infiltration. No focal hepatic lesions. "}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain LIVER: Mildly coarse and echogenic liver parenchyma without mass. Liver length 16 cmGALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatationPANCREAS: Diffuse edematous pancreas again notedRIGHT KIDNEY: No significant abnormalities noted. 11.8 cm in length OTHER: Left kidney 12.7 cm in length. Spleen 13.5 cm in length. No ascites.", "output": "Mildly coarse and echogenic liver parenchyma suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Gallbladder sludge without acute inflammation. Diffuse edematous pancreas again noted consistent with acute pancreatitis. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 64 years old; Reason: h/o goiter History: goiter RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 1.3 x 2.0 x 4.7 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 1.1 x 1.7 x 3.8 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.2 cm.RIGHT LOBE: The right lobe is mildly heterogeneous. There is a hypoechoic nodule revisualized from prior ultrasound in the mid-right lobe, measuring 0.5 cm x 0.4 cm x 0.3 cm. This was previously measured 0.3 cm x 0.3 cm x 0.5 cm. No internal microcalcifications are seen.LEFT LOBE: The left lobe is mildly heterogeneous. No nodules identified.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted.", "output": "1. Mildly heterogeneous thyroid gland with a right subcentimeter nodule that appears to stable in size and appearance from prior ultrasound. This measures 0.5 x 0.4 x 0.3 cm.2. No suspicious adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female with history of neck tightness, thyroid nodules. RIGHT LOBE MEASUREMENTS: 5.3 x 1.4 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.3 x 1.5 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Prominently solid right lower pole thyroid nodule with small echogenic foci measuring 1.7 x 1.1 x 0.9 cm is not significantly changed compared with prior studies. The previously described lower pole 5 mm nodule is less conspicuous compared with the prior study but grossly unchanged. No new thyroid nodules are present.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 significant interval change in previously biopsied right lower lobe thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female with prior thyroidectomy for thyroid cancer. 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 change. No evidence for recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old male with urgency and urinary frequency. RIGHT KIDNEY: Measures 11.4 cm in length. Normal echogenicity without hydronephrosis, nephrolithiasis, or mass lesion. LEFT KIDNEY: Measures 10.7 cm in length. Normal echogenicity without hydronephrosis, nephrolithiasis, or mass lesion. URINARY BLADDER: 1.8 cm cystic focus along the bladder dome likely represents a urachal remnant or cyst. Pre-void bladder volume was 128.3 mL, and post-void bladder volume was 61.1 mL.OTHER: Significantly enlarged prostate measures 6.1 x 5.7 x 5.6 cm.", "output": "1. Marked prostate enlargement and pre/post void residual bladder volumes as detailed above suggest benign prostatic hypertrophy. Recommend correlation with clinical examination. 2. Unremarkable examination of the kidneys. "}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain status post cholecystectomy LIVER: No significant abnormalities noted. 13.7 cm in lengthGALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 8.1 cm in lengthOTHER: Left kidney 9.3 cm in length. Spleen 9.1 cm in length. No ascites", "output": "Status post cholecystectomy. No evidence for hepatobiliary abnormality."}
{"instruction": "Generate impression based on findings.", "input": "HCV LIVER: Normal hepatic morphology. Mildly heterogeneous echotexture without mass. Liver length 16.1 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 8.9 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.8 cm in lengthOTHER: Left kidney 11.1 cm in length. No ascites.", "output": "Normal noncirrhotic morphology with mildly heterogeneous echotexture without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Male 51 years old Reason: Eval for etiology of ckd History: elevated creatinine RIGHT KIDNEY: Right kidney measures 10 cm in length. The renal parenchyma is normal in echogenicity. However, the cortex appears thin, consistent with chronic kidney disease. Single focus of twinkle artifact indicates a very small right renal calculus. No hydronephrosis.LEFT KIDNEY: Left kidney measures 10.2 cm in length. Renal parenchyma is normal in echogenicity. The cortex in the left kidney is also thinned, consistent with chronic kidney disease. No shadowing calculi. No hydronephrosis.BLADDER: No significant abnormalities noted.", "output": "No hydronephrosis. Cortex of the kidneys are thinned bilaterally consistent with chronic kidney disease."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Lebeau is a 54 year old female with a known history of right breast cancer. She presents today for skin marking prior to surgery. Targeted right breast ultrasound was performed at the location of the known right breast cancer. No sonographic correlate was seen for the known right breast cancer nor was any sonographic correlate seen for the biopsy clip placed within the cancer. Thus, a decision to proceed with mammographically guided localization was made.DIAGNOSTIC MAMMOGRAPHIC", "output": "Successful localization of the clip at the site of known malignancy in the right breast. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "History of thrombocytopenia. LIVER: The liver measures 22 cm in craniocaudal dimension. It is mildly coarse in echotexture. No focal suspicious lesion or biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 0.2 cm/s. The gallbladder is normally distended without gallstones, pericholecystic fluid or focal tenderness.BILIARY TRACT: The common duct measures approximately 3 mm at the level of the pancreatic head, within normal limits.PANCREAS: Partially imaged pancreatic head is unremarkable.SPLEEN: The spleen measures 11 cm in length without focal lesion.RIGHT KIDNEY: The right kidney measures 10.3 cm without hydronephrosis. OTHER: The left kidney measures 11.1 cm without hydronephrosis.", "output": "1. Normal splenic size without focal lesion.2. Borderline prominent liver measuring 22 cm. It is mildly coarsened in echotexture which is nonspecific and may represent parenchymal dysfunction. No focal liver lesion."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old female with acute renal failure. RIGHT KIDNEY: Measures 9.9 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 12.0 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Collapsed with a Foley catheter in placeOTHER: No significant abnormalities noted.", "output": "1. Increased renal echogenicity consistent with medical renal disease. 2. No nephrolithiasis, hydronephrosis, or suspicious mass lesion. "}
{"instruction": "Generate impression based on findings.", "input": "52-year-old male with history of thyroid cancer. Evaluate for recurrence. 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: Hyperechoic nodular focus in the left thyroid bed unchanged measuring 0.8 x 0.4 x 0.6 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level 4 lymph node measuring 1.1 x 0.5 x 0.8 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": "Female 26 years old; Reason: thyroid nodules (possible toxic nodule) History: hyperthyroidism RIGHT LOBE MEASUREMENTS: 5.8 x 2.3 x 2.2 cm.LEFT LOBE MEASUREMENTS: 6.7 x 3.0 x 3.1 cm.ISTHMUS MEASUREMENT: 0.9 cm.RIGHT LOBE: The right lobe appears diffusely heterogeneous without a discrete nodule. There is hypovascularity of the right lobe.LEFT LOBE: The left lobe appears diffusely heterogeneous without discrete nodule. There is hypovascularity of the left lobe.ISTHMUS: The isthmus appears diffusely heterogeneous without discrete nodule. There is hypovascularity of the isthmus.LYMPH NODES: No suspicious adenopathy noted. OTHER: No significant abnormality noted.", "output": "1.Diffusely heterogeneous gland with hypovascularity could indicate thyroiditis - Correlate with thyroid lab values."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old male for preheart transplant workup. Ischemic cardiomyopathy. LIVER:Liver is moderately to markedly echogenic. This is non--- specific and could be due to fatty infiltration or other parenchymal disease. No focal hepatic abnormality.GALLBLADDER, BILIARY TRACT: Gallbladder appears distended and contains dependent sludge. No definite shadowing gallstones and no wall thickening or pericholecystic fluid.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted.KIDNEYS: The right kidney measures 14.4 cm in length. No hydronephrosis, shadowing calculus or mass. The left kidney measures 12.7 cm in length. No hydronephrosis, shadowing calculus or mass. ABDOMINAL AORTA: Aorta cannot be adequately assessed due to bowel gas.INFERIOR VENA CAVA: The hepatic portion of the inferior vena cava is patent. Remainder is in adequately visualized due to bowel gas.OTHER: No ascites. Urinary bladder poorly distended with Foley catheter in place.", "output": "#1. Echogenic liver.#2. Distended gallbladder with sludge.3. Inadequate visualization of the aorta."}
{"instruction": "Generate impression based on findings.", "input": "Nausea vomiting and elevated bilirubin LIVER: Coarse echogenic liver echotexture without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 15.5 cmBILIARY TRACT: Mildly prominent extra hepatic duct without intrahepatic ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: Old splenic infarct. 11.2 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 8.9 cm in lengthOTHER: Left kidney 9.6 cm in length", "output": "Coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or significant ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female with history of chronic hepatitis C. LIVER: Measures 13.7 cm in length. Increased hepatic echogenicity without discrete focal lesion.BILIARY TRACT: Small nonmobile echogenic focus in the gallbladder most likely represents a small polyp. No gallbladder wall thickening or pericholecystic fluid. No biliary 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 chronic liver disease, without discrete lesion. "}
{"instruction": "Generate impression based on findings.", "input": "Thyroid carcinoma 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 mass or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Weight loss and abnormal alkaline phosphatase LIVER: Mildly coarse liver echotexture without mass. Liver length 14.5 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.7 cm in lengthOTHER: Left kidney 10.1 cm in length. Spleen 7.8 cm in length. No ascites", "output": "Mildly coarse liver echotexture raises the possibility of fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 57 years old; Reason: history of follicular thyroid carcinoma, please evaluate for evidence of recurrence History: tired, insomnia The patient is status post total thyroidectomy.POSTOPERATIVE BED: There is a hypoechoic focus within the left thyroid bed measuring 0.7 cm x 0.7 cm x 0.5 cm. This was seen on prior ultrasound in 2015 measuring at that time 0.4 cm x 0.4 cm x 0.7 cm. This appears stable in size and appearance. No other areas suspicious for recurrence within the thyroid bed.LYMPH NODES: No suspicious adenopathy noted. On the prior ultrasound there was a left submandibular node that was felt to be benign and is no longer visualized on this study.", "output": "Stable thyroid ultrasound status post total thyroidectomy. The small focus in the left thyroid bed appears stable from prior ultrasound. No suspicious adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old male patient with ascites and impaired synthetic function. Evaluate vasculature. Limited evaluation secondary to patient body habitus. LIMITED ABDOMENLIVER: The liver measures 15.0 cm in length, demonstrates increased parenchymal echogenicity, and is nodular in contour.BILIARY TRACT: No gallstones or gallbladder wall thickening is identified. There is no intra or extrahepatic biliary ductal dilatation. The common duct measures 3 mm in diameter.PANCREAS: The pancreas is not visualized on this examination.SPLEEN: The spleen measures 10.0 cm in length. RIGHT KIDNEY: The right kidney measures 11.1 cm in length. No evidence of hydronephrosis.OTHER: The left kidney measures 11.1 cm in length. No evidence of hydronephrosis.There is moderate ascites.", "output": "1. Cirrhotic morphology of liver with patent hepatic vasculature.2. Moderate ascites."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old female with chronic kidney disease. RIGHT KIDNEY: Measures 9.8 cm in length. 1.3 cm cyst without septation or solid component. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 9.2 cm in length. 6.8 x 5.2 cm cyst without 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. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluating thyroid nodules. pt was instructed to obtain outside records to take to appt History: pt with h/o thyroid nodules previously monitored q 1-2 yr by US, diffusely enlarged thyroid gland on exam today. no clinical s/sx of thyroid dysfunction TFT's pending RIGHT LOBE MEASUREMENTS: 5.1 x 1.8 x 1.0 cmLEFT LOBE MEASUREMENTS: 5.6 x 1.6 x 0.7 cmISTHMUS MEASUREMENTS: 0.2 cm in the AP dimensionRIGHT LOBE: No significant abnormality noted. Several tiny anechoic lesions, compatible with colloid cysts. Inferior pole cyst measures 0.4 x 0.2 x 0.4 cm.LEFT LOBE: No significant abnormality noted. Several tiny anechoic lesions, compatible with colloid cysts. Superior pole cyst measures 0.7 x 0.4 x 0.4 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted. No cervical lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Multiple bilateral colloid cysts. No suspicious nodules or lesions."}
{"instruction": "Generate impression based on findings.", "input": "Ms Li is a 20-year-old female presenting with a non-tender left breast lump. On the physical exam, there is nodularity in the upper periareolar left breast in patient's area of palpable concern.Targeted ultrasound of the left breast 12:00 position 1 cm from the nipple reveals no suspicious solid or cystic mass.", "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": "Reason: Evaluate liver for pathology History: elevated liver enzymes LIVER: The liver measures 17.1 cm in length. Mildly coarse, echogenic hepatic parenchyma. The portal vein is patent with normal hepatopedal directional blood flow, peak velocity 28.3 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: The gallbladder is not visualized. The common bile duct measures 0.4 cm. No biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.47 m in length. The left kidney measures 10.3 cm in length. Small simple cyst in the mid left kidney measures 0.8 x 0.9 x 0.9 cm. No hydronephrosis or shadowing stones.OTHER: No ascites. The spleen measures 9.5 cm in length.", "output": "Mildly coarse, echogenic liver, consistent with hepatic steatosis or parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess mobile nodule on upper back History: non-tender hard mobile mass upper back An indeterminate, hypoechoic, nonvascular mass measuring 2.0 x 1.8 x 1.3 cm is noted on sonographic evaluation of the mid back swollen area.", "output": "Indeterminate hypechoic nonvascular mass at the area of swelling in mid back"}
{"instruction": "Generate impression based on findings.", "input": "80 year-old female patient with chronic kidney disease. RIGHT KIDNEY: Echogenic renal parenchyma compatible with medical renal disease/parenchymal dysfunction. No hydronephrosis or shadowing renal calculi.LEFT KIDNEY: Echogenic renal parenchyma compatible with medical renal disease/parenchymal dysfunction. No hydronephrosis or shadowing renal calculi. Multiple renal cysts. A mildly complex cyst in the superior pole of the left kidney measures 1.4 cm.OTHER: No significant abnormalities noted.", "output": "1.Echogenic renal parenchyma compatible with medical renal disease/parenchymal dysfunction.2.Mildly complex cyst in the superior pole of the left kidney."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter RIGHT LOBE MEASUREMENTS: 2.5 x 1.8 x 5.8 cmLEFT LOBE MEASUREMENTS: 2.8 x 12.1 x 7.2 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Multiple benign-appearing cystic and mixed cystic solid colloid nodules. A representative mid pole nodule measures 1 x 0.5 x 0.9 cm.LEFT LOBE: Solid lower pole nodule measuring 1.6 x 1 x 1.3 cm. Additional benign-appearing colloid nodules. A representative mid pole nodule measures 1.2 x 0.6 x 1.2 cm.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 benign-appearing cystic and mixed cystic solid colloid nodules. Solid left lower pole nodule as described; the patient states that this nodule has been biopsied in the past; if prior documentation is not available, this nodule would be amenable to ultrasound-guided percutaneous biopsy. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old female with a lump in the right armpit With physical exam, there is a mild elevation of the tissue at right axilla. Focused ultrasound is performed. There is normal subcutaneous fat the tissue, without any suspicious findings.", "output": "No sonographic evidence for malignancy. Clinical follow-up is recommended. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old male patient with hypertensive emergency. Renal evaluation, AKI. RIGHT KIDNEY: The right kidney measures 10.3 cm in length and has increased echogenicity. No evidence of hydronephrosis.LEFT KIDNEY: The left kidney measures 11.3 cm in length and has increased echogenicity. No evidence of hydronephrosis. There is a 1.9 x 1.4 x 1.8 cm left upper pole simple renal cyst.OTHER: There are small bilateral pleural effusions.", "output": "1. Medical renal disease. No evidence of hydronephrosis.2. Small bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Farrell is a 20 year old female presenting with a palpable mass in her left breast. She reports a family history of breast cancer in her grandmother. On physical examination, a mobile mass is palpated in the left breast upper-outer quadrant.A targeted left breast ultrasound was performed for the palpable area of concern. In the left breast, 2:00 position, 5 cm from the nipple, there is a hypoechoic macrolobulated mass with internal flow. This palpable mass measures 2.1 x 1.2 x 1.6 cm.", "output": "2.1 cm lobulated mass in the left breast corresponding to the palpable concern, which most likely represents a fibroadenoma. Surgical consultation is recommended for this palpable concern. Results and recommendations were discussed with the patient.Patient already has an appointment scheduled with her breast surgeon today.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Reason: screen for HCC History: + cirrhosis LIVER: The liver measures 19.3 cm in length, indicating hepatomegaly. Coarse echogenic liver parenchyma without focal lesion or mass. Normal portal venous directional hepatopedal blood flow, peak velocity 24.5 cm/s, mildly pulsatile.GALLBLADDER, BILIARY TRACT: Multiple small hyperechoic stones in the dependent portion of the gallbladder without pericholecystic inflammation. The gallbladder wall measures 0.3 cm. The common bile duct measures 0.6 cm. No biliary ductal dilatation. Negative sonographic Murphy's sign.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 9.6 cm in length. No hydronephrosis, masses, or stones.LEFT KIDNEY: The left kidney measures 9.3 cm in length. No hydronephrosis, masses, or stones.OTHER: No ascites.", "output": "1. Coarse echogenic liver parenchyma, consistent with chronic liver disease or parenchymal dysfunction. No focal mass or ductal dilatation.2. Cholelithiasis without acute inflammation."}
{"instruction": "Generate impression based on findings.", "input": "Pancreas carcinoma with right upper quadrant pain and elevated bilirubin LIVER: Extensive central hepatic mass lesion with peripheral satellite lesions again noted.GALLBLADDER, BILIARY TRACT: Thickened gallbladder wall with internal stones and sludge again noted and unchanged. Positive Murphy's sign. No worsening ductal dilatationPANCREAS: Not visualized due to overlying gas.", "output": "Large central hepatic mass lesion with peripheral hepatic satellite lesions again noted. Gallbladder wall thickening with internal stones and sludge present. No worsening ductal dilatation. While there is a positive Murphy's sign, this is difficult to interpret given the extent of adjacent tumor; however acute inflammation of the gallbladder cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": "Reason: goiter History: fatigue RIGHT LOBE MEASUREMENTS: 6.0 x 2.0 x 2.0 cmLEFT LOBE MEASUREMENTS: 7.4 x 2.3 x 2.5 cmISTHMUS MEASUREMENTS: 2.13 cm.RIGHT LOBE: Parenchyma echotexture is mildly heterogeneous but no dominant nodule.LEFT LOBE: There is a heterogeneous nodule in the left mid and lower poles with mild internal vascularity and a cystic foci, overall measuring 5.2 x 2.1 x 2.9 cm.ISTHMUS: There is a large nodule within the isthmus extending to the left lower pole which is isoechoic with minimal vascularity and no calcifications measuring 3.9 x 2.1 x 2.8 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Two large indeterminate thyroid nodules in the isthmus and left lower poleI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "37 year old woman with history of left breast cancer, BRCA1 positive, s/p right prophylactic mastectomy and reconstruction, now with palpable mass. A targeted right ultrasound was performed for the palpable area of concern. Normal fat lobulations are seen, some of which appear mildly inflammed but there is no solid or cystic mass identified.", "output": "Mild fat inflammation without sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "55 year-old female with abdominal discomfort and nausea. LIVER: The liver parenchyma is mildly heterogeneous and increased in echogenicity. The liver is mildly increased in size measuring 21.2 cm in craniocaudal dimension. No intrahepatic biliary ductal dilatation or focal hepatic lesion is identified. There is normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: A normally distended gallbladder is noted without gallstones, wall thickening, pericholecystic fluid, or focal tenderness. No extrahepatic biliary ductal dilatation with the common duct measuring 3 mm.PANCREAS: The visualized pancreatic body and head are normal.SPLEEN: The spleen measures 9.2 cm in length.RIGHT KIDNEY: The right kidney measures 10.2 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. OTHER: The left kidney measures 10.5 cm in length without hydronephrosis, shadowing calculus or a discrete lesion evident.", "output": "Mildly coarsened heterogeneous liver parenchyma compatible with diffuse fat infiltration and/or parenchymal dysfunction. No focal hepatic lesion or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are screening mammogram dated 3/30/2015 and diagnostic mammogram and ultrasound dated 4/2/2015 performed at Franciscan Healthcare-Munster. Screening mammogram 3/30/2015: Two standard views of both breasts were obtained. The breast parenchyma is mostly fatty replaced, distributes fairly symmetrically in both breasts. The patient was recalled for an ovoid circumscribed asymmetry measuring 4 mm in the medial right breast seen only on the CC view with no definite correlate is seen on MLO view. Diagnostic mammogram and ultrasound dated 4/2/2015:Mammogram: The asymmetry in the medial breast persists on spot compression views and has benign morphology. On the MLO full field view a correlate is identified in the inferior breast. Ultrasound: A possible pseudolesion was identified in the inferior right breast at 6:00.", "output": "Repeat right breast ultrasound is recommended to evaluate the benign morphology asymmetry seen on mammography and evaluate for a correlate for the questionable lesion seen on prior ultrasound at 6:00 position.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal LFTs. LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. 16.7 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 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 10.1 cm in length. The left kidney is 9.9 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 10.2 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid identified.", "output": "No sonographic abnormality identified."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female with history of left thyroid nodule. RIGHT LOBE MEASUREMENTS: 2.4 x 1.9 x 6.9 cm.LEFT LOBE MEASUREMENTS: 2.9 x 2.3 x 6.9 cm.ISTHMUS MEASUREMENTS: 0.7 cm.RIGHT LOBE: There is a spongiform lesion measuring 0.7 x 0.6 x 0.7 cm in the right inferior thyroid that does not demonstrate calcification or vascularity.LEFT LOBE: Heterogeneous, nonvascular left thyroid nodule with hypoechoic rim measuring 1.8 x 1.5 x 2.1 cm. This lesion is amenable to biopsy as indicated.ISTHMUS: No significant abnormality noted.LYMPH NODES: Bilateral benign-appearing lymph nodes.OTHER: No significant abnormality noted.", "output": "Right thyroid nodule without specific suspicious features. Left thyroid nodule as described above amenable to biopsy as indicated."}
{"instruction": "Generate impression based on findings.", "input": "Hematuria RIGHT KIDNEY: Normal echogenicity. No worrisome mass, stone, or hydronephrosis. Midpole benign-appearing cyst. 11.7 cm in length.LEFT KIDNEY: Normal echogenicity. No worrisome mass, stone, or hydronephrosis. Multiple benign-appearing cysts. 11.3 cm in lengthOTHER: Bladder trabeculation without distention. Enlarged prostate", "output": "Normal renal parenchyma echogenicity without worrisome mass, stone, or obstruction. Bladder trabeculation without distention. Enlarged prostate."}
{"instruction": "Generate impression based on findings.", "input": "Proteinuria and obesity RIGHT KIDNEY: Unremarkable echogenicity without mass, stone, or hydronephrosis. 14 cm in lengthLEFT KIDNEY: Unremarkable echogenicity without mass, stone, or hydronephrosis. 14 cm in length.OTHER: Bladder nondistended", "output": "Negative renal ultrasound. Normal parenchymal echogenicity without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "75-year-old female with elevated creatinine and chronic kidney disease. Evaluate RIGHT KIDNEY: The right kidney has increased echogenicity and measures 17 cm in length. There are multiple anechoic foci within the right kidney most likely cysts.LEFT KIDNEY: The left kidney measures 15.9 cm in length and is increased in echogenicity. There are multiple anechoic to hypoechoic foci throughout the left kidney.BLADDER: No significant abnormalities noted.", "output": "Innumerable bilateral renal cysts with bilateral echogenic kidneys consistent with chronic medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old female with multinodular goiter, follow-up examination. RIGHT LOBE MEASUREMENTS: 2.1 x 2.1 x 5.8 cmLEFT LOBE MEASUREMENTS: 1.9 x 1.4 x 5.9 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Three nodules again identified on the right. Superior pole nodule predominantly solid with cystic components measures 1.6 x 1.6 x 1.6 cm, unchanged. Mid right nodule solid with a central cystic component measures 1.6 x 1.4 x 2.0 cm, unchanged. Inferior pole nodule predominately solid measures 1.3 x 0.8 x 2.0 cm, unchanged.LEFT LOBE: Mid left thyroid nodule, solid with hyperechoic and hypoechoic regions measures 1.7 x 1.6 x 1.3 cm, unchanged.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 nodules without significant interval change since the prior study."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis LIVER: Cirrhotic liver again noted without mass. Liver length 14.4 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right kidney 9.7 cm in lengthOTHER: Left kidney 11.2 cm in length. Spleen 14.6 cm in length. Trace ascites.", "output": "Stable cirrhotic morphology without worrisome mass or ductal dilatation. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "66 years old, Male, Reason: Periumbilical abd pain History: Please check GB, liver, pancreas LIVER: The liver is mildly enlarged measuring 20 cm in length. Increased parenchymal echogenicity is is suggestive of fatty infiltration. Focal hypoechoic hepatic lesion may represent focal fatty sparing although is indeterminate on this ultrasound examination. Further characterization with MRI is recommended. 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 CBD is mildly enlarged measuring 10 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 9.7 cm in length. RIGHT KIDNEY: Kidney measures 9.1 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.2 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Focal hypoechoic lesion may represent focal fatty sparing although is indeterminate on this ultrasound examination. Dedicated MRI is recommended for further characterization of this lesion.2.Fatty infiltration of the liver.3.No evidence of cholelithiasis or cholecystitis."}
{"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": "Hepatitis B LIVER: Mildly heterogeneous liver echotexture again noted without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 19.2 cmBILIARY TRACT: Subcentimeter gallbladder polyp measuring 0.2 x 0.2 x 0.1 cm. No ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 11.3 cm in length.RIGHT KIDNEY: No significant abnormalities noted. 11.2 cm in length.OTHER: Left kidney 11.1 cm in length. No ascites.", "output": "Stable mildly heterogeneous liver echotexture consistent with chronic liver disease without mass or ductal dilatation. Subcentimeter gallbladder polyp. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Patient presents with a palpable lump at the right breast. Left breast benign biopsy (fibroadenoma as per the patient) performed at outside hospital in April 2015. Family history of breast cancer in mother at the age of 38 and great aunt. On physical examination, a mobile 2 cm palpable mass identified in the right breast 12:00 position, 5 cm from the nipple.A targeted right ultrasound was performed for the palpable area of concern. Ultrasound demonstrates a parallel oriented uniformly hypoechoic mass measuring 2.8 x 1.2 x 2.6 centimeters with peripheral blood flow consistent with a benign fibroadenoma.", "output": "Palpable abnormality the right breast 12:00 position is most consistent with a fibroadenoma basin imaging. Surgical consultation is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "49 year old female one year post islet cell transplant. Evaluate portal vein. LIVER: Normal echogenicity of the liver measuring 14.5 cm in length. No focal hepatic lesions. The portal vein is patent with appropriate directional flow; peak velocity measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. Common duct measures 7 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Distal body and tail are obscured by overlying bowel gas. The remaining visualized portions are unremarkable.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 10.2 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the spleen measuring 9.5 cm in length. Normal echogenicity of the left kidney measuring 10.9 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "Patent portal vein."}
{"instruction": "Generate impression based on findings.", "input": "81-year-old female patient with right upper quadrant pain, fever, vomiting. Concern for choledocholithiasis. LIVER: The liver measures 15.1 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 is distended and contains gallstones. There is pericholecystic fluid. Marked bilobar intra- and extrahepatic biliary ductal dilatation is identified. The common duct measures 13 mm in diameter. No obstructing stone is identified on this examination, however, a stone is identified within the distal duct on the CTA from the same date.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 8.7 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.1 cm in length. No evidence of hydronephrosis.The spleen measures 7.5 cm in length.", "output": "1. Marked intra- and extrahepatic biliary ductal dilatation secondary to obstructing distal common bile duct as seen on CTA from the same date. 2. Cholelithiasis with distended gallbladder and pericholecystic fluid is likely secondary to obstructing distal CBD stone."}
{"instruction": "Generate impression based on findings.", "input": "Female 72 years old Reason: evaluate left renal mass, compare to previous. RIGHT KIDNEY: 9.9 cm in length. No definite masses seen by ultrasound. No hydronephrosis or hydroureter. Normal echogenicity. Normal blood flow on limited color Doppler ultrasound.LEFT KIDNEY: 9.4 cm in length.No definite masses seen by ultrasound. No hydronephrosis or hydroureter. Normal echogenicity. Normal blood flow on limited color Doppler ultrasound.URINARY BLADDER: No significant abnormality noted.OTHER: No significant abnormalities noted.", "output": "Small cortical-based left upper pole lesion seen on CT scan 2013 is not visible by ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal failure RIGHT KIDNEY: No obvious worrisome mass or hydronephrosis. Right kidney 9.5 cm in length.LEFT KIDNEY: No obvious worrisome mass or hydronephrosis. Renal cysts again noted. Left kidney 14.2 cm in length.OTHER: Bladder nondistended", "output": "Technically limited study due to patient's body habitus. No obvious worrisome mass or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Female 75 years old; Reason: Possible splenomegaly on exam. Evaluate for hepatosplenomegaly. History: left upper quadrant pain and dullness in Traube's space. LIVER: The liver measures 13.8 cm in length. There is increase echogenicity of the liver parenchyma. No intrahepatic ductal dilation is seen. There is a anechoic cyst measuring 5.9 cm x 6 cm x 7.1 cm located superiorly within the liver, as seen on prior CT. Additionally, there is another anechoic cyst located inferiorly within the liver measuring 5.8 cm x 4.8 cm x 7.5 cm. This was also seen on prior CT. The main portal vein is patent with normal hepatopetal flow measured at 15.2 cm/s. GALLBLADDER/BILIARY TRACT: The common bile duct measures 10.7 mm in diameter. The common hepatic duct measures 0.6 cm.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 7.8 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 12.2 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 12.3 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "No sonographic evidence of hepatosplenomegaly. Revisualization of two simple cysts within the liver seen on prior CT. The liver also appears echogenic which is compatible with fatty infiltration/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Anuria Please note that examination is limited due to inability to reposition the patient and overlying postsurgical bandages.RIGHT KIDNEY: 9.7 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 9.2 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: Collapsed.OTHER: No significant abnormality noted.", "output": "Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "No urine output. Decreased GFR. RIGHT KIDNEY: 14.4 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 13.6 cm in length. Benign-appearing 1.7 cm cyst again noted. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Male 65 years old Reason: assess for cholecystitis History: AMS, leukocytosis, CT abdomen with distended gallbladder LIVER: Partially visualized liver is normal in appearance.BILIARY TRACT: Sludge and small stones are present within the gallbladder. Possible small, subcentimeter gallbladder polyps are present. No gallbladder wall thickening, pericholecystic fluid, or evidence of acute inflammation. No common bile duct stones are identified. Common bile duct is within normal limits measuring up to 5 mm. Unable to assess for a Murphy's sign secondary to patient's mental status.OTHER: No significant abnormalities noted.", "output": "Sludge and small stones are present within the gallbladder. No evidence of acute inflammation to suggest acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for perinephric abscess and/or ascites. Targeted examination was performed to evaluate for perinephric fluid and ascites. Small pleural effusions are noted. No perinephric fluid collection or significant ascites. Fluid-filled small bowel is noted.", "output": "Small pleural effusions without a perinephric fluid collection or significant ascites."}
{"instruction": "Generate impression based on findings.", "input": "Liver lesions on outside CT LIVER: Measures 17.6 cm in length. Hepatic steatosis. Three hepatic cysts are identified in the right hepatic lobe, the largest measuring up to 3 cm and is minimally complex. The portal vein is patent.GALLBLADDER, BILIARY TRACT: Gallbladder is normal in appearance without wall thickening or biliary dilation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Measures 10.9 cm in length. 0.8 cm stone in the lower pole. OTHER: The left kidney measures 12.8 cm in length. The spleen measures 11.4 cm in length.", "output": "1.Hepatic steatosis with minimally complex cysts in the right hepatic lobe.2.Nonobstructive right lower pole renal stone."}
{"instruction": "Generate impression based on findings.", "input": "74 years old, Female, Reason: Eval thyromegaly, masses History: hx of hyperthyroidism, etiology unknown RIGHT LOBE MEASUREMENTS: 6.5 x 3.2 x 3.7 cmLEFT LOBE MEASUREMENTS: 5.0 x 2.6 x 1.3 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Multiple nodules and cysts throughout the right thyroid lobe. Most of these cysts and nodules are subcentimeter. There is a solid 1 cm right isoechoic nodule with hypoechoic rim.The largest of these right thyroid nodules is hypovascular with multiple echogenic foci within the and measures 1.0 x 1.1 x 1.7 cm.LEFT LOBE: Multiple nodules and cysts are present in the left lower lobe, most of which appear subcentimeter in size. Single largest solid thyroid nodule which is isoechoic to thyroid tissue with microcalcifications and hypoechoic rim measuring 3.0 x 1.3 x 1.9 cm. Another mixed density hypoechoic lesion in the left thyroid lobe measures 1.5 x 1.0 x 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": "Single dominant solid left thyroid nodule which is isoechoic with a hypoechoic rim and echogenic foci which are present microcalcifications."}
{"instruction": "Generate impression based on findings.", "input": "History of Graves' disease. RIGHT LOBE MEASUREMENTS: 4.0 x 1.9 x 2.2 cmLEFT LOBE MEASUREMENTS: 4.5 x 1.7 x 1.9 cmISTHMUS MEASUREMENTS: 5 mmRIGHT LOBE: The thyroid parenchyma is diffusely heterogeneous and enlarged. It is mildly hypervascular. There is a 8 x 4 x 9 mm well-defined hypoechoic nodule in the superior pole.LEFT LOBE: The thyroid parenchyma is diffusely heterogeneous and enlarged. It is mildly hypervascular. No discrete nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal morphology right level 2 lymph node.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous and enlarged thyroid gland compatible with chronic thyroiditis/Graves' disease. 9 mm hypoechoic right superior thyroid lobe nodule."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B LIVER: Coarse echogenic liver parenchyma without mass. Liver length 13.7 cm.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11 cm in lengthOTHER: Left kidney 11.7 cm in length. Spleen 8.2 cm in length. No ascites.", "output": "For parenchyma consistent with chronic liver disease without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "60 years old, Male, Reason: 60 yo M hx with bilirubin, liver enzyme elevation. Pls eval for gallbladder stones, mass, or liver abnormality. History: asymptomatic now, but one episode of abdominal pain last month LIVER: The liver is enlarged measuring 20.5 cm cm in length. The echogenicity of the liver mildly increased suggesting fatty infiltration. 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: The gallbladder is not well visualized due to wall echo shadow sign consistent with a gallstone filled gallbladder. If further evaluation of the gallbladder is clinically warranted CT is recommended. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 7 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: A small splenule is present. The spleen measures 13.4 cm in length. RIGHT KIDNEY: Kidney measures 13.4 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 13.4 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Wall echo shadow sign consistent with gallstone filled gallbladder, less likely porcelain gallbladder. No definite evidence of cholecystitis. If further evaluation of the gallbladder is clinically warranted CT is recommended.2.Increased echogenicity of the liver consistent with fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "28 year old female with bilateral breast masses/fibrocystic breasts. Family history of breast cancer diagnosed in aunt in her 40s. Patient reports palpable area of concern in the right greater than left 6 to 7 o'clock position. Limited bilateral breast physical examination of the palpable area of concern in the lower outer quadrants demonstrated mobile thickening in the right breast near 7:00. A targeted bilateral ultrasound was performed for the palpable area of concern. There is no solid or cystic mass identified in the 6-7 o'clock positions. Areas of dense glandular tissue are noted bilaterally.", "output": "No sonographic evidence for malignancy. Clinical correlation with physical exam is recommended. As long as these benign results are concordant with physical exam, then routine follow up is recommended. BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "46 years old, Male, Reason: Rule out hydronephrosis History: Elevated Bun/Creatinine from time of transplant RENAL TRANSPLANT: Renal transplant is normal in echogenicity without significant perinephric fluid collection or hydronephrosis.LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedURINARY BLADDER: The urinary bladder is incompletely distended.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels Patent renal transplant vessels with mildly elevated peak systolic velocity of 2.1 m/sec in the area of the renal anastomosis with elevated resistive index of 0.9. The proximal transplanted renal artery, just distal to the anastomosis, also has an elevated peak systolic velocity of 2.1 with a resistive index of 0.9. The mid transplanted renal artery has an elevated peak systolic velocity of 2.4 with an elevated resistive index 0.87. Arcuate and segmental artery resistive indices are elevated ranging from 0.76 to 0.85.OTHER: No significant abnormality noted", "output": "1.Increased peak systolic velocities and resistive indices in the area of the renal artery anastomosis which is suspicious for stenosis.2.Echogenicity of the renal parenchyma is within normal limits without evidence of hydronephrosis.Findings discussed with Dr. Khairi at time of dictation. "}
{"instruction": "Generate impression based on findings.", "input": "Renal cysts RIGHT KIDNEY: Normal parenchymal echogenicity. No worrisome mass, stone, or hydronephrosis. Subcentimeter benign cysts stable. Right kidney 10.1 cm in lengthLEFT KIDNEY: Normal parenchymal echogenicity. No worrisome mass. Echogenic foci with posterior shadowing lower pole Mild hydronephrosis unchanged. No change in multiple minimally complex cysts. The largest measures 4.4 x 4.7 x 3.9 cm.OTHER: No significant abnormalities noted..", "output": "Stable bilateral renal cysts, including minimally complex left renal cysts. Stable mild left hydronephrosis. Possible nonobstructing subcentimeter lower pole left renal stones."}
{"instruction": "Generate impression based on findings.", "input": "24-year-old female post muscle biopsy left thigh with drainage and pain at site. There is a complex fluid collection in the deeper subcutaneous tissues at the site of biopsy measuring 1.4 x 1.8 x 5 cm. This contains internal septation and focally echogenic areas. No gross, peripheral flow by color Doppler.", "output": "Fluid collection left left thigh. This may represent hematoma, although abscess or other fluid collection cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female presents as a callback from screening mammography for bilateral asymmetries, for which comparison to outside prior mammograms was recommended. These prior studies were not available at this time. Family history of breast cancer (maternal mother, aunt, and grandmother; paternal grandmother). Three standard views of both breasts with bilateral 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).Asymmetric glandular tissue in the right breast disperses upon spot compression.Left retroareolar circumscribed mass and upper outer breast asymmetries persist with spot compression.ULTRASOUND", "output": "1. Benign left breast retroareolar cyst correlating with a mammographic asymmetry. Other questioned asymmetries are most consistent with normal breast parenchyma. 2. No evidence of malignancy in either breast. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually. Additionally, submission of prior studies for comparison was recommended. These findings were discussed with the patient at the time of the examination. Given the patient's strong family history of breast cancer, consultation with the University of Chicago Medicine Cancer Risk and Prevention Program is recommended. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Difficulty swallowing. RIGHT LOBE MEASUREMENTS: 4.3 x 1.4 x 1.7 cm. Normal in size with normal background echotexture and vascularity.LEFT LOBE MEASUREMENTS: 4.4 x 1.2 x 1.9 cm. Normal in size with normal background echotexture and vascularity.ISTHMUS MEASUREMENTS: 5 mm in AP dimension.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "Normal sonographic appearance of the thyroid gland."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal LFTs LIVER: Mildly echogenic and heterogeneous liver echotexture without mass. Liver length 17.4 cm.GALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 8.2 cm in lengthOTHER: Left kidney 9.9 cm in length. Spleen 11.9 cm in length. No ascites", "output": "Mildly echogenic and heterogeneous liver echotexture suggestive for parenchymal dysfunction/fatty infiltration without mass or ductal dilatation. Cholelithiasis without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old female with palpable lump in the right breast for 2 years. With physical exam, a mobile mass is palpated at right retroareolar region. With ultrasound, there is a circumscribed hypoechoic mass measuring 35 x 23 x 39 mm with peripheral blood flow, likely a fibroadenoma.", "output": "High probability benign mass, likely a fibroadenoma, in the right breast. In view of relatively large size, surgical consultation is recommended. Results and recommendations were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "History of CHF, undergoing heart transplant workup. LIVER: The liver is top normal in size measuring 18.1 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 0.25 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. The distal pancreas is obscured by bowel gas.SPLEEN: No significant abnormalities noted.The spleen measures 7.0 cm in length. RIGHT KIDNEY: Kidney measures 7.0 cm in length. Normal echogenicity. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 9.7 cm in length. Normal echogenicity. No hydronephrosis, shadowing calculus or mass.ABDOMINAL AORTA: The aorta is normal in caliber without aneurysmal dilatation and is patent on Doppler images.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: The bladder is incompletely distended but appears grossly unremarkable. No ascites.", "output": "Atrophic right kidney. Exam otherwise unremarkable."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old male with left triple negative breast cancer status post chemotherapy presents for wire localization of the index left breast mass, satellite lesion and metastatic axillary lymph node. MAMMOGRAM", "output": "Successful needle localization of the left breast malignancy (2 sites) and metastatic left axilla node with mammographic and ultrasound guidance.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Female 31 years old Reason: 1 cm nodule of the L upper back/shoulder History: NUB v lipoma v cyst v other Very small hypoechoic focus measuring 0.4 x 0.3 x 0.4 cm in the subcutaneous fat.", "output": "Findings likely represent a benign process such as a small lipoma."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with urinary retention for suprapubic tube placement. Ultrasound guidance", "output": "Ultrasound guidance as noted above."}
{"instruction": "Generate impression based on findings.", "input": "History papillary thyroid carcinoma 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 mass or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Hematemesis LIMITED ABDOMENLIVER: Cirrhotic morphology without mass. Liver length 16.8 cm.BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation; diffuse gallbladder wall thickening presumed secondary to cirrhosis and ascites.OTHER: Moderate ascites", "output": "Cirrhotic morphology without mass. Thickened gallbladder wall without acute inflammation or ductal dilatation. Moderate ascites. Patent patent hepatic vessels with normal directional flow cervical however reduced main portal vein velocities consistent with known portal venous hypertension."}
{"instruction": "Generate impression based on findings.", "input": "Recurrent UTIs. Sepsis. RIGHT KIDNEY: 8.9 cm in length. Minimally increased renal parenchymal echogenicity, with lobular cortical contour suggestive of scarring. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 11.2 cm in length. Minimally increased renal parenchymal echogenicity, with lobular cortical contour suggestive of scarring. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: Distended with fluid. Foley catheter identified.OTHER: No significant abnormality noted.", "output": "1. No hydronephrosis.2. Lobular renal cortices, suggestive of scarring.3. Distended bladder with Foley catheter in place. Catheter evaluation may be helpful."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old male with chronic and acute renal insufficiency with malignant hypertension. RIGHT KIDNEY: The right kidney measures 9.7 cm in length. Echotexture is within normal limits. There is no hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 10.3 cm in length. Echotexture is normal. There is no hydronephrosis, shadowing calculus or mass.URINARY BLADDER: Poorly distended without gross abnormalityOTHER: No significant abnormalities noted.", "output": "Normal kidneys."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old female with prior thyroidectomy for cancer with thyroid bed nodules. Evaluate for stability. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS.: ThyroidectomyRIGHT LOBE: In the inferior right bed there is again noted a small hypoechoic nodule measuring 0.6 x 0.6 x 1 cm. Given configuration and stability in 2 dimensions, this is most consistent with a benign nodule.LEFT LOBE: In the left thyroid bed there is a lobulated, predominantly hypoechoic nodule although a portion of it has a mildly echogenic focus suggestive of lymph node. On today's study, this measures 0.8 x 1.4 x 1.8 cm. Review of the prior study demonstrates that there was a typographical error in the report, and the nodule measured 0.9 x 1.2 x 2.2 cm and therefore nodule has not increased in the interim.ISTHMUS: No significant abnormality noted. PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable, bilateral thyroid bed masses. See corrected measurements of prior exam. "}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with history of ethanol and heroine use, hepatitis C antibody positive. Assess for cirrhosis. LIVER: Measures 14.4 in length. Unremarkable hepatic morphology and echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Gallbladder sludge but no evidence of 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. Increased renal echogenicity. Subcentimeter renal cysts.OTHER: The bladder is collapsed with a Foley catheter in place.", "output": "1. No evidence of hepatic cirrhosis or focal lesion. 2. Increased renal echogenicity consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "child with thyroid autoimmunity and pyramidal lobe; possible goiter RIGHT LOBE: Heterogeneous, enlarged thyroid gland. The right lobe measures 5.0 x 1.3 x 1.7 cmLEFT LOBE: Heterogeneous, enlarged thyroid gland. The left lobe measures 4.1 x 1.2 x 1.5 cmISTHMUS: Heterogeneous, enlarged thyroid gland.LYMPH NODES: Normal appearing cervical lymph nodes with fatty hila.OTHER: Mild increased vascularity of the thyroid.", "output": "Diffusely heterogeneous and enlarged thyroid gland. Normal appearing lymph nodes in area of palpation."}
{"instruction": "Generate impression based on findings.", "input": "43 years old, Female, Reason: primary hyperparathyroidism, please eval for enlarged parathryroids History: as above RIGHT LOBE MEASUREMENTS: 5.1 x 2.1 x 1.3 cmLEFT LOBE MEASUREMENTS: 5.0 x 2.0 x 1.5 cmISTHMUS MEASUREMENTS: 0.8 cmRIGHT LOBE: Hypoechoic subcentimeter right thyroid nodule measuring 0.4 x 0.3 x 0.4 cm.LEFT LOBE: Left thyroid lobe is without significant abnormality.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Very hypoechoic nodule posterior inferior to the right thyroid lobe is favored to represent a parathyroid adenoma measuring 1.3 x 0.7 x 0.7 cm.LYMPH NODES: No significant abnormality noted.OTHER: Posterior to the left internal jugular vein and definitely separate from the left thyroid lobe is a focus that is slightly hypoechoic to normal thyroid tissue and may represent a hematoma. Special attention to this area should be paid on future scans.", "output": "1.Right posterior inferior extrathyroidal nodule consistent with clinically suspected parathyroid adenoma.2.Slightly hypoechoic to normal thyroid tissue and posterior to the left internal jugular vein focus which may represent a hematoma although is indeterminate on this examination. Special attention to this area should be paid on future scans."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Nesbit is a 15 year old female presenting with a focal area of intermittent right breast pain and a physician palpated mass-like area in the left breast. Upon physical exam of the right breast at the patient's area of concern, no discrete mass is appreciated. Targeted right breast ultrasound is performed for the patient's area of concern. No suspicious cystic or solid mass was identified. Upon physical exam of the left breast at the palpable area of abnormality, no discrete mass is appreciated. Targeted left breast ultrasound is performed for the physician-palpated area of concern. No suspicious cystic or solid mass was identified. However, there was dense fibroglandular tissue at this area.", "output": "No sonographic evidence for malignancy. Patient should follow-up with her primary care physician as clinically warranted. BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "67 years old, Female, Reason: abnormal lfts need vascular imaging History: abnormal LFTs need vascular imagin to r/o liver thrombosis Ultrasound exam is extremely limited due to patient body habitus.LIVER: The liver measures 19.8 cm in length. Increased hepatic parenchyma echogenicity is consistent with fatty infiltration. No focal hepatic lesions or masses are definitely identified. PORTAL VENOUS: The main portal vein is is not well-visualized with a possible peak systolic flow 1.3 cm/s which is elevated. No definite thrombus is identified.HEPATIC ARTERIES: The hepatic arteries are not well visualized.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. The common bile duct is not well visualized.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: The spleen is not well visualized. No significant abnormalities noted. The spleen measures 9.6 cm in length. RIGHT KIDNEY: No hydronephrosis or shadowing calculus.LEFT KIDNEY: No hydronephrosis or shadowing calculus.OTHER: No significant abnormalities noted.", "output": "1.Exam is limited due to patient body habitus. Within these limitations the portal vein appears patent with an increased peak systolic velocity. No definite thrombus is identified. Recommend dedicated CT to evaluate vascular patency. 2.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "68 years old, Male, Reason: s/p esophagectomy check for abdominal free fluid History: s/p esophagectomy check for abdominal free fluid Limited evaluation shows mild to moderate amount of ascites is noted throughout the abdomen most of which is located in the right lower quadrant.", "output": "Mild to moderate amount of ascites is noted throughout the abdomen, most of which is located in the right lower quadrant."}
{"instruction": "Generate impression based on findings.", "input": "Female; 44 years old. Reason: r/o hepatobiliary pathology History: hepatitis LIVER: Liver measures 18.4-cm. Normal echotexture. No focal hepatic lesions. No intra-biliary ductal dilation. Main portal vein is patent with peak systolic velocity of 0.2 m/sec and normal directional flow.GALLBLADDER, BILIARY TRACT: Gallbladder wall appears prominent, though it measures up to 2 mm. No cholelithiasis, pericholecystic fluid, or sonographic Murphy sign to suggest acute cholecystitis. Common bile duct measures are 4 mm.PANCREAS: No gross abnormalities of the pancreatic head. The pancreatic tail is obscured by overlying bowel gas.RIGHT KIDNEY: Right kidney is 12.1-cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: Left kidney is 12.1-cm in length. Normal cortical echotexture. No hydronephrosis.", "output": "1. Mild hepatomegaly.2. Prominent gallbladder wall, which is nonspecific in the setting of hepatitis. No specific evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for obstruction. History of kidney failure. RIGHT KIDNEY: The right kidney measures 8 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow. The renal cortex is echogenic.LEFT KIDNEY: The left kidney measures 11.1 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow. The renal cortex is echogenic.URINARY BLADDER: The urinary bladder is partially distended. The left ureteral jet is visualized.OTHER: No significant abnormalities noted.", "output": "No hydronephrosis. Echogenic renal cortices compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic renal parenchyma without worrisome mass, stone, or hydronephrosis. Benign-appearing renal cyst. Right kidney 7.4 cm in lengthLEFT KIDNEY: Echogenic renal parenchyma without worrisome mass, stone, or hydronephrosis. Benign-appearing renal cyst. Left kidney 8.6 cm in length.OTHER: 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": "Renal stone RIGHT KIDNEY: Stable nonobstructing 0.8 x 0.4 cm right upper pole stone. No worrisome mass or hydronephrosis. Right kidney 10.9 cm in length.LEFT KIDNEY: Stable minimally complex renal cysts. No worrisome mass, stone, or hydronephrosis. 10.3 cm in lengthOTHER: Bladder nondistended", "output": "Stable subcentimeter nonobstructing right upper pole renal stone. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess for TRAS History: rising SCr, h/o TRAS RENAL TRANSPLANT: Right iliac fossa transplant kidney measures 11.4 cm in length and demonstrates mild splaying in the lower poles.LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedCOLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels . The right iliac artery has a peak systolic velocity of 105.7 cm/s and resistive index of 0.87. The anastomotic artery has a peak velocity of 89.9 cm/s and a resistive index of 0.75. Midpole segmental arteries demonstrated peak velocity of 55.86 cm/s and resistive index of 0.7. Right arcuate arteries in the lower pole demonstrate a peak velocity of 26.5 and a resistive index of 0.73. Right middle pole arcuate arteries demonstrated the peak velocity of 35.5 cm/s and resistive index of 0.7. Right segmental lower pole arteries demonstrated peak velocity of 17.17 and a resistive index of 0.73. Right upper pole arcuate arteries demonstrate peak velocity of 32.2 and a resistive index of 0.6.OTHER: No significant abnormality noted", "output": "Patent vasculature of the transplant kidney. No evidence of renal artery stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Rule out underlying thyroid nodule History: Graves' disease with asymmetry one exam (L>R) RIGHT LOBE MEASUREMENTS: 3.5 x 0.8 x 1.1 cmLEFT LOBE MEASUREMENTS: 2.5 x 5.5 x 1.7 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: The right thyroid lobe is somewhat atrophic and appears heterogeneous with increased vascularity. No focal nodules or masses.LEFT LOBE: The left thyroid lobe is asymmetrically enlarged and appears heterogeneous with increased vascularity. No focal nodules or masses.ISTHMUS: Heterogeneous with increased vascularity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Heterogeneous, hypervascular thyroid, consistent with thyroiditis. No nodule or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Male, 56 years old. BPH, rule out hydronephrosis. RIGHT KIDNEY: The right kidney measures 11.2 cm in length with normal cortical echogenicity. No focal lesions or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.6 cm in length with normal cortical echogenicity. No focal lesions or hydronephrosis.OTHER: The bladder is distended, with a small amount of layering debris. The prostate is mildly enlarged.", "output": "1.No hydronephrosis.2.Small amount of debris within the bladder."}
{"instruction": "Generate impression based on findings.", "input": "41 year old female patient with history of thyroidectomy for papillary thyroid cancer. RIGHT LOBE: Status post thyroidectomy without residual parenchymal tissue identified.LEFT LOBE: Status post thyroidectomy without residual parenchymal tissue identified.ISTHMUS: Status post thyroidectomy without residual parenchymal tissue identified.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A subcentimeter left level three lymph node is again noted.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy without evidence of recurrence or significant interval change."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old female patient with splenomegaly. Assess portal flow. LIVER: The liver measures 15.5 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 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 11.2 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 12.4 cm in length. No evidence of hydronephrosis.The spleen measures 13.8 cm in length.", "output": "1. Splenomegaly.2. Patent portal vein.3. Coarsened hepatic parenchymal echogenicity which could represent hepatic parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Coarse echogenic liver echotexture again noted with mild contour irregularity. No mass. Liver length 16 cm.GALLBLADDER, BILIARY TRACT: Stable 0.3 x 0.3 x 0.4 cm gallbladder polyp.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Stable right subcentimeter cyst. Right kidney 10 cm in lengthOTHER: Left kidney 10.8 cm in length. Spleen 8.4 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture with cirrhotic morphology without mass or ductal dilatation. No ascites. Stable subcentimeter gallbladder polyp."}
{"instruction": "Generate impression based on findings.", "input": "Female, 63 years old. Renal cell carcinoma sp left nephrectomy RIGHT KIDNEY: The right kidney measures 8.1 cm in length with increased cortical echogenicity. An exophytic cyst measures 1.3 x 1.2 x 1.2 cm, slightly increased from prior. Additional subcentimeter cysts are noted.LEFT KIDNEY: The left kidney is surgically absent.OTHER: Heterogeneous liver echotexture is noted.", "output": "1.Increased renal cortical echogenicity compatible with medical renal disease. Small renal cysts.2.Status post left nephrectomy.3.Heterogeneous liver echotexture compatible with fatty infiltration or parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Recurrent UTIs RIGHT KIDNEY: Unremarkable echogenicity. No worrisome mass, stone, or hydronephrosis. Benign-appearing cyst. 11.1 cm in length.LEFT KIDNEY: Unremarkable echogenicity. No worrisome mass, stone, or hydronephrosis. 10.6 cm in lengthOTHER: Bladder nondistended", "output": "Negative renal ultrasound. No worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old female with diastasis recti is status post 2 pregnancies. Bloating and intermittent abdominal pain. There is wide separation of the rectus muscles just superior to the umbilicus, compatible with diastasis recti. There is a focal 2 cm ventral herniation of mesenteric fat, without bowel. No associated fluid is identified. These findings do not change with Valsalva maneuver.", "output": "Diastasis recti and small mesenteric fat ventral hernia without evidence of complication."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male with hepatitis C cirrhosis, evaluate for HCC. LIVER: Measures 14.6 cm in length. Increased hepatic echogenicity without discrete focal lesion.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.KIDNEY: 4.7 x 5.2 x 4.0 cm left renal cyst without septation or solid component. OTHER: No significant abnormalities noted.", "output": "Increased hepatic echogenicity consistent with chronic liver disease, without discrete focal lesion or significant interval change. "}
{"instruction": "Generate impression based on findings.", "input": "27 years, Female, Reason: r/o adenopathy, recurrence History: h/o thyroid cancer. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Status post thyroidectomy. No significant abnormality.LEFT LOBE: Status post thyroidectomy. No significant abnormality.ISTHMUS: Status post thyroidectomy. No significant abnormality.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing lymph nodes bilaterally, the largest including a right level Ib node measuring 2.3 x 1.4 x 0.6 cm and a left level Ib node measuring 2.5 x 1.4 x 0.7 cm.OTHER: No significant abnormality noted.", "output": "No evidence of local recurrence or significant interval change."}
{"instruction": "Generate impression based on findings.", "input": "History Crohn's disease with elevated LFTs LIVER: Mildly coarse and echogenic liver echotexture without mass. Main portal vein patent with normal directional flow. Liver length 17.5 cm.BILIARY TRACT: Status post cholecystectomy. No ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 10.7 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 9.8 cm in lengthOTHER: Left kidney 10.7 cm in length. No ascites.", "output": "Mildly coarse and echogenic liver echotexture raises the possibility of fatty infiltration without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female patient with hyperthyroidism with palpable nodules. Evaluate size and characteristics of nodules. RIGHT LOBE MEASUREMENTS: 1.6 x 1.6 x 4.4 cm.LEFT LOBE MEASUREMENTS: 3.6 x 3.7 x 5.4 cm.ISTHMUS MEASUREMENTS: 4 mm in thickness.RIGHT LOBE: There are two discrete nodules in the right thyroid lobe. A spongiform-appearing nodule within the superior pole measures 1.0 x 0.6 x 1.2 cm. An additional subcentimeter spongiform nodule is noted within the lower pole.LEFT LOBE: The left thyroid lobe is predominantly replaced by heterogeneous solid and cystic nodule measuring approximately 3.3 x 3.3 x 4.6 cm. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Multiple enlarged lymph nodes noted within the right neck. A nondescript right level five lymph node without observed fatty hilum measures 1.4 x 1.2 x 1.4 cm. A right level four lymph node measures 1.1 x 0.8 x 0.7 cm.OTHER: No significant abnormality noted.", "output": "1. Dominant complex left thyroid nodule, which is amenable to biopsy.2. Two spongiform appearing right thyroid nodules, favor a benign etiology.3. Indeterminate enlarged right lower neck lymph nodes; biopsy is recommended for further evaluation.Findings discussed via telephone with Dr Sarne at 1421 hrs on 11/11/2015."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female patient with ALL with elevated bilirubin and ALK. Evaluate for obstruction or liver disease. LIVER: The liver measures 22.0 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 contains sludge. There is 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 normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 13.0 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 13.1 cm in length. No evidence of hydronephrosis.The spleen measures 16.5 cm in length.", "output": "1. Hepatosplenomegaly.2. Biliary sludge."}
{"instruction": "Generate impression based on findings.", "input": "Female 25 years old; Reason: 25 y.o. female with hyperparathyroidism. Ultrasound shows left thyroid nodule measuring 1.5x0.7x0.8cm. RIGHT LOBE MEASUREMENTS: 4.1 x 1.1 x 1.2 cmLEFT LOBE MEASUREMENTS: 4.1 x 1.2 x 1.3 cmISTHMUS MEASUREMENT: 0.1 cmRIGHT LOBE: Normal appearing thyroid gland with no dominant nodule.LEFT LOBE: Normal appearing thyroid gland with no dominant nodule.ISTHMUS: No significant abnormality noted.LYMPH NODES: 0.9 x 0.7 x 0.2 cm left level 5 lymph node with a fatty hilum, favoring benignity.OTHER: Posterior to the superior pole of the left lobe of the thyroid is a 1.3 x 1.0 x 0.6 cm hypoechoic structure with increased vascularity relative to the adjacent thyroid. This correlates with the structure seen on the outside study where it measured 1.5 x 0.7 x 0.8 cm.", "output": "1.Hypoechoic structure with increased vascularity relative to the adjacent thyroid appears extrathyroidal in location. The characteristics of this lesion support the diagnosis of a parathyroid adenoma rather than a thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old male with left groin cellulitis. Evaluate for interval changes in fluid collection. Again seen is infiltrating fluid and edema in the subcutaneous soft tissues of the left groin compatible with cellulitis. Previously noted more focal hypoechoic complex fluid collection now measures 1.6 cm x 1.2 cm x 1.4 cm. There is interval placement of packing material.Reactive lymph node is noted in the adjacent soft tissues, one of which measures 1.0 cm x 1.9 cm x 0.8 cm.", "output": "Left groin cellulitis with possible small loculated fluid collection not significantly changed. Reactive lymph nodes in the adjacent soft tissues. "}
{"instruction": "Generate impression based on findings.", "input": "Male 25 years old Reason: eval for abscess RLE (calf) History: open draining wound RLE, lateral calf Ultrasound evaluation around the wound in the patient's right calf showed no evidence of loculated fluid collections in the muscle or subcutaneous tissues.", "output": "No evidence of fluid collection to suggest abscess."}
{"instruction": "Generate impression based on findings.", "input": "Papillary thyroid carcinoma; assess lymph nodes RIGHT LOBE MEASUREMENTS: 5.3 x 1.3 x 1.7 cmLEFT LOBE MEASUREMENTS: 4 x 1.2 x 1.5 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: 1 x 1 x 0.9 cm lower pole nodule with ill-defined borders, significant internal heterogeneity and punctate calcifications consistent with known papillary thyroid carcinoma. Spongiform nodule mid pole measuring 1.1 x 10.6 x 1 cm. Additional subcentimeter spongiform nodules also noted.LEFT LOBE: Diffusely heterogeneous gland with multiple subcentimeter spongiform nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Worrisome right lower pole nodule with ill-defined borders, significant internal heterogeneity, and punctate calcifications consistent with known papillary thyroid carcinoma. Additional bilateral spongiform nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "28 year old woman with history of mastalgia in the lateral right breast. A targeted right breast ultrasound was performed for the patient\u2019s area of concern. No solid or cystic mass was identified.", "output": "No sonographic evidence for malignancy. Clinical follow up for her pain is recommended. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Flank pain RIGHT KIDNEY: Multiple nonobstructing right renal stones. The largest stone within the lower pole measures 1 x 0.9 x 0.9 cm. No worrisome mass or hydronephrosis. Right kidney 10.7 cm in length.LEFT KIDNEY: Probable nonobstructing subcentimeter left renal stone. Stable left renal cyst. No worrisome mass or hydronephrosis. Left kidney 10.6 cm in lengthOTHER: Bladder nondistended", "output": "Multiple nonobstructing right renal stones. Probable nonobstructing subcentimeter left renal stone. No worrisome mass "}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter and hyperparathyroidism RIGHT LOBE MEASUREMENTS: 6.3 x 1.7 x 2 cmLEFT LOBE MEASUREMENTS: 4.5 x 2.2 x 1.5 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Diffusely heterogeneous gland without dominant nodule.LEFT LOBE: Diffusely heterogeneous gland. 1.1 x 0.8 x 1 cm lower pole predominant solid nodule.ISTHMUS: Diffusely heterogeneous gland.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland raises the possibility of chronic thyroiditis. Dominant solid lower pole left thyroid nodule. By patient history, this nodule was biopsied at an outside hospital. Would recommend comparison with prior pathology; if this is not available, would recommend ultrasound-guided biopsy of this nodule prior to surgery.No parathyroid adenoma candidate could be visualized. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Status post liver transplant with UTI. Evaluate for pyelonephritis. RIGHT KIDNEY: The right kidney measures 11.3 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow. The cortex is echogenic and thin compatible with chronic renal disease.LEFT KIDNEY: The left kidney measures 11.2 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow. The cortex is echogenic and thin compatible with chronic renal disease. Trace perirenal fluid.URINARY BLADDER: The urinary bladder is partially distended resulting in apparent diffuse wall thickening. Ureteral jets were not identified.OTHER: No significant abnormalities noted.", "output": "No evidence of hydronephrosis, shadowing nephrolithiasis or discrete lesion. Ultrasound is insensitive for the evaluation of pyelonephritis."}
{"instruction": "Generate impression based on findings.", "input": "13-year-old male with a history of obstructive megaureter status post reimplantation in December 2014. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. 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: 0 Left: 0  Length*** Right: 9.8 cm Left: 9.9 cm   Mean for age: 10 cm  Range for age: 8.3 - 11.6 cmADDITIONAL OBSERVATIONS: None", "output": "Normal examination of the bladder and kidneys.*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": "Male 51 years old Reason: abnormal LFT History: RUQ abdominal pain LIVER: Partially visualized liver is normal in appearance.BILIARY TRACT: No acute inflammatory changes of the gallbladder. Gallbladder wall measures 2 mm. No gallstones are present. No significant pericholecystic fluid. No intra or extra hepatic biliary ductal dilatation. Common bile duct measures 2 mm.OTHER: No significant abnormalities noted.", "output": "No evidence of cholelithiasis or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Follow-up of a left testicular lesion. RIGHT TESTIS: The right testis is normal in morphology and echogenicity and size, measuring 4.0 x 3.2 x 2.1 without a focal lesion. Color and spectral Doppler ultrasound evaluation demonstrates normal blood flow.LEFT TESTIS: The left testis is normal in morphology, echogenicity and size, measuring 3.8 x 2.9 x 2.2 cm. The complex partially cystic/solid lesion anterior to the inferior mediastinum measures 0.6 x 0.4 x 0.5 cm, unchanged. No significant vascularity.There is a 0.6 x 0.5 x 0.4 cm well circumscribed mixed cystic and solid lesion inseparable from the left inferior mediastinum. This lesion demonstrates no appreciable vascularity. This lesion has not changed in its appearance when compared to 7/14/2014.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Stable well-circumscribed mixed cystic and solid subcentimeter lesion without appreciable vascularity. Given this lesion's temporal stability from the prior study and a report from 2002 mentioning a cystic focus arising from the same the left inferior mediastinum location, a benign etiology is favored (such as a post inflammatory/fibrotic lesion.) Would suggest annual ultrasound surveillance monitoring of this lesion."}
{"instruction": "Generate impression based on findings.", "input": "Male 34 years old; Reason: 34 year old M with left thyroid cyst noted on CT imaging History: Patient reports additional history of recent sinus infection on antibiotics. RIGHT LOBE MEASUREMENTS: 8.0 x 2.7 x 2.4 cmLEFT LOBE MEASUREMENTS: 8.4 x 2.8 x 2.1 cmISTHMUS MEASUREMENT: 0.8 cmRIGHT LOBE: Diffusely heterogeneous gland with multiple small hypoechoic mainly cystic or complex cystic nodules. There is no dominant nodule.LEFT LOBE: Diffusely heterogeneous gland with multiple small hypoechoic mainly cystic or complex cystic nodules. A dominant nodule in the midpole measures 1.1 x 0.7 to 0.8 cm. It is cystic with a peripheral solid component. Vascularity is not increased on color Doppler. There is no calcification.ISTHMUS: Diffusely heterogeneous without dominant nodule.LYMPH NODES: Prominent bilateral cervical lymph nodes. A left level 2 node measures 0.6 x 0.5 x 0.9 centimeters with a fatty hilum. A right level 3 node measures 1.3 x 0.5 x 1.6 cm with a fatty hilum.OTHER: No significant abnormality noted.", "output": "1.Bilateral small cystic and complex cystic nodules with appearance most consistent with colloid nodules.2.Prominent bilateral cervical chain lymph nodes are likely reactive given their otherwise normal ultrasound appearance and the patient's reported current sinus infection."}
{"instruction": "Generate impression based on findings.", "input": "Chronic renal disease RIGHT KIDNEY: Echogenic renal parenchyma again noted without mass, stone, or hydronephrosis. Right kidney 8.3 cm in length.LEFT KIDNEY: Echogenic renal parenchyma again noted without mass, stone, or hydronephrosis. Left kidney 7.5 cm in length.OTHER: Bladder nondistended", "output": "Echogenic renal parenchyma again noted consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female patient with multinodular goiter. Evaluate thyroid nodules. RIGHT LOBE MEASUREMENTS: 5.5 x 1.5 x 1.9 cm, previously 5.6 x 1.9 x 1.9 cm.LEFT LOBE MEASUREMENTS: 4.5 x 1.1 x 1.4 cm, previously 5.2 x 1.7 x 1.6 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: Multiple complex cystic nodules are noted within the right thyroid lobe. The largest within the right mid lobe measures approximately 1.9 x 1.2 x 1.4 cm, previously 1.5 x 1.1 x 1.2 cm, slightly increased in size. Additional nodules within the right thyroid lobe are not significantly changed.LEFT LOBE: Multiple complex cystic nodules are noted within the left thyroid lobe. The largest measures 1.8 x 1.4 x 1.1 cm, previously 2.1 x 1.3 x 1.5 cm. Additional nodules are not significantly changed in size.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."}
{"instruction": "Generate impression based on findings.", "input": "Reason: hematuria s/p MVA History: hematuria s/p MVA RIGHT KIDNEY: The right kidney measures 10.9 cm in length. Unremarkable renal parenchyma. Moderate hydronephrosis and hydroureter. No shadowing stones or masses are identified.LEFT KIDNEY: The left kidney measures 11.0 cm in length. Moderate hydronephrosis and hydroureter. No shadowing stones or masses are identified.OTHER: The bladder is massively distended with urine. Moderate sized bilateral pleural effusions. Layering debris in the dependent aspect of the bladder may represent proteinaceous material or blood.", "output": "1. Massively distended bladder with bilateral hydronephrosis and hydroureter. No obstructing lesion identified.2. Layering echogenic debris in the posterior aspect of the bladder may represent blood products or proteinaceous debris.3. Moderate-sized bilateral pleural effusions.These findings were communicated to the ordering physician David Tehrani at 3:30 PM on 2/24/16."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old male patient with chronic ascites, abdominal pain. Evaluate for source of abdominal pain. LIVER: The liver measures 15.4 cm in length and demonstrates slightly coarsened parenchymal echotexture. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: There are gallstones with borderline gallbladder wall thickening measuring 4 mm, which is non-specific in the setting of ascites. No pericholecystic fluid is identified. The gallbladder is not hydropic. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 4 mm in diameter.PANCREAS: The pancreas is poorly visualized on this examination.RIGHT KIDNEY: The right kidney measures 9.8 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. OTHER: The left kidney measures 9.9 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. There is a 4.3 x 3.0 x 2.4 cm left upper pole renal cyst.The spleen measures 17.5 cm in length.There is minimal ascites and a right pleural effusion. Catheter noted in the IVC.", "output": "1. Cholelithiasis without specific inflammatory changes to suggest acute cholecystitis.2. Coarsened hepatic echotexture which can be seen with hepatic parenchymal dysfunction.3. Splenomegaly and minimal ascites.4. Medical renal disease.5. Right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "Reason: R facial lump and cervical adenopathy History: painless swelling of discrete subcutaneous nodule X 2 months Within the right parotid gland, there is a well-circumscribed mass measuring 1.6 x 1.5 x 2.1 cm. The mass is predominantly hypoechoic, contains internal complexity, and demonstrates peripheral vascularity.", "output": "Nonspecific mass within the right parotid gland differential considerations for which include both benign and malignant etiologies. The mass would be amenable to fine-needle aspiration."}
{"instruction": "Generate impression based on findings.", "input": "History of left lateral thigh squamous cell carcinoma status post Mohs procedure 8/1/2013 Targeted grayscale and color Doppler ultrasound of the left groin swelling demonstrates a 3.2 x 2.4 x 1.3 cm hypoechoic oval mass with surrounding mild inflammatory changes and internal vascularity. No drainable fluid collection.An adjacent mildly prominent 1.7 x 0.6 x 2.2 cm lymph node demonstrates a normal fatty hilum, may be reactive.", "output": "Left inguinal solid vascular mass is more suspicious for metastatic lymphadenopathy given the history of patient's squamous cell carcinoma. Surrounding inflammatory changes without drainable fluid collection. This is amenable to percutaneous biopsy."}
{"instruction": "Generate impression based on findings.", "input": "24-year-old male with transaminitis and alcohol intake. Evaluate liver. LIVER: Measures 15.4 cm. Normal echogenicity. No ascites, focal mass, or intrahepatic biliary dilation. The main portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. Wall measures 0.1 cm. No stones or sludge. The hyperechoic foci measuring approximately 0.2 x 0.3 x 0.2 cm is consistent with a gallbladder polyp. Common hepatic duct measures 0.37 m.PANCREAS: Evaluation of the pancreas limited due to overlying bowel gas.SPLEEN: Spleen measures 9.2 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 10.7 cm. Left kidney measures 11.2 cm. OTHER: No significant abnormality noted.", "output": "1. Gallbladder polyp as described above."}
{"instruction": "Generate impression based on findings.", "input": "Male, 73 years old. Reason: Assess for hydronephrosis, renal parenchyma History: as above RIGHT KIDNEY: Right kidney measures 13.5 cm in length. Renal parenchymal echogenicity is increased. No renal stone or mass. Mild right hydronephrosis is unchanged.LEFT KIDNEY: Left kidney measures 13.4 cm. Renal parenchymal echogenicity is increased. No renal mass, stone, or hydronephrosis.URINARY BLADDER: Foley catheter in place within a collapsed urinary bladder which limits evaluation.OTHER: Right nephroureteral stent seen on prior radiograph is not visualized.", "output": "1. Stable mild right hydronephrosis. The left renal collecting system is normal.2. Increased echogenicity of the renal parenchyma bilaterally consistent with parenchymal dysfunction/medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Ryan is a 73 year old female with a family history of breast cancer in 1 aunt and 3 cousins. She presents for further imaging evaluation of a new mass in the right breast, identified on screening mammography on 7/27/2016. 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), unchanged in pattern and distribution. Compression spot views redemonstrate a circumscribed, oval 16 mm mass in the right upper outer quadrant 11:00 position, containing calcifications. Additional scattered benign calcifications are again appreciated.RIGHT BREAST ULTRASOUND;", "output": "16 mm mass in the right upper outer quadrant 11:00 position with suspicious mammographic and sonographic characteristics, for which biopsy is recommended. The patient has a significant medical history of a myocardial infarction, for which she takes a regimen of Aspirin + Plavix. It is recommended that these medications be held for the 5 days preceding the anticipated biopsy, but only as approved and managed by her primary physician or cardiologist. These findings and recommendation were discussed with the patient, as well as with her husband. BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old male with history of hepatitis B, s/p liver transplant. Evaluate for trauma. LIMITED ABDOMENLIVER: 16.8 cm length. Again noted is heterogeneous echotexture, and a small stable cyst. No focal masses.BILIARY TRACT: Gallbladder is surgically absent. No intrahepatic or extrahepatic biliary dilatation.PANCREAS: Obscured by bowel gas.SPLEEN: 11.6 cm length. RIGHT KIDNEY: 9.3 cm in length. No hydronephrosis or hydroureter.OTHER: Left kidney 10.4 cm in length. Left lower pole cyst, measuring 2.5 x 3.8 x 2.7 cm. No hydronephrosis.", "output": "Patent vasculature, with no focal liver masses or other significant abnormality. Unchanged exam."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female with stage IV chronic kidney disease. Ultrasound guidance was provided for biopsy the patient's right kidney.", "output": "Ultrasound guidance"}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain and evidence of pancreatitis, please evaluate gallbladder and CBD LIVER: Liver measures 20.8 cm, mildly increased in size with mild increased echogenicity suggestive of hepatic steatosis. No evidence of liver lesions. Hepatic vessels appear patent. Portal vein demonstrates normal flow directionality and patency.BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. Gallbladder is well distended with gallbladder wall thickness measuring up to 2 mm. Multiple stones noted within the gallbladder. Common hepatic duct and common bile duct measure 3 and 6 mm respectively, no evidence of any sludge or stones noted within it.PANCREAS: Not visualized due to overlying bowel gas.SPLEEN: Spleen measures 8.5 cm without any focal lesions.RIGHT KIDNEY: Right kidney measures 11.2 and left kidney measures 10.9 cm. No focal lesions noted. No hydronephrosis. OTHER: No ascites", "output": "1. Mild hepatic steatosis.2. Cholelithiasis without evidence of acute cholecystitis. Common bile duct is not dilated without evidence of any sludge or stones within it. If clinically warranted, MRCP can be performed for thorough evaluation of the common bile duct."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female with abnormality noted on carotid ultrasound RIGHT LOBE MEASUREMENTS: 2.0 x 1.7 x 4.9 cmLEFT LOBE MEASUREMENTS: 1.3 x 1.7 x 5.2 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: 0.7 x 0.5 x 0.8 cm nodule in the right mid polar region with mixed solid and cystic components and a hypoechoic halo. No microcalcifications.LEFT LOBE: 0.6 x 0.4 x 0.8 cm mixed solid/cystic nodule in the left isthmus/left lower lobe.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Subcentimeter thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female patient call back from screening mammogram for new mass in the right upper inner quadrant. History of left breast cyst aspiration. Maternal aunt diagnosed with breast cancer at age 65 and maternal grandmother with ovarian cancer at age 74. DIAGNOSTIC 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, unchanged in pattern and distribution. Again seen is a focal asymmetry in the upper inner quadrant of the right breast with associated calcifications, which has been present since 2008. This focal asymmetry in question dispersed on spot compression views. An additional subjacent 5 mm lobulated asymmetry in the 3 o'clock position of the right breast was seen on standard views and persisted on spot compression views. This asymmetry was targeted for ultrasound. Few benign calcifications are again seen.DIAGNOSTIC ULTRASOUND: Targeted right breast ultrasound was performed. In the 3 o'clock position of the right breast there is a small cluster of cysts that measures 4 x 3 x 3 mm.", "output": "Cluster of cysts in the 3 o'clock position of the right breast 2 cm from the nipple. Recommend repeat diagnostic right breast ultrasound in 6 months to ensure stability.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "Female 32 years old Reason: abdominal wall hematoma? Left superior to incision History: pain, tense abdomen, drop in hemoglobin There is only a small irregular fluid collection just lateral to the incision measuring 2.6 x 0.7 x 1.8 cm. May represent postop fluid small hematoma. Soft tissues appears somewhat edematous. Additional hematoma that might be soft tissue in density is not seen separate from the muscles.", "output": "Within limitations of ultrasound: very small linear loculated fluid insufficient for tap."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old male with history of thyroid cancer with prior recurrence. Tg has been increased but stable. Small lesions in thyroid bed have been stable. Evaluate for adenopathy or recurrence. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Previously noted two hypoechoic foci in the thyroidectomy bed are unchanged, one of which measures 4 mm x 4 mm x 6 mm (previously 4 mm x 4 mm x 4 mm) and the other located more inferiorly measures (5 mm x 5 mm x 7 mm), previously 5 mm 5 mm x 5 mm. New hypoechoic focus in the thyroidectomy bed measures 4 mm x 3 mm x 2 mm.LEFT LOBE: Two hypoechoic foci in the left thyroidectomy bed are not significantly changed, one of which measures 2 mm x 2 mm x 3 mm (previously 3 mm x 3 mm x 3 mm) and the other measures 6 mm x 3 mm x 4 mm (previously 5 mm x 4 mm x 6 mm). ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "New hypoechoic focus in the right thyroidectomy bed is noted. Previously seen hypoechoic foci bilaterally are unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or significant hydronephrosis. Benign-appearing upper pole cyst. Right kidney 12.6 cm in lengthLEFT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Left kidney 13 cm in lengthOTHER: Bladder nondistended", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or significant hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Follow-up renal abscess RIGHT KIDNEY: No significant abnormalities noted. 9.3 cm in length LEFT KIDNEY: Continued interval decrease in size of complex cystic focus arising from the mid left kidney now measuring 1.3 x 1.4 x 1.3 cm; this is in comparison to 2.1 x 2.2 x 2.7 cm on 7/19/2016. Left kidney 9.4 cm in length.OTHER: Bladder collapsed.", "output": "Continued interval decrease in size of complex cystic focus arising from the mid left kidney consistent with resolving abscess."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female with thyroid nodules identified on imaging, please evaluate for characteristics, small gland on exam. The patient reports dysphonia. RIGHT LOBE MEASUREMENTS: 5.2 x 1.7 x 1.8 cm.LEFT LOBE MEASUREMENTS: 5.2 x 1.5 x 1.1 cm.ISTHMUS MEASUREMENT: 0.2 cm.RIGHT LOBE: On a background of thyroid heterogeneity in the right mid thyroid is a hypoechoic nodule with a small central cystic area measuring 1.3 x 1.1 x 0.8 cm, which has increased vascularity.LEFT LOBE: Within the left lower pole on a background of thyroid heterogeneity is a hypoechoic nodule measuring 1.1 x 0.7 x 0.7 cm.ISTHMUS: Within the isthmus is a hypoechoic nodule measuring 1.2 x 1.1 x 0.8 cm.LYMPH NODES: Multiple small benign-appearing bilateral lymph nodes are visualized.OTHER: No significant abnormality noted.", "output": "Findings compatible with multinodular goiter."}
{"instruction": "Generate impression based on findings.", "input": "History of metastatic invasive bladder cancer status post cystectomy and urostomy. Left lower quadrant abdominal pain. Clinical concern for hydronephrosis. RIGHT KIDNEY: 10.5 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 11.7 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. There is mild hydronephrosisBLADDER: Collapsed.OTHER: No significant abnormality noted.", "output": "Mild left hydronephrosis. This asymmetry of hydronephrosis is new compared to the prior CT on 12/31/2015."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male patient with chronic hepatitis B. LIVER: The liver measures 14.3 cm in length. Hepatic parenchymal echogenicity is increased consistent with hepatic steatosis with geographic areas of sparing. 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. 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 9.7 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.3 cm in length. No evidence of hydronephrosis.The spleen measures 8 cm in length.No ascites.", "output": "1. Hepatic steatosis with geographic areas of fatty-sparing. No focal hepatic lesion is identified.2. No ascites. "}
{"instruction": "Generate impression based on findings.", "input": "71-year-old female with shock, hepatic abnormality, cirrhosis. Evaluate for cholangitis. LIVER: Coarse in echotexture with a nodular contour measuring 13.5 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate directional flow; peak velocity measures 0.4 m/sec. Small amount of perihepatic fluid.GALLBLADDER, BILIARY TRACT: Multiple shadowing stones within the gallbladder. Mild gallbladder wall thickening measuring 4 mm in thickness. No pericholecystic fluid. Unable to assess for sonographic Murphy's sign. Common duct measures 4 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Distal tail of the pancreas is obscured by overlying bowel gas. The remaining portions of the visualized pancreas are unremarkable.SPLEEN: Not well visualized. KIDNEYS: Right kidney measures 9.0 cm in length and is increased in echogenicity. Left kidney measures 10.2 cm in length and is increased in echogenicity. No shadowing calculi or hydronephrosis is noted. ABDOMINAL AORTA: The visualized aorta appears patent.INFERIOR VENA CAVA: The visualized IVC is patent with appropriate directional flow.OTHER: Foley catheter within a decompressed bladder limits adequate evaluation.Right pleural effusion. Fluid filled stomach.", "output": "1. Cirrhotic liver morphology with no focal hepatic lesions noted. 2. Cholelithiasis with mild gallbladder wall thickening which is nonspecific in the setting ascites, however findings could represent early cholecystitis. 3. Increased echogenicity of the kidneys suggestive of parenchymal dysfunction. No obstruction. 4. Small amount of perihepatic fluid. Right pleural effusion. "}
{"instruction": "Generate impression based on findings.", "input": "Male, 52 years old. Reason: abnormal nodules, nodes History: thyroid cancer RIGHT LOBE: Status post thyroidectomy. No focal lesion in the thyroid bed.LEFT LOBE: Status post thyroidectomy. No focal lesion in the thyroid bed.ISTHMUS: Status post thyroidectomy. No focal lesion in the thyroid bed.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are identified. A right level 2 lymph node measures 0.9 x 0.2 x 1.7 cm, with a fatty hilum. A left level 2 lymph node measures 1.1 x 0.5 x 1 .8 cm, with a fatty hilum.OTHER: An anechoic collection is identified in the left lateral neck measuring 2.4 x 1.3 x 3.2 cm, has a surrounding hypoechoic rim, and no internal vascularity.", "output": "2 to 3-cm hematoma or postsurgical collection in the left lateral neck. No evidence of recurrent or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old male with worsening kidney function. Ultrasound technologist guidance was provided to the clinical service for renal biopsy. Two passes were performed.", "output": "Technical assistance provided for renal biopsy. "}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with history of thyroid nodule, benign cytology in August 20, 2014. Evaluate for change in nodular characteristics. History of dysphonia. RIGHT LOBE MEASUREMENTS: 5.0 x 1.7 x 1.2 cm.LEFT LOBE MEASUREMENTS: 5.8 x 1.4 x 1.3 cm.ISTHMUS MEASUREMENTS: 0.2 cm.RIGHT LOBE: Subcentimeter hypoechoic nodules without significant interval change and no specific suspicious characteristics.LEFT LOBE: 2.9 x 1.8 x 1.2 cm left thyroid nodule with spongiform features, not significantly changed compared with the prior study.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Thyroid nodules without significant interval change since the prior study."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female patient with right upper quadrant and epigastric pain. Evaluate for biliary etiology. LIVER: The liver measures 15.3 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.4 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 9.4 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.3 cm in length. No evidence of hydronephrosis.The spleen measures 8.9 cm in length.", "output": "No specific findings to account for the patient's symptoms. "}
{"instruction": "Generate impression based on findings.", "input": "Female 31 years old; Reason: history of hypothyroidism, possible nodule on the right versus heterogeneity secondary to autoimmune process History: none RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 7.1 x 1.9 x 1.9 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 6.0 x 2.6 x 2.2 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.5 cm.OTHER: The thyroid appears markedly enlarged and heterogeneous without any discrete nodules which is compatible with thyroiditis.RIGHT LOBE: No significant abnormality noted except that as above.LEFT LOBE: No significant abnormality noted except that as above.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted.", "output": "1.Markedly enlarged and heterogeneous without any discrete lesions compatible with thyroiditis. Correlate with laboratory values."}
{"instruction": "Generate impression based on findings.", "input": "68 years, Female. Reason: Evaluate for increased free air, intraabdominal process History: New abdominal pain and vomiting, known hx of free air. Distended small and large bowel, new from earlier exam. Stable to mild interval increase in pneumoperitoneum, may be postprocedural, correlation with patient's clinical history/physical exam recommended. Alongside left lateral aspect of centrally located bowel are possible small locules of air, while may reflect pneumoperitoneum, underlying pneumatosis not entirely excluded. Redemonstration of pelvic drain, bilateral common iliac stents, and subcutaneous emphysema of the right abdominal and pelvic wall. Please refer to concomitant chest radiography from same day for additional findings.", "output": "Persistent free air, see above, including smaller locules of pneumoperitoneum (versus possible pneumatosis) along lateral wall of centrally located bowel. Correlation with patient's clinical history and interval surgery recommended. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 77 years old. Microscopic Hematuria. RIGHT KIDNEY: The right kidney measures 8.8 cm in length, with normal echotexture. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.5 cm in length, with normal echotexture. No shadowing stones or hydronephrosis.OTHER: The bladder is nondistended.", "output": "No renal stones or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: is there hepatic/GB abnormality History: epigastric pain LIVER: The liver measures 15.3 cm in length. The liver demonstrates increased parenchymal echogenicity with coarsened echotexture. There is a round, hypoechoic area within the right lobe of the liver measuring up to approximately 4 cm seen only on a single image; it is unclear whether this is artifactual or represents a focal hepatic lesion. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.34 m/s.BILIARY TRACT: Cholelithiasis without associated significant gallbladder wall thickening or pericholecystic fluid. The sonographic Murphy's sign is negative. No intrahepatic biliary ductal dilatation. The common bile duct is mildly prominent both proximally and distally measuring up to 9 mm. No shadowing choledocholithiasis identified.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 9.6 cm in length. RIGHT KIDNEY: Kidney measures 10.3 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 11.8 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Cholelithiasis without sonographic evidence of acute cholecystitis. Prominent common bile duct without shadowing choledocholithiasis identified but distal CBD not well assessed due to adjacent bowel gas. MRCP may be considered for additional evaluation as clinically warranted.2.Increased hepatic echogenicity raising the possibility of parenchymal dysfunction/fatty infiltration.3.Possible hepatic lesion versus artifact in the right hepatic lobe (or possibly the right kidney).Findings discussed with the inpatient service, APN Anna at 8:48 a.m. on 12/15/16; possible hepatic lesion to be evaluated on forthcoming contrast-enhanced MRI/MRCP using liver protocol."}
{"instruction": "Generate impression based on findings.", "input": "59 years old, Female, Reason: nodule size and characteristics History: multinodular goiter RIGHT LOBE MEASUREMENTS: 7.8 x 4.5 x 3.4 cmLEFT LOBE MEASUREMENTS: 5.0 x 1.7 x 1.9 cmISTHMUS MEASUREMENTS: 0.18 cmRIGHT LOBE: The right lobe of the thyroid is enlarged and heterogeneous with focal subcentimeter anechoic areas, solid areas in some areas possibly representing colloid.LEFT LOBE: Multiple left thyroid nodules. The most superior nodule is solid in appearance measuring 1.9 x 1.0 x 1.3 cm. The superior solid nodule is indeterminate on this ultrasound examination and is amenable to biopsy. Another mid left thyroid nodule is solid in appearance measuring 1.0 x 0.9 x 0.8 cm. The most inferior nodule is predominantly cystic in appearance measuring 1.2 x 1.0 x 1.0 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Findings consistent with multinodular goiter.2.Diffusely enlarged heterogeneous right thyroid lobe.3.Multiple left thyroid nodules, the largest of which is amenable to biopsy if clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "62 year old male patient with history of colloid nodules. Question of enlarging bilateral nodules. RIGHT LOBE MEASUREMENTS: 6.6 x 3.1 x 2.4 cm.LEFT LOBE MEASUREMENTS: 6.6 x 2.2 x 2.1 cm.ISTHMUS MEASUREMENTS: 5 mm in thickness. RIGHT LOBE: There is a 1.9 x 1.1 x 1.8 cm spongiform nodule within the right mid pole, previously 1.4 x 1.3 x 1.7 cm. An adjacent spongiform nodule within the lower pole measures 0.9 x 0.6 x 0.9 cm, previously 1 x 0.5 x 0.8 cm.LEFT LOBE: A complex, mostly solid nodule within the left inferior pole measures 2.4 x 1.4 x 1 cm, previously 2.3 x 1.6 x 1.0 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A benign morphology lymph node is noted in the left neck.OTHER: No significant abnormality noted.", "output": "Bilateral thyroid nodules with slight interval increase in size of a spongiform right midpole nodule."}
{"instruction": "Generate impression based on findings.", "input": "Call back from screening whole breast ultrasound for right breast findings. Focused ultrasound was performed for upper outer quadrant of right breast. There is no solid or cystic lesions or other abnormalities.", "output": "No sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "80 year-old male with a history of a large right inguinal hernia with testicular swelling. Please compared to previous measurements since the patient has intermittent discomfort in the area. RIGHT TESTIS: The right testes has normal echotexture, morphology and measures 4.0 x 2.3 x 2.0 cm, previously 5 x 2.4 x 2.5 cm. There is a large right hydrocele appearing similar to the previous exam. Color and Doppler flow are preserved.LEFT TESTIS: The left testicle has normal echotexture, morphology and measures 3.4 x 2.3 x 3.2 cm, previously 4.1 x 2.2 x 2.8 cm. There is a large left hydrocele appearing similar to the previous exam. Color and Doppler flow preserved.RIGHT EPIDIDYMIS: No significant abnormalities noted. The right epididymis measures 3.5 x 2.9 x 3.2 cm.LEFT EPIDIDYMIS: No significant abnormalities noted. The left epididymis measures 0.9 x 2.0 x 0.6 cm.OTHER: Large hernia is again noted in the right inguinal canal appearing similar to the previous exam.", "output": "Large bilateral hydroceles and large right inguinal hernia appearing similar to the previous exam."}
{"instruction": "Generate impression based on findings.", "input": "49 year old male with polycystic kidney disease, evaluate left renal lesion, superior pole RIGHT KIDNEY: Renal parenchyma is completely replaced by innumerable cysts compatible with history of polycystic kidney disease. There is a mixture of simple and complex cysts. The ability of ultrasound to detect smaller, solid masses and polycystic kidneys is limited. Kidney grossly enlarged. No obvious hydronephrosis.LEFT KIDNEY: Renal parenchyma is completely replaced by innumerable cysts compatible with history of polycystic kidney disease. There is a mixture of simple and complex cysts. The ability of ultrasound to detect smaller, solid masses and polycystic kidneys is limited. Kidney grossly enlarged. No obvious hydronephrosis.Left upper pole hyper density noted on prior CT study is difficult to visualize given the innumerable cysts present. OTHER: No significant abnormalities noted. Bladder poorly distended.", "output": "Findings are compatible with patient's history of polycystic kidney disease. Left upper pole hyper density noted on prior CT study is difficult to visualize given the innumerable complex cysts present. "}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male with history of thyroid cancer status post thyroidectomy complains of neck swelling. RIGHT LOBE, LEFT LOBE, ISTHMUS: The thyroid has been surgically removed. No evidence of recurrence or masses.LYMPH NODES: Normal lymph nodes in the right and left neck.OTHER: No significant abnormality noted.", "output": "Surgical changes of a thyroidectomy without no evidence of recurrence, masses, or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male patient with increased creatinine. Evaluate for intrinsic versus post renal injury. RIGHT KIDNEY: The right kidney measures 10.1 cm in length. No evidence of hydronephrosis. Renal cortical echogenicity is slightly increased.LEFT KIDNEY: Left kidney is largely obscured by bowel.URINARY BLADDER: The bladder is decompressed and contains a Foley catheter.OTHER: No significant abnormalities noted.", "output": "1. Medical renal disease of the right kidney without evidence of hydronephrosis.2. Largely obscured left kidney."}
{"instruction": "Generate impression based on findings.", "input": "80-year-old male with a history of cirrhosis. Evaluate for ascites. Moderate ascites in all 4 quadrants. Additionally, there are small bilateral pleural effusions.", "output": "1. Moderate ascites, as described above.2. Small bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old male with CT scan nodule liver, increased INR. Evaluate for liver changes in architecture, cause for increased INR. LIVER: Nodular contour of the liver with coarse echotexture. No focal hepatic lesions. Portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Sludge noted within the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. Sonographic Murphy's sign is negative. Common bile duct measures 3 mm in caliber. No intra or extrahepatic biliary ductal dilatation. PANCREAS: Visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: Increased echogenicity of the right kidney measuring 13.2 cm. No hydronephrosis or shadowing calculus are noted. Right renal cyst measures 3.9 cm x 3.7 cm x 3.0 cm.OTHER: Increased echogenicity of the right kidney measuring 12.6 cm. no hydronephrosis or shadowing calculus are noted. Renal cyst measures 1.9 cm x 2.3 cm x 3.5 cm.Spleen is large measuring 18.6 m in length.Perihepatic ascites and bilateral pleural effusions.", "output": "1. Findings compatible chronic liver disease and cirrhotic liver morphology.2. Splenomegaly. 3. Increased renal echogenicity suggestive of parenchymal dysfunction. Bilateral renal cysts. 4. Perihepatic ascites and bilateral pleural effusions. "}
{"instruction": "Generate impression based on findings.", "input": "67-year-old male with acute renal insufficiency. Evaluate for obstruction. RIGHT KIDNEY: The right kidney measures 11 cm in length. There is no evidence for hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 10.4 cm in length. There are at least 2 small cortical cysts identified. There is no hydronephrosis, shadowing calculus or solid massURINARY BLADDER: Bladder is collapsed with Foley catheterOTHER: No significant abnormality identified", "output": "No evidence for hydronephrosis or abnormal parenchymal echogenicity"}
{"instruction": "Generate impression based on findings.", "input": "63-year-old male with anemia, neutropenia and abnormal liver function. Evaluate for source of infection and abnormal liver function. LIVER: Liver is significantly echogenic consistent with fatty infiltration or other source of parenchymal dysfunction. There is no focal hepatic abnormality identified.GALLBLADDER, BILIARY TRACT: Gallbladder is decompressed with cholecystostomy tube in place which limits evaluation. The visualized biliary tract is normal in caliber.PANCREAS: Not visualized due to bowel gas.RIGHT KIDNEY: Right kidney is echogenic consistent with parenchymal disease. No hydronephrosis.OTHER: Left kidney is echogenic consistent with parenchymal disease.Diffuse ascites without change.", "output": "No significant change.Echogenic liver and kidneys.Ascites."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old female patient with cirrhosis, worsening ascites. Evaluate for portal vein thrombosis. LIMITED ABDOMENLIVER: The liver measures 15.8 cm in length, is nodular in contour, and heterogeneous in echotexture.BILIARY TRACT: The gallbladder is absent. There is no intra or extrahepatic biliary ductal dilatation. The common duct measures 6 mm in diameter.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen measures 14.6 cm in length. RIGHT KIDNEY: The right kidney measures 9.3 cm in length. No evidence of hydronephrosis. There is a 3.5 x 3.5 cm right upper pole renal cyst.OTHER: There is no ascites.", "output": "1. Cirrhotic morphology of the liver. 2. Patent TIPS.3. Right renal cyst. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: s/p liver resection with increased drain output. Please eval portal vein ONLY History: as above LIMITED ABDOMENLIVER: Echogenic, which can be seen in diffuse parenchymal dysfunction/fatty infiltration.OTHER: Minimal ascites.", "output": "Limited abdominal Doppler ultrasound showing a patent portal vein. Bilateral pleural effusions and minimal ascites."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old female with goiter. Follow-up study. Evaluate for nodule. RIGHT LOBE MEASUREMENTS: 5.7 x 2.8 x 2.2 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.7 x 1.5 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Diffusely heterogeneous with a pattern consistent with thyroiditis. No dominant nodule.LEFT LOBE: Diffusely heterogeneous with a pattern consistent with thyroiditis. No dominant nodule.ISTHMUS: There is again noted adjacent to the right isthmus and ovoid nodular area measuring 0.4 x 0.8 x 0.9 cm. This has the appearance of lymph node on today's study.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Adjacent to the inferior left lobe of the thyroid there again noted to ovoid hypoechoic nodular densities measuring 0.3 x 0.4 x 0.5 cm and 0.4 x 0.5 x 0.8 cm. These likely represent lymph nodes.OTHER: No significant abnormality noted.", "output": "Stable examination with thyroiditis pattern. Benign-appearing lymph nodes as noted."}
{"instruction": "Generate impression based on findings.", "input": "Chronic viral hepatitis B, HCC screening LIVER: Increased echogenicity of the liver noted, liver measures 18.5 cm. No intrahepatic biliary ductal dilatation. No focal lesions noted. Portal vein demonstrates normal flow directionality and patency.BILIARY TRACT: Gallbladder is well-distended without any focal lesions. Gallbladder wall thickness measures up to 2 mm. Common hepatic duct measures up to 2 mm. No pericholecystic fluid noted.PANCREAS: Head of the pancreas visualized appears unremarkable. Body and tail of pancreas not visualized due to overlying bowel gas.SPLEEN: 10.3 cm in length without any focal lesions.RIGHT KIDNEY: Right kidney measures 9.7 cm and left kidney measures 10.5 cm. No hydronephrosis or hydroureter. No suspicious focal lesion. OTHER: No ascites", "output": "Increased hepatic echogenicity compatible with hepatic steatosis. No focal hepatic lesions noted.No ascites"}
{"instruction": "Generate impression based on findings.", "input": "AKI, sepsis; assess for abscess, perinephric stranding, pyelonephritis, obstruction RIGHT KIDNEY: The right kidney measures 10.2 cm. A right midpole cyst measures up to 3 cm. No hydronephrosis.LEFT KIDNEY: The left kidney measures 9.4 cm. There is moderate left hydronephrosis. A simple cyst in the left kidney measures 1.8 cm.OTHER: Foley catheter in nondistended bladder. Trace perinephric fluid.", "output": "Left hydronephrosis. No evidence of abscess."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic thyroid cancer with segment 7 liver lesion; assess for biopsy LIVER: 1.5 cm echogenic focus within the peripheral superior aspect of segment 7 of the right lobe liver is identified. However, despite changes in positioning and transducer orientation, no safe access to this lesion could be identified.", "output": "1.5 cm lesion corresponding to the PET-positive focus within the peripheral superior aspect of segment 7 of the right lobe of liver is visible by ultrasound. However, despite changes in positioning and transducer orientation, no safe access to this lesion could been identified at this time. Would recommend repeat attempt at biopsy in 3 months assuming this lesion increases in size in the interval."}
{"instruction": "Generate impression based on findings.", "input": "49 year-old female with pancreatitis. Evaluate for gallbladder stones. LIVER: Increased echogenicity of the liver measuring 14.3 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: Normal echogenicity of the gallbladder. No evidence of cholelithiasis. No gallbladder wall thickening. No pericholecystic fluid. Common bile that measures 3 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: Atrophic echogenic native right kidney.OTHER: Right lower quadrant transplant kidney is normal in echogenicity measuring 11.9 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "Increased echogenicity of the liver compatible with fatty infiltration. No evidence of cholelithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Alcohol abuse. Sarcoidosis. Pulmonary hypertension. LIVER: Non-cirrhotic liver morphology. 12.9 cm in length. Normal parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Few subcentimeter gallstones noted. Otherwise unremarkable 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 8.5 cm in length. The left kidney is 9.3 cm in length. The renal parenchyma is mildly echogenic bilaterally. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9.1 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No upper abdominal free fluid is identified.", "output": "1. Cholelithiasis without cholecystitis.2. No sonographic evidence of cirrhosis.3. Echogenic renal parenchyma compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old female. Right breast lumpectomy for IDC status post XRT. Presents for palpable lymph node in the right axilla. Patient pointed to a palpable area in the right axilla. Right axillary ultrasound performed for this palpable area of concern demonstrated a benign appearing lymph node with normal morphology. No suspicious lymph nodes are identified.", "output": "Patient's area of palpable concern corresponds to a benign appearing lymph node.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess for hydronephrosis, post-obstructive source of AKI History: AKI RIGHT KIDNEY: The right kidney measures 10.8 cm in length. Echogenic renal parenchyma. No shadowing renal calculi or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.7 cm in length. Echogenic renal parenchyma. No shadowing renal calculi or hydronephrosis.OTHER: Unremarkable bladder, distended with fluid.", "output": "Echogenic renal edema, consistent with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old male with Burkitt's lymphoma and HIV and chemotherapy with right groin swelling and pain. Limited evaluation of the right groin demonstrates a highly complex and capsulated fluid collection with internal septation measuring approximately 3.3 X 6 x 6 cm. No gross internal flow by color Doppler", "output": "Complex fluid collection right groin. Differential considerations would include a hematoma/infected hematoma, frank abscess or even suppurative lymph node."}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine RIGHT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. Right kidney 8.8 cm in lengthLEFT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. Left kidney 9 cm in lengthOTHER: Bladder mildly distended", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Reason: NASH cirrhosis evaluate for HCC History: cirrhosis LIVER: The liver measures 12.1 cm in length. Coarse liver echotexture is redemonstrated. Anechoic focus in the right hepatic lobe is again seen measuring, 1.1 x 1.1 x 1.1 cm, previously 0.8 x 0.7 x 0.7 cm. No new suspicious masses. The portal vein is patent with normal hepatopedal portal venous blood flow, maximum flow rate 23.1 cm/s.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. No intrahepatic or extrahepatic biliary ductal dilatation. The gallbladder wall measures 0.1 cm. The common hepatic duct measures 0.3 cm. Negative sonographic Murphy sign.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 8.7 cm in length. No hydronephrosis.LEFT KIDNEY: The left kidney measures 8.1 cm in length. No hydronephrosis.OTHER: No ascites.", "output": "1. Persistent coarse liver echotexture, consistent with hepatic parenchymal dysfunction, hepatic steatosis, or chronic liver disease.2. Stable right hepatic cyst. No new masses."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old male with cholecystitis, evaluate for choledocholithiasis, right upper quadrant pain, elevated liver function tests. Very limited examination secondary to patient body habitus.LIVER: Measures 22.1 in length. Markedly increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Redemonstration of cholelithiasis and gallbladder wall thickening with mild gallbladder distention. Very limited visualization of the common bile duct.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": "1.Cholelithiasis with persistent gallbladder wall thickening remains concerning for cholecystitis, either acute or chronic. Limited sensitivity for the detection of choledocholithiasis. If further imaging evaluation is warranted clinically, MRI/MRCP may be considered. 2.Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: No significant abnormalities noted. Liver length 14.5 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 9.8 cm in length. Spleen 10.5 cm in length. No ascites.", "output": "Negative right upper quadrant ultrasound. No hepatobiliary abnormality."}
{"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": "Patient with recent fall and bruise of the left breast with palpable lesion. Three standard views of the left breast and 2 spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. There is a 20 mm mass superficially located in the left upper outer quadrant with a streaky band of focal asymmetry extending 67 mm centrally. The round subcentimeter focal asymmetry in the central breast at anterior depth is stable. LEFT BREAST ULTRASOUND", "output": "Findings most compatible with a left upper outer breast hematoma and fat necrosis. Short term follow up is recommended to ensure resolution. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram and possible mammogram is recommended in 6 months. Results and recommendation 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": "Female 64 years old with epigastric/RUQ pain. History of open cholecystectomy in 1970s. LIVER:The liver has a smooth contour and measures 16.3 cm in length. The parenchyma is somewhat coarse and echogenic. No focal liver lesion is identified. The main portal vein is patent with a velocity of 22.4 cm/s. There is no ascites.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. The common duct measures 4 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreatic head and body are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 9.9 cm in length.KIDNEYS: The right kidney measures 11.0 cm in length and the left measures 11.2 cm. The renal cortices are normal in echogenicity. There is no shadowing renal stone, hydronephrosis or evidence of renal mass. OTHER: No significant abnormality noted.", "output": "Mild hepatomegaly and increased echogenicity of the liver parenchyma suggestive of hepatic steatosis/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "54 years old, Male, Reason: neutropenic stem cell transplant patient w/ complaints of dysuria and elevated Cr. History: dysuria, Cr trending up over last couple days. Cr today 2.9 RIGHT KIDNEY: Kidney measures 11.8 cm in length. Mildly increased echogenicity consistent with medical renal disease. No evidence of hydronephrosis.LEFT KIDNEY: Kidney measures 11.4 cm in length. Mildly increased echogenicity consistent with medical renal disease. No evidence of hydronephrosis or shadowing calculus.Bladder: The bladder is at least moderately distended and concentrically thick walled which is nonspecific but may be secondary to cystitis. Other: Partially visualized liver parenchyma is increased in echogenicity consistent with fatty infiltration.", "output": "1.Mildly increased echogenicity bilaterally consistent with medical renal disease. No evidence of hydronephrosis.2.The bladder wall is concentrically thickened, nonspecific but may be seen in setting of cystitis, correlation with patient's clinical history and urinalysis recommended.3.Partially visualized liver parenchyma is increased in echogenicity consistent with fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Helgeson is a 37 year old female presenting for a short-term follow-up for high probability benign fat necrosis of the right breast. Family history of breast cancer in mother and maternal aunt. Targeted right breast ultrasound was performed for the patient's area of concern.In the right breast 4:00 location, approximately 8 cm from the nipple, there is revisualization of an ovoid hyperechoic mass measuring approximately 1.5 x 0.3 x 1.2 cm, previously measuring 1.3 x 0.3 x 1.1 cm. Sonographic findings are compatible with benign fat necrosis.", "output": "Benign fat necrosis of the right breast. No sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually, starting at the age of 40. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Female 80 years old Reason: acute cholecystitis History: right upper quandrant pain; nausea/vomiting LIVER: Liver echogenicity is within normal limits. Liver measures 13.8 cm. No focal hepatic mass. Vein portal vein is patent with peak velocity of 21.1 cm/s.BILIARY TRACT: Patient is status post cholecystectomy. No gallbladder is visualized. No intra or extra hepatic biliary ductal dilatation. Common bile duct measures 3 mm.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 9.3 cm. KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Left kidney measures 10.1 cm. Right kidney measures 11 cm.OTHER: No ascites.", "output": "No biliary or hepatic abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for change in right thyroid nodule RIGHT LOBE MEASUREMENTS: 4.7 x 2.4 x 2.3 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.1 x 1.4 cmISTHMUS MEASUREMENTS: 0.3 cm in AP dimensionRIGHT LOBE: Dominant mid pole nodule measures 3.6 x 1.6 x 3.0 cm, previously 3.4 x 1.5 x 2.9 cm and stable in size. The nodule is predominantly solid with cystic components and demonstrates hypervascularity without microcalcifications.LEFT LOBE: No significant abnormality noted. No new suspicious nodules or masses.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: None visualized.LYMPH NODES: Mildly heterogeneous, hypoechoic right level 3 cervical lymph node measures 2.7 x 0.7 x 0.9 cm and was not measured previously. No other enlarged or suspicious lymph nodes are visualized.OTHER: No significant abnormality noted.", "output": "1. Indeterminate dominant right thyroid nodule is stable in size and appearance.2. Right level 3 cervical lymph node is indeterminate and amenable to biopsy.These findings were communicated to ordering physician Mizuho Mimoto at 2:30 PM on 2/25/16."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old male patient with elevated transaminase, abdominal pain. Question of portal vein thrombosis, intra-abdominal bleed after islets cell transplant seven days ago. LIVER: The liver is diffusely heterogeneous in echogenicity, similar to the prior study. There is a 9.4 x 5.7 x 8.1 cm heterogeneously hypoechoic lesion within the right hepatic lobe, which is increased in size compared to the CT dated 10/21/2015. No obvious active bleeding is detected by color Doppler criteria. Main portal vein flow is hepatopetal and measures 0.2 m/sec.", "output": "Interval increase in size of a heterogeneous right hepatic lobe lesion compared to CT dated 10/21/2015. These findings favor a hematoma over abscess formation."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female patient with epigastric pain, gassiness. Evaluate for gallbladder disease. LIVER: The liver measures 11.6 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 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 10.5 cm in length. No evidence of hydronephrosis.The spleen measures 8.7 cm in length.", "output": "No specific findings to account for the patient's symptoms. "}
{"instruction": "Generate impression based on findings.", "input": "Male; 57 years old. Reason: of liver, hep c, screen for hcc History: same LIVER: The liver measures 16.9 cm in length. The liver contour is smooth, the parenchyma is coarse in echotexture and increased in echogenicity. No worrisome mass is identified. There is no ascites.The main portal vein is patent with hepatopetal flow with a peak velocity of 0.2 m/sec.BILIARY TRACT: Again seen is adenomyomatosis the gallbladder fundus. The gallbladder wall is normal thickness. The common duct measures 5 mm. There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreas is obscured by overlying bowel gas.SPLEEN: The spleen measures 9.9 cm in length.RIGHT KIDNEY: The right kidney measures 10.3 cm in length. The cortex is normal in echogenicity. There is no hydronephrosis, renal stone, or worrisome mass identified. OTHER: The left kidney measures 10.1 cm in length. Again seen within the inferior pole of the left kidney is a 8.4 x 5.9 x 6.0 cm simple cysts (previously 7.4 x 6.6 x 6.2 cm).", "output": "Coarse echogenic liver compatible with hepatic steatosis. No worrisome mass is identified."}
{"instruction": "Generate impression based on findings.", "input": "Without The patient identified and CT is not seen with certainty. There is no is for mass or fluid collection.", "output": "No mass or fluid collection identified."}
{"instruction": "Generate impression based on findings.", "input": "Postoperative for hernia, cirrhosis with rising LFTs LIVER: Coarse echotexture of the liver consistent with cirrhotic morphology. Liver measures 15.2 cm. No focal lesions noted. Portal vein demonstrates normal flow directionality and patency. Perihepatic fluid/ascites noted which now demonstrates multiple septations and possibly loculated in nature.GALLBLADDER, BILIARY TRACT: Distended gallbladder with sludge and gallstones. Mild gallbladder wall thickening is secondary to the ascites. No intrahepatic biliary ductal dilatation.PANCREAS: Limited evaluation due to overlying bowel gas.RIGHT KIDNEY: Kidneys are mildly echogenic. Right kidney is not well visualized due to overlying bowel gas. Left kidney measures 11.6 cm with a nonobstructing stone in the mid pole which is unchanged from prior study.OTHER: Spleen measures 13 cm, mildly enlarged in size.", "output": "Cirrhotic morphology of the liver with portal hypertension mild splenomegaly. Moderate amount of perihepatic ascites which now demonstrates multiple septations and possibly loculated.CholelithiasisMildly echogenic kidneys. Limited evaluation of the right kidney. Nonobstructing left renal calculus."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old male with hypertension. Evaluate for renal artery stenosis. ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures 12.3 cm. The cortex has increased echogenicity. No shadowing calculi, hydronephrosis, or focal mass.LEFT KIDNEY: Left kidney measures 12.8 cm. The cortex has normal increased. No shadowing calculi, hydronephrosis, or focal mass.OTHER: Although the liver is partially imaged on this study, visualized portions have increased echogenicity.", "output": "1. No Doppler evidence of renal artery stenosis. No hydronephrosis.2. Increased echogenicity of the kidneys consistent with medical renal disease/parenchymal dysfunction. No hydronephrosis.3. Increased echogenicity of the liver parenchyma consistent with liver disease/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Male 38 years old Reason: Evaluate for graft patency History: urinary retention LOCATION: Left iliac fossaPERITRANSPLANT TISSUES: No perinephric fluid collection.KIDNEY: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass.URINARY BLADDER: Bladder has a Foley within it and is mildly distended. Adjacent to the bladder is a portion of the penile prosthesis.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels No significant abnormality of the floor of the vessels. Vessels are patent with normal waveforms. Resistive indices are within normal limits.OTHER: No significant abnormality noted", "output": "Normal evaluation of the transplant kidney without hydronephrosis. Patent inflow and outflow vessels."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female with acute kidney injury. Evaluate for hydronephrosis. RIGHT KIDNEY: Measures 11.5 cm in length. Increased echogenicity without hydronephrosis, discrete mass, or nephrolithiasis.LEFT KIDNEY: Measures 14.3 cm in length. Increased echogenicity without hydronephrosis, discrete mass, or nephrolithiasis.BLADDER: Collapsed and not clearly visualized.OTHER: Cholelithiasis and echogenic biliary sludge in the gallbladder lumen. Shadowing from these gallstones limits evaluation of the posterior wall of the gallbladder. Mild perihepatic ascites.", "output": "1.Increased renal echogenicity consistent with medical renal disease. No hydronephrosis.2.Limited images of the gallbladder demonstrate cholelithiasis and echogenic biliary sludge within the gallbladder lumen.3.Mild perihepatic 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": "30-year-old male with 1 cm mass in the left upper arm, suspected cyst versus lipoma. Grayscale and color ultrasound was performed in the left triceps area at the site of the patient's palpable complaint. Seen is a circumscribed 1.1 x 1.2 x 0.5 cm hyperechoic lesion in the subcutaneous soft tissues without significant vascularity, findings most consistent with a lipoma.", "output": "Findings consistent with a subcutaneous lipoma as detailed above. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Borisuth is a 17 year old female presenting with a palpable right breast mass x2 months with biopsy (July 2016) revealing a fibroepithelial lesion. A targeted right and whole left breast ultrasound was performed for the palpable areas of concern. In the right breast 12:00 location, approximately 3 cm from the nipple, there is a macrolobulated hypoechoic lesion identified 2.1 x 1.6 x 2.3 cm, compatible with biopsy proven fibroepithelial lesion. In the left breast 2:00 location, approximately 3 cm from the nipple, there is an additional macrolobulated hypoechoic lesion identified 1.7 x 0.6 x 1.1 cm, benign morphologic features suggestive of an additional fibroadenoma.", "output": "Biopsy proven fibroepithelial lesion of the right breast. High probability benign lesion of the left breast, likely representing fibroadenoma. A short term 6 month follow-up ultrasound can be performed in order to ensure stability of these findings. Patient is scheduled to follow-up with Dr. Bao immediately after radiology appointment. All results and recommendations were discussed with patient and her parents. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (6 Months). "}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female with HCV, cirrhosis. LIVER: Cirrhotic hepatic morphology with coarse hepatic echotexture. The liver is 16.9 cm in length. No new discrete hepatic mass lesions.BILIARY TRACT: Status post cholecystectomy. Prominence of the common bile duct unchanged.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Cirrhosis without focal hepatic mass."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules seen on prior CT. Thyroid gland is within normal limits. RIGHT LOBE MEASUREMENTS: 6.8 x 2.8 x 2.5 cmLEFT LOBE MEASUREMENTS: 8.2 x 3.7 x 3.1 cmISTHMUS MEASUREMENTS: 1.2 cm in AP dimension.RIGHT LOBE: Multiple spongiform nodules noted, the largest of which measures 2.6 x 2.3 x 2.5 cm in the inferior pole.LEFT LOBE: Left lower pole predominantly cystic nodule, measuring 4.0 x 2.6 x 3.0 cm, without associated vascularity or calcification. ISTHMUS: Cystic-solid nodule, measuring 4.2 x 5.0 x 3.3 cm, with minimal associated vascularity and without calcification. PARATHYROID GLANDS: Not visualized.LYMPH NODES: No lymphadenopathy identified.", "output": "Findings compatible with multinodular goiter, without suspicious nodule identified. "}
{"instruction": "Generate impression based on findings.", "input": "43-year-old male with history of acute kidney injury. RIGHT KIDNEY: Measures 9.7 cm in length. 1.2 cm right renal cyst without septation or nodular component. Increased echogenicity without hydronephrosis, calculus or solid mass.LEFT KIDNEY: Measures 10.2 cm in length. 3.3 x 3.0 cm left renal cyst without septation or nodular component. Increased echogenicity without hydronephrosis, calculus or solid mass.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Increased renal echogenicity consistent with medical renal disease. No hydronephrosis or nephrolithiasis. Renal cysts as described above, without suspicious features. "}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female with history of thyroid cancer status post surgery and radioablation. RIGHT LOBE MEASUREMENTS: Surgically absentLEFT LOBE MEASUREMENTS: Surgically absentISTHMUS MEASUREMENTS: Surgically absentRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Two hypoechoic lymph nodes are identified in the left supraclavicular area which were not seen on the prior examination. A palpable superficial node measures 0.6 x 0.6 x 0.3 cm. An additional slightly deeper node measures 0.6 x 0.4 x 0.3 cm. Other scattered bilateral cervical lymph nodes with overall benign morphologic features are without significant interval change.OTHER: No significant abnormality noted.", "output": "1. Two subcentimeter lymph nodes identified in the left supraclavicular region as described above, one of which is palpable, were not seen on the prior examination and are nonspecific but raise suspicion for nodal metastasis. 2. No evidence of recurrent disease in the thyroid bed or elsewhere in the neck. "}
{"instruction": "Generate impression based on findings.", "input": "39 years old, Male, Reason: Patient with old AV graft with acute swelling after trying to start line. Pleaes evaluate.for hematoma History: As above Ultrasound evaluation of the left mid arm swelling this was a heterogeneous collection consistent with hematoma measuring 4.8 x 1.2 x 4.9 cm.", "output": "Left mid arm hematoma measuring up to 4.9 cm in length."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male for abdominal distention. Limited sonographic evaluation of the abdomen demonstrates no ascites in the upper or lower quadrants. Incidentally noted cholelithiasis without evidence of acute inflammation. The bladder is collapsed with a Foley catheter in place.", "output": "No evidence of ascites."}
{"instruction": "Generate impression based on findings.", "input": "Ascites. Question of cirrhosis. LIVER: 17 cm in length. Non-cirrhotic liver morphology. Mildly increased hepatic echogenicity suggestive of a mild degree of parenchymal dysfunction. No focal hepatic lesions identified. Normal direction and flow of the portal vein.GALLBLADDER, BILIARY TRACT: Subcentimeter mural echogenicity with vascularity likely represents a benign polyp. There is minimal wall thickening, which is nonspecific in the setting of ascites. No sonographic Murphy's sign. No specific findings to suggest acute 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 7.3 cm in length, with markedly increased parenchymal echogenicity suggestive of medical renal disease. A 9 mm renal cyst is noted. No hydronephrosis is present.3.4 x 3.5 x 3.6 cm lobulated hypoechoic mass at the superior pole of the left kidney, without vascularity identified. The left kidney is otherwise not well visualized, likely due to diminutive size and increased echogenicity of medical renal disease. SPLEEN: 9.9 cm in length, without focal lesions evident.ABDOMINAL AORTA: Patent, without aneurysmal dilation.INFERIOR VENA CAVA: Patent, without significant abnormality noted.BLADDER: No significant abnormality noted.OTHER: Small bilateral pleural effusions are noted. Moderate amount of abdominal ascites is present.", "output": "1. Non-cirrhotic liver morphology. Mildly increased hepatic echogenicity suggestive of mild parenchymal dysfunction.2. 3.6 cm hypoechoic mass at the left upper renal pole, possibly a complex cyst, though better characterized on the prior CT. 3. Moderate amount of abdominal ascites. Small bilateral pleural effusions.4. Increased renal echogenicity, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "26 -year-old female. History of benign breast biopsy 2006 for a fibroadenoma and resection of multiple fibroadenomas in her right breast. Has pain in the lateral aspect of her right breast, currently breastfeeding. Targeted ultrasound of the patient's area of pain in the right lateral breast was performed. No suspicious underlying mass was identified. Two adjacent small cysts, the larger of which measured 9 x 3 mm, was seen at the 6 o'clock position.", "output": "Targeted ultrasound of the right breast at patient's site of pain showed no suspicious mass or other significant abnormality. Incidental note of benign simple cysts at the 6 o'clock position. Patient may follow-up with her clinician for management of her pain.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "60 year-old male with cirrhosis status post TIPS. LIVER: Cirrhotic liver morphology without focal hepatic lesion. The liver measures 12.5 centimeters in length. The TIPS is patent, however the undivided left portal vein still demonstrates hepatopedal flow. GALLBLADDER, BILIARY TRACT: The gallbladder is normal in appearance. There is no pericholecystic fluid, gallbladder wall thickening or cholelithiasis. PANCREAS: The head and proximal body of the pancreas are normal. The tail is obscured by bowel gas.SPLEEN: The spleen is normal in echogenicity and measures 16.3 cm in length. RIGHT KIDNEY: The right kidney measures 9.9 cm in length and shows diffusely increased echotexture. No stone or hydronephrosis. A 2.8 x 2.7 x 2.3 cm hypoechoic focus at the right upper pole may represent a discrete mass or may be due to artifact secondary to the echogenic cortex and irregular contour of the kidney.LEFT KIDNEY: The left kidney measures 12.8 cm in length and shows diffusely increased echotexture. No mass, stone or hydronephrosis.OTHER: No ascites.", "output": "1.The TIPS is patent, however the undivided left portal vein still demonstrates hepatopedal flow. No ascites.2.Diffusely increased echogenicity of both kidneys can be seen in the setting of medical renal disease/parenchymal dysfunction.3.A hypoechoic focus at the right upper pole may represent a discrete mass or may be due to artifact secondary to the echogenic cortex and irregular contour of the kidney. Would pay special attention to this lesion on future surveillance scans."}
{"instruction": "Generate impression based on findings.", "input": "26 year old female with history of AML diagnosed at age 11 status post stem cell transplant. Patient palpated left breast mass 1 week ago. Targeted physical examination of the left breast 8 o'clock position 0.5 cm from the nipple in the patient's palpable area of concern demonstrated denser tissue.A targeted left ultrasound was performed for the palpable area of concern. There is no solid or cystic mass identified. Dense breast tissue was demonstrated in the 8 o'clock position, 0.5 cm from the nipple.", "output": "No sonographic evidence for malignancy.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, stone, or hydronephrosis. Right kidney 15 cm in length.LEFT KIDNEY: Echogenic parenchyma again noted without mass, stone, or hydronephrosis. Left kidney 11 cm in length.OTHER: Bladder nondistended", "output": "Echogenic renal parenchyma again noted consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Rule out HCC History: HCV, cirrhosis LIVER: The liver measures 17.1 cm in length. Echogenic, coarse hepatic parenchyma. The portal vein is patent with normal directional hepatopetal flow, peak velocity 23.3 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The left kidney measures 11.1 cm in length. The right kidney measures 10.6 cm in length. No hydronephrosis or shadowing stones.OTHER: The spleen measures 9.9 cm in length. No ascites.", "output": "Echogenic, coarse hepatic parenchyma compatible with medical dysfunction or chronic liver disease. No biliary ductal dilatation or focal mass."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male for follow-up of thyroid nodules. RIGHT LOBE MEASUREMENTS: 6.7 x 2.7 x 2.7 cmLEFT LOBE MEASUREMENTS: 6.8 x 2.3 x 2.4 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: There are 3, adjacent spongiform-appearing nodules in the right lobe. The largest measures 1.1 x 1.9 x 1.9 cm when measured as on the prior exam. However, I believe that the longitudinal measurement incorporates 2 nodules and the larger nodule has a length of 1.4 cm on today's study without change. Previously measured spongiform nodule in the right lower pole measures 0.5 x 0.8 x 0.9 cm without change.LEFT LOBE: Solid nodule in the lower pole of the left thyroid measures 1.3 x 1.5 x 1.6 cm. When remeasuring this nodule on the prior exam, it measured 1.1 x 1.4 x 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": "No significant interval change in thyroid nodules. Two nodules are remeasured on today's study to improve accuracy. "}
{"instruction": "Generate impression based on findings.", "input": "Male 50 years old Reason: increased creatinine History: elevated creatinine RIGHT KIDNEY: Ultrasound guidance was provided for the nephrology service for a right iliac fossa renal transplant kidney biopsy.", "output": "Ultrasound guidance was provided for the nephrology service for a right iliac fossa renal transplant kidney biopsy."}
{"instruction": "Generate impression based on findings.", "input": "13-year-old female with bilateral fibroadenomas; clinical decrease in size of the right breast mass with increase in size of the known left breast mass. On physical examination, an additional mass is noted within the lower left breast. Ultrasound is requested for characterization of the new left breast mass, and to demonstrate stability of the known bilateral masses. A targeted left ultrasound was performed for the palpable areas of concern. At the one o'clock position of the left breast, 3 cm from the nipple, there is redemonstration of a parallel, circumscribed oval hypoechoic mass measuring 2.1 x 0.9 x 2.2 cm (previously 1.1 x 0.5 x 1.1 cm). This mass demonstrates mild peripheral vascularity. At the 6 o'clock position of the left breast, 5 cm from the nipple, there is a parallel, circumscribed, oval hypoechoic mass measuring 1.7 x 0.7 x 1.4 cm. The mass demonstrates increased vascularity.A targeted right ultrasound is performed for the palpable area of concern. At the 10 o'clock position of the right breast, 2 cm from the nipple, there is a 1.5 x 0.6 x 1.9 cm parallel, macrolobulated hypoechoic mass decreased in size from prior examination (previously 2.1 x 1.2 cm). This mass demonstrates minimal peripheral vascularity.", "output": "1. Increase in size of the previously demonstrated mass at the one o'clock position of the left breast, measuring 2.2 cm on today's examination. This finding likely represents a fibroadenoma. 2. New circumscribed hypoechoic mass at the 6 o'clock position of the left breast measuring 1.7 cm. This finding likely represents a fibroadenoma. 3. Decrease in size of the previously identified right breast mass now measuring 1.9 cm, corresponding to biopsy proven fibroadenoma.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "71 female with right upper quadrant pain, chills, CVA tenderness. History of cholecystectomy and reported renal cyst. LIVER: Increased echogenicity of the liver measuring 14.4 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/s. GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. The common duct measures 7 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Tail of the pancreas is obscured by overlying bowel gas. Visualized portions of the pancreas are unremarkable. RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 10.8 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the spleen measuring 7.8 cm in length. Normal echogenicity of the left kidney measuring 11.2 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "Increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesions."}
{"instruction": "Generate impression based on findings.", "input": "65 years old, Male, Reason: pt with aki; please eval for obstuction History: Aki RIGHT KIDNEY: Kidney measures 11.4 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.8 cm in length. Increased echogenicity of the kidney is consistent with medical renal disease. No hydronephrosis, shadowing calculus or mass.Bladder: Bladder nondistended", "output": "1.Increased echogenicity of the kidneys consistent with medical renal disease. 2.No evidence of hydronephrosis as clinically questioned."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for right upper quadrant obstructive liver disease, new hyperbilirubinemia with coagulopathy LIVER: Diffuse coarse echotexture of the liver remains unchanged, mildly enlarged measuring 20 cm. Perihepatic fluid noted. No intrahepatic biliary ductal dilatation. No focal lesion.Main portal vein is patent with normal flow directionality.BILIARY TRACT: Gallbladder wall appears mildly thickened probably related to adjacent ascites. Sonographic Murphy sign cannot be assessed. No evidence of gallstones.Common bile duct measures up to 4 mm without any stones within it.PANCREAS: Not well visualized due to overlying bowel gas.OTHER: Mild ascites, minimally increased from prior examination and mild right pleural effusion.", "output": "Coarse echotexture of the liver, enlarged liver, suspicious for parenchymal dysfunction.Thickened wall of the gallbladder secondary to adjacent ascites which appears minimally increased.Mild right pleural effusion.CBD measurement within normal limits without evidence of any stones."}
{"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": "Acute kidney injury. Evaluate renal lesion seen on CT in July 20, 2015 Evaluation is significantly limited by poor acoustic penetration.RIGHT KIDNEY: 10.3 cm. The renal parenchyma is echogenic. No large focal lesions or stones identified. No hydronephrosis.LEFT KIDNEY: Evaluation of the left kidney is significantly limited by poor acoustic penetration. The previously seen lesion on CT is not evident by ultrasound. No hydronephrosis is present.OTHER: No significant abnormalities noted.", "output": "Limited examination due to poor acoustic penetration. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Reason: new buttock swelling - undergoing immunotherapy with history of abscesses History: neuroblastoma s/p chemotherapy and stem cell transplant . Erythematous induration on R buttock. Soft tissue swelling without discrete fluid collection.", "output": "Soft tissue swelling without discrete fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "Male, 69 years old. CKD RIGHT KIDNEY: The right kidney measures 12.3 cm in length, with increased cortical echogenicity. No focal mass lesion, shadowing stones, or hydronephrosis.LEFT KIDNEY: The left kidney measures 12.1 cm in length, with increased cortical echogenicity. No focal mass lesion, shadowing stones, or hydronephrosis.OTHER: The bladder is nondistended.", "output": "Increased renal cortical echogenicity, compatible with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "19-year-old male complains of growth in right lateral mid thigh. No visible mass or fluid collection corresponding the palpable lesion.", "output": "1. No visible mass or fluid collection corresponding the palpable lesion on sonography."}
{"instruction": "Generate impression based on findings.", "input": "Male 23 years old Reason: mother with polycystic kidney disease, pt admitted for HTN urgency with elevated Cr eval for renal disease/cysts History: HTN, proteinuria RIGHT KIDNEY: 10.5 cm in length. Diffusely echogenic consistent with chronic medical renal disease. No evidence of hydronephrosis.LEFT KIDNEY: 11.1 cm in length. Echogenic. No hydronephrosis or hydroureter. Echogenic focal area abutting left upper pole of uncertain etiology. Uncertain if this is exophytic off the kidney or accessory spleen. CT may be obtained for the evaluation.Urinary bladder: No significant abnormality.", "output": "Echogenic kidneys consistent with chronic medical renal disease. No hydronephrosis. Echogenic focus in or adjacent to left upper pole may be evaluated further with CT."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female with generalized abdominal pain, greater on the left. RIGHT KIDNEY: The right kidney measures approximately 12.7 cm in length. No obvious hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Left kidney measures approximately 12.9 cm in length. No obvious hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "Limited exam without abnormality of the kidneys."}
{"instruction": "Generate impression based on findings.", "input": "Two month old male with hydrocephalus seen on serial head ultrasounds from baseline CT. There is no evidence of intracranial hemorrhage, mass or edema. The lateral ventricles are markedly enlarged, most noted in the occipital horn of the left lateral ventricle, which contains an external drainage catheter. The third ventricle is mildly enlarged, and the fourth ventricle demonstrates normal volume. Ventricular volumes are grossly stable from recent ultrasound exams, given differences in imaging technique. The ventricles remain midline. The basal cisterns are normal in size and configuration. The myelination pattern is within normal limits. There is mild encephalomalacia left parietal lobe near the enlarged occipital horn of the left lateral ventricle.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "Stable hydrocephalus and associated left parietal encephalomalacia as described."}
{"instruction": "Generate impression based on findings.", "input": "50 year-old female with thyroid cancer status post thyroidectomy, has paratracheal node with positive cytology for cancer. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: In the right inferior thyroid bed, there is a 0.7 x 0.6 x 0.6 cm hypoechoic nodule which is not changed substantially since the prior examination. Note there was a typographical error on that exam and the correct size of the nodule on the prior exam was 0.7 x 0.5 x 0.6 cm.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Reference level 4 lymph node measures 1.9 x 0.7 x 0.9 cm, unchanged compared to prior.OTHER: No significant abnormality noted.", "output": "No substantial interval change compared to prior with reference measurements given above."}
{"instruction": "Generate impression based on findings.", "input": "90 year-old female with remote history of capillary thyroid cancer in 1987. Evaluate for recurrence. THYROID: The patient is status post thyroidectomy. RIGHT THYROIDECTOMY BED: Status post thyroidectomy with no evidence of residual or recurrent disease. LEFT THYROIDECTOMY BED: Status post thyroidectomy with no evidence of residual or recurrent disease. ISTHMUS BED: Status post thyroidectomy with no evidence of residual or recurrent disease. LYMPH NODES: Bilateral morphologically unremarkable and normal-sized lymph nodes are identified.PARATHYROID GLANDS: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No evidence of tumor recurrence."}
{"instruction": "Generate impression based on findings.", "input": " Normally compressible veins in the right lower extremity from the popliteal vein to the CFV.Normally compressible veins in the left lower extremity from the popliteal vein to the CFV.Iliac veins and IVC was difficult to visualize on ultrasound due to patient body habitus.Following a discussion of the procedure with the patient and/or family, including its risks, benefits, alternatives and steps to prevent infection, an informed written consent was obtained and documented in the patient's chart. The patient was placed supine on the angiography table. The right neck was prepped with chlorhexidine and covered with a full body drape in the usual sterile fashion. Local anesthesia was achieved with 1% lidocaine. Midazolam and fentanyl were administered IV by the nurses during continuous hemodynamic monitoring. All operators present for the case performed standard preprocedural prep including hand washing, sterile gloves, gown, mask and cap.The right internal jugular vein was accessed using a micropuncture system. An 0.035 guidewire was advanced into the inferior vena cava under fluoroscopic guidance and exchanged for a 5 French pigtail catheter. This was positioned with the tip in the inferior IVC just below the bifurcation. Contrast was injected obtaining an inferior venacavagram.VENACAVAGRAM: There is a single, normal caliber IVC with normal renal vein inflow. No evidence of caval thrombus. The level of the renal veins was calibrated with a ruler. The filter deployment system was advanced over an Amplatz wire and the filter was deployed in the infrarenal IVC under fluoroscopic guidance. FOLLOW UP VENACAVAGRAM: Follow up imaging shows proper full deployment of an infrarenal IVC filter. The introducer system was removed and hemostasis was achieved at the site. The patient tolerated the procedure well without immediate complication. Routine post procedure instructions were documented in the chart and relayed to the referring clinical team.FLUOROSCOPY TIME: 6.3 minutesAIR KERMA: 181 mGyStart time: 12:48PMFinish time: 1:15 PMESTIMATED BLOOD LOSS: Less than 5 ccCONTRAST: Omnipaque 300VOLUME: 70 mL", "output": "Successful placement of Cook Celect IVC filter. The patient was entered into the IVC filter tracking database and should return to the interventional radiology department in 3 months for consultation regarding optional IVC filter removal."}
{"instruction": "Generate impression based on findings.", "input": "Male 57 years old; Reason: oof liver, cirrhosis, screen fo hcc History: same LIVER: The liver measures 14.5 cm in length. There is 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 23.9 cm/s. No ascites.GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.1 mm. No stones or sludge are seen. No pericholecystic fluid. 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 9.9 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.1 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "The liver has increased echogenicity compatible with fatty infiltration/parenchymal dysfunction. No ascites or worrisome masses are seen."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old male. Complicated UTI. Chronic hydronephrosis. RIGHT KIDNEY: Severe hydroureteronephrosis with marked cortical thinning/atrophy. The kidney is 10 cm in length. No abscess is identified.LEFT KIDNEY: Severe hydroureteronephrosis with moderate cortical thinning/atrophy. The kidney is 12.8 cm in length. No abscess is identified.OTHER: Collapsed bladder with a Foley balloon.", "output": "Severe bilateral hydroureteronephrosis with associated marked cortical thinning/atrophy, greater on the right. No renal abscess is evident.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: No significant abnormalities noted. Liver length is 16.1 cmGALLBLADDER, BILIARY TRACT: Gallbladder sludge with mild gallbladder wall thickening. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.2 cm in lengthOTHER: Left kidney 10.2 cm in length. Spleen 12.5 cm in length. No ascites. Right pleural effusion.", "output": "Gallbladder sludge with mild gallbladder wall thickening; some component of chronic inflammation cannot be excluded. No ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules RIGHT LOBE MEASUREMENTS: 4.4 x 1.9 x 1.5 cmLEFT LOBE MEASUREMENTS: 3.8 x 1.7 x 1.2 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Stable solid nodule measuring 1.4 x 1.2 x 1.4 cm.LEFT LOBE: Stable lower pole solid nodule measuring 0.9 x 0.9 cm.ISTHMUS: Stable left isthmus nodule measuring 0.9 x 0.6 x 0.8 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "Reason: History of left renal lesion, evaluate for change in size or characteristics RIGHT KIDNEY: The right kidney measures 9.2 cm in length. Normal echogenicity and echotexture. There is no focal mass or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.1 cm in length. Normal echogenicity and echotexture. There is a subcentimeter anechoic lesion in the inferior pole of the left kidney measuring 1.0 x 1.0 x 0.9 cm, consistent with a simple cyst. There is no focal mass or hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Simple cyst in the lower pole of the left kidney without significant interval change compared to CT from 10/24/2015."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with renal transplant and urinary retention. RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: Transplant kidney measures approximately 11.9 cm in length. There is no hydronephrosis, shadowing calculus or mass. Parenchyma is well-maintained.COLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: Decompressed with Foley catheterOTHER: No significant abnormality noted", "output": "Normal-appearing renal transplant."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal sufficiency RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 9.4 cm in lengthLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 9.4 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": "Status post partial lobectomy for benign goiter LEFT LOBE MEASUREMENTS: 4.6 x 1.3 x 1.8 cmISTHMUS MEASUREMENTS: No significant abnormality noted.RIGHT LOBE: Status post right lobectomy. Right thyroid bed unremarkable without evidence for massLEFT LOBE: Mildly heterogeneous echotexture without noduleISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: 1.9 x 1.1 x 0.6 cm hypoechoic lymph node left level 3 best considered indeterminate with respect to morphology.OTHER: No significant abnormality noted.", "output": "Status post right thyroid lobe resection. Right thyroid bed unremarkable. Mildly heterogeneous left thyroid gland without nodule.Mildly enlarged hypoechoic lymph node left level 3 best considered indeterminate with respect to morphology. Would recommend special attention to this lymph node on future surveillance scans."}
{"instruction": "Generate impression based on findings.", "input": "Reason: left hand mass - eval for vascularity and depth History: painful mass At the site of the patient's reported palpable abnormality in the superficial soft tissues of the left palm, there is a oval-shaped structure measuring approximately 1.4 x 0.5 x 0.9 cm. The structure demonstrates heterogeneous but predominantly hypoechoic echogenicity internally and demonstrates peripheral but not internal vascularity. The structure resides approximately 2 mm deep to the skin surface.", "output": "Nonspecific possibly cystic mass lesion within the superficial soft tissues of the left palm. Superimposed infection is not excluded. If further characterization is warranted, MRI can be considered."}
{"instruction": "Generate impression based on findings.", "input": "17-year-old male patient with hematuria. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. Distal Ureter -- SFU Grade**  Right: 0  Left: 0   Ureteral Jets Right: Not observed  Left: Observed.KIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 10.3 cm Left: 10.4 cm   Mean for age: 10.5 cm  Range for age: 10.0 - 11.1 cmADDITIONAL OBSERVATIONS: None.", "output": "Normal examination.*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": "Elevated LFTs LIVER: Mildly heterogeneous and echogenic liver echotexture without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 19.4 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 11 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.4 cm in lengthOTHER: Left kidney 10.5 cm in length. No ascites.", "output": "Mildly enlarged and heterogeneous/echogenic liver echotexture raises the possibility of fatty infiltration without worrisome mass or ductal dilatation. Collapsed gallbladder without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Anderson is a 56 year old female who returns today for further imaging evaluation of an asymmetry in the posteromedial right breast identified on screening mammogram dated 4/6/2016. Full field right ML view, right cleavage view and right CC spot compression view were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography (BiRads Density Category D), unchanged in pattern and distribution. Asymmetry in the medial right breast in the very posterior location is again seen. ULTRASOUND", "output": "Dilated tubular structures within the right lower inner quadrant with no internal vascularity and occasional internal fluid movement, an imaging appearance most compatible with dilated intramammary ducts containing debris. Biopsy is recommended to confirm benignity. Findings and recommendation were discussed with Ms. Anderson, who agrees with the plan.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "87 year-old female with tachycardia and abnormal thyroid function tests. Evaluate for multinodular goiter. RIGHT LOBE MEASUREMENTS: 3.3 x 2.4 x 5.2 cmLEFT LOBE MEASUREMENTS: 2.3 x 2.3 x 5.9 cmISTHMUS MEASUREMENTS: 3 mm.RIGHT LOBE: There is a 2.1 x 2.4 x 2.7 cm hypoechoic interpolar solid nodule with small cystic components. There is mild internal vascularity and no definite associated calcifications. The margins are well-defined. There are numerous additional sub-5-mm nodules in the right thyroid lobe. LEFT LOBE: There is a 0.8 by 0.8 x 1.2 cm inferolateral left thyroid hypoechoic nodule with peripheral vascularity. The margins are well-defined. Punctate intralesional punctate echogenic foci, nonspecific, nonshadowing, no definite comet tail artifact. No definite flow seen within this nodule. Additional sub-5-mm nodules are scattered throughout the left thyroid lobe.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.", "output": "1. Indeterminate dominant 2.7 cm right thyroid nodule. Given the large size of the right thyroid nodule, further evaluation with fine needle aspiration may be considered. 2. Numerous other smaller nodules seen bilaterally."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with history of hepatitis C virus. LIVER: Diffusely increased hepatic echogenicity.. No focal hepatic lesion or mass. The liver measures 15.9 cm in length. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts.The main portal vein is patent with normal hepatopedal flow and velocity of 29.5 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is normal in appearance. There is no pericholecystic fluid, gallbladder wall thickening or cholelithiasis. The common bile duct measures 0.4 cm in diameter. PANCREAS: The head and proximal body of the pancreas are normal. The tail is obscured by bowel gas.SPLEEN: The spleen is normal in echogenicity and measures 9.2 cm in length. RIGHT KIDNEY: The right kidney measures 9.6 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.5 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.URINARY BLADDER: The urinary bladder is normal in appearance.OTHER: There is no free or loculated fluid.", "output": "Fatty infiltration of the liver without suspicious hepatic mass or lesion."}
{"instruction": "Generate impression based on findings.", "input": "68 year-old female with history of hepatitis C and right upper quadrant pain. The study was limited and suboptimal due to the patient's body habitus.LIVER: The liver is coarse, echogenic and has decreased through transmission, limiting evaluation for a focal lesion. Given this limitation, no focal lesion or intrahepatic biliary dilatation is evident. The liver contour appears slightly nodular, suggesting underlying cirrhosis/fibrosis. Liver is mildly prominent, measuring 20.8 cm in craniocaudal dimension. There is normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: There is a normally distended gallbladder without wall thickening, pericholecystic fluid, gallstones, or focal tenderness.PANCREAS: The pancreas is suboptimally visualized.SPLEEN: The spleen is moderately enlarged, measuring 14.7 cm.RIGHT KIDNEY: The right kidney measures 13.2 cm without hydronephrosis. OTHER: The left kidney measures 14.9 cm without hydronephrosis.", "output": "1. Findings compatible with diffuse fatty infiltration/parenchymal dysfunction, limiting evaluation for a focal lesion. Within this limitation, no focal lesion is evident. If there is continued clinical concern, a dedicated liver CT/MRI should be considered.2. Liver morphology suggestive of early cirrhosis.3. No evidence of gallbladder disease or biliary ductal dilatation.4. Moderate splenomegaly. "}
{"instruction": "Generate impression based on findings.", "input": "Small neck mass. RIGHT LOBE MEASUREMENTS: 4.8 x 1.7 x 1.2 cm. Normal background echotexture and vascularity.LEFT LOBE MEASUREMENTS: 4.4 x 1.5 x 1.2 cm. Normal background echotexture and vascularity.ISTHMUS MEASUREMENTS: 1 mm in AP dimension.RIGHT LOBE: 7 x 5 x 4 mm hypoechoic round nodule in the superior pole of the right lobe, not previously seen. LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing lymph nodes identified.OTHER: In the region of palpable concern, there is an unchanged 5 mm round hypoechoic nodule within the midline subcutaneous fat.", "output": "1. New hypoechoic 7 mm nodule in the superior right thyroid lobe. This lesion may be amenable to percutaneous biopsy. 2. Unchanged 5 mm nodule in the subcutaneous fat, possibly representing a thyroglossal duct cyst, lymph node, or less likely a blood vessel."}
{"instruction": "Generate impression based on findings.", "input": "Female 78 years old Reason: Hx ESRD with secondary hyperparathyroidisms, evaluate for enlarged parathyroid glands and thyroid nodules RIGHT LOBE MEASUREMENTS: 3.9 x 1.6 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.5 x 1.7 x 1.6 cmISTHMUS MEASUREMENTS: 0.4 cm.RIGHT LOBE: Numerous nodules are present in the right thyroid. Most superior nodule measures 0.8 x 0.9 x 0.7 cm. Mid nodule is partially calcified measuring 0.2 x 0.3 x 0.1 cm. The most inferior right right inferior nodule measures 1.1 x 0.9 x 0.7 cm. Hyperechoic focus in the inferior pole of the right thyroid, given the background nodular thyroid, may represent an exophytic nodule.LEFT LOBE: Small spongiform appearing cyst in the left thyroid lobe measuring 0.5 x 0.6 x 0.5 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Inferior to the left thyroid lobe is a hypoechoic nodule measuring 1.0 x 1.4 x 1.5 cm, consistent with a parathyroid adenoma.LYMPH NODES: Small benign-appearing lymph nodes are present bilaterally.OTHER: No significant abnormality noted.", "output": "When correlated with nuclear medicine scan, findings are most consistent with a parathyroid adenoma inferior to the left thyroid lobe. Multiple intrathyroid nodules are present."}
{"instruction": "Generate impression based on findings.", "input": "Male 74 years old Reason: hematuria History: hematuria RIGHT KIDNEY: The right kidney measures 11.1 cm. There is a heterogeneous, vascular, solid mass arising from the midpole of the right kidney with deformity of the renal contour. This measures 3.1 x 3.1 x 3.6 cm and is suspicious for renal cell carcinoma.LEFT KIDNEY: The left kidney measures 12.1 cm. There is no hydronephrosis. URINARY BLADDER: The bladder is poorly distended.OTHER: No significant abnormalities noted.", "output": "Solid 3.6 cm renal mass, suspicious for renal cell carcinoma. Further evaluation with renal protocol CT is recommended.Findings discussed by myself Dr. Ward with Dr. Christopher Riedinger 01/30/15. "}
{"instruction": "Generate impression based on findings.", "input": "45-year-old male with hepatitis B. Evaluate for HCC. LIVER: Heterogenous echotexture is nonspecific but can be seen in cirrhosis. Normal liver contour without evidence of nodularity. The liver measures 14.7 cm in length. No suspicious liver mass is identified. The main portal vein is patent.BILIARY TRACT: Normal gallbladder. No biliary ductal dilatation. Common bile duct measures 2 mm in diameter.PANCREAS: Pancreatic duct is again noted measuring 2 mm in diameter. No mass detected.SPLEEN: 9.1 cm in length. Normal echogenicity.RIGHT KIDNEY: 11.1 cm in length. There are no shadowing stones, hydronephrosis, or suspicious renal masses.OTHER: Left kidney measures 10.0 cm in length. There are no shadowing stones, hydronephrosis, or suspicious renal masses.", "output": "No lesions suspicious for HCC."}
{"instruction": "Generate impression based on findings.", "input": "Female 67 years old Reason: eval for portal vein thrombosis History: hx of HCC, hx of portal vein thrombosis at OSH, hemoglobin drop LIVER: Liver echogenicity is coarse. Liver measures 15.5 cm. There is an ill-defined heterogeneous echotexture mass in the right lobe of the liver extending into the hepatic hilum. There is thrombus in the main portal vein. Posterior branch of the right portal vein could not be visualized. Left portal vein is patent.GALLBLADDER, BILIARY TRACT: Cholelithiasis. Gallbladder wall is thickened. No evidence of intra or extrahepatic biliary dilatation. Common bile duct measures 5.PANCREAS: Not well visualized due to overlying bowel gas.RIGHT KIDNEY: Echogenic kidney. No evidence of hydronephrosis.OTHER: Small amount of ascites. Spleen measures 10.9 cm.", "output": "Ill-defined hypoechoic heterogeneous right lobe mass with portal vein thrombosis. Contrast-enhanced MRI is recommended for further evaluation of this mass and thrombus. Small amount of ascites."}
{"instruction": "Generate impression based on findings.", "input": "Reported history of hepatic hemangiomas seen on outside CT including one 2 cm hemangioma at the dome and a 1 cm hemangioma in the left inferior liver. LIVER: The liver measures 15.6 cm in length. The liver parenchymal echotexture is normal. There is a hyperechoic structure within the inferior right liver with faceted margins which measures 0.8 x 0.6 x 0.7 cm and which is nonspecific but compatible with a hemangioma. 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 diameterPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. The spleen measures 8.2 cm in length. RIGHT KIDNEY: Kidney measures 10.5 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.3 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "Single subcentimeter hypoechoic lesion within the right inferior liver which is nonspecific but in the absence of underlying liver disease or history of malignancy most likely represents a benign hemangioma. Correlation with prior outside imaging would be helpful."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old male patient with epigastric/right upper quadrant pain. Evaluate for biliary pathology. LIVER: The liver measures 16.6 cm in length. There are innumerable hypoechoic lesions within the liver. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 3 mm in diameter.PANCREAS: The head of the pancreas demonstrate normal echogenicity. The remaining pancreas is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney is absent.OTHER: The left kidney measures 12.1 cm in length. No evidence of hydronephrosis. A 2.4 cm left lower pole renal cyst is noted.The spleen measures 10.7 cm in length.", "output": "Innumerable hypoechoic lesions within the liver which are better evaluated with CT. No intra or extra hepatic biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "81-year-old female with history of multinodular goiter, status post bilateral subtotal thyroidectomy. RIGHT LOBE MEASUREMENTS: 2.5 x 0.8 x 1 cm. Previously 1.9 x 0.9 x 0.6 cm.LEFT LOBE MEASUREMENTS: 5.8 x 2 x 2.4 cm. Previously 5.8 x 2.2 x 2.1 cm.ISTHMUS MEASUREMENTS: 0.25 cm in thickness. Previously 0.17 cm in thickness.RIGHT LOBE: Residual tissue in the right thyroid bed measures 2.5 x 0.8 x 1 cm. Previously 1.9 x 0.9 x 0.6 cm.LEFT LOBE: Multiple large lobulated masses in the left thyroid bed, which are approximately unchanged. A representative posterior left lower thyroid nodule measures 1.3 x 1.4 x 2 cm. The overall size of the left thyroid lobe is unchanged.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. No significant interval change in the multifocal nodules of the left lobe and stable residual soft tissue in the region of the right thyroid bed."}
{"instruction": "Generate impression based on findings.", "input": "History of a mobile sternal subcutaneous palpable lesion. Targeted grayscale and color Doppler ultrasound of the patient's reported palpable parasternal subcutaneous soft tissues demonstrates no discrete solid lesion or fluid collection.", "output": "No discrete solid lesion or fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "Female 53 years old; Reason: evaluate liver for chronic liver disease History: elevated INR LIVER: The liver measures 20.4 cm in length. There is mildly increased and coarse 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 wall measures 1.8 mm. Several stones are seen. No pericholecystic fluid. The common bile duct measures 5.0 mm in diameter at the maximum point. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 12.1 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.8 cm in length. The cortex has mildly increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 9.1 cm in length. The cortex has mildly increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.", "output": "1. Cholelithiasis of unknown chronicity without signs of acute cholecystitis.2. Increased and coarse echogenicity of the liver parenchyma consistent with fatty liver."}
{"instruction": "Generate impression based on findings.", "input": "Female 56 years old Reason: Patient with left tail parotid mass. Please do u/s guided fna. History: Patient with left tail parotid mass. Please do u/s guided fna. Timeout was performed.Written informed consent was obtained. Risks of pain, infection and bleeding explained to the patient.Skin was anesthetized with 1% lidocaine over the region of the left parotid gland lesions.Under ultrasound guidance 25-gauge needle was placed into the superior lesion and bloody fluid was obtained and submitted for cytologic analysis.Under ultrasound guidance 25-gauge needle was placed into the inferior lesion at 5 cc of slightly yellowish translucent fluid was obtained and submitted for cytologic analysis.Patient refused additional attempts for the superior lesion.Postprocedure the inferior lesion decreased significantly in size after removal of fluid.Preliminary report from cytology shows macrophages and lymphocytes. Full report to follow.Less than 1 cc blood loss.", "output": "Both lesions sampled. Questionable adequacy for the more cephalad lesion. Caudal lesion was mostly drained."}
{"instruction": "Generate impression based on findings.", "input": "Female 82 years old Reason: ? Renal cyst, pancreatic path History: seen in ER for abd pain; had abn CT in 4/16 LIVER: Mildly coarse liver echotexture which is a nonspecific finding, clinical correlation is recommended. No focal mass. Liver measures 12.7 cm. Main portal vein is patent with normal directional flow and a peak velocity of 15.9 cm/s.BILIARY TRACT: Gallbladder has a normal appearance. Common bile duct measures 3 mm. No intra or extrahepatic biliary ductal dilatation.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 6.7 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 11.4 cm. Right mid kidney cyst measuring 1.3 x 1.3 x 1.5 cm. Left kidney measures 11.1 cm.OTHER: No significant abnormalities noted.", "output": "Small right renal cyst. No hydronephrosis or renal calculus."}
{"instruction": "Generate impression based on findings.", "input": "Female 73 years old Reason: hepatocellular injury, assess for vascular abnormalities and liver architecture, patient with AKI, please assess kidneys History: as above ABDOMENLIVER: Liver is normal in morphology and measures 15.8 cm in length. The hepatic parenchyma is homogenously increased echotexture. No focal mass lesion is evident.BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilatation. The common bile duct measures 4 mm in diameter.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen is normal in size measuring 11.8 cm in length. RIGHT KIDNEY: The right kidney is normal in size measuring 11.5 cm in length. The renal parenchyma is mildly echogenic but normal in thickness. No hydronephrosis or shadowing stones.LEFT KIDNEY: The left kidney is normal in size measuring 9.2 cm in length. Evaluation of the parenchyma is mildly limited due to technical factors, however the renal parenchyma appears mildly echogenic. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Mildly echogenic hepatic parenchyma which can be seen in hepatic steatosis.2.Mildly echogenic renal parenchyma bilaterally compatible with medical renal disease. No hydronephrosis or stones are evident.3.Normal Doppler examination of the abdomen."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old female with primary hyperparathyroidism. Please evaluate. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.6 x 2.3 x 2.1 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.1 x 2.2 x 1.6 cm.ISTHMUS MEASUREMENTS: The thyroid isthmus measures 0.5 cm in thickness.RIGHT LOBE: There are multiple subcentimeter hypoechoic nodules with a spongiform appearance. The largest of these nodules measures 0.9 x 0.8 x 0.5 cm and is located in the anterior right upper pole.LEFT LOBE: Multiple subcentimeter hypoechoic nodules with a spongiform appearance. The largest of these nodules measures 0.9 x 0.7 x 1 cm and is located in the left lower pole. An additional complex cystic nodule posterior to the left mid thyroid lobe measures 1.5 x 1.2 x 1.4 cm. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: See below.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Complex cystic nodule posterior to the left mid thyroid pole could represent an exophytic cystic thyroid nodule, however a cystic parathyroid adenoma cannot be excluded. Correlation with nuclear medicine imaging is recommended.Multiple thyroid nodules bilaterally; favor benign etiology. "}
{"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 suspicious mass identified.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Male 80 years old; Reason: evaluate liver parencyhma for cirrhossi History: low albumin, transaminits, persistent lactate, rv failure LIVER: The liver measures 15.1 cm in length. There is coarse increased echogenicity of the liver parenchyma. There is a very subtle nodular morphology along the liver capsule. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 36.6 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.8 mm. No stones or sludge are seen. No pericholecystic fluid. The common bile duct measures 1.5 mm in diameter. PANCREAS: The pancreas is not well-visualized due to bowel gas.SPLEEN: The spleen was not visualized due to difficulty with patient positioning.RIGHT KIDNEY: The right kidney measures 10.2 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.5 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. There is a very subtle nodular appearance to the liver with increased echogenicity which is concerning for possible early cirrhosis. No worrisome masses are seen.2. Bilaterally the kidneys have increased echogenicity which is compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "65 years old, Male, Reason: evalaute for obstruction History: AKI RIGHT KIDNEY: Kidney measures 13.5 cm in length. Increased echogenicity of the right kidney consistent with medical renal disease. Right upper pole renal cyst measuring 2.4 x 2.6 by 2.1 cm. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 13.8 cm in length. Increased echogenicity of the left kidneys consistent with medical renal disease. No hydronephrosis, shadowing calculus or mass.Bladder: There is a Foley within the bladder.", "output": "1.No evidence of hydronephrosis as clinically questioned.2.Increased echogenicity of the kidneys bilaterally consistent with medical renal disease.3.Right upper pole simple appearing renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "History papillary thyroid carcinoma, with mixed cystic solid isthmic nodule. RIGHT LOBE MEASUREMENTS: 1.7 x 1.4 x 5.6 cmLEFT LOBE MEASUREMENTS: 1.6 x 1.3 x 5 cm ISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant change in predominately cystic left isthmic focus measuring 0.7 x 0.6 x 0.7 cm. The central solid nodular component within the cystic lesion measures 0.2 x 0.3 x 0.4 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable predominantly cystic left isthmic nodule with central solid component. No regional adenopathy. Would recommend continued surveillance ultrasound in 10 months."}
{"instruction": "Generate impression based on findings.", "input": "Female; 48 years old. Reason: Mass R shoulder measures 0.5 cm, evaluate History: mass Sonographic interrogation in the region of the patient's palpable abnormality reveals a 1.4 x 0.7 x 1.2 cm encapsulated lesion located beneath the subcutaneous fat. This has longitudinal internal striations and echogenicity similar to the adjacent musculature. No internal vascular flow is seen.", "output": "Corresponding to patient's palpable abnormality is a 1.4 cm lesion with a sonographic appearance compatible with a lipoma."}
{"instruction": "Generate impression based on findings.", "input": "41 year old female with ascites, anasarca. Moderate four quadrant ascites is noted. Incompletely visualized bilateral pleural effusions.", "output": "Moderate four quadrant ascites. Bilateral pleural effusions. "}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Coarse liver echotexture again noted without mass. Liver length 13.9 cmGALLBLADDER, BILIARY TRACT: Stable subcentimeter gallbladder polyps measuring 0.6 x 0.5 x 0.3 cm and 0.5 x 0.4 x 0.5 cm. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.6 cm in lengthOTHER: Left kidney 12.3 cm in length. Spleen 10.6 cm in length. No ascites.", "output": "Stable coarse echogenic liver echotexture consistent with chronic liver disease without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal renal function and severe hypertension poorly controlled. Rule out renal artery stenosis. ULTRASOUND KIDNEYSRIGHT KIDNEY: Right kidney measures 10.4 cm in length. There is no evidence of hydronephrosis. Kidney appears mildly echogenic.LEFT KIDNEY: Left kidney measures 10.9 cm in length. There is no hydronephrosis. Similar to the right kidney, it appears mildly echogenic compatible medical renal diseaseOTHER: Bladder is well-distended and grossly normal in contour", "output": "No findings to suggest renal artery stenosis. Mildly echogenic kidneys compatible medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Tabituha Cox is a 22 year old female with a personal history of bilateral masses and status post left breast mass excision. RIGHT BREAST: (Compared to the prior exam 3/31/2015)On physical examination, 2 masses are palpated to in the right breast at 2:00 and 6:00 position.A targeted right ultrasound was performed for the palpable area of concern. --In the right breast, 2:00 position, 4 cm from the nipple, a circumscribed hypoechoic mass, 1.9 x 0.6 x 1.6 cm, unchanged in size from the prior.--In the right breast, 6:00 position, 2 cm from the nipple, a circumscribed hypoechoic mass, 1.1 x 0.5 x 1 cm, unchanged in size from the prior.LEFT BREAST: ( Compared to the prior exam 7/16/2013)On physical examination, no discrete mass is palpated in the left breast. A targeted left ultrasound was performed at the sites of the previously identified masses. --In the left breast, 9:00 position, 1 cm from the nipple, a circumscribed hypoechoic mass, 0.8 x 0.4 x 0.6 cm, unchanged in size from the prior.--In the left breast, 12:00 position, 2 cm from the nipple, a circumscribed hypoechoic mass, 0.8 x 0.6 x 1.4 cm, unchanged in size from the prior.Of note, the previously identified large 2.5 cm mass had been surgically removed.", "output": "Multiple stable bilateral masses, compatible with fibroadenomata. Clinical follow up is recommended. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female with history of thyroid carcinoma status post thyroidectomy. RIGHT LOBE MEASUREMENTS: Surgically absentLEFT LOBE MEASUREMENTS: Surgically absentISTHMUS MEASUREMENTS: Surgically absentRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Unchanged appearance of the left inferior thyroid bed compared with prior studies, no new masses or suspicious lesions.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No evidence of recurrent or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Female 67 years old Reason: fluid pocket, abscess, soft tissue infection at PEG site RUQ History: oozing pus from PEG site, patient w/ sepsis Minimal induration is seen in the region of soft tissues of the PEG site. No loculated fluid collections are seen.", "output": "No drainable fluid collection identified."}
{"instruction": "Generate impression based on findings.", "input": "History of hepatitis B, screen for hepatocellular carcinoma. LIVER: The liver measures 13.0 cm in length. There is mildly coarse echotexture of the liver parenchyma. 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 a comet artifact arising from the gallbladder wall consistent with adenomyomatosis. 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 3 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 9.3 cm in length. RIGHT KIDNEY: Kidney measures 9.9 cm in length. The parenchyma is slightly echogenic. No hydronephrosis. Stable echogenic focus in the upper pole measuring 0.7 x 0.6 x 0.4 cm. LEFT KIDNEY: Kidney measures 10.1 cm in length. The parenchyma is slightly echogenic. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Mildly coarse echotexture of the liver. No focal masses or ascites is present.2.Mildly echogenic renal parenchyma bilaterally consistent with medical renal disease.3.Adenomyomatosis/cholesterolosis of the gallbladder. "}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female with history of hepatitis B presents for screening for hepatocellular carcinoma. LIVER:Measures 10.5 cm. Heterogenous echotexture. No focal mass, intrahepatic biliary dilation, or ascites. Renal vein is patent with hepatopedal flow.GALLBLADDER, BILIARY TRACT: Gallbladder is nondistended with an anechoic lumen. There is a hyperechoic foci that shadows within the lumen. No pericholecystic fluid or wall thickening. A second focus measuring approximately 0.3 x 0.4 x 0.2 cm is in the lumen of the gallbladder. The common duct measures 0.2 cm.PANCREAS: Evaluation of the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 7.9 cm without sonographic abnormality.KIDNEYS: Right kidney measures 8.6 cm. Left kidney measures 8.6 cm. Unremarkable echogenicity. No focal mass, shadowing calculi, or hydronephrosis. OTHER: No significant abnormality noted.", "output": "Cholelithiasis without signs of acute cholecystitis. Small subcentimeter focus may represent a gallbladder polyp or nonshadowing stone."}
{"instruction": "Generate impression based on findings.", "input": "35 years old, Male, Reason: jaundice LIVER: The liver is mildly enlarged measuring 17.6 cm in length. Coarse nodular contour the liver consistent with cirrhosis. There is a moderate to large amount of perihepatic ascites. No focal hepatic identified. The portal vein is patent demonstrating pulsatile hepatopetal flow, which may be seen in setting of CHF, with a velocity of 0.3 m/s.BILIARY TRACT: Edematous contracted gallbladder with a thickened wall measuring up to 0.6 cm is likely related to cirrhosis and congestive heart failure. 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 11.3 cm in length. A small splenule is present.RIGHT KIDNEY: Kidney measures 10.8 cm in length. Normal echotexture. No hydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 12.0 cm in length. Normal echotexture. No hydronephrosis or shadowing calculus.OTHER: Dilatation of the IVC is consistent with CHF.", "output": "1.Cirrhotic liver morphology with a moderate to large amount of ascites. No focal hepatic lesion identified.2.Edematous contracted gallbladder likely related to cirrhosis and CHF.3.IVC dilatation and pulsatile flow in portal vein, likely reflecting underlying right-sided heart failure."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are mammogram (3/9/15 diagnostic mammogram, 12/8/14 screening mammogram) and ultrasound (3/9/15) exams performed at Regenstein Breast Imaging (Rush University). For comparison,screening mammogram (3/12/13) from Little Company of Mary Hospital are available. MAMMOGRAM An ML view and seven spot compression views of the left breast were obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. There are focal asymmetries in a branching distribution spanning in total 4 cm in the left upper outer breast, with associated benign coarse morphology calcifications. These focal asymmetries have slightly increased in prominence compared to prior, though the calcifications remain stable and could be most likely associated with multiple papillomatas. Additional two subcentimeter focal asymmetries in the medial left breast were evaluated at outside hospital.ULTRASOUND", "output": "1. Increased prominence of focal asymmetries in the left upper outer breast. The branching distribution and associated calcifications of these focal asymmetries are suggestive of multifocal papillomata. Diagnostic ultrasound of the left breast given that the most recent mammogram was almost 5 months ago with ultrasound evaluation of left upper outer quadrant is recommended.2. Stable medial left breast subcentimeter focal asymmetries, corresponding to simple and complex cysts as confirmed on outside ultrasound exam. No further work up is needed. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant abdominal pain, evaluate for gallstones or obstruction LIVER: Hepatomegaly with fatty infiltration. No focal hepatic lesions. No biliary ductal dilation. The portal vein is patent.GALLBLADDER, BILIARY TRACT: Cholelithiasis without pericholecystic fluid or wall thickening.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Measures 13.1 cm. No hydronephrosis.OTHER: The left kidney measures 12.4 cm. The spleen measures 11.4 cm.", "output": "1.Hepatomegaly with fatty infiltration. 2.Cholelithiasis without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old female patient with history of multinodular goiter. Ultrasound in 2014 revealed a 3.0 x 3.4 x 4.0 cm right nodule and a 1.2 x 1.5 x 1.7 cm left-sided nodule. Now with subjective growth on the right. RIGHT LOBE MEASUREMENTS: 6.6 x 4.5 x 3.0 cm.LEFT LOBE MEASUREMENTS: 4.8 x 1.6 x 1.5 cm.ISTHMUS MEASUREMENTS: 3 mm in thickness.RIGHT LOBE: The right thyroid lobe is predominantly replaced by a 4.9 x 2.2 x 3.9 heterogeneous, mostly solid nodule with a few cystic spaces. This nodule has a hypoechoic rim.LEFT LOBE: There is a 1.4 x 0.9 x 1.1 cm heterogeneous, hypoechoic, solid nodule within the left lower pole which does not have significant internal vascularity on color Doppler imaging.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A benign morphology left level two lymph node is noted.OTHER: No significant abnormality noted.", "output": "Dominant bilateral thyroid nodules without definite suspicious features; these are amenable to biopsy if clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "History of right upper quadrant and epigastric pain, concern for cholelithiasis or cholecystitis. LIVER: The liver measures 13.2 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 3 mm in diameter.PANCREAS: No significant abnormalities noted. Portions of the pancreatic tail are obscured by bowel gas.SPLEEN: No significant abnormalities noted.The spleen measures 6.9 cm in length. RIGHT KIDNEY: Kidney measures 8.2 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 8.7 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "No cholelithiasis, cholecystitis, or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Reason: CT abdomen with innumerable hepatic hypodensities on 11/11/16 History: AML s/p chemotherapy complicated by prolonged pancytopenia. LIVER: The liver measures 14.4 cm in length. Mildly increased parenchymal echogenicity is suggestive of fatty infiltration/parenchymal dysfunction. The portal triads are perhaps mildly echogenic. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.26 m/s.BILIARY TRACT: The gallbladder appears contracted. No 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: Not well visualized.SPLEEN: No significant abnormalities noted.The spleen measures 6.3 cm in length. RIGHT KIDNEY: Kidney measures 10.6 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.7 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: Right pleural effusion. The IVC is mildly dilated.", "output": "Mildly coarse liver echotexture, may represent nonspecific fatty infiltration/parenchymal dysfunction. No focal liver lesion identified. Dedicated cross-sectional imaging may be considered for further evaluation as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Oxley is a 22-year-old female presenting with a tender palpable mass in the right axillary region that intermittently increases in size. However, on today's examination, patient states that the mass has disappeared. She has no family history of breast cancer. Upon physical exam at the patient's area of concern, no discrete mass is palpable. Targeted right axillary ultrasound is performed.In the right axillary region, at site of patient's area of concern, no suspicious cystic or solid mass is appreciated.", "output": "No sonographic evidence of malignancy. Should patient's symptoms return, a repeat right axillary ultrasound can be performed if clinically desired. Patient should also follow up with her primary care physician. All results and recommendations were relayed to the patient. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old male with hepatitis B. Evaluate for hepatocellular carcinoma. LIVER: Liver is coarsely echogenic without focal mass. The liver is normal in size. Limited spectral and color Doppler demonstrates patency and appropriate flow direction in the main portal vein. BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber. PANCREAS: Limited due to bowel gas.SPLEEN: Upper normal without change.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Stable exam. No evidence for hepatic mass."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male with history of hypertension. RIGHT KIDNEY: Measures 10.8 cm in length. Mild cortical thinning, otherwise unremarkable echogenicity. No hydronephrosis or nephrolithiasis.LEFT KIDNEY: Measures 11.3 cm in length. Mild cortical thinning, otherwise unremarkable echogenicity. No hydronephrosis or nephrolithiasis.OTHER: The bladder is not clearly seen due to underdistention. Increased hepatic echogenicity partially imaged.", "output": "1.Mild thinning of the renal cortices, otherwise unremarkable examination of the kidneys without hydronephrosis or nephrolithiasis.2.Increased hepatic echogenicity partially imaged, consistent with hepatic steatosis or parenchymal disease."}
{"instruction": "Generate impression based on findings.", "input": "The patient submitted outside mammograms dated 3/2/2012, 4/11/2012, 6/20/2013 and outside ultrasounds dated 3/22/2012 and 4/11/2012 from Metrosouth Medical Center. Submitted outside study was compared to the current mammogram dated 7/17/2015. A T-shaped clip is identified within the left breast at the 6:00 position which corresponds to a fibroadenoma on prior biopsy performed on 4/11/2012. All the masses in left breast are stable and most likely correspond to benign cysts or fibroadenomas corresponding to the ultrasound dated 3/22/2012. A lesion seen on ultrasound from 3/22/2012 in the right retroareolar region was not reproduced on ultrasound dated 4/11/2012 and therefore biopsy was not performed.", "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": "49-year-old female with elevated liver function tests. LIVER: Enlarged liver measures 22.7 cm in length. Markedly increased hepatic echogenicity without discrete focal lesion.BILIARY TRACT: Small amount of layering material in the gallbladder without posterior acoustic shadowing most likely represents sludge. No gallbladder wall thickening or pericholecystic fluid. No biliary ductal dilation.PANCREAS: The pancreas is incompletely visualized. The imaged portions of the pancreas appear unremarkable.SPLEEN: No significant abnormalities noted.KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "1. Hepatomegaly with increased echogenicity consistent with hepatic steatosis or parenchymal disease. 2. No evidence of acute biliary pathology. "}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for HCC. History of hepatitis C cirrhosis. LIVER: The liver is coarsely echogenic with a nodular contour suggestive of chronic liver disease.It measures 17 cm in craniocaudal dimension. Normal hepatopedal portal venous blood flow at 26 cm/s. No intrahepatic biliary ductal dilatation.In the left hepatic lobe peripherally there is a hypoechoic lesion measuring 1.3 x 1.0 x 1.3 cm with internal echoes and apparent enhanced through transmission. The lesion bulges the capsule. The lesion demonstrates mild interval growth from the 10/2314 ultrasound and 7/27/2012 CT.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 3 mm. Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid or focal tenderness.PANCREAS: The visualized portions of the pancreatic head and body are unremarkable. The remainder is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 9.6 cm in length without a focal lesion.RIGHT KIDNEY: The right kidney measures 11.5 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 12.1 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.", "output": "1.3 cm left hepatic lobe peripheral lesion demonstrates mild interval growth. Further characterization with a dedicated liver MRI/CT is recommended.Findings suggestive of chronic liver disease."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old female patient with HCV, cirrhosis. Evaluate for HCC. LIVER: The liver measures 16.1 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: 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 9.7 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.1 cm in length. No evidence of hydronephrosis.The spleen measures 9.1 cm in length.", "output": "Increased hepatic echogenicity which may be seen with hepatic steatosis/hepatic parenchymal dysfunction. No focal hepatic lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: Coarse echogenic liver parenchyma without mass. Liver length 16.5 cm.GALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.6 cm in lengthOTHER: Left kidney 12.8 cm in length. Mild ascites", "output": "Coarse echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Gallbladder sludge without acute inflammation. Mild ascites."}
{"instruction": "Generate impression based on findings.", "input": "Renal transplant with decreased urine output RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality noted. Transplant kidney 12.7 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 The examination was technically limited due to overlying gas. Although some arterial and venous waveforms could be elicited when interrogating the iliac vessels and transplant renal vessels, these tracings cannot be reliably interpreted.OTHER: No significant abnormality noted", "output": "The examination was technically limited due to overlying gas. Although some arterial and venous waveforms could be elicited when interrogating the iliac vessels and transplant renal vessels, these tracings cannot be reliably interpreted. No evidence for significant perinephric collection or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "34-year-old female patient with right upper quadrant pain. Evaluate for gallbladder dysfunction. LIVER: The liver measures 14.4 cm in length. The hepatic parenchyma is slightly coarsened in echotexture. A 1.2 x 1.2 x 0.8 cm well-defined hyperechoic lesion within the right hepatic lobe is favored to represent a hemangioma. 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 of the pancreas demonstrates normal echogenicity. The body and tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 9.5 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.3 cm in length. No evidence of hydronephrosis.The spleen measures 8.1 cm in length.No ascites.", "output": "1. Slightly coarsened hepatic echotexture which can be seen in the setting of hepatic parenchymal dysfunction.2. No cholelithiasis or sonographic evidence of acute cholecystitis.3. Probable right hepatic lobe hemangioma. "}
{"instruction": "Generate impression based on findings.", "input": "Urinary tract infections. Evaluate for stones or hydronephrosis. RIGHT KIDNEY: 11.1 cm in length. Normal renal parenchymal echogenicity. No focal lesions or stones identified. Minimal prominence of the collecting system, which resolves postvoid. No hydronephrosis.LEFT KIDNEY: 12.0 cm in length. Normal renal parenchymal echogenicity. No focal lesions or stones identified. No hydronephrosis.BLADDER: Distended, without significant abnormality noted. Minimal residual fluid post void.OTHER: No significant abnormalities noted.", "output": "No evidence of renal stones or hydronephrosis."}
{"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": "Cirrhosis. Abdominal distention. LIVER: Cirrhotic liver morphology. Coarsened parenchymal echogenicity. 17 cm in length. No focal hepatic lesions. Patent portal vein with normal direction of flow. Pulsatile portal venous flow likely reflects patient's cardiac failure.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Thickened gallbladder wall, which is nonspecific in the setting of ascites. Biliary sludge noted. 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 6.8 cm in length. The left kidney is 7.6 cm in length. The renal parenchyma is markedly echogenic. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 10.1 cm in length, without focal lesions evident.OTHER: Moderate amount of ascites present.", "output": "1. Cirrhosis without suspicious hepatic lesions identified.2. Moderate amount of ascites.3. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old male with history of septic shock and elevated LFTs LIVER: The hepatic parenchyma is coarsely hyperechoic. No biliary dilatation or focal masses.GALLBLADDER, BILIARY TRACT: Small amount of sludge/stones in the gallbladder. No biliary dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. The right kidney measures 10 cm.OTHER: No significant abnormalities noted. Left kidney within normal limits, and measures 10 cm. The spleen measures 11 cm, and is within normal limits.", "output": "Findings suggestive of hepatic steatosis, without biliary dilatation or other significant abnormality."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old male with a history of bilateral varicoceles. RIGHT TESTIS: The right testicle measures 4.4 x 3.0 x 2.0 cm, previously 4.8 x 3.2 x 2.0 cm. Homogeneous echotexture without discrete lesion identified. Testicular microlithiasis is better appreciated on the prior ultrasound examination. Vasculature is patent.LEFT TESTIS: The left testicle measures 4.7 x 2.8 x 2.2 cm, previously 5.3 x 2.6 x 2.3 cm. Homogeneous echotexture without discrete lesion identified. Testicular microlithiasis is again noted. Vasculature is patent.RIGHT EPIDIDYMIS: The right epididymis measures 1.0 x 0.8 x 0.7 cm and is normal in echotexture.LEFT EPIDIDYMIS: Left epididymis measures 1.1 x 0.7 x 0.8 cm and is normal in echotexture.OTHER: Bilateral varicoceles, appearing similar to the prior examination.", "output": "1. Bilateral varicoceles, not significantly changed from the prior examination.2. Bilateral microlithiasis. Continued surveillance is suggested."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female with abdominal pain and concern for cholecystitis.Chart review reveals patient is status post cholecystectomy. LIVER: Hepatomegaly measuring 22.1 cm. No intra or extrahepatic biliary ductal dilation. The liver parenchyma appears unremarkable. Portal flow is unremarkable. GALLBLADDER, BILIARY TRACT: Patient is status post cholecystectomy.PANCREAS: The pancreas is obscured by bowel gas.KIDNEYS: No significant abnormalities noted.BLADDER: Bladder is well distended without evidence of stone.SPLEEN: Not well visualized on this examination.OTHER: No significant abnormalities noted.", "output": "Patient is status post cholecystectomy. No evidence of intrahepatic or extrahepatic biliary ductal dilation."}
{"instruction": "Generate impression based on findings.", "input": "Reason: elevated liver enzymes LIVER: The liver measures 15.7 cm in length. Unremarkable hepatic parenchymal echogenicity. The main portal vein is patent with normal directional hepatopedal flow, peak velocity 28.1 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: There are several echogenic, shadowing stones in the neck of the gallbladder. No evidence of pericholecystic inflammation or fluid. Common bile duct measures 3.6 mm. The gallbladder wall measures 2.7 mm. No intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: Poorly visualized due to overlying bowel gas.RIGHT KIDNEY: The right kidney measures 9.7 cm in length. The left kidney measures 9.47 m in length. No hydronephrosis or shadowing renal calculi.OTHER: The spleen measures 12.6 cm in length, at the upper limit of normal.", "output": "1. Cholelithiasis without evidence of acute inflammation or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old female with renal transplant, increased creatinine, acute kidney injury. Evaluate for hydronephrosis. RIGHT KIDNEY: Right iliac fossa renal transplant measures 10.4 cm in length. No hydronephrosis. Renal cysts are again noted, and the largest parenchymal cyst measures 1.7 x 2 x 1.8 cm in the upper pole. Slight increased echogenicity of the renal parenchyma.LEFT KIDNEY: Native kidneys not evaluated.OTHER: The urinary bladder is collapsed and not visualized.", "output": "1. Right iliac fossa renal transplant without hydronephrosis.2. Urinary bladder is collapsed and not visualized."}
{"instruction": "Generate impression based on findings.", "input": "Chronic kidney disease. Elevated creatinine. RIGHT KIDNEY: 8.8 cm in length. Mildly atrophic morphology. No hydronephrosis. No focal lesions. LEFT KIDNEY: 9.6 cm in length. Mildly atrophic morphology. No hydronephrosis. No focal lesions.BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Mildly atrophic kidneys without hydronephrosis, compatible with chronic renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Male 78 years old; Reason: cirrhosis -- assess for hepatoma History: some weight loss LIVER: The liver measures 17.3 cm in length. There is heterogeneous increased echogenicity of the liver parenchyma. The liver is coarse and nodular in appearance. The main portal vein is patent with normal hepatopetal flow measured at 27.9 cm/s. Numerous anechoic cysts are revisualized from prior ultrasound without significant change. Small hyperechoic foci seen on prior ultrasound are not redemonstrated on this study.GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.8 mm. Several small echogenic stones are seen along with a small amount of layering sludge. No pericholecystic fluid. The common bile duct measures 2.5 mm in diameter. There is no intrahepatic ductal dilation.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.8 cm and no significant abnormalities are noted. A small splenule is revisualize superiorly.RIGHT KIDNEY: The right kidney measures 8.4 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen. Very small renal cysts are visualized from prior ultrasound.LEFT KIDNEY: The left kidney measures 8.8 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen. A renal cyst is revisualized superiorly measuring 4.3 cm x 2.4 cm x 3.5 cm. Another anechoic cyst is seen at the lower pole measuring 3.8 cm x 2.5 cm x 3.6 cm.ABDOMINAL AORTA: The abdominal aorta is patent with appropriate directional flow and peak systolic velocity of 75.7 cm/s. The proximal portion of the abdominal aorta was measured 2.0 cm x 2.4 cm. The midportion which measured 1.9 cm x 1.6 cm. The distal portion was measured 2.9 cm x 2.2 cm.INFERIOR VENA CAVA: The IVC is patent with hepatofugal flow.ILIAC ARTERIES: The bilateral iliac arteries are patent with appropriate directional flow. The left iliac measures 1.4 cm x 1.1 cm. The right iliac measures 1.4 cm x 1.4 cm.OTHER: The bladder is visualized without any significant abnormalities noted.", "output": "1. Cirrhotic morphology is again redemonstrated with scattered small hepatic cysts as seen on prior ultrasound. Small echogenic foci seen on prior ultrasound were not revisualized on this study. No new worrisome masses are seen within the liver.2. Cholelithiasis without overt sonographic evidence of acute cholecystitis.3. Bilateral echogenic kidneys compatible with medical renal disease.4. The distal portion of the abdominal aorta has mild aneurysmal dilatation measuring 2.9 cm x 2.2cm."}
{"instruction": "Generate impression based on findings.", "input": "Recurrent papillary thyroid carcinoma status post resection RIGHT LOBE: Status post thyroidectomy. Interval resection of recurrent focus. No worrisome lesion appreciated.LEFT LOBE: Status-post thyroidectomy. Interval resection of recurrent focus. No worrisome lesion appreciated.ISTHMUS: Status post thyroidectomy without massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Status post resection of bilateral recurrent tumor foci. No worrisome lesion appreciated. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: neck mass Within the subcutaneous tissues underneath the chin to the left of midline there is a prominent lymph node measuring 1.7 cm x 1.1 cm x 2.3 cm. Similarly a lymph node is noted to the right of midline measuring 2.7 cm x 1.5 cm x 2.9 cm. No discrete fluid collection is identified.", "output": "Nonspecific prominent lymph nodes noted. These can be followed up with repeat ultrasound to assess for stability or resolution if warranted."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid carcinoma RIGHT LOBE: Status post thyroidectomy without worrisome mass.LEFT 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": "Hepatitis B LIVER: Unremarkable echogenicity without mass. Liver length 14.1 cmGALLBLADDER, BILIARY TRACT: Stable subcentimeter gallbladder polyp measuring 0.2 cm in diameter. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.2 cm in length.OTHER: The left kidney 10.9 cm in length. Spleen 8.7 cm in length. No ascites.", "output": "Stable examination. Normal liver echogenicity without mass or ductal dilatation. Stable subcentimeter gallbladder polyp. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Eight hours old male with left renal pelvis measuring 7.5 mm on prenatal ultrasound. Evaluate for structural abnormalities. KIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 4.1 cm Left: 4.3 cm   Mean for age: 5.0 cm  Range for age: 4.0 - 6.0 cmADDITIONAL OBSERVATIONS: Please note that ultrasound can underestimate the degree of hydronephrosis in a newborn due to dehydration.", "output": "Normal examination. Please note ultrasound can underestimate the degree of hydronephrosis in a newborn due to dehydration. Recommend follow up ultrasound in one week for definitive evaluation.*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.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": "Male; 61 years old. Reason: Evaluate known right thyroid nodule History: right thyroid nodule RIGHT LOBE MEASUREMENTS: 5.1 x 1.8 x 1.5 cmLEFT LOBE MEASUREMENTS: 3.8 by 1.6 x 1.3 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: A dominant 2.1 x 2.0 x 1.7 cm solid, hypoechoic right mid thyroid lobe nodule with no calcifications or vascularity on color Doppler.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No worrisome lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Dominant 2.1-cm solid right thyroid nodule is amenable to percutaneous ultrasound-guided biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain evaluate left oblique/flank swelling Normal grayscale appearance of the subcutaneous tissues of the abdomen without evidence of fluid collection or mass.", "output": "No evidence of fluid collection or mass."}
{"instruction": "Generate impression based on findings.", "input": "Atrial fibrillation and hepatic failure LIMITED ABDOMENLIVER: Mildly echogenic liver parenchyma without mass. Liver length 17.5 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. RIGHT KIDNEY: No significant abnormalities noted. Benign-appearing cyst. 11.1 cm in length.OTHER: Left kidney 10.8 cm in length.", "output": "Mildly echogenic liver parenchyma suggestive for 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": "57-year-old woman with bilateral nipple pain. History of left breast cysts. Family history of breast cancer in her aunt at age 32. Aunt with ovarian cancer at age 55. MAMMOGRAM", "output": "Left 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": "27 day old male with right duplex kidney and hydronephrosis. Evaluate for interval change. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. Distal Ureter -- SFU Grade**  Right: Not Identified  Left: Not Identified   Ureteral Jets Right: Not observed  Left: Not observedKIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: Duplex right kidney: Grade 2 in both the upper and lower pole moieties. Left: 1  Length*** Right: 5.8 cm Left: 5.0 cm   Mean for age: 4.2 cm  Range for age: 4.0 - 6.0 cmADDITIONAL OBSERVATIONS: Duplex right kidney.", "output": "Duplex right kidney with grade 2 hydronephrosis of both the upper and lower moieties. Grade 1 left-sided hydronephrosis.*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": "51-year-old male with a history of thyroid cancer. RIGHT LOBE MEASUREMENTS: Surgically absent.LEFT LOBE MEASUREMENTS: Surgically absent.ISTHMUS MEASUREMENTS: Surgically absent.RIGHT LOBE: Surgically absent.LEFT LOBE: Surgically absent.ISTHMUS: Surgically absent.LYMPH NODES: Note is made of a 2.2 x 0.6 centimeter lymph node, corresponding to the patient's palpable area of concern. There is preservation of the normal fatty hilum without evidence of increased cortical vascularity. Multiple additional benign morphology left and right level 2 cervical lymph nodes are identified", "output": "2.2 cm benign morphology lymph node corresponding to the patient's palpable area of concern in the soft tissues of the left neck adjacent to the left ear. While a benign etiology is favored, follow up examination may be considered to establish stability/resolution. 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 72 years old; Reason: hx of hypercalcemia, evaluate for parathyroid adenoma History: hypercalcemia RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 0.6 x 2.2 x 4.6 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 1.8 x 1.7 x 5.3 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.5 cm.RIGHT LOBE: The right lobe is heterogeneous but no discrete nodules are seen.LEFT LOBE: The left lobe is heterogeneous but no discrete nodules are seen.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted. OTHER: There is a round extrathyroidal hypoechoic mass located posterior to the inferior portion of the right thyroid lobe measuring 2.2 x 1.0 x 1.3 cm.", "output": "Posterior and inferior extrathyroidal mass measuring 2.2 cm x 1.0 cm x 1.3 cm that is consistent with a suspected parathyroid adenoma. No discrete thyroid nodules are seen. No suspicious adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Renal stones RIGHT KIDNEY: Normal echogenicity for age. Stable renal cyst. Unchanged multiple nonobstructing renal stones. The largest within the lower pole measures 1.3 x 0.9 x 0.6 cm. Right kidney 9.9 cm in lengthLEFT KIDNEY: Normal echogenicity for age. Unchanged nonobstructing renal stones. The largest measuring 0.8 x 0.5 x 0.7 cm. Left kidney 8.8 cm in lengthOTHER: Bladder nondistended.", "output": "Stable bilateral nonobstructing renal calculi."}
{"instruction": "Generate impression based on findings.", "input": "Male; 42 years old. Reason: change in mass in thyroid bed History: thyroid cancer RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Status post thyroidectomy. No evidence of recurrence.LEFT LOBE: Status post thyroidectomy. There is a heterogeneous focus in the left thyroid bed that measures 7 x 5 x 12 mm (previously 6 x 4 x 17 mm).ISTHMUS: Status post thyroidectomy. No evidence of recurrence.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Left level 3 cervical lymph node seen on the prior study currently measures 8 x 6 x 13 mm (previously 9 x 5 x 15 mm), has a fatty hilum and benign appearance.OTHER: No significant abnormality noted.", "output": "Heterogeneous focus in the left thyroid bed is stable in appearance and slightly decreased in size. This again favors a benign etiology however attention to this area on future studies is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: Mildly heterogeneous liver echotexture with dilated hepatic veins. No mass. Liver length 18 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 10.6 cm in lengthOTHER: Left kidney echogenic; 9.3 cm in length. Spleen 9 cm in length. Trace ascites. Small right pleural effusion", "output": "Mildly heterogeneous and enlarged liver with dilated hepatic veins suggestive for congestion secondary to cardiac dysfunction. No mass lesion. Trace ascites. Echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Female 57 years old Reason: r/o liver cirrhosis History: shortness of breath ; abdominal distension LIVER: The liver is coarse with a mildly nodular appearance of the capsule which is suggestive of early mild cirrhosis. No focal hepatic mass lesion. Main portal vein is patent with normal directional flow in the peak velocity of 28.6 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. The gallbladder is normal in appearance. No gallstones. Common bile duct measures 4 mm.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 6.3 cm.KIDNEYS: Right kidney measures 10.4 cm. Left kidney measures 9.2 cm. Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass.OTHER: No ascites.", "output": "Mildly nodular contour of the liver suggestive of early mild cirrhosis."}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 11.1 cm in lengthLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 11.4 cm in lengthOTHER: Bladder nondistended. Left pleural effusion.", "output": "Echogenic renal parenchyma suggestive for parenchymal dysfunction/medical renal disease without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female presents for follow-up of a multinodular thyroid. RIGHT LOBE MEASUREMENTS: 5.0 x 1.7 x 1.8 cm.LEFT LOBE MEASUREMENTS: 4.7 x 1.9 x 2.2 cm.ISTHMUS MEASUREMENTS: 0.4 cm.RIGHT LOBE: Nodule 1 (superior right lobe): Measures approximately 2.1 x 1.3 x 1.1 cm. Mixed cystic-solid nodule with some spongiform components. Appears stable in comparison to the prior study.Nodule 2 (mid-inferior right lobe): Measures approximately 1.7 x 1.0 x 1.6 cm. Mixed cystic-solid with some spongiform components. Was not measured on the previous study but appears stable in comparison.LEFT LOBE: Nodule 1: Measures approximately 2.5 x 1.8 x 1.8 cm. Appears similar to the nodules on the right and is of stable size.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Multinodular goiter as described above. Stable in comparison to the prior study."}
{"instruction": "Generate impression based on findings.", "input": ": History of bilateral prophylactic mastectomies due to family history breast cancer with new tender right upper outer quadrant mass over reconstruction/implant. A targeted right ultrasound was performed for the palpable area of concern. There is no solid or cystic mass at the 11:00 position. There is a hypoechoic focus without vascular flow at the 10:00 position, approximately 4 cm from the nipple measuring approximately 7 x 4 mm.", "output": "Benign appearing subcentimeter hypoechoic lesion at palpable area of concern as above. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old male with transaminitis. Evaluate for biliary obstruction. LIVER: Measures 17.1 cm. The parenchyma is heterogenous and coarse, some of which has a 'starry sky' appearance which can be seen in hepatitis but is nonspecific. No focal masses, intrahepatic biliary dilation, or ascites. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with a normal anechoic lumen. No stones, sludge, or pericholecystic fluid. The common bile duct measures 3.7 mm. The gallbladder wall measures 1.8 mm. PANCREAS: Evaluation the pancreas limited due to overlying bowel gas.SPLEEN: Measures 8.7 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 10.7 cm. Left kidney measures 10.5 cm. Parenchyma is mildly echogenic. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "1. No evidence of biliary dilation.2. Coarse heterogenous echotexture of liver consistent with fatty infiltration and chronic liver disease/parenchymal dysfunction.3. Echogenic kidneys consistent with medical renal disease/parenchyma dysfunction. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old male with history of hepatitis C virus. Evaluate for liver mass. LIVER: Liver is mildly and coarsely echogenic. Overall hepatic length is within normal limits. Main portal vein is patent with appropriate flow directionality. Very mild nodularity of the liver surface with enlargement of the left lobe.BILIARY TRACT: Dependent gallstones within the gallbladder without gross wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Echogenic with cysts as previously noted. OTHER: Kidney echogenic with cysts as previously noted. Splenic size within normal limits.", "output": ". 1. Echogenic liver with borderline nodularity of the contour with left lobe enlargement.2. No evidence for hepatic mass.3. Gallstones.4. Echogenic kidneys with cysts."}
{"instruction": "Generate impression based on findings.", "input": "Female 78 years old Reason: evaluate kidney History: renal insuffiencey. RIGHT KIDNEY: The right kidney measures 8.2 cm. The renal cortex is hyperechoic. There is no hydronephrosis. There is a 3.7 x 3.2 x 3.0 cm simple cyst at the upper pole of the right kidney.LEFT KIDNEY: The left kidney measures 8.3 cm. The renal cortex is hyperechoic. There is no hydronephrosis. There is a mildly complex cystic lesion at the mid/lower pole of the left kidney which measures 1.0 x 1.0 x 1.0 cm. There is a thin septation at the superior portion and a suggestion of a small calcification dependently within the lesion. This is stable/minimally increased compared to a prior CT 08/05/12.OTHER: The bladder is incompletely distended.", "output": "1. No hydronephrosis.2. Hyperechoic renal cortex bilaterally suggestive of medical renal disease. 3. Mildly complex left renal cyst, stable/mildly increased compared to prior CT 08/05/12. This remains nonspecific but warrants ongoing imaging follow-up.4. Stable right upper pole simple cyst."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female patient with right breast cancer containing LCIS and DCIS. Evaluate for interval change status post chemotherapy. A targeted right breast ultrasound was performed. There is an ill-defined mass with multiple hyperechoic calcifications at 11 o'clock position, 4 cm from nipple, measuring 33 x 21 x 30 mm (previously 34 x 22 x 27 mm). Another portion of the tumor has become cystic, measuring 14 x 11 x 16 mm (previously 23 x 11 x 20 mm), with remaining solid component with calcifications. This is located at 10 o'clock position, 5 cm from nipple.", "output": "Status post chemotherapy for the right breast cancer. Slight reduction of the size of tumor. Part of the tumor has become cystic.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female patient with follow-up for thyroid cancer. Evaluate for possible recurrence. RIGHT LOBE: Status post thyroidectomy without residual or recurrent tissue identified.LEFT LOBE: Status post thyroidectomy. There is a stable benign-appearing echogenic focus within the left thyroidectomy bed, measuring similar to prior studies.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy without evidence of disease recurrence or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with AKI, recurrent UTI. RENAL TRANSPLANT: The transplanted kidney measures 13.3 cm in length and is normal in echogenicity.LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No perinephric fluid.COLLECTING SYSTEM/URETER: No hydronephrosis.URINARY BLADDER: No significant abnormality notedOTHER: No significant abnormality noted", "output": "No hydronephrosis or perinephric collection surrounding the transplant kidney."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old male with history of kidney stones. RIGHT KIDNEY: The right kidney measures 12.2 cm in length. Normal parenchymal echogenicity. No evidence of renal stone, hydronephrosis, or renal mass.LEFT KIDNEY: The left kidney measures 12.9 cm in length. Normal parenchymal echogenicity. A 1.3 x 1.0 cm stone is identified in the lower pole, similar to that seen on previous CT. No evidence of hydronephrosis or renal mass.OTHER: Hyperechoic, coarse liver echotexture suggestive of hepatic steatosis.", "output": "1.Nonobstructing 1.3 cm left inferior pole renal stone.2.Hepatic steatosis."}
{"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 lymphoma 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": "Male; 37 years old. History of a remote right inguinal hernia repair now with pain. Scanning of the bilateral inguinal area reveals no evidence of hernia at rest or with Valsalva maneuver, no hematoma/fluid collection.", "output": "No evidence of hernia or fluid collection/hematoma."}
{"instruction": "Generate impression based on findings.", "input": "Reason: elevated liver enzymes History: rule out steatohepatitis -check liver and spleen and rule out cirrhosis or hepatitis LIVER: The liver measures 16.7 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 0.15 m/s.BILIARY TRACT: Cholelithiasis 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 10.5 cm in length. RIGHT KIDNEY: Kidney measures 9.5 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.4 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Mildly increased hepatic echogenicity suggestive of fatty infiltration/parenchymal dysfunction.2.Cholelithiasis without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "History of thyroid cancer status post surgery. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy. ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Status post thyroidectomy.LEFT LOBE: Status post thyroidectomy. The previously described hypoechoic focus in the left thyroidectomy bed measures 8 x 3 x 4 mm, previously 9 x 4 x 4 mm.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing cervical lymph nodes are again noted bilaterally.OTHER: No significant abnormality noted.", "output": "Unchanged nonspecific subcentimeter hypoechoic focus in left thyroid bed. No specific evidence of disease recurrence."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B. Evaluate for hepatocellular carcinoma LIVER: Non-cirrhotic liver morphology. 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 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. The left kidney is 12.5 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 10.5 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites.", "output": "Increased hepatic echogenicity compatible with parenchymal dysfunction, without suspicious hepatic lesion is identified."}
{"instruction": "Generate impression based on findings.", "input": "Female 46 years old Reason: assess for structural lesion History: hypertensive RIGHT KIDNEY: Right kidney measures 12 cm. Slightly echogenic kidney. No evidence of focal lesions or hydronephrosis.LEFT KIDNEY: Left kidney measures 10.6 cm. Echogenic kidney. No focal lesions or hydronephrosis.OTHER: Bladder wall is slightly thickened.", "output": "Bilateral echogenic kidneys. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "73 year-old male with shock, alcohol abuse, CAD, CHF. Evaluate for liver disease. Limited exam as patient was unable to lie in decubitus position.LIVER: Diffuse increased echogenicity of the liver measuring at least 18.2 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: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. Common hepatic duct measures 7 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Not well visualized.RIGHT KIDNEY: Right kidney measures 10.3 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measuring 11.5 cm in length. No hydronephrosis or shadowing calculi are noted.Spleen is not well visualized.", "output": "1. Hepatomegaly with increased echogenicity suggestive of parenchymal dysfunction/fatty infiltration.2. No evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old female for follow-up exam. Evaluate for stability of thyroid gland and resolution of cervical lymphadenopathy. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 1.6 x 1.1 x 4.4 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 1.6 x 1 x 4.8 cm.ISTHMUS MEASUREMENTS: The thyroid isthmus measures 0.3 cm in thickness.RIGHT LOBE: Mildly heterogenous echotexture. No discrete nodules.LEFT LOBE: Mildly heterogenous echotexture. No discrete nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No suspicious cervical lymphadenopathy.OTHER: No significant abnormality noted.", "output": "1. Mildly heterogenous thyroid gland without evidence of discrete nodules.2. No cervical lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Chronic kidney disease, evaluate for obstructive uropathy RIGHT KIDNEY: Echogenic kidney measures 10.7 cm. Simple cyst in the midpole measures up to 4 cm. No hydronephrosis.LEFT KIDNEY: Echogenic kidney measures 10.6 cm. No hydronephrosis or mass.OTHER: The bladder is not distended.", "output": "Medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "79-year-old male with febrile condition. Status post robotic mitral valve repair and developed post operative fever. Positive UA. RIGHT KIDNEY: The right kidney measures 13.2 cm in length. No hydronephrosis, shadowing calculi, or suspicious lesions. Increased echogenicity of the renal parenchyma.LEFT KIDNEY: The left kidney measures 10.1 cm in length. No hydronephrosis, shadowing calculi, or suspicious masses. Increased echogenicity of the renal parenchyma.URINARY BLADDER: The distended urinary bladder shows no acute abnormality.OTHER: No significant abnormalities noted.", "output": "1. Mild increased echogenicity of the renal parenchyma is nonspecific and suggestive of chronic medical renal disease.2. No acute abnormality."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old male with history of hepatitis C who presents for evaluation of cirrhosis and HCC. LIVER: The hepatic parenchyma is mildly coarse in echotexture. There is no nodularity of the hepatic capsule or other findings to suggest cirrhosis. No hepatic masses are identified. The liver measures 17 cm in length.GALLBLADDER, BILIARY TRACT: No cholelithiasis, pericholecystic fluid, or gallbladder wall thickening. No intra or extrahepatic biliary ductal dilatation with the common bile duct measuring 0.3 cm.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: There is an echogenic focus in the right mid pole with shadowing, consistent with nephrolithiasis. No hydroureteronephrosis. The right kidney measures 11.6 cm and the left kidney measures 11.4 cm in length.SPLEEN: The spleen is normal in echotexture and measures 10.6 cm in length.", "output": "1.No evidence of cirrhosis or hepatic mass. 2.Small right midpole nonobstructing nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "History of Hashimoto's thyroiditis with right nodule, evaluate for change. RIGHT LOBE MEASUREMENTS: 4.2 x 2.2 x 1.7 cm.LEFT LOBE MEASUREMENTS: 4.1 x 1.6 x 1.7 cm.ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: Heterogeneous echotexture with increased vascularity. Previously described possible subcentimeter discrete nodule within the midpole not well seen on today's examination.LEFT LOBE: Heterogeneous echotexture with increased vascularity. No discrete nodules delineated.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: See discussion below. LYMPH NODES: A few benign morphology cervical lymph nodes are noted. In addition, there are 2 oval-shaped hypoechoic structures posterior to the inferior pole of the left lobe of the thyroid the larger of which measures 1.0 x 0.9 x 0.6 cm. There is a suggestion of hilar blood flow and fatty hila.OTHER: No significant abnormality noted.", "output": "1.Diffusely heterogeneous thyroid gland with increased vascularity, appearance suggestive of underlying thyroiditis. Previously described subcentimeter right thyroid nodule is not well seen today.2.Subcentimeter hypoechoic structures posterior to the inferior pole of the left thyroid which are nonspecific but are favored to represent lymph nodes. However, if there is clinical suspicion for hyperparathyroidism, evaluation for parathyroid adenoma/hyperplasia with nuclear medicine scan can be considered as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Hyperthyroidism RIGHT LOBE MEASUREMENTS: 2.4 x 2 x 5.5 cmLEFT LOBE MEASUREMENTS: 1.9 x 1.8 x 5.3 cm ISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Diffusely heterogeneous gland with increased vascularity. Numerous predominately solid nodules. The largest within the midpole measures 1.2 x 0.8 x 1.3 cm.LEFT LOBE: Diffusely heterogeneous gland with increased vascularity. Numerous predominately solid nodules. A representative midpole nodule measures 1.5 x 1.2 x 1.4 cm.ISTHMUS: Diffuse heterogeneous gland with increased vascularityPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland with increased vascularity suggestive for Graves' disease or acute thyroiditis. Numerous bilateral thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old female with a history of biopsy-proven fibroadenomas in the right breast and a new palpable mass at the 10:00 position left breast. A targeted bilateral breast ultrasound was performed for the areas of palpable and clinical concern. On physical examination, the patient has multiple palpable masses in the right breast. A palpable mass at the 12:00 position in the left breast and a new 2 cm palpable mass at the 10:00 position in the left breast.There are bilateral breast masses all which are hypoechoic with parallel orientation and circumscribed margins suggestive of fibroadenomas. On the right:1. 12 o'clock, 3 cm from the nipple, measuring 1.1 x 0.6 x 1.3, unchanged.2. 4 o'clock, 3 cm from the nipple, measuring 1.0 x 0.3 x 1.6 cm (previously 1.0 x 0.7 x 1.6 cm).3. 8 o'clock, 3 cm from the nipple, measuring 0.6 x 0.2 x 0.6 (previously 0.6 x 0.3 x 0.8 cm).4. 9 o'clock, 4 cm from the nipple, measuring 1.1 x 0.4 x 1.0 cm, unchanged.5. 10 o'clock, 4 cm from the nipple, measuring 1.4 x 0.9 x 1.4 cm (previously 1.4 x 1.1 x 1.5 cm) containing a percutaneously placed clip.6. 10 o'clock 3 cm from the nipple, 0.8 x 0.3 x 0.6 cm (previously 1.1 x 0.5 x 1.2 cm).On the left:1. 12 o'clock, 5 cm from the nipple, measuring 1.0 x 0.4 x 0.9 (previously 1.1 x 0.5 x 1.3 cm).2. The newly palpable mass at 10 o'clock, 5 cm from the nipple, measuring 2.2 x 0.9 x 2.4 cm; this mass has some internal vascularity.3. There is an additional similar mass at 4:00 measuring 1.5 x 1.5 cm.", "output": "Multiple bilateral masses as described above, compatible with fibroadenomas. The patient will be seen by Dr. Barrera in breast surgery clinic today for clinical management of her multiple breast masses.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney is normal in size measuring 10.9 cm without hydronephrosis shadowing nephrolithiasis or discrete lesion.LEFT KIDNEY: The left kidney is normal in size measuring 10 cm in length without hydronephrosis. Demonstrated again is a superior pole well-defined echogenic lesion measuring 3.6 x 2.7 x 3.4 cm compatible with an angiomyolipoma, as definitively characterized on CT dated 4/21/2012.OTHER: Normally distended urinary bladder.", "output": "Left upper pole angiomyolipoma is not significantly changed in size accounting for technical differences."}
{"instruction": "Generate impression based on findings.", "input": "Hyperparathyroidism status post resection RIGHT LOBE MEASUREMENTS: RemovedLEFT LOBE MEASUREMENTS: 2 x 0.7 x 0.8 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Status post resection without worrisome lesionLEFT LOBE: Mildly heterogeneous gland without massISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Mildly heterogeneous left lobe of the thyroid without mass. Status post right thyroid lobe resection. No regional adenopathy. No evidence for suspicious extrathyroidal nodule to suggest parathyroid adenoma."}
{"instruction": "Generate impression based on findings.", "input": "Female 58 years old Reason: RUQ US History: RUQ pain LIVER: Liver measures 15.5 cm. No focal lesions. Normal echogenicity.BILIARY TRACT: There is a large gallstone in the gallbladder. Gallbladder wall is slightly thickened. However there is no evidence of sonographic Murphy's sign or pericholecystic fluid. No evidence of intra or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 10.4 cm.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Cholelithiasis with mild gallbladder wall thickening. Sonographic Murphy sign could not be elicited. No evidence of acoustic fluid. Although an early acute cholecystitis cannot be excluded, given the lack of sonographic Murphy's sign and pericholecystic fluid this is considered less likely."}
{"instruction": "Generate impression based on findings.", "input": "48 years old, Male, Reason: assess for splenic sequestration History: thrombocytopenia Spleen is normal in echogenicity measuring 12.3 cm.", "output": "Unremarkable exam."}
{"instruction": "Generate impression based on findings.", "input": "85-year-old female with hyperparathyroidism presents for evaluation of thyroid and parathyroid glands. RIGHT LOBE MEASUREMENTS: 9.7 x 5.0 x 5.0 cm.LEFT LOBE MEASUREMENTS: 10.2 x 7.2 x 8.37 m.ISTHMUS MEASUREMENTS: 2.32 cm.RIGHT LOBE: The right lobe is largely replaced by multiple nodules. The most dominant nodule measures probably 5.9 x 5.4 x 3.2 cm. It has mixed echogenicity and small cystic spaces. It appears stable in comparison to the prior study.LEFT LOBE: Left lobe is largely replaced by heterogeneous multiple nodules. The left gland appear similar to the prior study. There are coarse calcifications noted.ISTHMUS: The isthmus has been largely replaced by multiple nodules. It is similar in appearance to the prior study.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional adenopathy.OTHER: No significant abnormality noted.", "output": "1. Large multinodular thyroid as described above that is similar in appearance to the prior study. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "78 year old female with history of pulmonary fibrosis and suspected cholestasis. Elevated LFTs. LIVER: Heterogeneous liver echogenicity, without additional significant abnormalities noted. The liver measures 15 cm.GALLBLADDER, BILIARY TRACT: Cholecystectomy years ago. No significant biliary dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. The right kidney measures 8.6 cm.OTHER: No significant abnormalities noted. The left kidney is normal in appearance, and measures 10 cm. The spleen measures 12 cm, and has arterial calcifications at the hilum.", "output": "Post cholecystectomy changes and mildly heterogeneous liver parenchyma, without additional significant abnormality."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male with microscopic hematuria RIGHT KIDNEY: Measures 9.6 cm in length. Unremarkable echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 10.3 cm in length. Unremarkable echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Incompletely distended without focal abnormality. Markedly enlarged prostate measures 8.1 x 8.0 x 5.0 cm.OTHER: No significant abnormalities noted.", "output": "1.Markedly enlarged prostate.2.No nephrolithiasis or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Female 60 years old Reason: multinodular goiter - pls eval \\T\\ compare past studies History: as above RIGHT LOBE MEASUREMENTS: 6 x 3.1 x 2.7 cmLEFT LOBE MEASUREMENTS: 9.4 x 4.8 x 3.7 cmISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: Again noted numerous nodules, not significantly changed compared to previous study. Largest nodule measures 2.7 x 2.4 x 2.2 cm. This is a solid nodule with cystic component in the inferior lobe of the thyroid.LEFT LOBE: Again noted multiple nodules in the left lobe of the thyroid. Largest nodule measures 6.1 x 4.1 x 4.9 cm, not significantly changed compared to previous study.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. No significant change from previous study."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B LIVER: Echogenic coarse echotexture again noted. No mass. Liver length 19.6 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 10.9 cm in length. Spleen 9.8 cm in length. No ascites.", "output": "Echogenic coarse liver echotexture again noted consistent with fatty infiltration/chronic liver disease associated with mild hepatomegaly without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Technical repeat ultrasound of the left breast is performed due to image acquisition error during the recent automated study. A targeted left ultrasound was performed for the area of technical repeat needed based on the automated study. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy. Routine screening examinations are recommended in one year.Please note that as this was a technical repeat examination, the patient should not be charged for this study.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Patient called back from screening for evaluation of partially circumscribed mass in the right upper outer quadrant. RIGHT BREAST DIGITAL MAMMOGRAM: One right breast ML and 3 right breast 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. Again noted is a partially circumscribed mass in the right upper-outer quadrant which persists on the spot compression views.TARGETED RIGHT BREAST ULTRASOUND: Targeted right breast ultrasound demonstrated 2 hypoechoic lesions at 9:00 position, 3 cm from nipple and 2 cm from nipple with internal vascularity. The larger of these lesions measures 11 x 6 x 10 mm and likely corresponds to the mammographic abnormality.", "output": "2 hypoechoic masses at 9:00 position with increased vascularity. Percutaneous ultrasound-guided biopsy of the larger lesion which corresponds to the mammographic abnormality is recommended. If larger lesion is malignant, further biopsy of the smaller lesion should be considered.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodule felt on exam RIGHT LOBE MEASUREMENTS: 5.9 x 1.7 x 3.2 cmLEFT LOBE MEASUREMENTS: 5 x 1.4 x 3.5 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Heterogeneous gland. Subcentimeter benign-appearing spongiform nodule measuring 0.6 x 0.3 x 0.5 cm.LEFT LOBE: Diffusely heterogeneous gland without discrete nodule.ISTHMUS: 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 gland without worrisome nodule. Findings raise the possibility of chronic thyroiditis. Subcentimeter benign-appearing right colloid nodule. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and additional left MLO, additional right CC view were performed 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. 12 mm lobulated asymmetry in the right inferior breast seen only on the right MLO for which further evaluation with spot compression views and ultrasound is recommended. Multiple benign scattered calcifications in each breast.", "output": "12 mm lobulated asymmetry in the right inferior breast seen only on the right MLO for which further evaluation with spot compression views and ultrasound is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EC - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "15 year old female with fever, dysuria, abdominal pain, HbgSS disease, admitted for pyelonephritis. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. 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: 0 Left: 0  Length*** Right: 10.8 cm Left: 10.2 cm   Mean for age: 10.5 cm  Range for age: 9 - 11.5 cmADDITIONAL OBSERVATIONS: None.", "output": "Normal examination.*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": "Elevated LFTs and altered mental status LIVER: Coarse echogenic liver echotexture again noted without mass. Liver length 18 cmBILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: Not visualizedRIGHT KIDNEY: No significant abnormalities noted. 11.2 cm in lengthOTHER: Left kidney 11 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture again noted consistent with fatty infiltration/parenchymal dysfunction. Mild hepatomegaly. No mass or ductal dilatation. Gallbladder sludge without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "50 year-old female with history of a large thyroid. RIGHT LOBE MEASUREMENTS: 2.9 x 2.2 x 6.2 cmLEFT LOBE MEASUREMENTS: 2.8 x 1.9 x 6.3 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Within the right thyroid lobe has a heterogeneously hypoechoic nodule with several coarse internal calcifications measuring 1.3 x 0.9 x 1.3 cm. The margin is not entirely distinct. Remaining right thyroid lobe is within normal limits.LEFT LOBE: Within the posterior left thyroid lobe is an approximately 1.7 x 1.1 x 1.4 cm nodule that was heterogeneous but isoechoic to thyroid glandular tissue. The margins are distinct. The remaining left thyroid lobe 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": "Bilateral thyroid nodules as described above. The right thyroid nodule contains internal calcifications and somewhat indistinct margins - scheduled to undergo biopsy today."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate liver cirrhosis, hepatitis C LIVER: The liver measures 15.5 cm in length and is mildly nodular in contour. The liver parenchymal echotexture is coarse. 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: Status post cholecystectomy. 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 9.3 cm in length. RIGHT KIDNEY: Kidney measures 9.8 cm in length. Increased parenchymal echogenicity. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.1 cm in length. Increased parenchymal echogenicity. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Cirrhotic liver morphology without focal hepatic lesions identified.2.Echogenic kidneys suggestive of medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old male with history of renal transplant, anemia, decreased urine output. KIDNEY: Right iliac fossa transplant kidney measures 9.3 cm in length and demonstrates mildly increased echogenicity, but no hydronephrosis or perinephric fluid collections.OTHER: No significant abnormalities noted.", "output": "Mildly increased renal echogenicity but no hydronephrosis or perinephric fluid collections."}
{"instruction": "Generate impression based on findings.", "input": "51 year-old woman with history of new mass in the left breast seen on screening mammography. An 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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A round, circumscribed mass measuring approximately 3 x 1.9 cm is again seen in the left breast at approximately 3 cm depth and 5 o'clock position. There are no associated calcifications.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: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "22-year-old male status post OLT remote history of HCC. LIVER: Coarse echogenicity of the liver measuring 12.5 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: Status post cholecystectomy. Common duct measures 4 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Not well-visualized.RIGHT KIDNEY: Measures 10.8 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Spleen is normal in echogenicity measuring 11.4 cm in length.Left kidney measures 11.0-cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "Coarse echogenicity of the liver suggestive of hepatic dysfunction/fatty infiltration. No focal hepatic lesion."}
{"instruction": "Generate impression based on findings.", "input": "47 year old female with left breast invasive ductal carcinoma receiving chemotherapy. Patient presents to assess lesion response to therapy. A targeted left ultrasound was performed in the area of known breast cancer at the 3:00 position, approximately 1 cm from the nipple. There has been interval decrease in size of the hypoechoic mass, which does not have significant internal vascularity, now measuring 13 x 10 x 15 mm, previously 21 x 15 x 23 mm. A biopsy clip is noted within the mass.", "output": "Interval decrease in size of the left breast mass compatible with biopsy-proven invasive ductal carcinoma.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "70 years old, Female, Reason: Evaluate hypoechoic masses seen on CT A/P 1/16 History: Renal transplant Transplanted KIDNEY: Kidney measures 13.5 cm in length. Normal echotexture. Nohydronephrosis. Multiple simple appearing renal cysts the largest of which measures 1.7 x 1.6 x 1.7cm. The vascularity to the transplanted kidney appears patent.OTHER: The bladder is nearly empty around Foley catheter.", "output": "Multiple simple appearing renal cysts within the transplanted kidney without evidence of hydronephrosis. "}
{"instruction": "Generate impression based on findings.", "input": "Hematuria. Chronic kidney disease. RIGHT KIDNEY: The right kidney measures 8.8 cm. The cortex is echogenic and thinned. No hydronephrosis or renal calculi are identified.LEFT KIDNEY: The left kidney measures 9.3 cm. The cortex is echogenic and thin. No hydronephrosis or renal calculi are identified.URINARY BLADDER: The bladder is distended with anechoic fluid. Large bladder diverticuli are identified, similar to prior.OTHER: No significant abnormalities noted.", "output": "Echogenic atrophic kidneys, compatible with chronic renal disease. No hydronephrosis or renal calculi are identified. Given gross hematuria and large bladder diverticuli, recommend dedicated renal CT or MR if hematuria persists."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female female with possible right parathyroid adenoma. Evaluate thyroid. RIGHT LOBE MEASUREMENTS: 3.6 x 1.5 x 0.9 cm.LEFT LOBE MEASUREMENTS: 3.3 x 1.6 x 0.9 cm.ISTHMUS MEASUREMENTS: 1.0 cm.RIGHT LOBE: Homogenous parenchyma without abnormality.LEFT LOBE: Homogenous parenchyma without abnormality.ISTHMUS: Nodule in the isthmus measuring approximately 3.5 x 1.1 x 2.1 cm has mixed echogenicity, is well-defined, appears unchanged since prior the exam.PARATHYROID GLANDS: Posterior to to the inferior aspect of the right gland is a well-defined, hypoechoic approximately 1.8 x 1.2 x 0.9 cm focus which may represent a parathyroid adenoma or hyperplastic gland.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Parathyroid adenoma candidate posterior and inferior to the right gland.2. Thyroid nodule appears unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Patient has multiple myeloma, hypertension, PE presented with recurrent abdominal pain, vomiting and diarrhea found to have increased lipase on CT scan so far ? Pancreatitis. RIGHT KIDNEY: Right kidney measures 14.2 cm increased echogenicity. No evidence of hydronephrosis or hydroureter. A prominent calyx noted in the right upper pole. No focal lesions.LEFT KIDNEY: Left kidney measures 13.4 cm, increased echogenicity. No evidence of hydronephrosis or hydroureter. No focal lesions.OTHER: Moderately distended bladder, limited evaluation without any focal lesions.", "output": "Bilateral echogenic kidneys consistent with underlying medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "18 year-old male with history of sickle cell disease and proteinuria RIGHT KIDNEY: The right kidney measures 10.4 cm, and does not demonstrate hydronephrosis or other significant abnormality.LEFT KIDNEY: The left kidney measures approximately 10 cm, and does not demonstrate hydronephrosis or other significant abnormality.OTHER: Bladder is within normal limits. No shadowing stones appreciated.", "output": "Normal-appearing kidneys and bladder as above."}
{"instruction": "Generate impression based on findings.", "input": "84-year-old male with elevated creatinine. RIGHT KIDNEY: Measures 8.8 cm in length. 3.0 and 2.6 cm renal cysts without septation or solid component. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 9.4 cm in length. 2.0 cm superior pole renal cyst without 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. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Kerby is a 28 year old female presenting with pain/burning in the lower aspects of the breasts bilaterally associated with the menstrual cycle. A targeted bilateral ultrasound was performed for the patient\u2019s 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": "33-year-old female with history of biopsy-proven left papillary thyroid cancer. Assess lymph nodes. RIGHT LOBE MEASUREMENTS: 1.6 x 1.7 x 4.7 cmLEFT LOBE MEASUREMENTS: 1.6 x 1.6 x 4.7 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Right lobe is diffusely heterogeneous. There is a discrete heterogeneous rounded nodule with a hypoechoic rim in the midportion of the right lobe, measuring 1 x 1.2 x 1.3 cm. This has significant peripheral vascularity.LEFT LOBE: Left lobe is diffusely heterogeneous in echotexture. I see no measurable, focal mass within the left lobe.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: See below.LYMPH NODES: Inferior to the right lobe is a 0.2 x 0.4 x 0.6 cm ovoid nodule with an appearance most suggestive of lymph node. Inferior to the left lobe and medial to the vasculature there is a prominent, 0.5 x 0.7 x 1.1 cm lymph node with likely normal morphology.Normal lymph nodes identified bilaterally including a very superficial level 4 node on the left which has a normal appearance and measures 5 mm in greatest diameter.OTHER: No significant abnormality noted.", "output": "1. Solid right lobe mass. No left lobe mass identified.2. Diffusely heterogeneous gland with a pattern suggestive of thyroiditis.3. Presumed lymph nodes inferior to both lobes, likely normal, although unusual in position.."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for gallstones History: abdominal pain LIVER: The liver measures 16.9 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 0.14 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 diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 7.1 cm in length. RIGHT KIDNEY: Kidney measures 9.9 cm in length. Normal cortical echotexture. No hydronephrosis. Subcentimeter interpolar cystLEFT KIDNEY: Kidney measures 10.2 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": "Reason: hx of goiter s/p thyroidectomy now with regrowth of thyroid tissue lateral on his neck RIGHT LOBE MEASUREMENTS: Status post thyroidectomy. See below.LEFT LOBE MEASUREMENTS: Status post thyroidectomy. See below.ISTHMUS MEASUREMENTS: No significant abnormality noted.RIGHT LOBE: Heterogeneous multilobular mass/residual tissue with internal vascularity but without discrete nodules identified. No suspicious microcalcifications.LEFT LOBE: Heterogeneous multilobular mass/residual tissue measuring up to 4.6 x 4.2 x 6.4 cm with internal vascularity but without discrete nodules identified. No suspicious microcalcifications.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No lymphadenopathy identified.OTHER: No significant abnormality noted.", "output": "Multilobular mass/residual tissue within the bilateral thyroidectomy beds without discrete nodules or suspicious microcalcifications. These would be amenable to FNA biopsy if clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Miller is a 46 year old female with a personal history of 2 prior excisional biopsies of the right breast and 4 prior excisional biopsies of the left breast, one of which showed atypia. Patient previously took tamoxifen for 5 years and stopped in 2012. She 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. Numerous benign simple cysts are identified bilaterally. No suspicious cystic or solid mass is identified.This exam was interpreted by two radiologists.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B. Hepatocellular carcinoma screening. LIVER: Non-cirrhotic liver morphology. 16.3 cm in length. Mildly coarsened parenchymal echogenicity, similar to prior. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. 2 mm gallbladder polyp again noted. Otherwise unremarkable 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 9.0 cm in length. The left kidney is 10.6 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 10.1 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites.", "output": "Mildly coarsened liver echogenicity, compatible with parenchymal dysfunction, without suspicious lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: Coarse echogenic liver echotexture without mass. Liver length 13.9 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.4 cm in lengthOTHER: Left kidney 12.5 cm in length. Spleen 7.4 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "81-year-old female patient with abdominal pain. LIVER: The liver measures 15.9 cm in length. 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. Visualized portions of the pancreatic duct measures up to 3 mm in diameter, similar to a prior CT. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 10.7 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.3 cm in length. No evidence of hydronephrosis. There is a 2.1 x 2.2 x 2.4 cm well-defined echogenic lesion within the left lower pole. This is grossly stable in size when compared to prior MR lumbar spines dating back to 11/28/2003, given differences in modality/technique.The spleen measures 6.8 cm in length.", "output": "1. No acute sonographic findings to account for the patient's symptoms.2. 2.4 cm echogenic left lower pole renal lesion appears stable in size when compared to MRI lumbar spines dating back to 11/28/2003, given non-dedicated imaging and differences in modality/technique. The length of stability of the lesion favors a benign etiology, possibly an angiomyolipoma."}
{"instruction": "Generate impression based on findings.", "input": "27-year-old female status post thyroidectomy RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.POSTOPERATIVE BED: No suspicious thyroid bed lesions.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Left neck lymph node measures 2.5 x 1.1 x 0.5 cm, previously measuring 2.3 x 1.1 x 0.5 cm. Right level 2/3 lymph node measures 1.1 x 0.8 x 0.6 cm with a fatty hilum. Right level 5 lymph node measures 2.5 x 1.7 x 0.6 cm, previously measuring 2.1 x 1.3 x 0.5 cm,OTHER: No significant abnormality noted.", "output": "1.Benign-appearing bilateral lymph nodes.2.No suspicious lesions in the thyroid bed."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old female with a history of thyroid cancer with possible nodule on ultrasound. RIGHT LOBE: Status post thyroidectomy. Redemonstration of unchanged hyperechoic focus within the right thyroid bed representing benign postoperative change.LEFT LOBE: Status post thyroidectomy without massISTHMUS: Status post thyroidectomy without massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered, subcentimeter lymph nodes.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy without evidence of worrisome mass or regional adenopathy.."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old male patient with cardiomyopathy undergoing VAD workup. History of alcohol abuse, COPD. Question of cirrhosis, renal lesions. LIVER:The liver measures 15.5 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/s.GALLBLADDER, BILIARY TRACT: No gallstones, gallbladder wall thickening, or pericholecystic fluid is identified. There is no intra or extrahepatic biliary ductal dilatation. The common duct measures 3 mm in diameter.PANCREAS: No significant abnormality noted.SPLEEN: The spleen measures 7.2 cm in length.KIDNEYS: The right kidney measures 10.9 cm in length and the left kidney measures 10.1 cm in length. No evidence of hydronephrosis. ABDOMINAL AORTA: The aorta is normal in caliber.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: The bladder is decompressed and not visualized.", "output": "No acute sonographic findings within the abdomen."}
{"instruction": "Generate impression based on findings.", "input": "12-month-old male patient with history of omphalocele with expanders in place and concern for renal/ureteral compression, especially on the right. Note that the patient's right side is bandaged and contains a drain, which limits evaluation. KIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 6.5 cm Left: 6.0 cm   Mean for age: 6.65 cm  Range for age: 5.6 - 7.7 cmADDITIONAL OBSERVATIONS: None.", "output": "Normal examination without evidence of hydronephrosis.*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.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": "Female; 76 years old. Reason: 76 y/o with CLL s/p right inguinal lymph node excisional biopsy, now with fluid collection and concern for seroma/hematoma. Please evaluate if amenable to aspiration. In the right groin deep to the area of the prior lymph node biopsy today 5.8 x 5.3 x 3.0 cm well-circumscribed complex fluid collection. There is no vascularity within this collection on color Doppler.", "output": "5.8 x 5.3 x 3.0 cm complex fluid collection in the right groin compatible with hematoma. Infected fluid collection is a secondary possibility."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with abnormal thyroid function and thyroid nodules. Prior treatment for multinodular goiter with radioactive iodine. RIGHT LOBE MEASUREMENTS: 4 x 1.7 x 1.8 cmLEFT LOBE MEASUREMENTS: 2.9 x 0.9 x 1.1 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Anterior, solid nodule with peripheral calcification in the right lobe measures 1.3 x 1.5 x 2 cm without significant change.Significantly hypoechoic, solid nodule in the posterior, lower pole or adjacent to the lower pole measures 1.1 x 1.0 x 1.5 cm without significant change.Ovoid, hypoechoic nodule, likely representing summation of 2 nodules in the medial right lobe/isthmus measures 0.3 x 0.5 x 1 cm without change.LEFT LOBE: Hypoechoic, rounded nodule in the left lower pole measures 0.4 x 0.4 x 0.5 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 appearance of bilateral thyroid nodules. Again, the hypoechoic right nodule could be extrathyroidal."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old female with LFT elevation in setting of CHF. Evaluate for hepatic pathology LIVER: Hepatic parenchyma is mildly coarse in echotexture and measures 14.7 cm in length. Main portal vein is patent with peak velocity of 0.3 m/sGALLBLADDER, BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Common bile duct measures 0.3 cm in diameter. Gallbladder is absent.PANCREAS: No significant abnormalities noted.KIDNEYS: The right kidney measures 9.8 cm in length and is normal in echogenicity. The left kidney measures 9.1 cm in length and is normal in echogenicity. No hydronephrosis.OTHER: The spleen is normal echogenicity and measures 11.8 cm in length.", "output": "No sonographic evidence of hepatic mass or intra-/extrahepatic biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female who is pre-op for right sided parathyroid adenoma. Evaluate for thyroid nodules. RIGHT LOBE MEASUREMENTS: 1.4 x 2.2 x 4.2 cmLEFT LOBE MEASUREMENTS: 2.0 x 2.4 x 4.5 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: In the right lobe of the thyroid there is an ovoid, hypoechoic nodule measuring 0.6 x 1.2 x 1.3 cm which is nondescript in appearance although there is a suggestion of comet tail artifact as seen with colloid. Review of the prior study demonstrates that this was more cystic in 2013 but unchanged in size measuring 0.8 x 1.2 x 1.3 cm. There is at least one other small simple-appearing cyst as well as.LEFT LOBE: Occupying a significant portion of the left lobe is a large predominantly solid nodule with cystic components measuring 1.9 x 2.5 x 2.7 cm. This has comet tail artifact consistent with colloid. There is difficult to measure on the prior study but this mass was present. Adjacent to this is a smaller 0.8 x 0.9 x 1.1 cm complex cystic nodule with clear comet tail artifact consistent with colloid. This was also present on the prior exam and is not significantly changed in size or appearance.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: There is a large, hypoechoic mass posterior to the right lobe of the thyroid measuring 1 x 1.2 x 2.7 cm consistent with parathyroid adenoma.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Bilateral thyroid nodules. These appear likely to represent colloid nodules.2. Right extrathyroidal mass.US GUIDED FNA, US THYROID; 3/25/2016 10:32 AMCLINICAL INFORMATION AND PRE-OPERATIVE DIAGNOSIS: Right parathyroid adenoma. Bilateral thyroid nodules.POST-OPERATIVE DIAGNOSIS : Same OPERATORS: Doctors Paushter; I, the attending physician, Dr. Paushter, performed the entire procedure.TECHNIQUE: Following a discussion of the procedure with the patient, including its risks, benefits, alternatives and steps to prevent infection, an informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure.Localizing US demonstrated previously described bilateral nodules.. The skin over the target area was cleansed with chlorhexidine. Transducer was sterilely sheathed. Local anesthesia was obtained using 1% lidocaine, superficially and at depth. RIGHT side: Using aseptic technique, and continuous ultrasound guidance, the lesion was sampled using 25 gauge needles. 3 fine needle aspirations were performed. Due to capsular deflection of the needle and motion of the nodule, this biopsy was extremely difficult.LEFT side: Using aseptic technique, and continuous ultrasound guidance, the lesion was sampled using 25 gauge needles. 2 fine needle aspirations were performed.Cytology was present to confirm specimen adequacy. Specimen was handed to cytology. The patient tolerated the procedure well without immediate complications. Routine post procedure instructions were communicated to the patient.COMPLICATIONS: NoneESTIMATED BLOOD LOSS: Less than 5 cc. An adhesive bandage was placed on the patient\u2019s skin."}
{"instruction": "Generate impression based on findings.", "input": "Female, 77 years old. Microscopic Hematuria. RIGHT KIDNEY: The right kidney measures 8.8 cm in length, with normal echotexture. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.5 cm in length, with normal echotexture. No shadowing stones or hydronephrosis.OTHER: The bladder is nondistended.", "output": "No renal stones or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male with hyperbilirubinemia LIVER: Mildly echogenic liver measuring 13.2 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate directional flow; peak velocity at 0.3 m/sec.BILIARY TRACT: Normal echogenicity the gallbladder. No pericholecystic fluid. No gallbladder wall thickening. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Not well assessed due to overlying bowel gas.SPLEEN: Normal echogenicity of the spleen measuring 11.8 cm in length.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 10.8 cm in length. No hydronephrosis or shadowing calculi are noted. OTHER: Normal echogenicity of the left kidney measuring 11.1 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "Mild increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. "}
{"instruction": "Generate impression based on findings.", "input": "Female 60 years old; Reason: HCV s/p SVR, cirrhosis, NASH, eval for HCC History: Cirrhosis, NASH LIVER: The liver measures 18.5 cm in length. There is coarse and increased echogenicity of the liver parenchyma. The liver appears nodular as demonstrated on prior ultrasound. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 16.5 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.0 mm. Small shadowing echogenic foci are seen within the gallbladder. No pericholecystic fluid. Negative sonographic Murphy sign. The common bile duct measures 5.0 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9.0 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 12.9 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.5 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. The liver demonstrates cirrhotic morphology is seen in prior ultrasound. No worrisome masses are noted within the liver.2. Cholelithiasis without evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Female 66 years old; Reason: abnl LTs, liver usg History: same LIVER: The liver measures 17.1 cm in length. There is mildly 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 18.2 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.0 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 2.4 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 9.5 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 9.8 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "There is mildly increased echogenicity of the liver compatible with hepatocellular dysfunction/fatty infiltration. No worrisome masses."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old female with questionable enlarged thyroid on exam. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 5.8 x 1.8 x 2.8 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 6.3 x 1.8 x 2 cm.ISTHMUS MEASUREMENTS: The isthmus measures 6.1 mm in thickness.RIGHT LOBE: The right thyroid lobe has a homogeneous echotexture. No discrete nodules.LEFT LOBE: In the left lower pole, there is a 1.5 x 1.4 x 1.2 cm heterogenous nodule. The previously described 1.2 x 1 x 0.6 cm nodule of the left mid pole is no longer visualized and has likely regressed.ISTHMUS: No discrete nodules of the thyroid isthmus. Interval regression of the previously described subcentimeter hypoechoic nodule of the anterior thyroid isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Interval regression of the subcentimeter hypoechoic nodule of the isthmus and 1.2 cm nodule of the left mid pole.2. New heterogenous nodule of the left lower pole measuring 1.5 x 1.4 x 1.2 cm."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with a history of a multinodular thyroid presents for follow-up. RIGHT LOBE MEASUREMENTS: 4.0 x 1.2 x 1.6 cm.LEFT LOBE MEASUREMENTS: 4.5 x 1.8 x 1.4 cm.ISTHMUS MEASUREMENTS: Difficult to obtain accurate measurement.RIGHT LOBE: There are multiple nodules as described below.Nodule 1: Measures approximately 0.5 x 0.4 x 0.4 cm in the right inferior gland. Next heterogenous echotexture. No microcalcifications.Nodule 2: Measures approximately 0.7 x 0.5 x 0.8 m in the right inferior thyroid. Mixed echogenicity without microcalcifications or internal vascularity.LEFT LOBE: Nodule in the superior left thyroid measures probably 1.8 x 1.2 x 1.1 cm. Mixed echogenicity with both appear to be solid and cystic components. There are microcalcifications and there is peripheral vascularity.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: There is calcification within the lumen of the right carotid artery.", "output": "1. Multinodular thyroid as described above.2. Nodule in the left superior lobe of the thyroid amenable to biopsy.3. Calcification within the lumen of the right carotid likely reflect atherosclerotic disease."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: Coarse echogenic liver echotexture without mass. Liver length 13.5 cmGALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. Right kidney 8 cm in length.OTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis left kidney 9 cm in length. Spleen 8.2 cm in length. No ascites.", "output": "Coarse echogenic kidneys suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Gallbladder sludge without acute inflammation. Echogenic kidneys consistent with medical renal disease/parenchymal dysfunction without obstruction. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old female with history of benign right breast biopsy, new left palpable lump. A targeted left ultrasound was performed for the patient\u2019s area of concern at 12:00 in the left breast. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Female 51 years old Reason: Eval for gallstones History: Stones seen on bedside US, RUQ pain LIVER: Liver measures 18.4 cm. Mildly hyperechoic echogenicity of the liver parenchyma, which is nonspecific but may be seen in fatty infiltration or diffuse hepatic dysfunction.BILIARY TRACT: Shadowing gallstones at the neck of the gallbladder. Pericholecystic fluid, thickened gallbladder wall, and positive Murphy's sign. PANCREAS: The visualized portion of the pancreas are normal in appearance.SPLEEN: Spleen is normal in appearance measuring 8.5 cm.KIDNEYS: Normal cortical echogenicity bilaterally. No hydronephrosis or shadowing calculi. Right kidney measures 11.1 cm. Left kidney measures 12.8 cm.OTHER: No significant abnormalities noted.", "output": "Findings most consistent with acute cholecystitis. Discussed with ordering physician Dr. Bradley and ER physician Dr. Ward at approximately 1425 on 10/21/2016."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with history of AML status post stem cell transplant. Abnormal LFTs. LIVER: The liver is normal in morphology and size, measuring 19 cm in the craniocaudal dimension. It is mildly echogenic. No focal hepatic lesion or intrahepatic biliary ductal dilatation. Normal hepatopetal portal venous blood flow at 20 cm/sec.GALLBLADDER, BILIARY TRACT: Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid, or focal tenderness. No extrahepatic biliary ductal dilatation with the common duct measuring 5 mm.PANCREAS: The pancreas is obscured and poorly visualized.RIGHT KIDNEY: The right kidney is normal in size, measuring 11.9 cm without hydronephrosis, shadowing nephrolithiasis or discrete lesion evident.OTHER: The left kidney is normal in size, measuring 11.2 cm without hydronephrosis, shadowing nephrolithiasis or discrete lesion evident.The spleen is normal in size, measuring 11.3 cm.", "output": "Mildly echogenic liver most commonly seen in diffuse fatty infiltration. Otherwise, unremarkable right upper quadrant ultrasound. "}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury. Please evaluate transplant kidney. TRANSPLANT KIDNEY: Normal parenchymal echogenicity. No hydronephrosis. No focal lesions.DOPPLER", "output": "Acceleration of arterial blood flow near the transplant renal artery anastomosis, suggestive of some degree of stenosis. However, the arterial waveforms proximally and distally remain normal."}
{"instruction": "Generate impression based on findings.", "input": "LVAD with chronic kidney disease LIVER: Mildly coarse and echogenic liver without mass. Liver length 21 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma. Right renal cyst. No worrisome mass, stone, or obstruction. Right kidney 11.7 cm in length.OTHER: Echogenic left renal parenchyma. Left renal cyst. No left renal hydronephrosis. Bilateral pleural effusions. Trace ascites. Spleen 11.2 cm in length.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or obstruction. Hepatomegaly with mildly coarsened echogenic liver suggestive for liver parenchymal dysfunction; no ductal dilatation. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 35 years old Reason: eval for Cholelithiasis History: R flank pain, Right-abd pain No evidence of cholelithiasis or acute cholecystitis. Minimal prominence of the right renal collecting system is unchanged from previous study. Normal echogenicity of the liver. Normal size of the liver. Spleen is also normal size.", "output": "Mild right-sided caliectasis, unchanged from previous study."}
{"instruction": "Generate impression based on findings.", "input": "Rising creatinine, rule out hydronephrosis RIGHT KIDNEY: Right kidney measures 12.4 cm. Echogenic renal parenchyma. No hydronephrosis or solid mass.LEFT KIDNEY: Left kidney measures 11.6 cm. Echogenic renal parenchyma. No hydronephrosis or solid mass. Left renal cyst measures up to 2.5 cm.OTHER: The bladder is unremarkable.", "output": "Medical renal disease without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Male, 70 years old. AKI. Evaluate for obstruction. RIGHT KIDNEY: The right kidney measures 9.8 cm in length, with mildly increased cortical echogenicity. An upper pole simple cyst measures 1.2 x 1.1 x 1.4 cm. No hydronephrosis.LEFT KIDNEY: The left kidney measures 10.2 cm in length, with mildly increased cortical echogenicity. No focal lesions or hydronephrosis.OTHER: The bladder is decompressed.", "output": "1. No hydronephrosis.2. Findings compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Progressive left scrotal swelling RIGHT TESTIS: 3.5 x 2.4 cm. Ectasia of the rete testis. 0.6 x 0.5 cm intratesticular cystic focus with mural nodularity. Bilaterally symmetric Doppler flow characteristicsLEFT TESTIS: 3.6 x 2.1 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristicsRIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: Large epididymal cyst/spermatocele measuring 3.3 x 2.7 cm.OTHER: No significant abnormalities noted.", "output": "Large left epididymal cyst/spermatocele. Subcentimeter right intratesticular cystic focus with mural nodularity. While a benign etiology is favored, would recommend repeat ultrasound examination of this lesion in 6 months to document stability."}
{"instruction": "Generate impression based on findings.", "input": "Patient is a 67-year-old female who presents for diagnostic imaging. Her most recent screening mammogram demonstrated a focal asymmetry in her left breast. DIAGNOSTIC MAMMOGRAM OF LEFT BREAST: Three standard views of left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular is stable elements, unchanged in pattern and distribution. The focal asymmetry in the upper inner left breast on the prior screening mammogram is again noted on today's diagnostic mammogram with spot compression.TARGETED ULTRASOUND OF THE LEFT BREAST:Sonographic imaging of the upper inner left breast demonstrates a 4 x 4 x 3 mm irregular mass with irregular margin at the 10:00 location, 7 cm from the nipple. This mass demonstrates internal flow, posterior shadowing and antiparallel orientation.", "output": "4 mm irregular mass in the left breast. Ultrasound-guided biopsy is recommended for histologic evaluation. Results and recommendations were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female with history of lymphoma with PET avid lymph node remaining in the right axilla, presenting for targeted right axillary ultrasound. Evaluate ability to biopsy or place a wire. On physical examination, no palpable mass/lymph nodes were identified in the right axilla.A targeted right axillary ultrasound was performed. In the right axilla there is a borderline lymph node with slightly thickened cortex as compared to the other adjacent lymph nodes with fatty hila. It is located within the deep axilla measuring 9 mm x 7 mm by 11 mm and demonstrates normal morphology with hilar flow present on Doppler imaging. This likely corresponds to the FDG avid lymph node on recent PET scan and is located adjacent to blood vessels. There are additional smaller benign morphology lymph nodes elsewhere in the right axilla.", "output": "Borderline right axillary lymph node located in the deep axilla adjacent to a blood vessel. This likely corresponds to the FDG avid lymph node on recent PET scan. Based on location and size, a biopsy of this lymph node would be technically challenging. However needle localization of this lymph node with wire placement can be performed if an excisional biopsy is considered. Findings were discussed with Dr. Jaskowiak's team on 7/14/2016 at 4:40 PM. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old male requires evaluation prior to heart surgery. He has elevated bilirubin, bilateral lower extremity edema, dyspnea. LIVER: The liver measures 14.7 cm. The liver has coarse and increased echogenicity. No masses. No intrahepatic ductal dilatation. The portal vein is patent.BILIARY TRACT: The gallbladder is significantly dilated and is 7.2 cm at its maximum diameter. No stones. No pericholecystic fluid. Negative Murphy's. The gallbladder wall is measured at 1.9 m. The common bile duct is 6.22 mm, within normal limits for this patient's age.PANCREAS: Evaluation limited by overlying bowel gas.SPLEEN: The spleen measures 11.2 cm. No significant abnormalities noted.KIDNEYS: The right kidney measures 11.5 cm. The left kidney measures 12.1 cm. The cortex has normal echogenicity. No masses, stones, or hydronephrosis. OTHER: No significant abnormalities noted.", "output": "1. Distended gallbladder without acute inflammation at this time. No ductal dilatation.2. Increased and coarse echotexture of liver consistent with chronic liver disease/parenchymal dysfunction. No mass or ascites."}
{"instruction": "Generate impression based on findings.", "input": "44 years old, Male, Reason: Status post biliary drain; rule out hematoma gallbladder. History: abdominal pain/tenderness, obstipation, constipation LIVER: The liver measures 15.1 cm in length. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.4 m/s.BILIARY TRACT: Percutaneous cholecystostomy tube is noted with tip in the gallbladder. Echogenic material within the gallbladder appears somewhat more organized than on prior exam and still may represent sludge or hematoma. There is increased pericholecystic echogenic material which may represent pericholecystic fluid or hematoma. The common bile duct measures 5 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 8.5 cm in length. RIGHT KIDNEY: Kidney measures 9.6 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.3 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Echogenic material within the gallbladder appears somewhat more organized than on prior exam and still may represent sludge or hematoma.2.Increased pericholecystic echogenic material which may represent pericholecystic fluid or hematoma. 3.Stable percutaneous cholecystostomy tube is noted with tip in the gallbladder. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: history of papillary thyroid carcinoma, please evaluate for recurrence RIGHT LOBE: Status post thyroidectomy without evidence of disease recurrence.LEFT LOBE: Status post thyroidectomy without evidence of disease recurrence.ISTHMUS: Status post thyroidectomy without evidence of disease recurrence.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is a small subcentimeter left level 4 lymph node, favored benign. There is no regional lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy without evidence of disease recurrence. No mass or regional lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Ms. McWright is a 35-year-old female presenting with a tender palpable abnormality in the left axillary region for the past one week. Upon physical exam of the left axillary region, a subcentimeter pimple-like lesion is identified. There is minimal associated erythema and skin thickening.A targeted left axillary ultrasound was performed for the patient\u2019s area of concern. In the left axillary region, there is a superficial hypoechoic mass measuring 2.0 x 2.7 cm. This mass is located within the dermal layer and is associated with moderate to marked vascularity. Findings are compatible with an inflamed epidermal inclusion cyst, with minimal associated skin thickening. No suspicious cystic or solid mass is identified.", "output": "Inflamed epidermal inclusion cyst with no sonographic evidence for malignancy. Patient can try hot compresses for relief of symptoms.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with a history of recurrent ovarian cancer and abdominal distention. Evaluate for ascites. Targeted ultrasound was performed of the 4 abdominal quadrants to assess for ascites. There is a very small amount of fluid in the abdomen and at least small bilateral pleural effusions.", "output": "Minimal ascites and at least small bilateral pleural effusions partially seen. "}
{"instruction": "Generate impression based on findings.", "input": "22-year-old male with a history of ulcerative colitis with thrombocytopenia. Evaluate the liver and spleen. LIVER: The liver is coarse in echotexture. It is normal in size, measuring 14.8 cm in the craniocaudal dimension. No focal hepatic lesion or intrahepatic biliary ductal dilatation. Normal hepatopetal portal venous blood flow at 13 cm/sec.GALLBLADDER, BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 3 mm. Normally distended gallbladder without gallstones, wall thickening or pericholecystic fluid.PANCREAS: A partially visualized pancreatic head is unremarkable. The remainder of the pancreas is obscured.RIGHT KIDNEY: The right kidney is normal in size, measuring 11.3 cm, without hydronephrosis, shadowing nephrolithiasis or focal lesion evident. Color Doppler demonstrates hilar blood flow.OTHER: The left kidney is normal in size, measuring 11.7 cm without hydronephrosis, shadowing nephrolithiasis or discrete lesion evident. Color Doppler demonstrates hilar blood flow.The spleen is normal in size, measuring 10.8 cm without a discrete lesion evident.", "output": "Coarse hepatic parenchyma suggesting parenchymal dysfunction. No focal hepatic lesion or biliary ductal dilatation. Normal sized spleen."}
{"instruction": "Generate impression based on findings.", "input": "Male; 40 years old. Reason: enlarging, reportedly tender left testicular lump. Evaluate further History: palpable left testicular lump RIGHT TESTIS: 3.0 x 2.1 x 4.4 cm. Normal echotexture and vascularity. No intratesticular mass evident.LEFT TESTIS: 3.3 x 2.3 x 4.5 cm. Normal echotexture and vascularity. No intratesticular mass evident.RIGHT EPIDIDYMIS: 1.3 x 1.3 x 1.3 cm. Normal ultrasound appearance.LEFT EPIDIDYMIS: 1.2 x 1.1 x 1.7 cm. Normal ultrasound appearance.OTHER: There is a collection of dilated vessels with increased flow during Valsalva underlying the area of the patient's palpated abnormality. This finding is seen bilaterally. Small bilateral hydroceles.", "output": "Bilateral varicoceles and small hydroceles. No intratesticular mass is evident."}
{"instruction": "Generate impression based on findings.", "input": "Reason: history of multiple thyroid nodules, please evaluate for interval change History: dysphonia attributed to reflux disease RIGHT LOBE MEASUREMENTS: 5.8 x 1.8 x 1.9 cm.LEFT LOBE MEASUREMENTS: 5.9 x 1.7 x 1.7 cm.ISTHMUS MEASUREMENTS: 0.2 cm.RIGHT LOBE: Multiple benign-appearing colloid nodules appear stable in size. Representative nodule measures 1.7 x 0.7 x 1.2 cm. Lower pole complex cystic nodule measures 1.7 x 0.9 x 0.8 cm. No new suspicious nodules or masses.LEFT LOBE: Multiple benign-appearing colloid nodules appear stable in size. No new suspicious nodules or masses.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Complex left lower pole thyroid nodule and numerous additional nodules overall appear stable in size accounting for differences in technique."}
{"instruction": "Generate impression based on findings.", "input": "78-year-old male with tender left testicular mass, leukocytosis, fever, pyuria and hematuria. Evaluate left testicular mass. RIGHT TESTIS: Measures 3.6 cm x 2.1 cm x 2.0 cm and is normal in echogenicity. Right testicular cyst measures 3 mm x 3 mm x 3 mm. Arterial and venous flow is visualized on Doppler exam. LEFT TESTIS: Measures 3.5 cm x 2.4 cm x 2.8 cm and is normal in echogenicity. Arterial and venous flow was visualized on Doppler exam.RIGHT EPIDIDYMIS: Measures 1.9 cm x 1.4 cm x 2.3 cm and contains several cysts, the largest of which is in the epididymal head measuring 1.8 cm x 0.9 cm x 1.5 cm. Appropriate flow is visualized on Doppler exam. LEFT EPIDIDYMIS: Enlarged measuring 1.9 cm x 1.8 cm x 3.5 cm and is heterogeneous in echotexture and hyperemic. Extending from the left epididymis is a the complex cystic structure measuring 5.7 cm x 2.5 cm x 2.8 cm with peripheral vascularity.OTHER: Moderate left hydrocele.", "output": "1. Findings compatible with acute left epididymitis with associated abscess. Moderate left hydrocele. 2. Right testicular and epididymal cysts. "}
{"instruction": "Generate impression based on findings.", "input": "Palpable left breast lump. Family history of breast cancer in sister at age 70. Three standard views of both breasts and 2 spot compression views of both breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty. There is an irregular 3 cm hyperdense mass in the left upper inner breast at anterior depth with irregular margins without associated calcifications. No definite satellite lesions are seen.There is a focal asymmetry that measures 0.6 cm in the right lower outer breast persists on spot compression views.ULTRASOUND:", "output": "1. Irregular mass in the 11:00 o'clock position in the left breast is highly suspicious for malignancy. 2. Focal asymmetry in the right lower outer breast corresponds with normal appearing intramammary lymph node on ultrasound.Findings discussed with Dr. Jaskowiak and patient was scheduled for same day appointment.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: B - Surgical Consultation. "}
{"instruction": "Generate impression based on findings.", "input": "Thyroid carcinoma status post thyroidectomy 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 mass or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid cancer status post surgery RIGHT LOBE: Status post thyroidectomy. No soft tissue echogenicity delineated in thyroid bed to suggest residual tissue or local tumor recurrence. LEFT LOBE: Status post thyroidectomy. No soft tissue echogenicity delineated in thyroid bed to suggest residual tissue or local tumor recurrence. ISTHMUS: Status post thyroidectomy. No soft tissue echogenicity delineated in thyroid bed to suggest residual tissue or local tumor recurrence. PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "No evidence of residual or recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "Patient with cirrhosis and recurrent ascites. History of lysis of adhesions. Abdominal distention. Evaluate portal vein. LIVER: The liver is cirrhotic in morphology and increased echogenicity without a discrete lesion. The portal vein appears patent, however with abnormal retrograde flow, unchanged from the prior study which was incorrectly reported as antegrade flow. No thrombus is identified.BILIARY TRACT: No intrahepatic biliary ductal dilatation.PANCREAS: Not evaluated.SPLEEN: Not evaluated.RIGHT KIDNEY: Not evaluated. OTHER: There is a moderate volume of abdominopelvic ascites which demonstrates numerous septations indicative of loculated ascites.Moderate right pleural effusion.", "output": "1. The portal vein is patent with abnormal retrograde flow, unchanged.2. Moderate volume abdominopelvic ascites with extensive loculation.3. Right pleural effusion."}
{"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": "Ms. Tzur is a 70-year-old female with bilateral breast implants. Patient reports a nontender palpable mass in the right upper outer breast for the past 3 weeks. Upon physical exam at the patient's area of concern, a vague palpable mass is identified in the right upper outer breast.A targeted right breast ultrasound was performed for the palpable area of concern. In the right breast 10:00 location, approximately 4 cm from the nipple, there are three focal areas of increased echogenicity identified with blurring of the silicone implant contour. Sonographic findings are compatible with extracapsular rupture.", "output": "Sonographic findings compatible with extracapsular rupture of right silicone implant. A breast MRI can be performed for additional confirmation if clinically warranted. All results and recommendations were discussed with the patient. Patient is to follow-up with Donna Christian later today for further evaluation.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation"}
{"instruction": "Generate impression based on findings.", "input": "Male; 77 years old. Reason: Primary HPT. Please evaluate for parathyroid adenoma. History: Primary HPT. Please evaluate for parathyroid adenoma. RIGHT LOBE MEASUREMENTS: 4.6 x 1.7 x 1.5 cmLEFT LOBE MEASUREMENTS: 3.0 x 1.4 x 1.4 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: The thyroid is mildly heterogeneous but there is no discrete nodule.LEFT LOBE: The thyroid is mildly heterogeneous but there is no discrete nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Small amount of calcification is noted in the left carotid artery.", "output": "Mildly prominent thyroid with no discrete nodule."}
{"instruction": "Generate impression based on findings.", "input": "Female 18 years old; Reason: new onset hyperthyroidism History: tachycardia, anxiety, ams RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 1.2 x 1.9 x 5.4 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 1.6 x 1.6 x 4.2 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.7 cm.RIGHT LOBE: The right lobe is heavily vascular and heterogeneous. This appears slightly enlarged. No dominant nodules are identifiedLEFT LOBE: The left lobe is also heavily vascular, heterogeneous, and appears slightly enlarged. No dominant nodules are identified.ISTHMUS: The isthmus is heterogeneous, asymmetric, and lobular.LYMPH NODES: No suspicious adenopathy is noted. There is a right level 3 cervical lymph node that measures 0.4 x 1.1 x 2.9 cm. This is hypoechoic, slender, and has a fatty hilum. On the left at level 3/4, another lymph node is identified that is hypoechoic and has a fatty hilum. This measures 0.7 cm x 1.5 cm x 4.2 cm.OTHER: No significant abnormality noted.", "output": "The thyroid appears diffusely heterogeneous with increased blood flow consistent with thyroiditis. No dominant nodules are seen. Several benign-appearing lymph nodes but no suspicious adenopathy is identified."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C with right lobe mass LIVER: Coarse echogenic liver texture again noted. Liver length is 16.5 cm. Slight interval increase in size of right lobe peripheral echogenic mass now measuring 1.6 x 1.7 x 1.6 cm; this is in comparison to 1.5 x 1.4 cm on 10/1/2014.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma again noted without mass, stone, or hydronephrosis. 9.3 cm in lengthOTHER: Echogenic left kidney without mass, stone, or hydronephrosis. Left kidney 11 cm in length. Spleen 10 cm in length. No ascites.", "output": "Slight interval increase in size of peripheral right lobe hepatic echogenic focus. A neoplasm including hepatocellular carcinoma must be considered; would strongly suggest correlation with dedicated MR.Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "87-year-old female with thyroid nodule identified on outside imaging. RIGHT LOBE MEASUREMENTS: 5.3 x 1.8 x 2.2 cmLEFT LOBE MEASUREMENTS: 3.8 x 1.4 x 1.3 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: In the midportion of the right lobe of the thyroid there is a solid slightly hypoechoic nodule with small cystic components measuring 1.4 x 1.7 x 2.3 cm. In the inferior right lobe there is a well-defined slightly hypoechoic nodule with a full hypoechoic rim and no cystic component measuring 0.4 x 0.9 x 1.2 cm. LEFT LOBE: At the posterior aspect of lower pole of the left lobe there is a predominantly solid and isoechoic nodule with a focal hypoechoic rim measuring 0.8 x 1 x 1.3 cm. I believe this is more likely intrathyroidal been extrathyroidal in origin. There is also a small thyroid cysts with comet tail artifact consistent with colloid.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 nodules as noted above."}
{"instruction": "Generate impression based on findings.", "input": "31 years Male with soft tissue mass along left lateral abdominal wall near lower ribs suspected to be a lipoma. Within the subcutaneous soft tissues of the left lateral abdominal wall at the site of patient's reported palpable abnormality, there is a fusiform-shaped, wider than tall hyperechoic structure measuring 1.4 x 0.7 x 1.0 cm which demonstrates minimal internal vascularity.", "output": "1.4 cm structure corresponding to patient's palpable abnormality which is compatible with lipoma."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old male with hepatitis C and bridging fibrosis. Evaluate for hepatocellular carcinoma. LIVER: Liver is normal in size and contour. The parenchyma remains mildly to moderately echogenic, although less than on the prior exam. No focal hepatic mass is identified.BILIARY TRACT: Gallbladder appears normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: The head and body are normal. The tail is not adequately visualized due to bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: Limited views of left kidney demonstrate no abnormality.", "output": "No evidence for hepatic mass."}
{"instruction": "Generate impression based on findings.", "input": "72 old female with thyroid nodules. RIGHT LOBE MEASUREMENTS: 1.8 x 2.0 x 5.8 cmLEFT LOBE MEASUREMENTS: 1.4 x 2.5 x 5.0 cmISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: There are numerous right thyroid lobe nodules. Most of these are nearly completely cystic with small echogenic peripheral foci compatible with colloid cysts. The largest measures 1.6 x 1.3 x 1.0 cm and contains dependent debris. The margins are well-defined without calcifications or other specific suspicious sonographic features.LEFT LOBE: The left thyroid lobe contains numerous nodules, most are nearly completely cystic with small echogenic peripheral foci, compatible with colloid cysts. There is a 1.2 x 1.1 x 1.9 cm nodule with coarse calcifications and obscured posterior margins. The visualized margins are well-defined. There is no increased vascularity. This nodule is stable to slightly decreased in size compared to the prior study (from 2003) where it measured 1.6 x 1.4 x 2.0 cm.ISTHMUS: 2.0 x 0.8 x 1.8 cm cystic colloid nodule in the right aspect of the isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Morphologically unremarkable and normal size lymph nodes are noted bilaterally.OTHER: No significant abnormality noted.", "output": "1. Coarsely calcified 1.9-cm left thyroid lobe nodule, stable to slightly decreased in size compared to 2003, benignity is favored. 2. Multiple bilateral colloid cysts. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Caillouet is a 26-year-old female with presenting with right accessory nipple bleeding x 1 week. Physical examination of the right breast demonstrated an accessory nipple/growth from the right nipple. The tissue appeared erythematous and friable, with diffuse bleeding.A targeted right ultrasound was performed for the area of concern. There is no solid or cystic mass identified.", "output": "Friable appearance and diffuse bleeding and erythema from patient's right accessory nipple. No definite sonographic evidence for malignancy.Patient was instructed to follow-up with breast surgery. An appointment was scheduled for the patient on 05/31/15 at 8:00 AM. All results and recommendations were discussed with the patient and Ivy Akpotu at time of dictation.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Left breast pain and area of clinical concern in the left breast above the nipple. Area of concern is marked by the clinical service. A targeted left ultrasound was performed for the area of clinical concern. There is no solid or cystic mass identified. There are normal dense retroareolar elements noted.", "output": "No sonographic evidence for malignancy. Clinical correlation for causes of breast pain is recommended.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Male 51 years old Reason: elevated cr History: ?ain Ultrasound guidance provided for a renal biopsy performed by the nephrology service.", "output": "Ultrasound guidance provided for a renal biopsy performed by the nephrology service."}
{"instruction": "Generate impression based on findings.", "input": "Female 41 years old; evaluate for fatty liver LIVER: The liver measures 15.0 cm in length. There is coarse, slightly increased echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. There is a minimally complex hypoechoic hepatic cyst measuring 1.9 cm x 1.3 cm x 1.1 cm. The main portal vein is patent with normal hepatopetal flow measured at 26.0 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 3.0 mm. No stones are seen. No pericholecystic fluid. 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 measures 7.5 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.2 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.0 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. The liver has course slightly increased echogenicity, which is compatible with fatty infiltration/hepatic cellular dysfunction. No worrisome masses seen.2. There is a minimally complex hepatic cyst in the right lobe measuring 1.9 cm x 1.3 cm x 1.1 cm."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain with stones on bedside ultrasound and positive Murphy's sign. LIVER: The liver is coarse and echogenic. It measures 21 cm in craniocaudal dimension without a focal suspicious lesion or intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 0.4 m/s.Cholelithiasis with gallstone at the gallbladder neck which did not appear to be mobile. The gallbladder wall is mildly thickened measuring up to 4 mm with pericholecystic fluid. The patient was tender over the gallbladder fossa.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 6 mm.PANCREAS: The pancreas is mostly obscured by overlying bowel gas.SPLEEN: The spleen is normal in morphology and size measures 11 cm without a focal lesion.RIGHT KIDNEY: The right kidney is normal in size and morphology measuring 11.7 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. OTHER: The left kidney is normal in morphology and size measuring 10.3 cm without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.", "output": "1. Findings compatible with acute cholecystitis with cholelithiasis, gallbladder wall thickening, pericholecystic fluid and focal tenderness.2. The common bile duct measures up to 6 mm without choledocholithiasis.3. Hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "Male 69 years old Reason: Assess PEG tube site for abscess, draining purulent fluid. Heterogeneous next echogenic and fluid collection is seen along the PEG tube site corresponding to the hematoma seen on CT. Additional thin fluid is seen tracking. No single large collection separate from the hematoma that would be amenable to percutaneous drainage.", "output": "Tracking fluid along PEG tube and loculated collection consistent with hematoma in the anterior abdominal wall similar to that seen on the CT scan of 9/3/2016. Given the purulent nature of the discharge infected fluid cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old male status post LVAD with drainage around the drive line. Evaluate for fluid collection. A targeted portable ultrasound was performed of the left lower quadrant along the course of the LVAD drive line. There is no discrete fluid collection.", "output": "No discrete fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "61 year old female with history of right upper quadrant pain. LIVER: Multiple simple hepatic cysts are seen, with the largest left hepatic cyst measuring 2.8 x 2.1 x 2.7 cm. The largest right hepatic cyst measures 2.8 x 2.7 x 3.0 cm.GALLBLADDER, BILIARY TRACT: No cholelithiasis or gallbladder wall thickening. The biliary tract is not dilated.PANCREAS: Visualized portions unremarkable.RIGHT KIDNEY: The right kidney is within normal limits, and measures 10.1 cm.OTHER: The spleen is within normal limits, and measures 8.1 cm. The left kidney is within normal limits, and measures 9.3 cm. No hydronephrosis.", "output": "Several simple hepatic cysts."}
{"instruction": "Generate impression based on findings.", "input": "EtOH with increased LFTs LIVER: Mildly heterogeneous liver echotexture without mass. Liver length 22.9 cm. Perihepatic ascites. Liver is mildly nodular suggesting cirrhosis.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. Common duct measures 6 mm which is at the upper limits of normal.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.5 cm in lengthOTHER: Left kidney 12.8 cm in length. Spleen 10 cm in length. Small amount of ascites surrounds the liver.", "output": "New perihepatic ascites. Cirrhotic appearing liver."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old male with history of nasopharyngeal carcinoma with new right thyroid nodule seen on recent PET. RIGHT LOBE MEASUREMENTS: The right lobe measures 5.5 cm x 1.7 cm x 1.4 cm.LEFT LOBE MEASUREMENTS: The left lobe measures 4.9 cm x 1.6 cm x 0.8 cm.ISTHMUS MEASUREMENTS: The isthmus measures 0.3 cm.RIGHT LOBE: The right lobe is heterogeneous. There is a subcentimeter hypoechoic nodule superiorly. There is a spongiform nodule located at the lower pole measuring 1.5 cm x 1 cm x 1.3 cm.; this nodule is associated with internal comet tail artifact.LEFT LOBE: The left lobe is heterogeneous. There is a subcentimeter hypoechoic nodule seen in the mid left lobe and another mixed spongiform and hypoechoic nodule inferior to that measuring 0.9 cm x 0.4 cm 0.6 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: None visualized.LYMPH NODES: No suspicious adenopathy noted.", "output": "Bilateral thyroid nodules; favor benign etiology. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "69 years Female with history of endometrial carcinoma now with back pain and elevated creatinine, evaluate for hydronephrosis. RIGHT KIDNEY: Kidney measures 11.8 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.9 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.BLADDER: Not well distended, but no gross abnormalities.OTHER: No significant abnormalities.", "output": "No hydronephrosis. "}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male with hypercalcemia and possible hyperparathyroidism. Evaluate parathyroid. RIGHT LOBE MEASUREMENTS: 6.4 x 1.6 x 1.7 cm.LEFT LOBE MEASUREMENTS: 5.5 x 1.6 x 2.6 cm.ISTHMUS MEASUREMENTS: 0.4 cm.RIGHT LOBE: Homogenous parenchyma without abnormality.LEFT LOBE: A small subcentimeter cystic nodule in the left inferior lobe.ISTHMUS: Homogenous parenchyma without abnormality.PARATHYROID GLANDS: An approximately 1.3 x 0.7 x 0.6 cm oval hypoechoic lesion posterior to the right inferior thyroid may represent a parathyroid adenoma or a hyperplastic gland.LYMPH NODES: No suspicious adenopathy.OTHER: No significant abnormality noted.", "output": "1. Hypoechoic lesion posterior to the right inferior thyroid may represent a parathyroid adenoma or a hyperplastic gland. Correlation with patient's history and nuclear medicine imaging suggested."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old male with HBV. HCC screening. LIVER: Increased echogenicity of the liver measuring 14.9 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate directional flow.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No pericholecystic fluid. No gallbladder wall thickening. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Visualized pancreas is normal in echogenicity.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 9.5 centimeters in length. Incidental cyst is noted at the upper pole measuring 1.3 cm x 1.3 cm x 1.6 cm. No hydronephrosis or shadowing calculi.OTHER: Normal echogenicity the spleen measures 11.4 the liver cm in length. Normal echogenicity of the left kidney measuring 10.3 cm in length.", "output": "1. Increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesions. 2. Incidental benign right renal cyst is noted. "}
{"instruction": "Generate impression based on findings.", "input": "11-year-old female with the left breast being larger than the right, associated with left chest pain Whole left breast ultrasound is performed. There are no abnormal findings including solid or cystic masses.", "output": "No sonographic evidence for abnormality in the left breast BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female with history of primary hyperparathyroidism. Right inferior gland was not found on prior surgery. RIGHT LOBE MEASUREMENTS: 4.3 x 1.9 x 0.7 cm.LEFT LOBE MEASUREMENTS: 2.7 x 1 x 0.8 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: The right thyroid lobe has a heterogenous echotexture. In the inferior right lobe, there is 0.9 x 0.6 cm hypoechoic nodule, which is better seen on the prior exam.LEFT LOBE: Mildly heterogenous echotexture. No dominant nodule identified. Small thyroid volume compared to the right lobe, which could be related to prior surgery.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No definite right parathyroid adenoma identified.LYMPH NODES: Right level IV lymph node measuring 1.2 x 0.8 x 0.6 cm with a normal central fatty hilum.OTHER: No significant abnormality noted.", "output": "1. Small volume of left thyroid lobe could be related to prior surgery.2. No definite right parathyroid adenoma identified."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid carcinoma status post resection RIGHT LOBE: Status post thyroidectomy without mass.LEFT LOBE: Status post thyroidectomy without mass.ISTHMUS: Status post thyroidectomy without worrisome mass. Previously described focus within the midline superior to the isthmus bed has remained stable and appears to be a benign-appearing lymph nodePARATHYROID 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. Previously described focus within the midline superior to the isthmus bed has remained stable and appears to represent a benign appearing lymph node."}
{"instruction": "Generate impression based on findings.", "input": "80-year-old female with hyperparathyroidism. Evaluate for parathyroid adenoma RIGHT LOBE MEASUREMENTS: 1.9 x 1 x 3.3 cmLEFT LOBE MEASUREMENTS: 1.3 x 1 x 3.9 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Spongiform nodule in the superior right lobe measuring 0.2 x 0.5 x 0.5 cm. Is also a second small cystic nodule with comet tail artifact in the medial right lobe.LEFT LOBE: No discrete mass.ISTHMUS: In the right isthmus there is a cyst without complication measuring 0.3 x 0.2 x 0.4 cmPARATHYROID GLANDS: Posterior to the mid to upper pole of the right lobe of the thyroid there is a 0.5 x 0.8 x 1.5 cm mass. This, however, he has a hypoechoic periphery and a central echogenic region characteristic of lymph node. No other extrathyroidal mass identified.LYMPH NODES: Slightly heterogeneous level 4 lymph node on the left measuring 0.6 x 0.8 x 1.1 cm maintains normal shape and vascularity.OTHER: No significant abnormality noted.", "output": "Colloid nodules.Lymph node posterior to the right lobe of the thyroid."}
{"instruction": "Generate impression based on findings.", "input": "Reason: rule out change in size of nodules RIGHT LOBE MEASUREMENTS: 5.7 x 2.2 x 2.8 cm.LEFT LOBE MEASUREMENTS: 4.9 x 1.9 x 2.0 cm.ISTHMUS MEASUREMENTS: Up to 0.8 cm in thickness.RIGHT LOBE: Heterogeneous parenchymal echotexture with increased vascularity. No suspicious focal nodules identified.LEFT LOBE: Heterogeneous parenchymal echotexture with increased vascularity. No suspicious focal nodules identified.ISTHMUS: Heterogeneous parenchymal echotexture with increased vascularity. No suspicious focal nodules identified.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Mildly enlarged, heterogeneous thyroid gland with increased vascularity suggestive of thyroiditis. No suspicious discrete nodules identified."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: No significant abnormalities noted. 15.7 cm in lengthGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation. No focal Murphy's sign couldn't be elicited.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.8 cm in lengthOTHER: Left kidney 10.4 cm in length. Spleen 9.4 cm in length. No ascites.", "output": "Cholelithiasis without morphologic evidence for acute inflammation or ductal dilatation. Although the patient experienced diffuse pain while scanning, no focal Murphy's sign couldn't be elicited."}
{"instruction": "Generate impression based on findings.", "input": "32 year-old female with goiter. RIGHT LOBE MEASUREMENTS: 5.6 x 2.0 x 1.7 cmLEFT LOBE MEASUREMENTS: 6.0 x 1.9 x 1.5 cmISTHMUS MEASUREMENTS: 5 mmRIGHT LOBE: The right thyroid lobe is heterogeneous in echotexture with multiple sub-5 mm hypoechoic nodules with no discrete dominant nodule. LEFT LOBE: The left thyroid lobe is heterogeneous in echotexture with multiple sub-5 mm hypoechoic nodules with no discrete dominant nodule. Adjacent to the inferior aspect of the left thyroid lobe there is an 8 x 5 x 8 mm hypoechoic focus which may represent an exophytic nodular extension of the thyroid gland or an enlarged parathyroid adenoma. ISTHMUS: The isthmus is heterogeneous in echotexture with multiple subcentimeter hypoechoic nodules.PARATHYROID GLANDS: See above.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Heterogeneous thyroid gland with numerous sub-5 mm hypoechoic nodules with no discrete dominant nodule. Adjacent to the inferior left thyroid lobe there is an 8-mm focus which may represent an exophytic nodular extension of the thyroid gland or a parathyroid adenoma; correlate with serum calcium and PTH."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with history of kidney transplant and recent stent removal from the native kidney, now with acutely rising creatinine. Evaluate for hydronephrosis. RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: Adjacent to the transplant kidney there is a complex fluid collection measuring 13.5 cm x 8.4 cm x 7.1 cm. There is no evidence of active bleeding.TRANSPLANT KIDNEY: Transplant kidney measures 11.5 cm in length. There is mild hydronephrosis seen which is new compared to prior ultrasound. No stones or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 9 cm in length. Atrophy is seen of the kidney. There is mild hydronephrosis is visualized. No stones or worrisome masses are seen.RIGHT KIDNEY: The right kidney measures 8.7 cm in length. Atrophy of the right kidney is seen. There is mild hydronephrosis noted. No stones or worrisome masses are seen.URINARY BLADDER: No significant abnormality noted", "output": "1. Adjacent to the transplant kidney there is a hematoma measuring 13.5 cm x 2.4 cm x 7.1 cm. No evidence of active bleeding. 2. Mild hydronephrosis is seen in the transplant kidney which is new compared to prior ultrasound. No stones or worrisome masses are seen.3. Bilaterally the native kidneys demonstrate atrophy with mild hydronephrosis without stones or masses."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old male with hepatic failure and lymphoma. LIVER: There is hepatomegaly with the liver measuring at least 20 cm in length. Liver parenchyma is is mildly and heterogeneously echogenic which is non-specific, although this may be seen in irregular fatty infiltration. The caudate appears somewhat hypoechoic but this may be due to focal sparing rather than mass. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein. GALLBLADDER, BILIARY TRACT: There is no biliary tract dilatation. The gallbladder contains at least one 0.6 cm polyp. There is also a small echogenic focus involving the anterior wall which may represent cholesterolosis. No definite shadowing gallstones. Gallbladder wall is not thickened.PANCREAS: Limited. There is significant peripancreatic/retroperitoneal adenopathy.RIGHT KIDNEY: 3.8 cm complex cyst arising from the midpole of the right kidney with thin to moderate septations. No definite soft tissue component. Smaller cyst present as well. No hydronephrosis.OTHER: Presumed small cyst in the lower pole of the left kidney. No hydronephrosis.Mild ascites.Splenectomy.", "output": "1. No biliary obstruction.2. Gallbladder polyp.3. Complex right renal cyst. Hepatomegaly.4. Ascites.5."}
{"instruction": "Generate impression based on findings.", "input": "59 year-old female with hepatitis C virus. Evaluate for cirrhosis. LIVER: Liver is moderately and coarsely echogenic. The liver capsule is mildly undulating and there is enlargement of the left lobe suggestive of cirrhosis. There is no focal hepatic mass seen. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: Upper normal in size.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Echogenic liver with suggestion of cirrhotic morphology. No discrete mass."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female patient history of breast cancer status post right breast mastectomy. Bilateral silicone implants. New palpable abnormality in the left breast. Strong family history of breast cancer. A targeted left ultrasound was performed for the palpable area of concern in the left breast 5:00 position 4 cm from nipple. On physical exam, there is no tenderness or skin changes. Breast implant is present. There is a fold along the edge of the implant at the site of palpable abnormality. No solid or cystic masses are identified.", "output": "Palpable abnormality in left breast corresponds to a small fold/lobulation along the edge of the implant. No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Female; 44 years old. Reason: abdominal pain associated with food, negative EGD History: abdominal pain LIVER: The liver measures 14.4 cm in length. The liver surface is smooth, the parenchyma is mildly increased in echogenicity but normal in echotexture. Within the right lobe of liver is a 1.3 x 1.2 x 1.3 cm hyperechoic focus with no flow on color Doppler.The main portal vein is patent with hepatopetal flow and a peak velocity of 0.2 m/sec.BILIARY TRACT: The gallbladder is normal in appearance. There is no cholelithiasis, wall thickening or pericholecystic fluid. The common duct measures 0.1 cm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 9.4 cm in length.KIDNEYS: The right kidney measures 10.6 cm in length, the left measures 10.7 cm in length. There is no hydronephrosis or shadowing renal stone bilaterally.", "output": "1.No cholelithiasis or evidence of cholecystitis.2.1.3 cm echogenic focus in the right lobe of the liver. Benign etiologies such as focal fat or hemangioma are favored."}
{"instruction": "Generate impression based on findings.", "input": "58 year old female with a history of cirrhosis. Presents for CT screening. LIVER: The liver is nodular in contour and coarsened in echotexture consistent with cirrhosis. It is normal in size, measuring 17.3 cm in craniocaudal dimension. No suspicious focal hepatic lesion is identified. No intrahepatic biliary ductal dilatation. There is normal hepatopetal portal venous blood flow at 20 cm per second.GALLBLADDER, BILIARY TRACT: A normally distended gallbladder is present without gallstones, wall thickening or pericholecystic fluid. No extrahepatic biliary ductal dilatation with the common duct measuring 4 mm.PANCREAS: Visualized portions of the pancreas are normal.RIGHT KIDNEY: The right kidney measures 10.4 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident.OTHER: The left kidney is normal in size, measuring 11.2 cm in length without hydronephrosis. There is a 4-mm non-shadowing echogenic parenchymal focus, favoring a benign etiology. The spleen is normal in size, measuring 2 cm in length with a 7 mm cyst.", "output": "Cirrhotic liver morphology without discrete suspicious lesion."}
{"instruction": "Generate impression based on findings.", "input": "History of chronic hepatitis C and cirrhosis. Presents for HCC screening. LIVER: No overt morphologic features of cirrhosis. 1 cm right hepatic dome simple cyst. No suspicious focal liver lesion or intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 0.2 m/s.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 4 mm. Normally distended gallbladder. 5 mm non-shadowing dependent focus without vascularity may reflect a small gallbladder polyp.PANCREAS: The partially imaged pancreas is unremarkable.SPLEEN: The spleen is enlarged measuring 14.3 cm.RIGHT KIDNEY: The right kidney measures 10.9 cm in length without hydronephrosis or shadowing nephrolithiasis. OTHER: The left kidney measures 9.8 cm in length without shadowing nephrolithiasis or hydronephrosis.", "output": "1.No suspicious liver lesion.2.Mild splenomegaly.3.Small gallbladder polyp."}
{"instruction": "Generate impression based on findings.", "input": "History spermatocele RIGHT TESTIS: 5 x 2.4 x 3 cm. No intratesticular mass.LEFT TESTIS: 4.9 x 2.2 x 3.3 cm. No intratesticular mass.RIGHT EPIDIDYMIS: 5.8 x 2.8 x 3.9 cm cystic focus arising from the right epididymisLEFT EPIDIDYMIS: No significant abnormalities noted.DOPPLER EXAMINATION: Bilaterally symmetric Doppler flow characteristics.OTHER: No significant abnormalities noted.", "output": "Large benign-appearing right epididymal cyst/spermatocele. No intratesticular mass. Bilaterally symmetric normal Doppler flow characteristics."}
{"instruction": "Generate impression based on findings.", "input": "Female, 53 years old. Hx of left hydro after stone on CT. Eval for resolution of hydro RIGHT KIDNEY: 9.5 cm in length with normal cortical echogenicity. An upper pole cyst measures 1.2 x 1.2 x 1.1 cm. No shadowing stones or hydronephrosis.LEFT KIDNEY: 10.8 cm in length with normal cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The bladder is incompletely distended. A left ureteral jet is noted. The previously described stone at the left UVJ is not seen.", "output": "Resolution of left hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "39 years old, Female, Reason: hepatitis B, eval for HCC History: HBV LIVER: The liver measures 13.9 cm in length. Slightly coarsened liver echotexture. No nodularity of liver to suggest cirrhosis. 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 8.5 cm in length. RIGHT KIDNEY: Kidney measures 9.1 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.2 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Slightly coarsened echotexture of the liver without focal hepatic lesion. 2.No nodularity to suggest cirrhosis."}
{"instruction": "Generate impression based on findings.", "input": "Status post right ureteral reimplantation RIGHT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. Right kidney 9.5 cm in lengthLEFT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. Left kidney 9.3 cm in lengthOTHER: Bladder nondistended", "output": "Negative renal ultrasound. Specifically, no evidence for hydronephrosis/obstruction."}
{"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": "53-year-old with benign-appearing mass in the right breast seen on the outside screening mammogram presents for repeat ultrasound study of the right breast. Focused ultrasound was performed for the right breast lower inner quadrant. There are no solid or cystic lesions in the right breast.", "output": "No sonographic evidence for malignancy in the right breast. As the mammographic findings of the right breast are benign-appearing, follow-up right unilateral diagnostic mammogram in 6 months is recommended. BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for cirrhosis History: autoimmune hepatitis Examination somewhat limited.LIVER: The liver measures 16.1 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 normal hepatopetal flow with a velocity of 0.18 m/s.BILIARY TRACT: The gallbladder is contracted. No gallbladder wall thickening. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4.8 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 9.7 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or massLEFT KIDNEY: Kidney measures 10.5 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or massOTHER: Ascites.", "output": "Cirrhotic liver morphology without focal hepatic lesions identified. Ascites."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old male with history of left thyroid nodule on recent CT. RIGHT LOBE MEASUREMENTS: 6.7 x 1.7 x 2.3 cmLEFT LOBE MEASUREMENTS: 7.6 x 2.1 x 2.0 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: A solid isoechoic to slightly hypoechoic nodule near the isthmus measures 1.2 x 0.8 x 1.2 cm. A more posteriorly located nodule which is primarily solid centrally with an eccentric cystic component measures 1.3 x 0.9 x 1.3 cm.LEFT LOBE: Spongiform nodule in the posterior inferior left thyroid measures 1.3 x 1.0 x 1.6 cm. An adjacent more anterior complex cystic nodule with internal areas of comet tail artifact also appears benign. 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 nodules as detailed above, with the nodules on the right best characterized as indeterminate. The nodules on the left demonstrate benign spongiform morphologic or cystic features."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Steele is a 45-year-old female with history of bilateral breast reduction in 1993, who was recalled from screening exam of 07/15/16 for a partially-imaged circumscribed mass in the right axillary region. Patient reports that a palpable right axillary mass has been present for several years. An ML view, a laterally exaggerated CC view, as well as a a spot compression view of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Again seen is a round, circumscribed hyperdense lesion in the right axillary tail, best seen on the spot compression view.ULTRASOUND", "output": "Complicated cyst in the right axilla, correlating to mammographic area of concern. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended in 6 months. Results and recommendation 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": "Reason: hydronephrosis History: decreased urine output, aki The transplanted kidney measures 11.2 cm in length. Unremarkable parenchymal echogenicity and echotexture. No hydronephrosis or shadowing renal calculi. Small anechoic cyst measures 1.2 x 1.1 x 1.0 cm. The bladder is mildly distended with fluid and otherwise unremarkable.", "output": "Unremarkable ultrasound examination of the transplanted kidney. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "History of thyroid cancer status post thyroidectomy. THYROID : Status post thyroidectomy.RIGHT THYROIDECTOMY BED: No significant abnormality noted.LEFT THYROIDECTOMY BED: Stable 5 x 3 x 2 mm mildly hypoechoic ovoid nodule in the left thyroidectomy bed, may represent a lymph node.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No enlarged or pathologic-appearing cervical lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Stable ovoid soft tissue focus in the left thyroidectomy bed may represent a small lymph node."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female patient with right upper quadrant abdominal pain, nausea. Evaluate for cholecystitis. LIVER: No focal hepatic lesion is identified. The liver measures 19.5 cm in length. The main portal vein is patent with hepatopetal flow measuring approximately 0.2 m/s. BILIARY TRACT: There is no intra or extra hepatic biliary ductal dilatation. The gallbladder contains gallstones, however, there is no gallbladder wall thickening or pericholecystic fluid. The common bile duct measures approximately 5 mm in diameter. Sonographic Murphy's sign was negative. PANCREAS: The head and body of the pancreas appear normal. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 9.3 cm in length.RIGHT KIDNEY: The right kidney measures 10.2 cm in length and contains a subcentimeter simple cyst. No evidence of hydronephrosis.OTHER: The left kidney measures 10.9 cm in length. No evidence of hydronephrosis.", "output": "1. Cholelithiasis without evidence of acute cholecystitis.2. Hepatomegaly."}
{"instruction": "Generate impression based on findings.", "input": "62 year old male patient with history of thyroid nodules. RIGHT LOBE MEASUREMENTS: 6.1 x 2.4 x 2.0 cm.LEFT LOBE MEASUREMENTS: 5.3 x 1.5 x 1.6 cm.ISTHMUS MEASUREMENTS: 6 mm in thickness.RIGHT LOBE: A right lower pole spongiform-appearing nodule measures 0.6 x 0.6 x 0.7 cm, previously 0.7 x 0.6 x 0.5 cm.LEFT LOBE: No new discrete thyroid nodule is identified in the left lobe.ISTHMUS: A spongiform-appearing, previously biopsied left isthmic nodule measures 1.5 x 0.9 x 1.5 cm, previously 1.3 x 0.9 x 1.4 cm. A more solid right isthmus nodule measures 1.4 x 1.0 x 1.7 cm, previously 1.3 x 0.9 x 1.5 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Stable solid right isthmic nodule, which is amenable to biopsy if clinically indicated.2. Stable right lower pole and left isthmic nodules."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal LFTs LIVER: Coarse echogenic liver echotexture without mass. Liver length 13 cmBILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 11 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 11.4 cm in lengthOTHER: Left kidney 12.8 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Cholelithiasis without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Stent removal with mild hydronephrosis RIGHT KIDNEY: Stable renal cyst. No worrisome mass, stone, or hydronephrosis. 11.8 cm in length.LEFT KIDNEY: No change in mild left hydronephrosis. Stable renal cyst. Left kidney 12 cm in length.OTHER: Bladder nondistended.", "output": "No significant change in mild left hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "History Graves' disease RIGHT LOBE MEASUREMENTS: 2.4 x 1.9 x 4.9 cmLEFT LOBE MEASUREMENTS: 1.6 x 1.9 x 5.9 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Diffusely heterogeneous gland without discrete nodule. No increased vascularity.LEFT LOBE: Diffusely heterogeneous gland without discrete nodules. No increased vascularityISTHMUS: Diffusely heterogeneous gland without discrete nodules. No increased vascularityPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland without discrete nodules. No increased vascularity."}
{"instruction": "Generate impression based on findings.", "input": "Portal vein stenosis requiring stent LIVER: Status post left hepatic lobe transplant. Normal parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.BILIARY TRACT: No biliary ductal dilation. 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 9.7 cm in length. The left kidney is 9.1 cm in length. 10 mm simple appearing cyst in the superior pole of the left kidney. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: Splenomegaly, measuring 18.3 cm in length, without focal lesions.OTHER: No significant abnormalities noted. No ascites.DOPPLER", "output": "1. Patent portal vein with normal directional flow. Mildly increased portal venous velocity measurements, which is nonspecific.2. Splenomegaly.3. Stable examination otherwise."}
{"instruction": "Generate impression based on findings.", "input": "71 year old female with history of primary hyperparathyroidism and thyroid nodules. RIGHT LOBE MEASUREMENTS: 3.4 x 1.4 x 1.4 cm.LEFT LOBE MEASUREMENTS: 3.7 x 1.1 x 0.9 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: There is a 1.0 x 0.7 x 1.0 cm mildly hypoechoic, solid, interpolar nodule without increased vascularity or associated calcifications. The margins are well-defined. This nodule previously measured 1.0 x 0.7 x 1.0 cm. LEFT LOBE: The left thyroid lobe is mildly heterogeneous without a discrete nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Morphologically unremarkable and normal sized bilateral cervical lymph nodes are present.OTHER: No significant abnormality noted.", "output": "Stable right 1 cm solid nodule. No additional significant interval change."}
{"instruction": "Generate impression based on findings.", "input": "Increasing LFTs LIVER: Coarse echogenic liver echotexture without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 14.6 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. Spleen 11.6 cm in length.RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. Right kidney 9.7 cm in lengthOTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. Left kidney 10.5 cm in length. No ascites", "output": "Coarse echogenic liver echotexture suggestive for parenchymal dysfunction/fatty infiltration without mass or ductal dilatation. No ascites. Echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Renal stones. RIGHT KIDNEY: 12.1 cm in length. Normal renal parenchymal echogenicity. No hydronephrosis. A 5 x 4 x 5 mm stone is noted in the lower pole. No suspicious renal masses are identified. LEFT KIDNEY: 12.4 cm in length. Normal renal parenchymal echogenicity. No hydronephrosis. No stones identified. No suspicious renal mass is identified.BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "5 mm nonobstructing right renal stone."}
{"instruction": "Generate impression based on findings.", "input": "Palpable nodular thyroid RIGHT LOBE MEASUREMENTS: 3.9 x 2.1 x 1.6 cm, within normal limits. Normal echogenicity and vascularity.LEFT LOBE MEASUREMENTS: 3.5 x 1.8 x 1.7 cm, within normal limits. Normal echogenicity and vascularity.ISTHMUS MEASUREMENTS: 3 mm in AP dimension.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Thyroid gland sonographically within normal limits."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old female with proteinuria and chronic kidney disease. Ultrasound guidance was provided for biopsy of right kidney", "output": "Ultrasound guidance was provided for biopsy of right kidney"}
{"instruction": "Generate impression based on findings.", "input": "28-year-old woman presents for further evaluation of a palpable mobile mass in the left upper-outer quadrant. Patient states there is a possibility she may be pregnant. On physical exam, there is a mobile palpable lump in the upper outer quadrant of the right breast, correlating to the patient's area of concern.A targeted grayscale and color Doppler left ultrasound was performed for the palpable area of concern. In the 2:00 position 3 cm from the nipple, there is a area of dense fibroglandular tissue with associated cystic change. The largest cluster of cysts within this area measures 10 x 6 mm. Another dominant cyst measures 5 x 3 mm. Milk of calcium is noted within all the cysts. There is no solid component or internal vascularity associated with the cysts. No suspicious solid masses are identified in the area.", "output": "Benign fibrocystic changes involving the left upper outer quadrant, correlating with the area of palpable concern. No sonographic evidence for malignancy. As long as the physical exam is unchanged, screening mammogram is recommended per risk level. The findings and recommendations were discussed with the patient at time of the exam.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Follow-up."}
{"instruction": "Generate impression based on findings.", "input": "Female 70 years old; Reason: new onset ascites, evaluate liver and its vasculature History: ascites LIVER: Liver is normal in echotexture and echogenicity. No focal hepatic lesions. Hepatic length measures 17 cm. The main portal vein is patent with normal hepatopedal flow and a peak velocity of 25 cm/s. Hepatic veins appear prominent.GALLBLADDER/BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 3 mm. A small nonshadowing focus is noted in the gallbladder which is mobile, likely representing a stone. The common bile duct measures 1 mm in diameter. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.8 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. Thr right kidney measures 11.1 cm and has normal vascular flow. No hydronephrosis. The right kidney demonstrates slightly increased echogenicity.The left kidney is not wall visualized secondary to ascites. The left kidney measures 10.1 cm and has normal vascular flow. No hydronephrosis.OTHER: Moderate amount of ascites is noted in the upper quadrants. Enlarged heart is partially visualized.", "output": "1.Normal echotexture and echogenicity of the liver with moderate ascites in the upper quadrants.2.Partial visualization of the enlarged heart with enlarged hepatic veins, suggestive of right-sided heart failure.3.Cholelithiasis.4.Slight increased echogenicity of the right kidney, which is nonspecific and may be seen with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old male with acute kidney injury. RIGHT KIDNEY: The right kidney measures 9.6 cm in length and is highly echogenic consistent with parenchymal disease. There is a 2.2 cm simple cyst arising from the right kidney. There is no hydronephrosis, shadowing calculus or solid mass.LEFT KIDNEY: The left kidney measures 8.7 cm in length and is highly echogenic consistent with parenchymal disease. There is a mildly complex, septated 1 cm cyst arising from the lower pole. No hydronephrosis, shadowing calculus or solid mass.OTHER: Bladder decompressed with Foley catheter", "output": "Echogenic kidneys with bilateral cysts. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Female 69 years old Reason: Elevated Alk Phos, exclude focal lesions History: Elevated Alk Phos, exclude focal lesions LIVER: Increased echogenicity of the liver compatible with fatty infiltration. Benign-appearing cyst is present in the right lobe of the liver measuring 2.8 x 3.1 x 2.4 cm. No other solid hepatic masses.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. The gallbladder is somewhat contracted. Common bile duct measures 5 mm. No gallstones.PANCREAS: The visualized portions of the pancreas are normal in appearance.SPLEEN: Spleen is unremarkable.RIGHT KIDNEY: Right kidney measures 10.4 cm. Cyst in the right mid kidney measures 1.8 x 2.4 x 2.7 cm. No hydronephrosis or shadowing calculus.Left kidney measures 11.3 cm. Mildly complex cyst in the left kidney with septations measures 2.8 x 3.8 x 4.2 cm. No hydronephrosis or shadowing calculus.OTHER: No significant abnormalities noted.", "output": "1.Increased echogenicity of liver compatible with fatty infiltration.2.Mildly complex cyst in the left kidney. Recommend attention to this on follow-up studies to ensure stability."}
{"instruction": "Generate impression based on findings.", "input": "Female 67 years old Reason: evaluate size and location of nodules History: dysphagia, DOE, cough RIGHT LOBE MEASUREMENTS: 6.8 x 3.0 x 3.4 cm.LEFT LOBE MEASUREMENTS: 6.0 x 2.2 x 2.1 cm.ISTHMUS MEASUREMENTS: 0.8 cm.RIGHT LOBE: Multiple nodules are present in the right thyroid. Superior heterogeneous nodule measures 1.7 x 1.1 x 1.5 cm. Large hypoechoic nodule with peripheral punctate calcifications measures 3.1 x 2.9 x 1.0 cm.LEFT LOBE: Multiple nodules are also noted in the left thyroid lobe most superior nodule measures 2.2 x 1.2 x 1.7 cm. Inferior heterogeneous 2.7 x 1.7 x 2.8 cm.ISTHMUS: Heterogeneous isthmus nodule measures 1.8 x 1.2 x 2.2 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Mildly prominent, benign appearing left level 1 lymph node measures 1.2 x 0.5 x 2.2 cm.OTHER: No significant abnormality noted.", "output": "Enlarged multinodular thyroid. Large complex hypoechoic right thyroid nodule, which is amenable to biopsy, if this has not already been performed."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are ultrasound images of both breasts (2/13/15), ultrasound images of left breast (8/7/15) performed at Christie Clinic. For comparison, digital mammographic images (4/22/13, 10/10/11) are available. ULTRASOUND IMAGES OF BOTH BREASTS (2/13/15):A tiny simple cyst, measuring 5 x 3 mm, is present in the right 3:00 position.In the left breast, there is a complex cystic lesion, measuring 10 x 9 mm at 9:00 position.ULTRASOUND IMAGES OF LEFT BREAST (8/7/15):Left 9:00 cystic lesion is unchanged and appears to be benign.", "output": "Benign simple cyst in both breasts.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Female 67 years old; Reason: elevated LFT History: elevated LFT This exam was limited due to patient's intubated status.LIVER: The liver measures 18.0 cm in length. There is a slight increase in 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 38.8 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 4.0 mm. Several subcentimeter shadowing foci seen within the gallbladder and minimal sludge. Minimal pericholecystic fluid is present. Sonographic Murphy sign was not attempted as patient was intubated. The common bile duct measures 3.5 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen was poorly visualized in this study due to patient being intubated.RIGHT KIDNEY: The right kidney measures 10.4 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 9.8 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.", "output": "1. The liver has slight increase in echogenicity which is compatible with fatty infiltration/hepatocellular dysfunction.2. Cholelithiasis without overt evidence of acute cholecystitis.3. Bilaterally the kidneys have increased echogenicity which is compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Male, 70 years old. CKD, decreased renal output. RIGHT KIDNEY: The right kidney measures 12.4 cm in length, atrophic, with increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney is not visualized.OTHER: The bladder is decompressed, with Foley catheter in place. Moderate ascites.", "output": "1.Atrophic, echogenic right renal cortex, compatible with medical renal disease. No right-sided hydronephrosis. 2.The left kidney is not visualized.3.Moderate ascites."}
{"instruction": "Generate impression based on findings.", "input": "History: thyroid cancer s/p surgery RIGHT LOBE: No nodules or masses in the thyroidectomy bed.LEFT LOBE: No nodules or masses in the thyroidectomy bed.ISTHMUS: No nodules or masses in the thyroidectomy bed.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Multiple benign appearing prominent cervical lymph nodes with fatty hila:Right level 3 cervical lymph node measures 1.5 x 0.7 x 0.7 cm, previously 1.1 x 0.7 x 0.7 cm.Left level 3 cervical lymph node measures 1.8 x 0.6 x 0 1.1 cm, previously 2.0 x 1.0 x 0.8 cm.Left level 3 cervical lymph node measures 1.9 x 0.5 x 1.1 cm, without prior measurement for correlation.OTHER: No significant abnormality noted.", "output": "1. Stable exam without evidence of new suspicious nodules or masses.2. Prominent benign-appearing cervical lymph nodes without interval change."}
{"instruction": "Generate impression based on findings.", "input": "12-year-old male patient with cyclic vomiting. Evaluate for hydronephrosis. KIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 9.0 cm Left: 8.5 cm   Mean for age: 10.4 cm  Range for age: 8.66 - 12.1 cmADDITIONAL OBSERVATIONS: None.", "output": "Normal examination.*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.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": "69-year-old male patient with hepatitis C. Evaluate stage of disease. LIVER: The liver measures 16.2 cm in length. Hepatic parenchymal echogenicity is within normal limits. There is a 0.7 x 0.7 x 0.9 cm anechoic lesion within the right hepatic lobe with posterior acoustic enhancement compatible with a simple cyst. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There is no gallbladder wall thickening or pericholecystic fluid. There is a 0.4 x 0.3 x 0.4 cm gallbladder polyp. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 6 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 7.1 x 7.3 x 6.4 cm right upper pole renal cyst.OTHER: The left kidney measures 11.5 cm in length. No evidence of hydronephrosis.The spleen measures 9.9 cm in length.", "output": "1. Simple right hepatic cyst and right renal cyst.2. Subcentimeter gallbladder polyp requires no follow up by size criteria."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female with chronic viral hepatitis C. Evaluate for cirrhosis. LIVER: Overall hepatic size is within normal limits. Liver is mildly and coarsely echogenic. Contours not grossly cirrhotic. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Gallbladder is normal without wall thickening, pericholecystic fluid or cholelithiasis. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.SPLEEN: Poorly visualized due to high position and bowel gas.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Echogenic liver without mass or complication."}
{"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 mass identified. A few simple cysts are seen in both breasts.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female with cholangiocarcinoma, now with abnormal renal function. RIGHT KIDNEY: Right kidney measures 11 cm in length. Echotexture is mildly increased and heterogeneous. The hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 10.7 cm in length. Echotexture is mildly increased and heterogeneous. The hydronephrosis, shadowing calculus or mass.OTHER: Collateral vessels seen near the liver hilum consistent with cavernous transformation. Patient's known liver masses not evaluated.Bladder appears unremarkable.", "output": "Mildly echogenic kidneys without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Islet cell transplant LIVER: Pneumobilia noted. Liver length 14.1 cm. Limited interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Main portal vein velocity 32 cm/sGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.2 cm in lengthOTHER: Left kidney 10.3 cm in length. Spleen 8.2 cm in length. No ascites.", "output": "Pneumobilia noted. No liver mass. Main portal vein patent with normal directional flow. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Nontoxic multinodular goiter follow-up of thyroid nodules RIGHT LOBE MEASUREMENTS: 3.5 x 1.4 x 1.4 cm, homogeneous echotextureLEFT LOBE MEASUREMENTS: 4 x 1.4 x 1.3 cm, homogeneous echotextureISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: Previously described predominantly cystic circumscribed round nodule in the right lobe has been aspirated as per the patient. No new nodules noted.LEFT LOBE: Previously described hypoechoic nodule in the midpole could not be reproduced on today's imaging.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Interval drainage of right thyroid lobe cystic nodule.No new nodules noted"}
{"instruction": "Generate impression based on findings.", "input": "HBV LIVER: Coarse liver echotexture again noted without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 13.8 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 8.3 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10 cm in lengthOTHER: Left kidney 10.2 cm in length no ascites", "output": "Mildly coarse liver echotexture again noted without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C. Evaluate for HCC. History of cholecystectomy in October 2015. LIVER: 14.8 cm in length. Cirrhotic liver morphology with nodular contours and coarsened parenchymal echogenicity. Moderate perihepatic ascites. No focal hepatic lesions. Patent portal vein with hepatopetal blood flow measuring 15 cm/s.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Status post cholecystectomy. A 4 cm fluid collection with debris is noted in the gallbladder fossa.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 11 cm in length. The left kidney is 11 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 12.1 cm in length, without focal lesions evident.", "output": "1. Cirrhotic liver morphology with moderate ascites. No suspicious hepatic lesions.2. 4 cm fluid collection in the gallbladder fossa, likely post-surgical in etiology."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for fatty liver. LIVER: The liver is mildly coarse and echogenic. It measures 15.6 cm in length without a focal lesion or intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 36 cm/s. The common hepatic duct measures 6 mm.BILIARY TRACT: No intrahepatic biliary ductal dilatation. Common hepatic duct measures 6 mm, within normal limits. The common bile duct is obscured by overlying bowel gas.Distended gallbladder is noted with suspected wall echo shadow sign indicating multiple gallstones filling the lumen. This is favored over diffuse gallbladder wall calcification/porcelain gallbladder as some images demonstrate a small amount of fluid between the wall and echogenic shadowing gallstones. No significant wall thickening pericholecystic fluid or focal tenderness.PANCREAS: The pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 7.5 cm and is suboptimally visualized.RIGHT KIDNEY: The right kidney measures 10.5 cm in length without hydronephrosis, shadowing nephrolithiasis or suspicious lesion. Color Doppler demonstrates hilar blood flow.OTHER: The left kidney measures 12.7 cm in length without hydronephrosis. 1.6 cm echogenic shadowing probable nonobstructive calculus. 4.0 x 3.6 cm anechoic lesion with a thin septation, likely a minimally complex cyst.", "output": "Coarse and echogenic liver parenchyma may be seen in parenchymal dysfunction and/or fatty liver.The gallbladder is likely full of gallstones without specific findings of gallbladder inflammation. This is favored over a porcelain gallbladder as described above.4.0 cm minimally complex left renal cyst. 1.6 cm left renal probable nonobstructive calculus."}
{"instruction": "Generate impression based on findings.", "input": "Male 23 years old Reason: assess fir resolution of abscess following bedside I\\T\\D History: previous ultrasound demonstrated fluid collection now possibly drained.Additional history from patient: Patient is on antibiotics currently. No definitive fluid collections is seen either in the midline, to the right or to the left. The hypoechoic area seen on the prior scan does not show definitive increased through transmission and is now not convincing for fluid.", "output": "No ultrasound evidence of fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male with history of chronic liver disease recently on spironolactone complaining of new bilateral nipple sensations and enlargement, and pulling sensation along the lateral aspect of the left breast. Family history is positive for premenopausal breast cancer in mother. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. Bilateral central subareolar glandular tissue extending into posterior adipose tissue in a fanlike configuration slightly asymmetric to the right, compatible with gynecomastia.Triangular marker overlying the left upper outer breast indicates area of palpable concern as indicated by the patient. There is no underlying correlating mammographic finding.LEFT BREAT ULTRASOUND:Targeted ultrasound of the left upper outer breast was performed in the area of concern as indicated by the patient.No solid or cystic mass was identified.", "output": "Bilateral gynecomastia. No evidence of malignancy in either breast. Suggest clinical correlation for potential causes of gynecomastia.  BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Thyrotoxicosis. Goiter seen on CT. RIGHT LOBE MEASUREMENTS: 5.5 x 1.8 x 1.9 cm. LEFT LOBE MEASUREMENTS: 5.5 x 2.3 x 2.0 cm. ISTHMUS MEASUREMENTS: 2 mm in AP dimension.RIGHT LOBE: Multiple mixed cystic and solid nodules throughout the right lobe, with spongiform features. The dominant nodule in the inferior pole measures 1.6 x 1.4 x 1.6 cm.LEFT LOBE: Multiple mixed cystic and solid nodules throughout the left lobe, with spongiform features. The dominant nodule in the inferior pole measures 2.0 x 1.9 x 2.3 cm. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "Multiple bilateral cystic and solid nodules with benign features."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Miller is a 24 year old female with recent benign left axillary lymph node biopsy in 2016 with pathology of reactive lymphoid hyperplasia. She presents for short-term follow-up of her left axillary lymphadenopathy. Targeted left axillary ultrasound was performed.In the left axilla, there is revisualization of the previously biopsied left axillary lymph node, now measuring 3.0 x 1.1 x 2.1 cm, previously measuring 3.1 x 1.2 x 2.1 cm.No additional abnormal morphology lymph nodes are identified in the left axilla.", "output": "Stable size and appearance of biopsied left axillary lymph node with benign pathology results. The patient should follow up with her primary care physician as clinically warranted, presuming these results are concordant with the physical exam findings. No additional imaging workup is necessary at this time. All results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female with nausea and abdominal pain (generalized) LIVER: Normal in size, contour and echogenicity. There is a rounded, hyperechoic and relatively homogeneous mass in the right lobe measuring 1.6 x 1.9 x 1.7 cm consistent with a hemangioma as seen on prior CT and without significant change in size. Portal venous system is patent with appropriate flow direction.GALLBLADDER, BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: The head and body are normal. The tail is less well seen.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "1. No findings to explain the patient's symptoms.2. Stable hepatic hemangioma."}
{"instruction": "Generate impression based on findings.", "input": "84-year-old male with history of multinodular goiter. Evaluate degree of substernal component. Evaluate for growth of nodules, adenopathy. RIGHT LOBE MEASUREMENTS: 6.5 cm x 3.1 cm x 2.5 cmLEFT LOBE MEASUREMENTS: 7.5 cm x 3.4 cm x 3.3 cmISTHMUS MEASUREMENTS: 3 mm in thicknessRIGHT LOBE: Heterogeneous in echotexture. Dominant solid nodule at the mid pole measures 2.9 cm x 2.2 cm x 3.8 cm, not significantly changed from prior exam. Subcentimeter cystic nodule at the upper pole is unchanged.LEFT LOBE: Heterogeneous in echotexture. Dominant heterogeneous solid nodule at the mid to inferior pole is difficult to definitively measure due to substernal extension however measures approximately 2.5 cm x 3.1 cm x 3.7 cm, not significantly changed. Previously noted smaller spongiform nodule at the mid pole is less apparent on today's exam but likely smaller in size.ISTHMUS: Solid isthmus nodule is again seen measuring 1.0 cm x 0.6 cm x 1.1 cm not significantly changed.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Heterogeneous thyroid gland with multiple bilateral thyroid nodules not significantly changed compared to prior exam."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male patient with HCV, cirrhosis. Evaluate for HCC. LIVER: The liver measures 17.9 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: The gallbladder is filled with shadowing stones without significant 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 11.8 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11 cm in length. No evidence of hydronephrosis.The spleen measures 11.5 cm in length.", "output": "1. Increased hepatic echogenicity which can be seen with hepatic steatosis/hepatic parenchymal dysfunction. No focal hepatic lesion identified.2. Cholelithiasis without sonographic evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old female with elevated ammonia. Evaluate for hepatic abnormality. LIVER: Overall hepatic size is upper normal to mildly enlarged. The echotexture is within normal limits. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Visualized portions of the intra and extrahepatic biliary tract are normal in caliber. Gallbladder appears unremarkable without cholelithiasis, wall thickening or pericholecystic fluid.PANCREAS: No significant abnormalities noted.SPLEEN: Mild splenomegaly.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Borderline hepatomegaly. Splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with transaminitis/jaundice. The exam is limited by patient positioning and inability to breath-hold.LIVER: Liver is normal in size and echotexture. No focal hepatic abnormality. Limited Doppler evaluation demonstrates patency and appropriate flow direction in the main portal vein. Pulsatility of waveform may be seen in congestive heart failure.BILIARY TRACT: Mild prominence the biliary tract without gross ductal dilatation. Common duct is normal in caliber. The gallbladder is incompletely distended but asymmetrically thick-walled associated with a trace of pericholecystic fluid. Small echogenic foci in the gallbladder likely represent small calculi. This cannot be verified due to inability to change patient's position. PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Mildly echogenic as previously noted.OTHER: Bilateral pleural effusions. Mildly echogenic left kidney.", "output": "There is mild, but asymmetric gallbladder wall thickening associated with a trace of pericholecystic fluid and perhaps small gallstones. Evaluation is limited by breathing and inability to appropriately change patient's position. This should be correlated with patient's symptomatology, since this could be the result of inflammation, adenomyosis or other mass.Mildly echogenic kidneys"}
{"instruction": "Generate impression based on findings.", "input": "24 year old female. Hyperbilirubinemia. Evaluate for any liver, gallbladder, or duct pathology. LIVER: Diffuse mildly increased echogenicity and coarsened echotexture of the liver consistent with hepatic steatosis/dysfunction. The liver is 16 cm in length. No focal mass. Hepatopetal portal venous flow.GALLBLADDER, BILIARY TRACT: No cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No biliary ductal dilatation. The common duct is 4 mm in diameter, within normal limits.PANCREAS: Visualized pancreatic head is normal in echogenicity. The rest of the pancreas is obscured by bowel gas.RIGHT KIDNEY: Right kidney is 10.5 cm in length. No hydronephrosis.OTHER: Spleen is 14.7 cm in length. Small splenule is noted. Left kidney is 10.5 cm in length. No hydronephrosis.", "output": "Mild increased echogenicity and coarsened echogenic of the liver consistent with hepatic steatosis/dysfunction. Mild hepatosplenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Rule out gallstones LIVER: Liver measures 22.7 cm, likely enlarged in size with multiple diffuse metastases, compatible with known metastases to lung cancer. No intrahepatic delivery ductal dilatation. Portal vein demonstrates normal flow directionality and patency.GALLBLADDER, BILIARY TRACT: Gallbladder is well-distended without any gallstones. No evidence of gallbladder wall thickening or pericholecystic fluid.PANCREAS: Limited evaluation of the pancreas. No obvious evidence of any peripancreatic fluid collection.KIDNEY: Right kidney measures 12 cm and left kidney measures 10.5 cm. No hydronephrosis. Normal collection noted. No focal lesions notedOTHER: Spleen measures 10.7 cm, without any abnormality", "output": "Coarse heterogenous enlarged liver with multiple diffuse metastasesNo evidence of gallstones.Limited evaluation of the pancreas due to overlying bowel gas."}
{"instruction": "Generate impression based on findings.", "input": "65 year old female who was recalled from screening mammogram for left breast calcifications and focal asymmetry in the right breast. No current breast complaints. 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. An ML view and two spot magnification views of the left breast were also 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. Scattered benign morphology calcifications are seen on the spot magnification views of the left breast upper outer quadrant. Focal asymmetry in the right breast central to the nipple mid to posterior depth partially disperses on the spot compression views. An ultrasound is recommended for further evaluation.RIGHT BREAST ULTRASOUND:On physical exam, there is no palpable or visible abnormality.Targeted ultrasound of the right breast was performed for the mammographic area of concern. Unremarkable fibroglandular tissue is seen in the right breast middle and posterior depth central to slightly medial to the nipple. No solid or cystic masses.", "output": "Benign left breast calcifications. 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 male with hepatitis C. Evaluate for HCC LIVER: Mild increased echogenicity of the liver measuring 16.5 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: Status post cholecystectomy. 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 increased in echogenicity similar to prior study suggestive of fatty atrophy, somewhat inappropriate for age.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 10.3 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the left kidney measuring 10.0 cm in length. No hydronephrosis or shadowing calculi are noted.Normal echogenicity of the spleen measuring 12.0 cm in length.", "output": "Mild increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesions."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old female with renal transplant, acute kidney injury and urinary retention. RENAL TRANSPLANT: LOCATION: Left iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: COLLECTING SYSTEM/URETER: There is again noted moderate dilatation of the left renal collecting system without visualized dilated ureter. This is unchanged from the prior study.URINARY BLADDER: Mild distention. Gallbladder wall is very mildly thick-walled.OTHER: Post void imaging not obtained.", "output": "Stable dilatation left renal collecting system. Mild urinary bladder distention with associated wall thickening.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; 52 years old. Reason: Septic with chronically infected kidneys. L perc nephrostomy pulled, R tube still in place. Eval L kidney for hydronephrosis, fluid collection, or signs of infection. History: above RIGHT KIDNEY: The right kidney measures 10.4 cm in length. The renal cortex is echogenic. Within the mid right kidney is a 2.6 x 2.8 x 2.7 cm minimally complex cyst. No shadowing renal stone, hydronephrosis, or worrisome renal mass is identified.LEFT KIDNEY: The left kidney measures 15 cm in length. Renal cortex is echogenic. There is minimal hydronephrosis. Evaluation is somewhat limited but no perinephric fluid collection is seen. No shadowing renal stone or worrisome renal mass is identified.OTHER: Moderate to severe ascites.", "output": "1.Echogenic kidneys consistent with medical renal disease.2.Minimal left hydronephrosis.3.Moderate to severe ascites. "}
{"instruction": "Generate impression based on findings.", "input": "71-year-old female with hepatitis C and cirrhosis. Evaluate for hepatocellular carcinoma LIVER: Liver is normal in size and coarsely echogenic as seen on the prior study. No focal hepatic mass is identified.BILIARY TRACT: Post cholecystectomy. The biliary tract is normal in caliber.PANCREAS: The head and body are normal. The tail was not well seen.SPLEEN: Normal in size.RIGHT KIDNEY: Renal pelvis cyst. OTHER: No significant abnormalities noted.", "output": "Stable appearance of the liver without mass."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate cholecystitis History: uptrending LFTs Exam is limited by inability to turn the patient.LIVER: Echogenic hepatic parenchyma, consistent with hepatic parenchymal dysfunction or steatosis.GALLBLADDER, BILIARY TRACT: The gallbladder is borderline distended. There is some evidence of edema around the gallbladder wall. There is a small volume of pericholecystic fluid. There is layering sludge within the dependent aspect of the gallbladder. An echogenic focus in the neck of the gallbladder with posterior acoustic shadowing may represent a stone, but the exam is limited due to the inability to turn the patient. The gallbladder wall measures 3 mm, normal-upper normal.. The common bile duct measures 0.5 cm, normal in size.PANCREAS: Obscured by bowel gas.OTHER: Moderate volume of ascites.", "output": "Borderline gallbladder wall thickening, some evidence of gallbladder wall edema, and probable stone in the neck of the gallbladder. These constellation of findings may be seen in acute cholecystitis, however are nonspecific in the setting of ascites and limitations of this exam."}
{"instruction": "Generate impression based on findings.", "input": "Altered anatomy, rule out abscess or pyelonephritis RIGHT KIDNEY: Right kidney appears small in size with multiple simple cysts within it, largest lobulated cyst measures approximately 7.7 x 4.2 cm. No hydronephrosis.LEFT KIDNEY: Left kidney measures 12.1 cm with normal echotexture. Mild to moderate hydronephrosis noted. No definite cause of obstruction seen on ultrasound. Few small cysts noted in the lower pole.OTHER: Urinary diversion pouch noted without adjacent abscess formation or loculation.", "output": "Small right kidney with multiple simple cysts.Mild to moderate left-sided hydronephrosis.Urinary diversion pouch noted without adjacent abscess"}
{"instruction": "Generate impression based on findings.", "input": "Alcoholic cirrhosis LIVER: Cirrhotic morphology without mass. Limited Doppler interrogation the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 16.7 cm.BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 11.9 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.4 cm in lengthOTHER: Left kidney 11.2 cm in length. Mild ascites.", "output": "Cirrhotic morphology without mass or ductal dilatation. Gallbladder sludge without acute inflammation. Mild ascites."}
{"instruction": "Generate impression based on findings.", "input": "Please evaluate four presumed lipomas along the anterolateral right thigh At least 3 parallel oriented homogeneous hyperechoic superficially located masses are identified corresponding to the palpable abnormalities. There are labeled as #1 and #2. The largest of the 2 lesions is #1 and mostly appears bilobed. It measures 3 cm x 0.5 cm. The second lesion measures 1.6 x 0.5 cm. Both these lesions are consistent with benign lipomas.", "output": "Palpable abnormalities in the right lateral thigh consistent with benign lipomas."}
{"instruction": "Generate impression based on findings.", "input": "Renal stones RIGHT KIDNEY: Mildly echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Minimally complex cyst. Right kidney 12 cm in length.LEFT KIDNEY: Mildly echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Minimally complex cyst. Left kidney 12.5 cm in lengthOTHER: Bladder nondistended", "output": "Mildly echogenic kidneys raises the possibility of medical renal disease/parenchymal dysfunction without worrisome mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 51 y.o. F with thyroid nodule. Please evaluate. RIGHT LOBE MEASUREMENTS: 4.5 x 2.1 x 2.6 cm.LEFT LOBE MEASUREMENTS: 2.6 x 0.9 x 1.1 cm.ISTHMUS MEASUREMENTS: Measures up to 0.2 cm in thickness.RIGHT LOBE: Normal background parenchymal echotexture. Predominantly solid nodule within the mid pole measures 3.0 x 1.7 x 2.6 cm, is predominantly isoechoic, demonstrates internal vascularity, and lacks suspicious microcalcifications. Overall, nodule is of intermediate suspicion for neoplasm.LEFT LOBE: Normal background parenchymal echotexture. Subcentimeter solid, hypoechoic nodule within the inferior pole measuring 0.4 x 0.3 x 0.4 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There are couple mildly prominent left cervical lymph nodes which demonstrate fatty hila, favor reactive. Left level 3 lymph node measures 1.2 x x 0.6 x 0.9 cm. Left level 4 lymph node measures 1.0 x 2.2 x 1.0 cm.OTHER: No significant abnormality noted.", "output": "Dominant right thyroid nodule measuring up to 3.0 cm of intermediate suspicion for neoplasm and which would be amenable to fine-needle aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Female 62 years old; Reason: 62 yo with hepatomegaly seen on OSH CT scan History: hepatomegaly Limited by body habitus and by increased echogenicity of the liver which made sonography difficult to penetrate deeper structures.LIVER: The liver measures 18.4 cm in length. There is increased, course, 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 measured at 28.4 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.1 mm. Gallstones and sludge are seen. No pericholecystic fluid. The common bile duct measures 1.7 mm in diameter. The common hepatic duct measures 1.7 mm. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 11.5 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.2 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.9 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.", "output": "1. Increased, course, heterogenous echotexture of the liver consistent with chronic liver disease/parenchymal dysfunction. No hepatic masses or intrahepatic ductal dilation.2. Mild hepatomegaly.3. Gallstones without signs of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Renal stones RIGHT KIDNEY: Status post right nephrectomyLEFT KIDNEY: Mildly echogenic parenchyma without mass or hydronephrosis. Left kidney 13.6 cm in length.No significant change in multiple nonobstructing left renal stones. The largest within the lower pole measures 1.8 x 1 x 1.4 cm.OTHER: Bladder nondistended", "output": "No significant change in multiple nonobstructing left renal stones."}
{"instruction": "Generate impression based on findings.", "input": "Female 65 years old; Reason: History: AKI Ultrasound guidance provided for biopsy of the right kidney. 2 passes were made.", "output": "1.Ultrasound guidance for biopsy as above."}
{"instruction": "Generate impression based on findings.", "input": "Female 72 years old; Reason: 71 yo with cirrhosis please screen for HCC History: none LIVER: The liver measures 19.2 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 20.6 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.5 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 5.4 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9.2 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 9.8 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.4 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.", "output": "Hepatomegaly. There is coarse increased echogenicity of the liver compatible with fatty infiltration/hepatocellular dysfunction. No worrisome masses are seen. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Low TSH, thyroid enlargement also cervical RIGHT LOBE MEASUREMENTS: 7.3 x 3.3 x 2.7 cm. Heterogenous echotexture, increased in size with increased vascularity.LEFT LOBE MEASUREMENTS: 6.6 x 2.9 x 2.3 cm, heterogenous echotexture, increased in size with increased vascularity.ISTHMUS MEASUREMENTS: 1 cmRIGHT LOBE: Large solid slightly hyperechoic mass with a hypoechoic halo identified in the inferior pole that measures 3.4 x 2.3 x 3.2 cm and needs further evaluation with fine-needle aspiration. LEFT LOBE: Heterogenous echotexture without any definite focal lesion.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Multiple enlarged reactive lymph nodes along the left level 5 chains, largest measuring 1.8 x 0.4 x 0.9 cm.OTHER: No significant abnormality noted.", "output": "Heterogenous echotexture of the thyroid gland suggestive of background thyroiditis.Dominant solid mass in the right lobe amenable to FNA.Level 5 left neck lymph nodes prominent, mostly reactive."}
{"instruction": "Generate impression based on findings.", "input": "75 years old, Male, Reason: ESRD s/p cadaveric transplant in 2003, now with AKI/ATN likely due to contrast nephropathy. assess graft function, obstruction History: AKI Transplanted kidney: No perinephric fluid collections are identified. The transplant kidney measures 11.8 cm in length. No shadowing calculus or suspicious lesions are evident. No evidence of hydronephrosis or hydroureter.Vascular Doppler data: The peak systolic velocity of the iliac artery is 1.0 m/sec. The peak systolic velocity at the anastomosis is 3.5 m/sec with a resistive index of 0.87 appearing similar to prior exam.Peak systolic velocity of the renal artery is 3.5 m/sec at the origin, 1.9 m/sec in the midportion, 1.3 m/sec distally with system indices of 0.88, 0.84, 0 .81 respectively. These peak systolic velocities and resistive indices are similar to prior exam.Resistive indices within parenchymal branches very between 0.7 and 0.8 which are minimally increased compared to the prior exam.Other: Mild to moderate amount of ascites is present.", "output": "1.Increase velocity at the renal artery anastomosis is stable since the prior exam, but significant stenosis at this site cannot be excluded.2.Increased resistive indices in the main renal artery and in the parenchymal arterial branches.3.Mild to moderate ascites is present."}
{"instruction": "Generate impression based on findings.", "input": "Liver transplant LIMITED ABDOMENLIVER: Stable mildly coarse liver echotexture without mass. Liver length 16 cmBILIARY TRACT: Pneumobilia secondary to biliary drain placement.PANCREAS: No significant abnormalities noted.SPLEEN: Spleen 13.2 cm in length RIGHT KIDNEY: Mildly echogenic parenchyma again noted without worrisome mass, stone, or hydronephrosis. Right kidney 8.5 cm in length.OTHER: Mildly echogenic left renal parenchyma again noted. Left kidney 9.6 cm in length. No left hydronephrosis. No ascites", "output": "Stable coarse liver echotexture suggestive for chronic liver disease without mass or ductal dilatation. No ascites. Patent hepatic vessels with normal directional flow."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male with history of thyroid cancer status post thyroidectomy. Evaluate for adenopathy. RIGHT LOBE MEASUREMENTS: Surgically absentLEFT LOBE MEASUREMENTS: Surgically absentISTHMUS MEASUREMENTS: Surgically absentRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered cervical lymph nodes with benign morphologic features. No new suspicious lymphadenopathy.OTHER: No significant abnormality noted.", "output": "No evidence of residual or recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old male presents for follow-up of palpable left breast mass. A targeted left ultrasound was performed for the palpable area of concern. In the left breast 6:00 periareolar region, immediately adjacent to the nipple, there is a 2.0 x 0.4 x 1.1 cm circumscribed oval hypoechoic mass within the skin, previously 1.9 x 0.6 x 1.3 cm. No internal vascularity is seen within this mass. There is peripheral vascularity.", "output": "Slight interval decrease in size of a palpable left breast lesion centered within the skin, suggestive of an epidermal inclusion cyst. Clinical correlation is recommended for further management. No sonographic evidence for malignancy in the left breast. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female who is pre-op for right sided parathyroid adenoma. Evaluate for thyroid nodules. RIGHT LOBE MEASUREMENTS: 1.4 x 2.2 x 4.2 cmLEFT LOBE MEASUREMENTS: 2.0 x 2.4 x 4.5 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: In the right lobe of the thyroid there is an ovoid, hypoechoic nodule measuring 0.6 x 1.2 x 1.3 cm which is nondescript in appearance although there is a suggestion of comet tail artifact as seen with colloid. Review of the prior study demonstrates that this was more cystic in 2013 but unchanged in size measuring 0.8 x 1.2 x 1.3 cm. There is at least one other small simple-appearing cyst as well as.LEFT LOBE: Occupying a significant portion of the left lobe is a large predominantly solid nodule with cystic components measuring 1.9 x 2.5 x 2.7 cm. This has comet tail artifact consistent with colloid. There is difficult to measure on the prior study but this mass was present. Adjacent to this is a smaller 0.8 x 0.9 x 1.1 cm complex cystic nodule with clear comet tail artifact consistent with colloid. This was also present on the prior exam and is not significantly changed in size or appearance.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: There is a large, hypoechoic mass posterior to the right lobe of the thyroid measuring 1 x 1.2 x 2.7 cm consistent with parathyroid adenoma.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Bilateral thyroid nodules. These appear likely to represent colloid nodules.2. Right extrathyroidal mass.US GUIDED FNA, US THYROID; 3/25/2016 10:32 AMCLINICAL INFORMATION AND PRE-OPERATIVE DIAGNOSIS: Right parathyroid adenoma. Bilateral thyroid nodules.POST-OPERATIVE DIAGNOSIS : Same OPERATORS: Doctors Paushter; I, the attending physician, Dr. Paushter, performed the entire procedure.TECHNIQUE: Following a discussion of the procedure with the patient, including its risks, benefits, alternatives and steps to prevent infection, an informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure.Localizing US demonstrated previously described bilateral nodules.. The skin over the target area was cleansed with chlorhexidine. Transducer was sterilely sheathed. Local anesthesia was obtained using 1% lidocaine, superficially and at depth. RIGHT side: Using aseptic technique, and continuous ultrasound guidance, the lesion was sampled using 25 gauge needles. 3 fine needle aspirations were performed. Due to capsular deflection of the needle and motion of the nodule, this biopsy was extremely difficult.LEFT side: Using aseptic technique, and continuous ultrasound guidance, the lesion was sampled using 25 gauge needles. 2 fine needle aspirations were performed.Cytology was present to confirm specimen adequacy. Specimen was handed to cytology. The patient tolerated the procedure well without immediate complications. Routine post procedure instructions were communicated to the patient.COMPLICATIONS: NoneESTIMATED BLOOD LOSS: Less than 5 cc. An adhesive bandage was placed on the patient\u2019s skin."}
{"instruction": "Generate impression based on findings.", "input": "Distended abdomen. Hepatitis C. LIVER: Mildly nodular liver morphology. Increased parenchymal echogenicity. 16.3 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 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 8.4 cm in length. The left kidney is 9.2 cm in length. The renal parenchyma is markedly echogenic bilaterally. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 10.5 cm in length, without focal lesions evident.OTHER: Moderate amount of ascites identified. Bilateral pleural effusions are partially imaged.", "output": "1. Mildly nodular liver contour with increased echogenicity, compatible with chronic liver disease.2. Moderate amount of ascites. Bilateral pleural effusions.3. Echogenic kidneys without hydronephrosis, compatible with medical renal disease"}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female with left breast IDC October 20, 2015 and metastatic axillary lymph node undergoing neoadjuvant chemotherapy. Assess for response prior to surgery. Three standard views of the left breast, left CC exaggerated, and left spot MLO 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. Again seen is a biopsy clip in the left upper outer breast with adjacent calcifications anteriorly and inferiorly measuring up to 15 mm in extent. The previously seen mammographic mass in this location has resolved, and no measurable mass is present currently. The left axillary biopsy clip is also partially imaged.ULTRASOUND", "output": "Favorable treatment response as described above, with no measurable residual disease in the left upper outer breast index malignancy, and significantly decreased size of previously biopsy left axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female with history of multinodular thyroid presents for follow-up. RIGHT LOBE MEASUREMENTS: 4.6 x 1.4 x 1.6 cm.LEFT LOBE MEASUREMENTS: 4.8 x 1.8 x 1.8 cm.ISTHMUS MEASUREMENTS: 0.4 cm.RIGHT LOBE: The parenchyma is mildly heterogeneous and appears similar to the prior exam.LEFT LOBE: The parenchyma is mildly heterogeneous appears similar to the prior exam. There are several nodules as described below.Nodule 1: Measures approximately 1.6 x 1.2 x 1.7 cm in the superior pole. It is well defined and spongiform. Stable since prior study.Nodule 2: Measures approximately 1.6 x 1.1 x 0.9 cm in the mid pole. It is well defined, hyperechoic. Stable since prior study.Nodule 3: Measures approximately 1.2 x 0.7 x 0.9 cm in the inferior pole. It is well defined and hyperechoic. Stable since prior study.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Stable multinodular thyroid as described above."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male patient with history of heavy drinking, now less, with elevated liver enzymes. Evaluate for liver disease. LIVER: The liver measures 14.9 cm in length. 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 4 mm in diameter.PANCREAS: The head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas. The main pancreatic duct is dilated up to 4 mm.RIGHT KIDNEY: The right kidney measures 9.9 cm in length. No evidence of hydronephrosis. There is a 6 mm right lower pole renal stone and a 2.0 x 1.6 x 1.5 cm right midpole simple renal cyst.OTHER: The left kidney measures 9.4 cm in length. No evidence of hydronephrosis.The spleen measures 5.6 cm in length.", "output": "1. No focal hepatic lesion.2. Pancreatic ductal dilatation of uncertain etiology; this can be further evaluated with MRCP if clinically indicated.3. Non-obstructing right nephrolithiasis and right renal cyst. "}
{"instruction": "Generate impression based on findings.", "input": "Bilateral flank pain with hematuria RIGHT KIDNEY: Multiple subcentimeter nonobstructing echogenic foci with posterior shadowing consistent with stones. The largest within the lower pole measures 0.6 x 0.5 x 0.3 cm. No worrisome mass or hydronephrosis. Right kidney 10.7 cm in length.LEFT KIDNEY: 1.8 x 1.7 x 1.4 cm hypoechoic focus upper pole left kidney with internal complexity. No stone or hydronephrosis. Left kidney 10.2 cm in length.OTHER: Bladder nondistended", "output": "Multiple subcentimeter nonobstructing right renal stones. Hypoechoic focus upper pole left kidney with internal complexity. While this may represent a complex benign cyst, it is best considered indeterminate. Would pay special attention to this lesion on future surveillance scans. If further characterization is clinically indicated, would recommend dedicated renal CT."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Large MNG, L>R, last US at OSH. Evaluate anatomy History: 68-year-old female with goiter RIGHT LOBE MEASUREMENTS: 2.0 cm x 1.5 cm x 5.4 cmLEFT LOBE MEASUREMENTS: 6.2 cm x 3.3 cm x 8.4 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: There is a dominant heterogeneous predominantly cystic nodule with internal echogenic foci which seems to demonstrate reverberation artifact consistent with inspissated colloid. No internal vascularity is seen. Several additional smaller cystic lesions noted. LEFT LOBE: The entire left lobe of the thyroid has been replaced by a large solid nodule with internal vascularity measuring 6.8 cm x 2.6 cm x 4.8 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multinodular goiter with a dominant left thyroid lobe solid nodule with internal vascularity, which would be amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "55 year old with history of diabetes and obesity with chronic elevated LFTs; evaluate for NASH/NAFLD vs cirrhosis. LIVER: The liver measures 18.8 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: Cholelithiasis. No gallbladder wall thickening. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 6 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 11.6 cm in length. RIGHT KIDNEY: Kidney measures 11.1 cm in length. Normal echotexture. Simple cyst measuring 6.4 x 7.9 x 6.5. LEFT KIDNEY: Kidney measures 10.9 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.", "output": "1.Cholelithiasis.2.Mildly increased parenchymal echogenicity is suggestive of fatty infiltration/parenchymal dysfunction. "}
{"instruction": "Generate impression based on findings.", "input": "76-year-old male who is status post cholecystectomy presents with right upper quadrant pain. LIVER:Measures 13.9 cm. Normal echotexture. No focal mass or ascites. There is dirty shadowing arising from the intrahepatic biliary tract, consistent with pneumobilia. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. The common hepatic duct measures 0.3 cm.PANCREAS: Evaluation of the pancreas limited due to overlying bowel gas.SPLEEN: Measures 12.5 cm.KIDNEYS: Right kidney measures 6.7 cm. Left kidney measures 13.1 cm. Normal echogenicity. Approximately 1.6 x 1.5 x 2.0 cm well-defined anechoic area is consistent with a simple renal cyst in the midpole of the left kidney. No shadowing calculi, hydronephrosis, or worrisome mass. OTHER: No significant abnormality noted.", "output": "1. Pneumobilia; benign. This was also present on a CT abdomen dated April 12, 2016. Otherwise, negative exam."}
{"instruction": "Generate impression based on findings.", "input": "22-year-old male patient with elevated LFTs. Assess for etiology of elevated LFTs. LIVER: The liver measures 18.2 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 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 10.8 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.0 cm in length. No evidence of hydronephrosis.The spleen is not visualized.", "output": "No specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male with right upper quadrant pain. Evaluate gallbladder and biliary tract. LIVER: Limited study performed without gross abnormality.BILIARY TRACT: Limited study performed without evidence for biliary tract dilatation. Gallbladder appears normal without cholelithiasis, wall thickening or pericholecystic fluid.OTHER: No significant abnormalities noted.", "output": "No gallbladder or biliary abnormality."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female with intermittent right flank pain, evaluate for renal pathology. RIGHT KIDNEY: Measures 10.8 cm in length. Linear echogenic focus in the mid polar region does not have typical imaging features of a renal calculus or mass lesion. No discrete renal calculi are identified. There is no hydronephrosis.LEFT KIDNEY: Measures 10.8 cm in length. No nephrolithiasis, hydronephrosis, or suspicious mass lesion.OTHER: Increased hepatic echogenicity partially imaged, which may represent hepatic steatosis or parenchymal disease.", "output": "No nephrolithiasis, hydronephrosis, or suspicious renal masses. "}
{"instruction": "Generate impression based on findings.", "input": "Renal calculi RIGHT KIDNEY: Stable nonobstructing lower pole renal stone measuring 0.8 x 0.5 x 0.8 cm. No worrisome mass or hydronephrosis. Right kidney 10.4 cm in length.LEFT KIDNEY: Stable nonobstructing lower pole stone measuring 0.8 x 0.6 cm. No worrisome mass or hydronephrosis. Left kidney 10.4 cm in length.OTHER: Bladder nondistended", "output": "Stable nonobstructing bilateral nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Diagnosed with papillary carcinoma, please evaluate lymph nodes History: PTC RIGHT LOBE MEASUREMENTS: 4.7 x 1.6 x 1.7 cm.LEFT LOBE MEASUREMENTS: 4.8 x 1.4 x 1.3 cm.ISTHMUS MEASUREMENTS: Up to 0.3 cm in thickness.RIGHT LOBE: Normal background parenchymal echotexture. Nodule within the midpole measuring 1.3 x 1.3 x 1.5 cm which is predominantly isoechoic, contains internal vascularity, and has a hypoechoic halo. Per electronic medical record, this nodule reportedly corresponds to biopsy-proven papillary carcinoma.LEFT LOBE: Normal background parenchymal echotexture. Nodule within the lower pole measuring 1.6 x 1.4 x 1.4 cm which is predominantly isoechoic, demonstrates peripheral vascularity, has a hypoechoic halo, and lacks definite suspicious microcalcifications. Per electronic medical record, this nodule reportedly corresponds to a biopsy-proven benign follicular nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No cervical lymph nodes are identified.OTHER: No significant abnormality noted.", "output": "Bilateral dominant thyroid nodules as described above. No lymphadenopathy identified."}
{"instruction": "Generate impression based on findings.", "input": "Male 53 years old; Reason: r/o recurrence History: h/o thyroid cancer RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomy ISTHMUS MEASUREMENT: Status post thyroidectomyRIGHT LOBE: No suspicious nodule in the thyroid bedLEFT LOBE: No suspicious nodule in the thyroid bedISTHMUS: No suspicious nodular in the thyroid bedLYMPH NODES: 1.0 x 0.7 x 0.4 cm right level 2 lymph node with a fatty hilum .OTHER: No significant abnormality noted.", "output": "1.Status post thyroidectomy. No evidence of disease recurrence.2.Prominent right level 2 lymph node has a benign appearance and is likely reactive in etiology."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for renal pathology History: BUN 93, confusion, syncope RIGHT KIDNEY: The right kidney measures 10.9 cm in length. Echogenic renal parenchyma. Soft tissue focus in the midpole of the right kidney and abnormal right renal contour are probably explained by partial duplication when correlated with CT dated 11/6/2014. No visualized shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 6.6 cm. Echogenic renal parenchyma. No visualized surrounding stones or hydronephrosis.OTHER: Unremarkable urinary bladder.", "output": "1. Echogenic renal parenchyma, consistent with medical renal disease.2. Soft tissue focus in the midpole of the right kidney is probably explained by partial duplication when correlated with CT dated 11/6/2014."}
{"instruction": "Generate impression based on findings.", "input": "Palpable area of concern in the left breast reconstruction. A targeted left ultrasound was performed for the palpable area of concern marked by the clinical service. At the site marked by the clinical service, there is an 8 x 8 mm round circumscribed nearly anechoic lesion with posterior acoustic enhancement compatible with a small oil cyst. There is no suspicious solid mass identified.", "output": "Findings compatible with an oil cyst at the site of palpable concern. No evidence of malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female patient with bloating with occasional constipation. Decreased appetite. History of scleroderma. Evaluate for intra-abdominal pathology. LIVER: The liver measures 15.5 cm in length and demonstrates increased parenchymal echogenicity with small focal areas of hypoechogenicity near the portal venous structures. There is a 0.7 x 0.6 x 0.6 cm left hepatic lobe cyst. 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. Sonographic Murphy's sign is negative. 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 10.8 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.1 cm in length. No evidence of hydronephrosis.The spleen measures 7.1 cm in length.No ascites.", "output": "1. Increased hepatic echogenicity consistent with hepatic steatosis with focal areas of sparring. 2. Left hepatic cyst. "}
{"instruction": "Generate impression based on findings.", "input": "Malignant neoplasm of the thyroid RIGHT LOBE MEASUREMENTS: Post thyroidectomy LEFT 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 or metastatic disease in the neck."}
{"instruction": "Generate impression based on findings.", "input": "Chronic kidney disease, stage V Ultrasound guidance was provided for a native kidney biopsy.", "output": "Ultrasound guidance for native kidney biopsy."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female with history of cirrhosis, ascites, large ventral hernia. Assess for residual ascites prior to hernia repair. Grayscale and color Limited abdominal ultrasound demonstrates moderate abdominal ascites without evidence of debris or loculation. A cirrhotic hepatic morphology is also visualized.", "output": "Moderate ascites. Cirrhotic hepatic morphology."}
{"instruction": "Generate impression based on findings.", "input": "53 years old, Male, Reason: transaminitis. please evaluate for evidence of cirrhosis vs. fatty liver etc History: transaminitis LIVER: The liver is enlarged measuring 20.1 cm cm in length. Increased echogenicity of the hepatic parenchyma is consistent with fatty infiltration. No focal hepatic lesion identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s. Hypoechoic area adjacent to the gallbladder likely represents focal fatty sparing. No surface nodularity of the liver to suggest cirrhosis.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. Per ultrasound technologist, 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: Hypoechoic focus in region of pancreatic body is nonspecific on this ultrasound examination and may be further evaluated with dedicated cross-sectional imaging.SPLEEN: No significant abnormalities noted. The spleen measures 12.5 cm in length. RIGHT KIDNEY: Kidney measures 11.8 cm in length. Normal echotexture. No evidence of hydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 12.3 cm in length. Normal echotexture. No evidence of hydronephrosis or shadowing calculus.OTHER: No evidence of ascites.", "output": "1.Hepatomegaly with fatty infiltration of the liver. No definite evidence of cirrhosis.2.Nonspecific hypoechoic focus in the area of the body of the pancreas. Recommend dedicated cross-sectional imaging with IV contrast to further evaluate this lesion."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for cholecystitis History: Right upper quadrant abdominal pain and elevated LFTs LIVER: The liver measures 16.2 cm in length. Mildly echogenic hepatic parenchyma. The portal vein is patent with normal directional hepatopedal portal venous blood flow, peak velocity 34.5 cm/s.GALLBLADDER, BILIARY TRACT: Multiple echogenic stones in the dependent aspect of the gallbladder. No evidence of acute pericholecystic inflammation. The gallbladder wall measures 0.2 cm. The common bile duct measures 0.3 cm. No biliary ductal dilatation. Negative sonographic Murphy's sign.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 9.8 cm in length. Normal echogenicity and echotexture. No hydronephrosis or shadowing stones.LEFT KIDNEY: The left kidney measures 10.6 cm in length. Normal echogenicity and echotexture. No hydronephrosis or shadowing stones.OTHER: The spleen measures 9.8 cm in length.", "output": "1. Cholelithiasis without evidence of acute inflammation or biliary ductal dilatation.2. Mildly echogenic liver, compatible with hepatic steatosis or parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury RIGHT KIDNEY: 10.5 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 completely distended, which limits evaluation. Mildly prominent circumferential wall thickness may reflect nondistended state, however correlation for symptoms of cystitis may be helpful.OTHER: No significant abnormality noted.", "output": "No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female with thyroid nodules RIGHT LOBE MEASUREMENTS: 4.9 cm x 1.4 cm x 1.8 cmLEFT LOBE MEASUREMENTS: 4.8 cm x 1.7 cm x 1.9 cmISTHMUS MEASUREMENTS: 7 mm in thicknessRIGHT LOBE: Heterogeneous echotexture with multiple hypoechoic subcentimeter nodules.LEFT LOBE: Heterogeneous echotexture. Small hyperechoic nodule favors a benign etiology. Additional solid nodule at the mid pole measures 1.8 cm x 1.3 cm x 1.6 cm which is heterogeneous in appearance likely sequela of prior biopsy.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign appearing lymph nodes in the neck. No pathologic lymphadenopathy. OTHER: No significant abnormality noted.", "output": "Heterogeneous thyroid gland with multiple subcentimeter hypoechoic nodules in the right lobe. Two solid nodules in the left lobe, one of which is small and hyperechoic favoring a benign etiology, and the other larger nodule which is heterogeneous in appearance likely sequelae of prior biopsy. "}
{"instruction": "Generate impression based on findings.", "input": "Female 23 years old Reason: is there evidence of cholecystitis History: ruq pain, history gallstones LIVER: Liver parenchyma is within normal limits. No focal hepatic mass. Liver measures 15.8 cm.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. No gallstones are present. The gallbladder wall is within normal limits measuring 2 mm. No evidence of acute cholecystitis. Common bile duct measures 3 mm.PANCREAS: The visualized portions of the pancreas are normal.SPLEEN: Spleen is normal measuring 8.5 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Left kidney measures 10.6 cm. Right kidney measures 9.9 cm.OTHER: No significant abnormalities noted.", "output": "No evidence of acute cholecystitis as clinically questioned. No specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old female. Follow-up thyroid nodule. RIGHT LOBE MEASUREMENTS: 4.5 x 1.6 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.3 x 1.5 x 1.8 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Homogeneous in echotexture. No mass identified.LEFT LOBE: Homogeneous in echotexture. In the lower pole of the left lobe there is a 0.4 x 0.5 x 0.4 cm ovoid hypoechoic mass with some central increased echogenicity. This is unchanged in size from the prior exam. The appearance suggest potential intrathyroidal lymph node.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable left lobe mass."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter RIGHT LOBE MEASUREMENTS: 5.6 x 4.1 x 6.2 cmLEFT LOBE MEASUREMENTS: 1.9 x 1.9 x 4.8 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Slight interval increase in size of large dominant mixed cystic and solid right thyroid nodule now measuring 5.4 x 3.8 x 4.9 cm. compared to 4.8 x 3.8 x 4.4 cm on 10/10/2014LEFT LOBE: No significant abnormality noted.ISTHMUS: Interval increase in size of right isthmus nodule now measuring 2.4 x 1.7 x 1.6 cm compared to 1.8 x 1.4 x 1.2 cm on 10/10/2014. This right isthmus nodule also demonstrates indistinct borders and internal calcifications.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: 2 abnormal right level 3 enlarged lymph nodes with effacement of fatty hilum. The largest measures 1.2 x 0.6 x 1.7 cm.OTHER: No significant abnormality noted.", "output": "Interval increase in size of right isthmic nodule demonstrating indistinct borders and internal calcifications. Would recommend ultrasound-guided percutaneous biopsy of this nodule.Abnormal right level 3 enlarged lymph nodes; would also recommend ultrasound guided percutaneous biopsy of these lymph nodes.Slight interval increase in size of dominant mixed cystic and solid right thyroid nodule; a benign etiology is still favored."}
{"instruction": "Generate impression based on findings.", "input": "Leukocytosis with positive urinalysis RIGHT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. Right kidney 12.7 cm in length.LEFT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. 13.6 cm in length.OTHER: Foley within a collapsed bladder.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old male with recent renal transplant and elevated creatinine. Pressure symptoms over allograft. RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: Transplanted kidney measures 12 cm in length without abnormality.COLLECTING SYSTEM/URETER: No hydronephrosis. Portions of the stent are noted in the renal collecting system.URINARY BLADDER: Poorly distended. Distal stent not visualized.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels Peak systolic velocity in the right iliac artery of 119 cm/s. Peak systolic velocity in the transplant renal artery at the anastomosis of 267 cm/s decreasing to 166 cm/s more distally.Resistive index averages 0.6. No parvus tardus.Transplant renal vein patent.OTHER: No significant abnormality noted", "output": "No hydronephrosis or fluid collection.Elevated velocity in the transplant renal artery at the level of the anastomosis, presumably due to residual postoperative edema."}
{"instruction": "Generate impression based on findings.", "input": "21-year-old female presents for short-term follow-up of right breast mass. On physical examination, there is a 1.5 cm lobulated, firm, mobile mass at the approximate 9 o'clock position of the right breast, 3 cm from the nipple.A targeted right ultrasound was performed for the patient\u2019s area of concern. The 9 o'clock position of the right breast, 3 cm from the nipple, there is redemonstration of a parallel, hypoechoic, lobulated circumscribed mass measuring 1.9 x 0.6 x 0.9 cm, not significantly changed from prior examination (previously 2.1 x 0.6 x 1.1 cm). Internal vascularity is present.", "output": "Sonographically stable 1.9-cm hypoechoic, lobulated mass at the 9 o'clock position of the right breast, likely representing fibroadenoma. Clinical management as per Dr. Jaskowiak. Result and recommendation were discussed with the patient and her mother. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old female presents for evaluation of a multinodular goiter. RIGHT LOBE MEASUREMENTS: 5.7 x 2.9 x 2.1 cm.LEFT LOBE MEASUREMENTS: 5.2 x 2.1 x 2.1 cm.ISTHMUS MEASUREMENTS: 0.51 cm.RIGHT LOBE: The parenchyma has a homogenous echotexture. Stable dominant mixed cystic solid nodule measuring approximately 1.8 x 1.0 x 1.8 cm appears stable since the prior exam.LEFT LOBE: The parenchyma has a homogenous echotexture. One stable nodule noted measuring approximately 0.3 x 0.3 x 0.3 cm in the left lobe appears stable.ISTHMUS: Homogenous parenchyma.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Stable multinodular thyroid as described above. Right sided nodule amenable to biopsy if not previously performed."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old male requires abdominal evaluation prior to heart transplantation. LIVER:The liver measures 18.0 cm. There is very mild heterogenous coarse echogenicity. The portal vein is patent with normal hepatopedal flow measured at 26.6 cm/s. No masses or ascites.GALLBLADDER, BILIARY TRACT: The gallbladder is normal in appearance without distention. The gallbladder wall measures 3.2 mm. No stones. Common bile duct measures 1.3 mm.PANCREAS: Visualization of the pancreas is limited by overlying bowel gas, however visualized portions are normal.SPLEEN: The spleen measures 10.0 cm. No abnormalities noted.KIDNEYS: The right kidney measures 10.9 cm. The cortex has normal echogenicity. No shadowing calculi or masses noted. Left kidney measures 11.1 cm. The cortex has normal echogenicity. No shadowing calculi or worrisome masses noted. No hydronephrosis bilaterally. There is a 0.8 x 0.9 x 0.9 cm round circular well-defined anechoic lesion with posterior acoustic shadowing, consistent with a simple renal cyst. ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: Inferior vena cava is patent.OTHER: The bladder is nondistended. The prostate measures 5.6 x 5.3 cm and is normal in appearance.", "output": "1. Very mild heterogeneous coarse echotexture of the liver consistent with mild chronic liver disease/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "62 years Male with history of thyroidectomy for micropapillary carcinoma. RIGHT LOBE: Status post thyroidectomy. No discrete nodules within the thyroidectomy bed.LEFT LOBE: Status post thyroidectomy. No discrete nodules within the thyroidectomy bed.ISTHMUS: Status post thyroidectomy. No discrete nodules within the thyroidectomy bed.PARATHYROID GLANDS: No significant abnormalities.LYMPH NODES: Small, normal-appearing lymph nodes are present in the right level 2 and left level 6 cervical regions.OTHER: No significant abnormalities.", "output": "Status post thyroidectomy without mass or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Mary Webb is a 30 year old female with right axillary pain and questionable self palpated lump. However, patient states that she could not feel the lump today. On physical examination, no discrete mass is palpated. A targeted right axilla ultrasound was performed for the patient\u2019s area of concern (pain). There is no solid or cystic mass identified. Incidental note is made of a normal appearing axillary lymph node.", "output": "Normal axillary lymph node. No sonographic evidence for malignancy. The patient should follow up with her primary care physician for pain as clinically warranted, presuming these results are concordant with the physical exam findings. Further evaluation of a clinically suspicious abnormality should not delayed by negative imaging. Rather, negative imaging may serve to reinforce a negative clinical impression. Results and recommendations were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Female 49 years old; Reason: cyst posterior left neck, TTP, x2 weeks, RA/sarcoid - eval etiology History: as above Within the subcutaneous tissues there is a relatively encapsulated isoechoic mass measuring 3.2 x 0.9 x 3.9 cm. it does not have any cystic foci of vascularity.", "output": "1.Findings compatible with a subcutaneous lipoma."}
{"instruction": "Generate impression based on findings.", "input": "Male 57 years old Reason: evaluate graft patency History: evaluate graft patency Limited study due to patient's body habitus and surgical bandagesRENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: Transplant kidney measures 10.5 cm.COLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: Not well visualized.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels Doppler evaluation of the transplant kidney is limited. Transplant renal artery is patent. Peak systolic velocity is 186 cm/s. RI values are borderline elevated measuring around 0.8 and 0.85. Transplant vein is patent.OTHER: No significant abnormality noted", "output": "Limited study of the transplant kidney and particularly Doppler evaluation. Transplant renal artery could not be visualized throughout its entire course. Borderline elevated RI values. No evidence of hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with right adrenal nodule seen on CT scan. RIGHT KIDNEY: Measures 11.2 cm in length. Unremarkable echogenicity without hydronephrosis. Right inferior pole solid lesion suspicious for renal cell carcinoma seen on prior CT is not clearly visualized on this examination due to bowel gas. LEFT KIDNEY: Measures 13.7 cm in length. Left renal cysts measuring up to 3.7 cm without septation or solid component. Unremarkable echogenicity without hydronephrosis. URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: 4.0 x 2.4 x 3.7 cm circumscribed hypoechoic right suprarenal lesion correlates with that seen on recent CT and is indeterminant.", "output": "1. Indeterminate right adrenal nodule. Dedicated adrenal protocol CT or MRI is recommended for complete characterization.2. Right inferior pole solid lesion suspicious for renal cell carcinoma seen on prior CT is not clearly visualized on this examination due to bowel gas. "}
{"instruction": "Generate impression based on findings.", "input": "Positive urine culture renal transplant RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: Multiple cysts again noted. Transplant kidney 11.1 cm in length.COLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: No significant abnormality notedOTHER: No significant abnormality noted", "output": "Stable right iliac fossa renal transplant without evidence for perinephric fluid collection, hydronephrosis, or obvious acute inflammatory process."}
{"instruction": "Generate impression based on findings.", "input": "Patient presents for 6 month follow-up right breast ultrasound to evaluate high probability benign clustered cyst at the 6 o'clock position A targeted right ultrasound was performed for the mammographic area of concern. Clustered cyst identified in the right breast 6:00 position measuring 10 x 5 x 9 mm, previously measured 8 x 4 x 8 mm mostly unchanged from prior study.", "output": "Stable clustered cyst right breast 6:00 position. As long as patient's physical examination remains unchanged, bilateral diagnostic mammogram is recommended in 6 months to assess stability.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male with parathyroid cancer with multiple prior surgeries and radiation. Evaluate for mass. RIGHT LOBE MEASUREMENTS: 3.5 x 2 x 2.8 cmLEFT LOBE MEASUREMENTS: Post thyroidectomy.ISTHMUS MEASUREMENTS: Post thyroidectomy.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No massesISTHMUS: No massesPARATHYROID GLANDS: No extrathyroidal mass identified.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Post partial thyroidectomy. Normal-appearing right lobe. No extrathyroidal masses."}
{"instruction": "Generate impression based on findings.", "input": "Female, 51 years old. History of hydronephrosis s/p bilateral ureteral stent removal. RIGHT KIDNEY: The right kidney measures 10.0 cm in length, with normal cortical echogenicity. A lower pole nonobstructing stone measures 0.5 x 0.3 x 0.5 cm. No hydronephrosis.LEFT KIDNEY: The left kidney measures 11.1 cm in length with normal cortical echogenicity. A midpole nonobstructing stone measures 0.4 x 0.2 x 0.4 cm. No hydronephrosis.OTHER: The bladder is incompletely distended. Previously seen bilateral ureteral stents are no longer in place.", "output": "Bilateral nonobstructing renal stones appear similar to prior. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "74 year-old male with septic shock. Evaluate for cholecystitis. LIVER: Normal echogenicity of the liver measuring 14.3 cm in length. No focal hepatic lesions. The portal vein is patent with appropriate direction of flow; peak velocity measures 0.2 m/sec.BILIARY TRACT: Mildly prominent gallbladder. No gallbladder wall thickening. No pericholecystic fluid. No shadowing calculi are seen. Common bile duct measures 5 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Distal tail of the pancreas is obscured by overlying bowel gas. The visualized portions of the pancreas are unremarkable.SPLEEN: Normal echogenicity of the spleen measuring 8.6 cm in length.RIGHT KIDNEY: Right kidney measures 11.3 centers in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 11.0 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "Mildly prominent gallbladder with no evidence of cholelithiasis or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old male with history of stones. Evaluate for nephrolithiasis. RIGHT KIDNEY: The right kidney measures 9.8 cm in length and is normal in echogenicity. No evidence of nephrolithiasis or hydronephrosis. At the inferior pole, there is a hypoechoic lesion measuring 1.5 x 0.5 x 0.9 cm without evidence of vascularity. Correlation with CT examination with contrast on 3/20/2015, demonstrates a cluster of simple cysts. There is an additional exophytic hypoechoic focus without internal vascularity measuring 1.1 x 1.2 x 1.1 cm and is likely a benign cyst.LEFT KIDNEY: The left kidney measures 12.2 cm in length and is normal in echogenicity. No evidence of nephrolithiasis or hydronephrosis.BLADDER: No significant abnormalities noted.", "output": "1.No evidence of nephrolithiasis or hydronephrosis. 2.Right renal cysts as above."}
{"instruction": "Generate impression based on findings.", "input": "Right-sided nephrolithiasis with flank pain. RIGHT KIDNEY: 0.6 cm nonobstructing stone within the right renal pelvis. No worrisome mass or hydronephrosis. Right kidney 11.9 cm in lengthLEFT KIDNEY: No significant abnormalities noted. 12.1 cm in length OTHER: Bladder nondistended", "output": "Subcentimeter nonobstructing stone within the right renal pelvis. No worrisome mass or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "60 year old female with history of hepatitis C. Screening for HCC. LIVER: Slightly increased liver echogenicity, without focal masses. BILIARY TRACT: No biliary dilatation. Gallbladder is within normal limits.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right kidney measures 9.3 cm in length.OTHER: No significant abnormalities noted. Left kidney measures 9.2 cm in length. Small, approximately 1.3 cm anechoic left kidney inferior pole cyst.", "output": "Slightly increased liver echogenicity, likely due to hepatic steatosis, without focal masses or other findings of malignancy."}
{"instruction": "Generate impression based on findings.", "input": "Enlarging hepatic lesion seen on CT. Question if cyst. LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. The segment 6 hepatic lesion measures approximately 3.6 x 3.4 x 3.3 cm. The lesion contains heterogeneous internal echogenicity with peripheral hypoechogenicity. There is no internal vascularity. No intrahepatic biliary ductal dilation is seen.OTHER: No significant abnormalities noted on this limited examination.", "output": "3.6 cm hepatic segment 6 mass, with characteristics excluding a benign cyst. The appearance of this mass may represent an abscess with echogenic debris or a necrotic soft tissue mass such as a metastasis. In the presence of known abscesses and absence of known primary malignancy, an abscess is favored."}
{"instruction": "Generate impression based on findings.", "input": "Female; 35 years old. Reason: pt w hyperthyroidism, to assess gland anatomy and thyroid volume to calculate RAI dose History: hyperthyroidism RIGHT LOBE MEASUREMENTS: 4.3 x 2.0 x 1.7 cmLEFT LOBE MEASUREMENTS: 2.8 x 1.4 x 1.3 cmISTHMUS MEASUREMENTS: 0.19 cmRIGHT LOBE: The right lobe is nodular and certain nodular portions are hypervascular.LEFT LOBE: The left lobe is atrophic and hypervascular.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Left level 3 lymph node measures 1.6 x 0.7 cm and has a fatty hilum.OTHER: No significant abnormality noted.", "output": "1.Nodular, partially hypervascular right thyroid lobe and atrophic, hypervascular left thyroid lobe, suspicious for thyroiditis.2.Measurements as above."}
{"instruction": "Generate impression based on findings.", "input": "Suppressed TSH RIGHT LOBE MEASUREMENTS: 4.6 x 1.1 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.1 x 1.1 x 1.8 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Diffusely heterogeneous gland with increased vascularity. No discrete nodule.LEFT LOBE: Diffusely heterogeneous gland with increased vascularity. No discrete nodule.ISTHMUS: Diffusely heterogeneous gland with increased vascularity. No discrete nodulePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland with increased vascularity consistent with Graves' disease or acute thyroiditis. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "30 year-old female with thyroid nodules. RIGHT LOBE MEASUREMENTS: 1.9 x 2.1 x 5 cmLEFT LOBE MEASUREMENTS: 1.5 x 1.6 x 5.1 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: There is a spongiform nodule in the midportion of the right lobe measuring approximately 0.5 x 0.8 by 0.7 cm . Although this measures slightly larger than on the prior exam the appearance is again consistent with benign nodule. There is again noted a large, solid and mildly hypoechoic and heterogeneous nodule at the posterior aspect of the lower pole. This measures 2 x 1.7 x 2.3 cm without change.LEFT LOBE: Small colloid cyst with comet tail artifact in the lower pole is stable measuring 0.2 x 0.2 x 0.4 cmISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No change in large right lobe mass. Other findings as noted above."}
{"instruction": "Generate impression based on findings.", "input": "Exposed to radiation as a child; hypothyroidism RIGHT LOBE MEASUREMENTS: 3 x 1 x 1.1 cmLEFT LOBE MEASUREMENTS: 3.9 x 1 x 1 cmISTHMUS MEASUREMENTS: 0.1 cmRIGHT LOBE: Atrophic diffusely heterogeneous gland without noduleLEFT LOBE: Atrophic diffusely heterogeneous gland without noduleISTHMUS: Atrophic diffusely heterogeneous gland without nodulePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Atrophic diffusely heterogeneous gland without nodule or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 3.1 cm hypoattenuating nodule posterior to the right lobe of the thyroid noted on CT Chest 11/29. Please please evaluate further. RIGHT LOBE MEASUREMENTS: 5.2 x 3.0 x 2.1 cm.LEFT LOBE MEASUREMENTS: 4.8 x 2.6 x 2.1 cm.ISTHMUS MEASUREMENTS: Up to 0.7 cm in thickness.RIGHT LOBE: Normal background parenchymal echotexture. There is a subcentimeter nodule in the mid pole with imaging features suggestive of a benign colloid nodule.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: There is an oval-shaped, partially solid and partially cystic nodule posterior to the inferior pole of the right lobe of the thyroid which measures approximately 3.4 x 2.3 x 3.1 cm and demonstrates mild peripheral vascularity.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Mixed solid and cystic nodule posterior to the right inferior pole of the thyroid. Differential considerations include degenerating parathyroid adenoma (favored) versus exophytic thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "Acute leukemia with hepatic dysfunction LIVER: Slightly increased echogenicity without mass. Liver length 17.5 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.6 cm in lengthOTHER: Left kidney 10.1 cm in length. Spleen 10.5 cm in length.", "output": "Slightly increased echogenicity of liver parenchyma suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old female with hepatitis C virus. Evaluate for cirrhosis or mass. LIVER: Liver is normal in size and mildly and coarsely echogenic consistent with parenchymal disease. No focal mass is identified and there is no gross evidence for cirrhosis.GALLBLADDER, BILIARY TRACT: The patient has had a cholecystectomy. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Small left renal cyst.Splenic size upper normal.", "output": "Mildly echogenic liver without mass.Splenic size upper normal."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old female with question of thyroid nodule on the right RIGHT LOBE MEASUREMENTS: 5.2 x 1.4 x 1.4 cmLEFT LOBE MEASUREMENTS: 5.4 x 1.6 x 1.2 cmISTHMUS MEASUREMENTS: 0.2 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: Right level two lymph node with fatty hilum measuring 2.1 x 0.3 x 0.7 cm.OTHER: No significant abnormality noted.", "output": "No thyroid nodule as clinically questioned. "}
{"instruction": "Generate impression based on findings.", "input": "Female 45 years old follow-up thyroid nodules. RIGHT LOBE MEASUREMENTS: 4.8 x 1.4 x 2.2 cmLEFT LOBE MEASUREMENTS: 3.8 x 1.2 x 1.8 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: The right thyroid lobe contains at least 3 nodules. The largest measures 1.0 by 1.0 x 1.1 cm and is mixed cystic and solid. There is no flow on color Doppler imaging. This nodule is low suspicion and does not meet criteria for FNA, per ATA guidelines. LEFT LOBE: There are 2 nodules on the left both of which are spongiform in appearance. The largest measures 1.0 x 0.6 x 1.1 centimeters and has no flow on color Doppler imaging.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal appearing cervical lymph nodes are seen bilaterally.OTHER: No significant abnormality noted.", "output": "Bilateral thyroid nodules measuring less than 1 cm as described above."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female with prior imaging with ascites. Evaluate liver parenchyma, signs of ascites or congestion. LIVER: Mildly enlarged and echogenic liver. The liver measures 17.3 cm in length. No focal hepatic mass is identified. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Dependent gallstones are identified. Gallbladder wall is diffusely and mildly thickened, measuring up to 6 mm, and nonspecific in the setting of ascites. No evidence of intrahepatic or extrahepatic periductal dilatation. Common bile duct measures 5 mm in diameter.PANCREAS: No significant abnormalities noted.SPLEEN: Not visualized due to limitations with patient's position.RIGHT KIDNEY: Echogenic right kidney measuring 8.3 cm in length. Renal calcifications may be vascular in etiology. No evidence of hydronephrosis. OTHER: Moderate ascites.", "output": "1.Mildly enlarged and echogenic liver, suggestive of fatty infiltration. No focal hepatic mass is identified.2.Echogenic right kidney, suggestive of medical renal disease.3.Cholelithiasis without evidence of acute cholecystitis. Diffusely mildly thickened gallbladder wall is nonspecific in the setting of ascites.4.Moderate ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 45 years old Reason: RUQ r/o cirrhosis History: elevated inr, low albumin, low-normal platelets LIVER: Liver has coarse echotexture consistent with patient's history of chronic portal vein thrombosis. No focal lesions are noted.BILIARY TRACT: Gallbladder is not visualized. No evidence of intra or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: Not visualized.RIGHT KIDNEY: No significant abnormalities noted. OTHER: Small amount of ascites.", "output": "Coarse echotexture of the liver. Small amount of ascites."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal LFTs, patient overweight LIVER: Hepatomegaly, liver measures 24 cm in longitudinal dimension. Markedly increased liver parenchymal echogenicity. Main portal vein patent with normal directional flow, velocity measures 20 cm/sec.GALLBLADDER, BILIARY TRACT: Gallbladder unremarkable. No mobile intraluminal echogenic foci seen to suggest underlying cholelithiasis. No secondary signs of acute cholecystitis.PANCREAS: Not well assessed secondary to obscuration by bowel gas.SPLEEN: Splenomegaly, spleen measures 17.6 cm.KIDNEYS: Right kidney measures 10.4 cm, while left kidney measures 12.9 cm. No hydronephrosis. Renal cortical echogenicity within normal limits.OTHER: No significant abnormality noted.", "output": "Markedly increased hepatic parenchymal echogenicity, likely reflecting underlying hepatic steatosis/parenchymal dysfunction.Hepatosplenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C with cirrhosis LIVER: Stable cirrhotic morphology without mass. Liver length 19.7 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. 10.5 cm in length.OTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. Left kidney 9.2 cm in length. Spleen 16.8 cm in length. No ascites.", "output": "Stable cirrhotic morphology without mass. Cholelithiasis without acute inflammation or ductal dilatation. No ascites.Echogenic renal parenchyma suggestive for medical renal disease without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "87-year-old male with proteinuria and chronic kidney disease. Ultrasound guidance was provided for biopsy of right kidney.", "output": "Ultrasound guidance."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old female complains of abdominal pain. Evaluate for cholelithiasis. LIVER:The liver measures 16.1 cm. Liver parenchyma has normal echogenicity. No focal masses, ascites, or intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: Echogenic foci within the lumen of the gallbladder shadow the posterior wall. The wall measures 0.3 cm. No pericholecystic fluid. The common duct measures 0.3 cm. Unable to determine whether gallbladder is distended due to heavy shadows from echogenic foci within the lumen. Negative sonographic Murphy's.PANCREAS: Evaluation limited due to overlying bowel gas and shadows from the gallbladder.SPLEEN: Measures 8.9 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 10.2 cm. Left kidney measures 10.3 cm. The cortices have normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass.OTHER: No significant abnormality noted.", "output": "1. Echogenic foci within the lumen of the gallbladder consistent with cholelithiasis. No evidence of acute inflammation. No ductal dilation. Pancreas unable to be fully visualized on this study as above."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Benign appearing subcentimeter cyst. Right kidney 9.6 cm in length.LEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 9.7 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": "Male 58 years old Reason: look for fluid/abscess around left upper extremity fistula History: h/o bacteremia following hemodialysis - asymptomatic , no erythema or edema Grayscale and color Doppler shows the left forearm fistula with blood flow. No fluid collections were seen in the surrounding soft tissues.", "output": "No evidence of fluid collections in the left forearm. "}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female 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. No suspicious cystic or solid mass is identified.This exam was interpreted by two radiologists.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old male patient with history of alcohol cirrhosis, stable IPMN. Assess for malignancy, worsening portal hypertension. LIVER: The liver measures 12.1 cm in length, demonstrates coarsened hepatic echotexture, and is mildly nodular in contour. There is a hyperechoic lesion within the left hepatic lobe measuring 0.8 x 0.5 x 0.6 cm, previously 0.7 x 0.5 x 0.6 cm. A 1 cm left hepatic lobe cyst is again noted. Main portal vein flow is hepatopetal and measures 0.16 m/sec.GALLBLADDER, BILIARY TRACT: There are gallstones though no 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 of the pancreas demonstrates normal echogenicity. The remaining pancreas is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 9 cm in length and demonstrate increased cortical echogenicity. No evidence of hydronephrosis. OTHER: The left kidney measures 10.4 cm in length and demonstrate increased cortical echogenicity. No evidence of hydronephrosis.The spleen measures 9.4 cm in length.", "output": "1. Cirrhotic morphology of the liver without new suspicious hepatic lesion.2. Cholelithiasis without sonographic evidence of acute cholecystitis. 3. Medical renal disease. "}
{"instruction": "Generate impression based on findings.", "input": "70 year old male patient with epigastric stomach pain reminiscent of past gallstone attack. Question of gallstones. LIVER: The liver measures 19.9 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder contains non-dependent shadowing echogenic foci and dependent non-shadowing material. There is no significant 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. The visualized pancreatic duct is non-dilated.RIGHT KIDNEY: The right kidney measures 11.3 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.2 cm in length. No evidence of hydronephrosis.The spleen measures 13 cm in length. Multiple subcentimeter echogenic foci are noted within the spleen.", "output": "1. Air and biliary sludge within the gallbladder are likely related to the patient's history of gallstone ileus, as seen on prior CTs. No sonographic evidence of acute cholecystitis. 2. Subcentimeter echogenic foci within the spleen are non-specific but likely benign in etiology, possibly representing hemangiomas. "}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 9 cm in lengthLEFT KIDNEY: Echogenic parenchyma without stone. Left kidney 9 cm in length. Abnormal echogenic focus occupying the central portion of the lower pole of the left kidney measuring approximately 3.3 x 3.2 x 4.1 cm. This finding is associated with focal caliectasis presumed secondary to obstruction by the central mass. In retrospect, this lesion may have been present on the 12/16/2012 CT but was considerably less conspicuous and smaller measuring 1.7 x 3.1 cm.OTHER: Bladder nondistended", "output": "Abnormal echogenic focus occupying the central portion of the lower pole left kidney associated with focal caliectasis presumed secondary to obstruction by this mass. A neoplastic etiology, including malignancy either of the collecting system or renal tubules must be excluded.Echogenic parenchyma consistent with medical renal disease/parenchymal dysfunction without significant obstruction.Dr. Stankus notified of findings 12/15/2015; 1:15pm"}
{"instruction": "Generate impression based on findings.", "input": "38-year-old male with pancreatitis and persistent abdominal pain, now trending conjugated bilirubin and LFTs Limited visualization of the solid organs and pancreas due to overlying bowel gasLIVER: Liver measures 20.7 cm, diffuse fatty liver noted. No intrahepatic ductal dilatation.. No definite focal lesions noted.GALLBLADDER, BILIARY TRACT: Gallbladder is well-distended without any focal lesions. Gallbladder wall thickness in the upper limit of normal measuring up to 5 mm probably secondarily inflamed due to pancreatitis. Minimal fluid noted in the Morison's pouch.Common hepatic duct measures up to 3 mm.PANCREAS: Head of the pancreas is visualized appears edematous. Rest of the pancreas not visualized due to overlying bowel gas. Haziness noted within the mid abdomen.KIDNEY: Right kidney measures 11.2 cm the left kidney measures 11 cm. No hydronephrosis. Normal echotexture noted. OTHER: Spleen measures 11.5 cm with normal echo texture.", "output": "Limited visualization of the pancreas and mid abdomen due to overlying bowel gas.Gated matter is head of the pancreas consistent with known pericarditis.Gallbladder wall thickness is secondary to the pancreatitisDiffuse fatty liver noted.Mild ascites"}
{"instruction": "Generate impression based on findings.", "input": "Change in nodules, multinodular goiter RIGHT LOBE MEASUREMENTS: 4.5 x 2.1 x 2.1 cmLEFT LOBE MEASUREMENTS: 5.2 x 1.8 x 2.3 cm ISTHMUS MEASUREMENTS: 9 mmRIGHT LOBE: Partly cystic partly solid nodule in the right mid lobe measures 1.9 x 2.1 x 1.5 cm and is stable from prior study.LEFT LOBE: Stable solid hypoechoic nodule in the left mid lobe measuring 2.4 x 1.5 x 1.4 cm.ISTHMUS: 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 in bilateral thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "45 year old present for follow up ultrasound after abnormal mammogram. A targeted right ultrasound was performed for the mammographic area of concern. There are several adjacent hypoechoic areas in the posterior depth of the right breast near 10:00. This may represent papillomatosis versus focal glandular tissue. The appearance would be unusual for malignancy.", "output": "Hypoechoic areas in the right outer breast are more than likely benign. Follow up options were discussed with the patient at length. Given her strong family history of cancer, she has elected for ultrasound guided biopsy for more definitive evaluation of this area. BIRADS: 3 - Probably benign finding.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female patient with GIB, concern for cirrhosis. Evaluate morphology of the liver. LIVER: The liver measures 13.1 cm in length. Hepatic parenchymal echogenicity is increased and coarsened, which limits sensitivity for detection of subtle lesions. Possible micronodular liver contour. Main portal vein flow is slow but patent and hepatopetal measuring 0.16 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder contains sludge. The gallbladder wall is mildly thickened measuring 5 mm, which is nonspecific in the setting of ascites. No pericholecystic fluid is identified. 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 11.6 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.9 cm in length. No evidence of hydronephrosis.The spleen measures 10.2 cm in length.There is mild ascites and a left pleural effusion.", "output": "1. Increased hepatic echogenicity which may be seen with hepatic steatosis/hepatic parenchymal dysfunction. Possible micronodular liver contour which may be seen in setting of cirrhosis; if there is continued clinical concern, further evaluation with dedicated CT imaging suggested.2. Biliary sludge with mild gallbladder wall thickening which is non-specific in the setting of ascites and liver disease.3. Mild ascites and left pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "Reason: RUQ ultrasound to assess for gallstones or ductal dilation given elevated LFTs LIVER: The liver measures 18.9 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 0.27 m/s.BILIARY TRACT: Sludge is present within the contracted gallbladder without evidence of significant gallbladder wall thickening or pericholecystic fluid. No shadowing gallstones. 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 within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 10.9 cm in length. RIGHT KIDNEY: Kidney measures 11.2 cm in length. Increased parenchymal echogenicity. LEFT KIDNEY: Kidney measures 12.6 cm in length. Increased parenchymal echogenicity. OTHER: Pericardial effusion as seen on recent chest CT.", "output": "1.Gallbladder sludge without specific evidence of acute cholecystitis or biliary ductal dilatation.2.Mild hepatomegaly. Echogenic liver raising the possible of parenchymal dysfunction/fatty infiltration.3.Echogenic kidneys suggesting medical renal disease.4.Pericardial effusion."}
{"instruction": "Generate impression based on findings.", "input": "73 year-old female with abdominal pain and pancreatitis. Are there gallstones? LIVER: Increased echogenicity of the liver is nonspecific, but can be seen in hepatic steatosis. Moderate hepatomegaly. The liver measures 21.2 cm in diameter. Portal vein flow is hepatopetal. Small amount of ascites.GALLBLADDER, BILIARY TRACT: Note is made of numerous punctate dependent gallstones within the gallbladder, including the body and gallbladder neck. There is mild nonspecific gallbladder wall thickening, measuring 3 mm in diameter. Sonographic Murphy sign is negative. The common duct measures 3 mm in diameter. No common duct stones are seen. PANCREAS: The pancreas appears slightly enlarged with decreased echogenicity consistent with the stated history of pancreatitis. The pancreas is partially obscured by overlying bowel gas.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Foley catheter in place.", "output": "1. Findings consistent with the stated history of acute pancreatitis.2. Hepatomegaly with a small amount of ascites.3. Increased echogenicity of the liver is nonspecific, but can be seen in hepatic steatosis.4. Gallstones without evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Female 19 years old Reason: ruq, bedside thickened GB wall, +sonographic murphys LIVER: Partially visualized liver is normal in appearance. Main portal vein is patent with normal directional flow.BILIARY TRACT: Gallbladder is distended with a thickened wall measuring up to 8 mm and pericholecystic fluid. Sludge and small stones are present within the gallbladder. No intra or extrahepatic biliary ductal dilatation. Common bile duct measures 3 mm.OTHER: Free fluid is present. Small pleural effusions.", "output": "Findings consistent with acute cholecystitis. No evidence of common bile duct enlargement or choledocholithiasis."}
{"instruction": "Generate impression based on findings.", "input": "History cholecystitis status post stent placement LIVER: Mildly coarse echogenic liver echotexture without worrisome mass. Hepatic cysts again noted. Liver length 17.5 cm.GALLBLADDER, BILIARY TRACT: Gallbladder sludge associated with diffuse gallbladder wall thickening.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Atrophic renal parenchyma with numerous cysts. 14 cm in lengthOTHER: Atrophic left renal parenchyma with numerous cysts. Left kidney 13 7-m in length. Spleen 11.3 cm in length. Mild ascites.", "output": "Gallbladder sludge associated with diffuse gallbladder wall thickening without ductal dilatation; chronic inflammation is suspected. Mildly coarse echogenic liver character echotexture without worrisome mass suggestive for chronic liver disease. Atrophic kidneys with numerous cysts bilaterally."}
{"instruction": "Generate impression based on findings.", "input": "55 year old female who was recalled from screening mammogram for right outer breast focal asymmetry. Personal history of bilateral benign breast biopsies. Family history of breast cancer in mother. 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, unchanged in pattern and distribution. 6-mm, round mass in the right lower/central with possible correlate in the central right breast posterior depth is noted. A 5-mm oval, partially circumscribed mass in the right upper, outer quadrant posterior depth is also noted that persists on spot compression views which could represent a benign intramammary lymph node. Ultrasound was subsequently performed.Ultrasound:Targeted left breast ultrasound is performed. A possible septated cyst identified in the right breast 8 o'clock position measuring 6 x 4 mm, corresponding to the new mammographic abnormality in question. No apical or peripheral blood flow is noted. In the right upper, outer quadrant a 6 x 4 mm benign intramammary lymph node with central fatty hilum is identified, possibly corresponding to the mammographic stable focal asymmetry in the upper outer quadrant.", "output": "6-mm new mass, right breast 8 o'clock position, with sonographic correlate, most likely representing a septated cyst. Options of a 6 month follow-up versus ultrasound guided cyst aspiration were discussed with the patient. Ultrasound guided cyst aspiration and post procedure mammogram to document resolution is planned.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"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": "64-year-old male with evolving fluid collection in the right lower quadrant status post JP drainage. RIGHT LOWER QUADRANT: There is an irregularly-shaped hypoechoic fluid collection with low-level internal echoes seen measuring 13 cm x 3 cm x 3 cm. Within the fluid collection is a hyperechoic structure representing the drainage catheter. No other abnormalities are noted.", "output": "Redemonstrated fluid collection in the right lower quadrant and drainage catheter seen within the collection."}
{"instruction": "Generate impression based on findings.", "input": "Male, 79 years old. Acute kidney injury RIGHT KIDNEY: The right kidney measures 11.8 cm in length, with increased cortical echogenicity. Multiple cystic lesions are identified. An upper pole simple cyst measures 3.2 x 2.8 x 2.9 cm.LEFT KIDNEY: The left kidney measures 12.2 cm in length with increased cortical echogenicity. Multiple cystic lesions identified. An upper pole simple cyst measures 3.8 x 4.6 x 3.5 cm.OTHER: The bladder is decompressed, with Foley catheter in place. The liver has a markedly heterogeneous appearance, compatible with known metastatic disease. Small ascites.", "output": "1.Increased renal cortical echogenicity, compatible with medical renal disease. Bilateral renal cysts better evaluated on prior CT imaging. No hydronephrosis.2.Multiple hepatic metastases. Small volume ascites."}
{"instruction": "Generate impression based on findings.", "input": "History of high calcium and nephrolithiasis. Evaluate for parathyroid adenoma. RIGHT LOBE MEASUREMENTS: 5.6 x 1.9 x 1.9 cmLEFT LOBE MEASUREMENTS: 6.1 x 2.0 x 1.6 cmISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: The right thyroid lobe parenchyma is normal in echogenicity. Along the dorsal aspect of the inferior right thyroid lobe pole is a 8 mm hypoechoic oval lesion with central echogenicity most compatible with a benign appearing lymph node.LEFT LOBE: The left thyroid lobe parenchyma is normal in echogenicity. A 6 mm cyst is 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 lesion suspicious for a parathyroid adenoma is visualized. Note is made of a benign lymph node along the dorsal aspect of the inferior right thyroid lobe with a fatty hilum."}
{"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. Multiple simple cysts are identified bilaterally. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - Benign.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"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": "58-year-old female patient with thyromegaly. RIGHT LOBE MEASUREMENTS: 5.3 x 1.4 x 1.9 cm.LEFT LOBE MEASUREMENTS: 9.4 x 4.5 x 3.9 cm.ISTHMUS MEASUREMENTS: 5 mm in thickness.RIGHT LOBE: The right thyroid lobe is heterogeneous in echogenicity containing multiple small cystic spaces. There is exophytic right lower pole thyroidal tissue measuring 1.1 x 0.7 x 0.7 cm.LEFT LOBE: The left thyroid gland is largely replaced by a heterogeneous, solid and cystic nodule with multiple echogenic foci, some of which demonstrate ringdown artifact suggesting colloid. This nodule measures 7.9 x 5.2 x 5.0 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is a benign morphology right level three lymph node. Additional lymph nodes are noted in the left level three and four stations measuring up to 2.6 x 0.9 x 0.5 cm. OTHER: No significant abnormality noted.", "output": "1. Dominant complex left thyroid nodule.2. No dominant thyroid lesion on the right. "}
{"instruction": "Generate impression based on findings.", "input": "24-year-old female with right breast lump for 2 months. With physical exam at right 12:00 position near the nipple, no discrete mass was palpated. Focused ultrasound was performed. There are no solid or cystic lesions in the area of concern. There is a small area of mild inflammation in the fatty tissue.", "output": "No sonographic evidence for malignancy. Palpable abnormality should be managed clinically. There is a small area of mild inflammation in the right breast near the nipple. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male patient with elevated creatinine. Reevaluate hydronephrosis. RIGHT KIDNEY: The right kidney is absent.LEFT KIDNEY: The left kidney measures 13.0 cm in length and demonstrates increased renal cortical echogenicity. Mild hydronephrosis is unchanged from the prior study.URINARY BLADDER: The bladder is decompressed with a Foley catheter.OTHER: No significant abnormalities noted.", "output": "Medical renal disease with unchanged mild left hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Known left breast masses presents for follow-up. A targeted left ultrasound was performed for the known masses. Left breast mass at 7:00 is circumscribed and anechoic compared to background, measuring 8 x 8 mm, not significantly changed. Left breast mass at 6:00 is mixed echogenicity with areas of hyperechoic tissue, suggesting fat necrosis. This measures 7 x 7 mm, not significantly changed. An alternative possibility is that this represents normal glandular tissue, but certainly a suspicious morphology mass is not present. Additional hypoechoic circumscribed mass at the 5:00 position measures 4 x 4 mm, slightly smaller than prior measurements.", "output": "No suspicious change in left breast masses. Given the short-term stability and typically benign appearance, further follow-up in the short-term is recommended. Please consider a 6 month ultrasound follow-up. The patient will see Dr. Barrera today as well. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for enlarging thyroid nodule History: history of thyroid nodule RIGHT LOBE MEASUREMENTS: 5.2 x 1.7 x 1.2 cmLEFT LOBE MEASUREMENTS: 5.2 x 1.5 x 1.0 cmISTHMUS MEASUREMENTS: 0.1 cmRIGHT LOBE: Three small benign appearing subcentimeter nodules, the largest of which measures 0.3 x 0.2 x 0.2 cm. The gland appears mildly heterogeneous.LEFT LOBE: Mildly heterogeneous thyroid gland.ISTHMUS: Mildly heterogeneous thyroid gland.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted. No regional adenopathy.OTHER: No significant abnormality noted.", "output": "Small subcentimeter benign appearing thyroid nodules and mildly heterogenous gland without regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Difficulty swallowing RIGHT LOBE MEASUREMENTS: 3.4 x 1.9 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.2 x 2 x 0.8 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: 0.6 x 0.3 x 0.5 cm lower pole hypoechoic noduleISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Normal sized thyroid gland. Subcentimeter hypoechoic lower pole left thyroid nodule. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Rule out cholestasis History: pruritis, pregnancy LIVER: The liver measures 13.7 cm in length. Normal parenchymal echogenicity and echotexture. The portal vein is patent with normal directional hepatopedal flow, peak velocity is 31.6 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. The gallbladder wall measures 0.3 cm. The common bile duct measures 0.3 cm. No biliary ductal dilatation.PANCREAS: The body and tail are obscured by bowel gas. No significant abnormalities noted.KIDNEYS: The right kidney measures 10.5 cm in length. The left kidney measures 10.4 cm in length. No hydronephrosis or shadowing stones.OTHER: No significant abnormalities noted.", "output": "No acute hepatobiliary abnormality."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old male with history of tonsillar carcinoma, now with palpable lymph node. A focused examination was performed in the region of the palpable abnormality just superior to the right clavicle at the base of the neck laterally. In this location there is a rounded, mildly hypoechoic solid lymph node measuring 0.7 x 0.9 x 1 cm. This appears to have abnormal vasculature.", "output": "Highly suspicious right supraclavicular lymph node. This would be amenable to fine-needle aspiration."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female patient with newly diagnosed invasive ductal carcinoma of the left breast. Patient has a history of right breast fibroadenoma in 1992. Patient palpated two masses in the L breast in 5/2015. DIAGNOSTIC MAMMOGRAM AND ULTRASOUND", "output": "1. Index cancer in the left breast breast 12:00 position measures up to 2.5 cm.2. Satellite mass that underwent biopsy in the upper outer quadrant of the left breast also compatible with malignancy. Note that the clip from this biopsy does not correspond to the additional area of microcalcifications on mammography. 3. Additional findings in the left breast suspicious for malignancy include: -Clustered pleomorphic calcifications seen on mammogram that likely correspond to the 6 x 9 mm enhancing mass in the left breast 12:00 position on MRI. -5 x 4 mm enhancing nodule in the left breast near the 8-o'clock position. -Further work up with targeted ultrasound and biopsies (12:00: US versus stereotactic biopsy; 8:00 US versus MRI biopsy) should be considered if it would change the surgical plan. 4. 7 x 5 mm focus of enhancement along the superior lateral left breast with skin hyperenhancement, may represent postbiopsy changes. Correlation with physical exam findings is recommended.5. No areas of abnormal enhancement in the right breast or bilateral axilla.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "87-year-old man with left calf swelling. Assess for abscess, hematoma or fluid collection. There is subcutaneous soft tissue thickening and edema with thickening of the intralobular septa extending from a few centimeters below the knee to just above the ankle. These findings are also present on the right, however with less soft tissue thickening, on the right. There is no hematoma or focal fluid collection. The subcutaneous tissues of the left calf demonstrate increased in vascular flow on color Doppler.", "output": "Bilateral subcutaneous edema. Skin and subcutaneous tissue thickening with increased vascularity on the left is compatible with cellulitis."}
{"instruction": "Generate impression based on findings.", "input": "Female 55 years old; Reason: evaluation of thyroid nodule seen on CT. RIGHT LOBE MEASUREMENTS: 5.6 x 2.0 x 2.2 cmLEFT LOBE MEASUREMENTS: 5.7 x 3.1 x 2.5 cmISTHMUS MEASUREMENT: 0.5 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Enlarged heterogenous thyroid gland, with solid and hypoechoic heterogenous dominant nodule measuring 3.7 x 2.5 x 1.9 cm. No microcalcifications. Peripheral vascularity is present.ISTHMUS: No significant abnormality noted.LYMPH NODES: Prominent right level 3 benign-appearing lymph node measures 1.5 x 0.9 x 0.3 cm. Prominent left level 3 benign-appearing lymph node measures 1.6 x 1.1 x 0.5 cm.OTHER: No significant abnormality noted.", "output": "Large left heterogenous thyroid gland with dominant heterogenous solid and hypoechoic nodule demonstrating peripheral vascularity and no microcalcifications. This is amenable to fine-needle aspiration if clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "Multiple thyroid nodules, evaluate for interval change RIGHT LOBE MEASUREMENTS: 3.7 x 1.2 x 1.7 cmLEFT LOBE MEASUREMENTS: 2.7 x 1.3 x 1.7 cmISTHMUS MEASUREMENTS: 12 mmRIGHT LOBE: Small hypoechoic nodule in the lower pole is unchanged from prior study and measures 1 x 0.7 x 0.8 cm, previously measured 0.8 x 0.7 x 1 cm.LEFT LOBE: A small hypoechoic nodule is noted in the mid pole of the left lobe measuring 1.4 x 0.7 x 1 cm, mostly unchanged from prior study when it measured 1.2 x 0.8 x 1 cmISTHMUS: 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 in the size of small thyroid nodules bilaterally"}
{"instruction": "Generate impression based on findings.", "input": "Reason: HPT. Assess for parathyroid adenoma. History of thyroid nodule that was biopsied in the past. RIGHT LOBE MEASUREMENTS: 4.0 x 1.4 x 0.7 cmLEFT LOBE MEASUREMENTS: 3.9 x 1.2 x 1.3 cm.ISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: Diffusely heterogeneous thyroid gland. No discrete nodules or masses.LEFT LOBE: Diffusely heterogeneous thyroid gland. Exophytic lesion in the inferior aspect of the left thyroid lobe measures 0.8 x 0.7 x 0.9 cm likely represents a benign colloid nodule.ISTHMUS: Diffusely heterogeneous thyroid gland. No discrete nodules or masses.PARATHYROID GLANDS: Well-defined hypoechoic extrathyroidal lesion projecting inferiorly to the right thyroid lobe measures 0.5 x 0.5 x 0.3 cm and is favored to represent suspected parathyroid adenoma.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Extrathyroidal lesion projecting inferior to the right thyroid lobe is consistent with a parathyroid adenoma candidate.Heterogeneous thyroid gland suggestive of chronic thyroiditis."}
{"instruction": "Generate impression based on findings.", "input": "28 years old, Male, Reason: r/u infectious process in liver History: elevated transaminases, distended abdomen, severe immunocompromise Ultrasound evaluation is somewhat limited due to patient being unable to lay in a decubitus position.LIVER: The liver measures 14.5 cm in length. Diffusely increased echogenicity of the liver is consistent with fatty infiltration. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.4 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 in the visualized portions of the pancreas. SPLEEN: Spleen is not well visualized. The visualized portion of the spleen measures 9.15 cm in length. RIGHT KIDNEY: Kidney measures 11.9 cm in length. Normal echotexture. Nohydronephrosis or shadowing calculus.LEFT KIDNEY: The left kidney is not well visualized. Kidney measures 12 cm in length. Normal echotexture. Left renal cyst which is difficult to fully characterize due to limited visualization measures 3.8 x 3.3 x 4.1 cm.OTHER: No significant abnormalities noted.", "output": "1.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis.2.Diffusely increased echogenicity of the liver is consistent with fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old female with renal transplant. Acute renal insufficiency and diarrhea. Renal transplant: Renal transplant is present in the right iliac fossa, measuring 12.8 cm in length. No hydronephrosis, shadowing calculus or mass. Echotexture appears normal.OTHER: Bladder is empty. No fluid collections.", "output": "Normal-appearing transplant."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Non-cirrhotic liver morphology. Mildly coarsened parenchymal echogenicity. 16.7 cm in length. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Adenomyomatosis noted. 3 mm gallbladder polyp identified. Otherwise unremarkable 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 9.2 cm in length. The left kidney is 10.3 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 9.1 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.", "output": "Mildly coarsened hepatic echogenicity, compatible with parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Male 73 years old; Reason: 73M recent scrotal abscess s/p I\\T\\D with rising LFTs, eval for liver pathology History: as above LIVER: The liver measures 7.0 cm in length. There is 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. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.5 mm. There is echogenic material in the gallbladder that could represent sludge or stones.. No pericholecystic fluid. The common bile duct measures 4.7 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: Evaluation spleen is limited on this study.RIGHT KIDNEY: The right kidney measures 10.1 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 9.6 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: There are trace bilateral pleural effusions study.", "output": "1. Increased echotexture of liver consistent with diffuse parenchymal dysfunction/fatty infiltration. No masses.2. Increased echogenicity of kidneys consistent with medical renal disease/parenchymal dysfunction.3. Sludge or stones in the gallbladder without signs of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Female; 24 years old. Reason: Twenty Four Year Old Female Perinatal HIV Infection with CD4 220 plus Left Thyroid Nodule for two years. RIGHT LOBE MEASUREMENTS: 5.7 x 2.2 x 2.1 cmLEFT LOBE MEASUREMENTS: 5.7 x 1.5 x 1.6 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: The dominant nodule in the inferior pole measures 2.4 x 1.5 x 1.6 cm. It is mixed solid and cystic with foci of increased echogenicity suggestive of focal colloid or microcalcification. There is a second nodule more superiorly with a similar appearance as well as the suggestion of other similar appearing underlying nodules. Adjacent to the anterior pole nodule is a macrocalcification with a hypoechoic rim measuring 0.5 x 0.3 x 0.4 cm.LEFT LOBE: The dominant nodule in the left lobe measures 1.7 x 1.2 x 1.3 cm, it is predominantly solid with cystic components solid and cystic and foci of increased echogenicity suggestive of colloid.ISTHMUS: In the left isthmus knee there is a 1.5 x 0.3 x 0.8 cm hyperechoic, solid nodule without calcification. This nodule is palpable, reported by the patient.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Prominent lymph nodes with fatty hila are seen in the bilateral cervical chains.", "output": "1.Bilateral thyroid nodules. A dominant nodule in the right lobe is amenable to ultrasound guided biopsy.2.The palpable left isthmus nodule does not meet definite imaging criteria for biopsy and can be followed."}
{"instruction": "Generate impression based on findings.", "input": "84-year-old female with history of intracystic capillary carcinoma on hormonal therapy. Annual follow-up surveillance. Limited mobility of the patient, ultrasound performed in sitting position.A targeted right ultrasound was performed for the patient\u2019s area of concern. In the 9:00 radian 5 cm from the nipple there is redemonstration of a isoechoic mass. The previously present cystic components have resolved. The mass now measures 1.0 x 0.7 x 1.5 cm, (previously 3.2 x 3.6 x 3.8 cm). There is persistent mild internal vascularity.", "output": "Interval decrease in size of right breast mass corresponding to the patient's biopsy-proven intracystic papillary carcinoma. The cystic components are most notably reduced.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate previously seen renal lesions. LIVER: The liver is normal in morphology and mildly coarse in echotexture. No focal lesion. It measures 15 cm in craniocaudal length. Normal hepatopedal portal venous blood flow at 29 cm/s.BILIARY TRACT: Cholelithiasis within a normally distended gallbladder without wall thickening, pericholecystic fluid or focal tenderness.No biliary ductal dilatation with the common duct measuring 3 mm.PANCREAS: Suboptimal evaluation of the pancreatic head and body is unremarkable. The remainder is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 12.4 cm in length without a focal lesion.RIGHT KIDNEY: Mild cortical thinning and echogenicity. The right kidney measures 11.6 cm. In the interpolar region there is an isoechoic round mass measuring 4.1 x 3.5 x 4.4 cm demonstrating internal vascularity. An adjacent 3.3 x 2.6 x 4.8 cm hypoechoic lesion with enhanced through transmission, a probable cyst.OTHER: The left kidney measures 12.3 cm in length with mild cortical thinning and echogenicity. Note is made of a 2.9 x 1.6 x 2.9 cm simple appearing cyst.", "output": "4.4 cm right interpolar round isoechoic mass with internal vascularity is suspicious for a renal neoplasm. Bilateral simple appearing cysts are also noted."}
{"instruction": "Generate impression based on findings.", "input": "Recently treated for epididymitis RIGHT TESTIS: 5.2 x 2.2 x 3.6 cm. No intratesticular mass. Bilateral symmetric Doppler flow characteristicsLEFT TESTIS: 4.6 x 2.4 x 3.3 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristicsRIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Small right hydrocele", "output": "Negative scrotal ultrasound. No evidence for intratesticular mass or acute inflammatory process. Bilaterally symmetric Doppler flow characteristics."}
{"instruction": "Generate impression based on findings.", "input": "Female 75 years old; Reason: history thyroid cancer, s/p total thyroidectomy and neck dissection for poorly diff carcinoma 2012 History: history thyroid cancer, s/p total thyroidectomy and neck dissection for poorly diff carcinoma 2012 The patient is status post total thyroidectomy.THYROIDECTOMY BED: No suspicious lesions are seen within the thyroidectomy bed suggesting recurrence.LYMPH NODES: No suspicious adenopathy noted. Small subcentimeter lymph nodes are seen with a fatty hilum. PARATHYROID GLANDS: No significant abnormalities", "output": "Stable thyroid exam status post total thyroidectomy. No evidence of recurrent disease or suspicious lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old female presents with right upper quadrant pain. Evaluate for hepatobiliary pathology. LIVER:Measures 18.7 cm. Increased, coarse echogenicity of the parenchyma. No focal mass, ascites, or intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended and the anechoic lumen. No pericholecystic fluid, stones, or sludge. The gallbladder wall measures 0.1 cm. The common hepatic duct measures 0.4 centers. Negative sonographic Murphy's sign.PANCREAS: Evaluation of the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 8.2 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 10.6 cm. Left kidney measures 9.5 cm. Unremarkable echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "1. Increased and coarse echotexture of the liver consistent with chronic liver disease and fatty infiltration/parenchymal dysfunction.2. No sonographic evidence of cholelithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Echogenic coarse liver parenchyma without mass. Liver length 20.8 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or duct dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.8 cm in length OTHER: Left kidney 11.7 cm in length. Spleen 13.9 cm in length. No ascites.", "output": "Hepatomegaly with echogenic coarse liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Cholelithiasis without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Male 58 years old Reason: Please eval the Right Upper Arm for Abscess/Soft tissue collection, nearby/ associated with the AV-Graft History: admitted with sepsis, MRSA bacteremia. Reports some swelling and 'infiltration\" at dialysis after accessing his RUE AV Graft. Graft is patent.At least 3 discrete nodular areas correspond to areas of dilated vascular spaces containing swirling blood and blood flow with arterial pulsation concerning for pseudoaneurysms. 3 discrete sites are found and measured.No loculated fluid collections separate from the above structures are seen to suggest abscess.", "output": "3 foci consistent with pseudoaneurysms . No evidence of abscess to explain bacteremia."}
{"instruction": "Generate impression based on findings.", "input": "Female 41 years old; Reason: r/o adenopathy, recurrence History: h/o thyroid cancer RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENT: Status post thyroidectomy.RIGHT LOBE: Small hypoechoic focus measuring 1.0 x 0.3 x 0.3 cm is noted in the right thyroid lobe bed. No microcalcifications or vascularity is noted. In retrospect this was present on the previous study and is unchanged since prior exam.LEFT LOBE: Small hypoechoic focus and is unchanged as compared to the prior exam, measuring 0.3 x 0.2 x 0.1 cm. No microcalcifications or vascularity.ISTHMUS: Patient status post thyroidectomy. No suspicious nodules or masses.LYMPH NODES: No significant lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Stable ultrasound examination with no significant change in bilateral hypoechoic foci in thyroid bed."}
{"instruction": "Generate impression based on findings.", "input": "Newly elevated bilirubin and INR, evaluate for choledocholithiasis LIVER: Diffuse coarse echotexture of the liver is noted, which approximately measures 23.5 cm. Enlarged liver. No evidence of intrahepatic biliary ductal dilatation.BILIARY TRACT: Gallbladder wall thickened. Cannot assess Murphy's sign as patient is intubated. Common hepatic duct appears mildly dilated measuring up to 1 cm without definite evidence evidence of stones. No evidence of gallstones.OTHER: Mild ascites.", "output": "Coarse echotexture of the liver, enlarged liver, suspicious for parenchymal dysfunction.Thickened wall of the gallbladder secondary to adjacent ascites, CBD is mildly dilated without definite evidence of stones. If clinically warranted, MRCP can be performed for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old male with abdominal distention. Evaluate for ascites. Grayscale and color limited abdominal ultrasound demonstrates moderate abdominal ascites without loculation. Splenomegaly is incompletely visualized.", "output": "1. Moderate ascites. 2. Splenomegaly incompletely visualized. "}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female patient with goiter. Assess thyroid nodules. RIGHT LOBE MEASUREMENTS: 7.2 x 4.9 x 3.8 cm.LEFT LOBE MEASUREMENTS: 7.1 x 2.8 x 2.4 cm.ISTHMUS MEASUREMENTS: 1.4 cm in thickness.RIGHT LOBE: The right thyroid lobe is heterogeneous and near completely replaced by a 4.6 x 2.9 x 5.5 cm mostly solid nodule with cystic spaces and coarse calcification.LEFT LOBE: The left thyroid lobe is heterogeneous and contains a cystic nodule near the isthmus. No suspicious dominant thyroid nodules are identified. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Dominant solid right thyroid nodule with coarse calcification, which is amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Rising creatinine RIGHT KIDNEY: Echogenic parenchyma again noted without worrisome mass, stone, or hydronephrosis. Stable right renal cysts. Right kidney 13.2 cm in lengthLEFT KIDNEY: Echogenic parenchyma again noted without worrisome mass, stone, or hydronephrosis. Stable left renal cyst. Left kidney 12.8 cm in lengthOTHER: Bladder nondistended", "output": "Echogenic renal parenchyma again noted consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male with weight loss. Evaluate status of thyroid gland anticipation of lung transplant. RIGHT LOBE MEASUREMENTS: 5.1 cm x 2.1 cm x 2.2 cm LEFT LOBE MEASUREMENTS: 5.1 cm x 1.4 cm x 2.6 cmISTHMUS MEASUREMENTS: 4 mm in thicknessRIGHT LOBE: Hypoechoic solid nodule in the midpole measures 7 mm x 8 mm x 6 mm with no definite microcalcifications or internal vascularity. Additional hypoechoic, solid nodule at the inferior pole measures 1.5 cm x 1.1 cm x 1.5 cm with peripheral vascularity and no definite microcalcifications.LEFT LOBE: 1.0-cm cyst at the inferior pole is noted.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 nodules. Dominant solid nodule in the right inferior pole is amenable to biopsy if clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female patient with elevated LFTs. Question of any architectural abnormality in the liver. LIVER: The liver measures 20.3 cm in length. Hepatic parenchymal echogenicity is increased. There is a 6.0 x 6.8 x 6.4 cm right hepatic cyst. An additional 2.8 cm hepatic cyst is noted. 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 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 12.6 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.3 cm in length. There is mild left hydronephrosis.The spleen measures 10.7 cm in length.", "output": "1. Hepatic steatosis.2. Two simple hepatic cysts.3. Mild left hydronephrosis. Findings discussed with J. Reyes-Genere via telephone prior to dictation."}
{"instruction": "Generate impression based on findings.", "input": "Renal failure. History of RCC RIGHT KIDNEY: 11.0 cm in length. Echogenic renal parenchyma. No focal lesions, renal stones, or hydronephrosis. Minimal cortical deformity with adjacent perinephric linear echogenicity likely reflects prior ablation.LEFT KIDNEY: 11.4 cm in length. Echogenic renal parenchyma. No focal lesions, renal stones, or hydronephrosis.BLADDER: The patient is post void. No significant abnormalities noted.OTHER: No significant abnormalities noted. No significant abdominal ascites is noted.", "output": "1. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease.2. Findings compatible with prior right renal ablation."}
{"instruction": "Generate impression based on findings.", "input": "76 year old female with family history of thyroid cancer. History of thyroid nodules, new nodule per patient report. RIGHT LOBE MEASUREMENTS: 1.9 cm x 1.5 cm x 4.1 cmLEFT LOBE MEASUREMENTS: 1.2 cm x 1.1 cm x 4.0 cmISTHMUS MEASUREMENTS: 1 mm in thickness.RIGHT LOBE: Three predominantly solid nodules are again seen. Dominant nodule at the midpole laterally measures 1.6 cm x 1.0 cm x 0.8 cm, previously measured 1.7 cm x 1.0 cm x 1.0 cm and contains echogenic foci with posterior acoustic shadowing similar to prior study. Nodule at the upper pole measures 9 mm x 8 mm x 4 mm, previously 9 mm x 8 mm x 7 mm. Nodule at the inferior pole measures 0.7 cm x 0.5 cm x 1.1 cm, previously measured 1.0 cm x 1.0 cm x 0.6 cm.LEFT LOBE: Two nodules are again seen. Predominant solid nodule at the lower pole measures 6 mm x 6 mm x 8 mm, previously 7 mm x 6 mm x 5 mm. Additional predominantly solid nodule at the lower pole measures 4 mm x 3 mm x 2 mm, previously 4 mm x 3 mm x 2 mm.ISTHMUS: Predominantly solid nodule along the right side of the isthmus measures 1.1 cm x 0.7 cm x 0.5 cm, previously 1.0 cm x 0.7 cm x 0.4 cm. PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right neck level 2/3 benign appearing lymph node measures 1.2 cm x 1.0 cm x 0.5 cm. Additional right neck level 2/3 benign appearing lymph node measures 1.8 cm x 1.2 cm x 0.5 cm. Left neck level 2/3 benign appearing lymph node measures 8 mm x 6 mm x 3 mm. No pathologic lymphadenopathy. OTHER: No significant abnormality noted.", "output": "Bilateral thyroid nodules unchanged. "}
{"instruction": "Generate impression based on findings.", "input": "24-year-old male with a history of testicular malignancies status post orchectomy now with subjective perceived growth of the remaining testicle. RIGHT TESTIS: The patient is status post colectomy.LEFT TESTIS: The left testicle measures 3.1 x 3.3 x 2.8 cm. No masses visualized within the left testicle. Vascular flow is without abnormality. Large left, bland hydrocele.RIGHT EPIDIDYMIS: Patient is status post orchiectomy.LEFT EPIDIDYMIS: The left epididymis measures 0.7 x 0.7 x 0.3 cm. Vascular flow remains intact.OTHER: No significant abnormalities noted.", "output": "1. Patient is status post right orchiectomy.2. The left testicle appears without mass and vascular flow is intact. Large, bland left hydrocele."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess for liver dysfunction History: elevated liver enzymes, history of hepatitis C LIVER: The liver measures 14.3 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 0.24 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 3 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 12.3 cm in length. RIGHT KIDNEY: Kidney measures 11.5 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": "Increased hepatic echogenicity suggestive of parenchymal dysfunction/fatty infiltration without focal masses identified. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 49 years old Reason: elevated lfts, distended abdomen; assess for ascites or liver abnormality History: confusion, elevated lft LIVER: Liver measures slightly large at 18.6 cm. Echogenicity is within normal limits. No focal hepatic mass. No evidence of cirrhosis. Mild perihepatic ascites is present. Main portal vein is patent with normal directional flow and a peak velocity of 36 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Common bile duct measures 2 mm. Patient is status post cholecystectomy.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: Spleen is not visualized, likely autoinfarcted or removed.KIDNEYS: The right and left kidney are atrophic and echogenic. Right kidney measures 7.2 cm. Left kidney measures approximately 10 cm. Visualization of the kidneys is difficult secondary to patient's body habitus.OTHER: No significant abnormalities noted.", "output": "1.Hepatomegaly without evidence of cirrhosis or focal mass.2.Mild perihepatic ascites.3.Atrophic and echogenic kidneys."}
{"instruction": "Generate impression based on findings.", "input": "Right breast fibroadenoma, assess stability. Patient indicates palpable mass right breast which she feels has decreased in size. A targeted right ultrasound was performed for the palpable area of concern. Ultrasound demonstrates the reference bilobed, or perhaps 2 adjacent small masses, at the 10 o'clock position. The hypoechoic encapsulated mass measures 2.3 x 1.2 x 2.5 cm, previously 2.5 x 1.2 x 2.4, not significantly changed when compared to the prior study. Peripheral and internal vascularity is identified on Doppler interrogation. There are no new masses noted.", "output": "No significant interval change in the reference right breast mass consistent with the patient's history of a fibroadenoma. Clinical correlation is indicated. These findings conveyed to the patient and her mother who reported the patient is to be seen in the breast surgery clinic today.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Enlarged appearing liver during C-section LIVER: No significant abnormalities noted. Liver length 16.7 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.4 cm in lengthOTHER: Left kidney 10.4 cm in length. Spleen 10.6 cm in length. No ascites.", "output": "Negative right upper quadrant ultrasound. Specifically, no evidence for hepatobiliary abnormality. Normal size liver."}
{"instruction": "Generate impression based on findings.", "input": "59 years old, Male, Reason: 59M with rectal ca s/p right hepatectomy now with GI bleeding. Evaluate portal vein. History: Evaluate portal vein patency LIVER: The liver measures approximately 10.3 cm in length. Echogenicity of the liver parenchyma is within normal limits.No focal hepatic lesions or masses are identified. Loculated perihepatic fluid collection is present.", "output": "1.Perihepatic loculated fluid collection.2.Mild amount of ascites is present.3.Extrahepatic main portal vein appears patent with normal hepatopedal flow without visualization of intrahepatic vessels due to the technically difficult exam."}
{"instruction": "Generate impression based on findings.", "input": "75 years old, Female, Reason: rule out thyroid nodules History: none RIGHT LOBE MEASUREMENTS: 4.3 x 1.4 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.2 x 2.0 by 2.4 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Multiple nodules on the right some of which are calcified. The lower calcified nodule measures 1.0 x 0.6 x 0.7 cm.LEFT LOBE: Multiple nodules on the left. Inferior medial solid appearing nodule along the left isthmus measures 2.1 x 1.3 x 1.7 cm and is amenable to biopsy. Another left thyroid nodule is mixed cystic and solid in appearance measuring 1.5 x 1.2 cm and is also 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.Multiple subcentimeter right thyroid nodules, some of which are calcified.2.Multiple left thyroid nodules which are amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Fifth finger injury The central slip is visualized inserting upon the tuberosity at the base of the middle phalanx dorsally and there is no evidence of central slip disruption. The tendon appears slightly enlarged and edematous which may represent a mild strain, but this is equivocal. The overlying subcutaneous soft tissues also appear edematous. The ulnar collateral ligament appears edematous, perhaps representing a mild sprain.", "output": "Possible mild edema of the central slip extensor tendon but without evidence of tear."}
{"instruction": "Generate impression based on findings.", "input": "Call back from screening mammogram for multiple new masses in both breasts. On the recent screening mammogram, there are multiple masses in both breasts. Some are stable in comparison to the old mammograms. An ML view and two spot compression views of the left breast were performed. A focal asymmetry at 12:00 position in the left breast partially disperses. Whole breast ultrasound was performed for both breasts. There are multiple echogenic lesions in both breasts, likely corresponding to the multiple masses on mammogram. All of these lesions are located superficially, and mild increased blood flow is associated. The largest lesion is at 1:00 position in the right breast, measuring 20 x 8 mm, and at 10:00 in the left breast, measuring 14 x 7 mm. They are likely benign, such as fat necrosis. Short term follow up is recommended.", "output": "Multiple bening appearing lesions in both breasts, likely fat necrosis. Bilateral diagnostic mammogram in 6 months is recommended. 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": "Female 68 years old Reason: 68 y/o female w/ palpable \"knot\" in left upper extremity/arm/shoulder. History: Please Evaluate for Composition. Focused ultrasound performed over the dorsal left upper extremity in the region of the triceps muscle. No focal mass or other abnormality is identified. Symmetric appearance of the right and left triceps region.", "output": "No sonographic abnormality is identified in the area of clinical concern."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Torres is a 48 year old female with known bilateral cysts. She 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. Numerous benign simple and complicated cysts are identified bilaterally. No suspicious cystic or solid mass is identified.This exam was interpreted by two radiologists.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Zhang is a 22-year-old female presenting with left breast pain for the past 3 to 4 days. However, on examination today, patient states that the pain is no longer present. Upon physical exam at the patient's area of concern, no discrete mass is appreciated.A targeted left breast ultrasound was performed for the patient\u2019s area of concern. In the left breast 3 o'clock location, approximately 2 cm from the nipple, no suspicious cystic or solid mass is identified.", "output": "No sonographic evidence for malignancy. Patient should follow-up with her primary care physician as clinically warranted.BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "54 years old, Male, Reason: ?AKI vs CKD, eval for obstruction History: see above RIGHT KIDNEY: Kidney measures 13.2 cm in length. The right kidney is diffusely echogenic indicating medical renal disease. Simple appearing right renal cyst is present measuring 1.2 x 1.2 x 1.3 cm.LEFT KIDNEY: Kidney measures 12.2 cm in length. Increased echogenicity of the left kidney is consistent with medical renal disease. No hydronephrosis, shadowing calculus or mass.BLADDER: No significant abnormalities. OTHER: No significant abnormalities noted.", "output": "1.No evidence of hydronephrosis or shadowing calculus.2.Diffusely increased echogenicity of the kidneys bilaterally is consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Bilateral hydronephrosis with ureteral stent placement. Septic shock. RIGHT KIDNEY: 11.5 cm in length. Increased renal parenchymal echogenicity. 10 mm simple appearing cyst noted in the inferior pole. Subcentimeter echogenic focus in the inferior pole may represent a nonobstructing stone or a portion of the ureteral stent. No suspicious lesions are evident. No hydronephrosis.LEFT KIDNEY: 11.0 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: Collapsed with Foley catheter identified.OTHER: Subcentimeter cholelithiasis without sonographic evidence of cholecystitis. Echogenic liver, partially imaged.", "output": "1. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease.2. Cholelithiasis without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain with leukocytosis LIVER: No significant abnormalities noted. 14.2 cm in lengthGALLBLADDER, BILIARY TRACT: Cholelithiasis with mild gallbladder wall thickening. No pericholecystic fluid. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. 8.6 cm in lengthOTHER: No ascites", "output": "Cholelithiasis with mild gallbladder wall thickening. No ductal dilatation. No strong evidence to suggest acute cholecystitis; however chronic inflammation of the gallbladder cannot be excluded.Echogenic right renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Albarek is a 62 year old female with a personal history of right breast core biopsy, benign in etiology in 2013. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. 2 additional spot magnification views of the right breast were performed. The breast parenchyma is composed of scattered fibroglandular density (BiRads Density Category B), unchanged in pattern and distribution.At about the 3:00 position, posterior depth of the right breast is a cluster of suspicious microcalcifications spanning approximately 9 mm, new from prior examination.", "output": "9 mm span of microcalcifications within the posterior depth of the right breast as above. Stereotactic biopsy is recommended for further evaluation. Results and recommendation were discussed with the patient and patient's daughter.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "21-year-old female with history of abdominal pain status post cholecystectomy. LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. The common bile duct is normal in caliber without evidence of choledocholithiasis. The gallbladder fossa is somewhat heterogeneous, consistent with postoperative changes. An echogenic focus in the gallbladder fossa demonstrates posterior shadowing but no twinkling, and may represent a surgical clip or less likely a small stone. There is no surrounding fluid collection. PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No abnormal fluid collections are identified.", "output": "Postoperative changes of cholecystectomy without specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Right hydrocele RIGHT TESTIS: 3.8 x 4.8 x 1.5 cm. No worrisome intratesticular mass. Subcentimeter peripheral benign cyst. Bilaterally symmetric Doppler flow characteristics.LEFT TESTIS: 3.7 x 2.6 x 4.1 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristicsRIGHT EPIDIDYMIS: Epididymal cysts.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Bilateral moderate hydroceles. Left hydrocele demonstrates internal complexity.", "output": "No worrisome intratesticular mass. Bilaterally symmetric Doppler flow characteristics. Right epididymal benign cysts. Bilateral moderate hydroceles. Left hydrocele demonstrates internal complexity which can be seen as sequela of prior inflammatory or traumatic mechanisms."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Coarse heterogeneous echotexture again noted without mass. Liver length 14.7 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: Cholelithiasis again noted without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted. Noted.RIGHT KIDNEY: No significant abnormalities noted. 9.9 cm in length.OTHER: Stable left renal cyst. Left kidney 10.3 cm in length. Spleen 9.6 cm in length. No ascites.", "output": "Coarse heterogeneous liver echotexture consistent with chronic liver disease without mass or ductal dilatation. Cholelithiasis unchanged without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female patient with postprandial abdominal pain. Evaluate for gallstones, sludge, common duct stones. LIVER: The liver measures 13.1 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.15 m/sec.GALLBLADDER, BILIARY TRACT: There is layering sludge within the gallbladder. No obvious gallstones are identified, although very small stones may not produce a shadow. There is no no 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 head and body of the pancreas demonstrate normal echogenicity. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 8.7 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.8 cm in length. No evidence of hydronephrosis.The spleen measures 7.7 cm in length.", "output": "Biliary sludge/tiny gallstones without sonographic evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female with a history of thyroid cancer. She status post total thyroidectomy. RIGHT LOBE, LEFT LOBE, ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Status post thyroidectomy.LEFT LOBE: Status post thyroidectomy. There is an approximately 1.8 x 1.2 x 0.7 cm round hypoechoic soft tissue nodule in the area of the left thyroid bed.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No adenopathy noted.OTHER: Extensive coronary artery plaque incompletely evaluated.", "output": "Postsurgical changes with hypoechoic nodule in the left thyroid bed. Since no prior is available for comparison differential considerations include postsurgical change versus recurrent disease. This can be managed with close interval ultrasound follow up (3 to 6 months) or if high degree of clinical suspicion exists, fine-needle aspiration.Carotid artery plaque.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old female with history of thyroid cancer status post thyroidectomy RIGHT LOBE MEASUREMENTS: Surgically absentLEFT LOBE MEASUREMENTS: Surgically absentISTHMUS MEASUREMENTS: Surgically absentRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant interval change in hypoechoic focus in the left thyroid bed since the prior study, favored to represent postoperative scarring. No new suspicious lesions are identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered cervical lymph nodes with benign morphologic features, without significant interval change.OTHER: No significant abnormality noted.", "output": "No significant interval change or evidence of recurrent or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 9 cm in lengthLEFT KIDNEY: Echogenic parenchyma without stone. Left kidney 9 cm in length. Abnormal echogenic focus occupying the central portion of the lower pole of the left kidney measuring approximately 3.3 x 3.2 x 4.1 cm. This finding is associated with focal caliectasis presumed secondary to obstruction by the central mass. In retrospect, this lesion may have been present on the 12/16/2012 CT but was considerably less conspicuous and smaller measuring 1.7 x 3.1 cm.OTHER: Bladder nondistended.Pre void bladder volume: 55.3 ccPost void bladder volume: 19 cc", "output": "Abnormal echogenic focus occupying the central portion of the lower pole left kidney associated with focal caliectasis presumed secondary to obstruction by this mass. A neoplastic etiology, including malignancy either of the collecting system or renal tubules must be excluded.Echogenic parenchyma consistent with medical renal disease/parenchymal dysfunction without significant obstruction.Dr. Stankus notified of findings 12/15/2015; 1:15pm"}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis LIVER: Stable cirrhotic morphology without mass. Liver length 13.8 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.7 cm in lengthOTHER: Left kidney 13.2 cm in length. Spleen 15.7 cm in length. Trace ascites", "output": "Stable cirrhotic morphology without mass or ductal dilatation. Trace ascites. Stable mild splenomegaly"}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Mildly echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Right renal cyst. Right kidney 10.1 cm in lengthLEFT KIDNEY: Mildly echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Left renal cysts. 9.6 cm in lengthOTHER: Bladder collapsed around Foley catheter", "output": "Mildly echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without worrisome mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "44 year old female who was recalled from screening mammogram for new asymmetry in the right axillary tail. Mammogram: An ML, MLO 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, unchanged in pattern and distribution. 7 mm asymmetry best seen on the MLO and ML view appears circumscribed, oval and does not have a definite correlate on the CC spot compression view. Ultrasound: Targeted right lower axillary/upper, outer quadrant ultrasound was performed. A 7 x 4 mm benign intramammary lymph node is identified with normal morphology.", "output": "Asymmetry in the right lower axillary region, most likely corresponds to a benign intramammary lymph node. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended in 6 months to confirm stability. Results and recommendation 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": "The patient submitted outside mammogram dated 10/12/2007, from presence St. Joseph Hospital. Submitted outside study was compared to the current mammogram dated 12/15/2015. There is no significant change between these two studies in the left breast. Focal asymmetry in the left upper-outer quadrant with calcifications and cluster of calcifications in central left breast are mostly unchanged.Segmental distribution calcifications in the right upper-outer quadrant spanning approximately 6 cm with associated focal asymmetry has increased from prior exams and needs further evaluation with spot magnification views and ultrasound.", "output": "Segmental distribution calcifications in the right upper-outer quadrant spanning approximately 6 cm with associated focal asymmetry has increased from prior exams and needs further evaluation with spot magnification views and ultrasound.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "Female; 67 years old. Reason: cirrhosis eval for HCC History: cirrhosis LIVER: The liver measures 5.5 cm in length. The liver parenchyma nodular and echogenic with a coarse echotexture. No suspicious lesion is identified. There is a small amount of ascites. The portal vein is patent and demonstrates a normal direction of flow with a peak velocity of 30 cm/sec.BILIARY TRACT: The gallbladder is not distended. There is no cholelithiasis, gallbladder wall thickening or pericholecystic fluid. The common bile duct measures 4 mm. There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreas is obscured by overlying bowel gas.SPLEEN: The spleen measures 20.2 cm in length.RIGHT KIDNEY: The right kidney measures 9.5 cm in length. The renal cortex demonstrates normal echogenicity. There is no hydronephrosis. OTHER: Left kidney measures 12.5 cm in length. There is no hydronephrosis.", "output": "1.Cirrhotic liver morphology without focal hepatic lesion. Small amount of ascites.2.Splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": " Ultrasound images were obtained intraoperatively. There is a tube noted within the bladder.", "output": "Intraoperative images showing tube placement within the bladder. "}
{"instruction": "Generate impression based on findings.", "input": "Worsening renal function. RIGHT KIDNEY: 9.0 cm in length. Normal parenchymal echogenicity for age. No focal lesions or hydronephrosis.LEFT KIDNEY: 10.8 cm in length. Normal parenchymal echogenicity for age. No focal lesions or hydronephrosis.BLADDER: Contracted. No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Unremarkable sonographic appearance of the kidneys for age."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female with left breast IDC October 20, 2015 and metastatic axillary lymph node undergoing neoadjuvant chemotherapy. Assess for response prior to surgery. Three standard views of the left breast, left CC exaggerated, and left spot MLO 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. Again seen is a biopsy clip in the left upper outer breast with adjacent calcifications anteriorly and inferiorly measuring up to 15 mm in extent. The previously seen mammographic mass in this location has resolved, and no measurable mass is present currently. The left axillary biopsy clip is also partially imaged.ULTRASOUND", "output": "Favorable treatment response as described above, with no measurable residual disease in the left upper outer breast index malignancy, and significantly decreased size of previously biopsy left axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal LFTs and thrombocytopenia LIVER: Mildly coarse echotexture without mass. Liver length 12.2 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.4 cm in lengthOTHER: Left kidney 11.3 cm in length. Spleen 10 cm in length. No ascites.", "output": "Mildly coarse liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites. Cholelithiasis without acute inflammation."}
{"instruction": "Generate impression based on findings.", "input": "Diarrhea, abdominal pain LIVER: Liver measures 14.4 cm, with coarse heterogenous echotexture and without any focal lesions. No intrahepatic biliary ductal dilatation. Portal vein demonstrates normal flow directionality and patency.BILIARY TRACT: Gallbladder is contracted with multiple echogenic areas few of which shadowing within it. Difficult to ascertain whether these are gallstones or calcifications along the wall of the gallbladder. No evidence of pericholecystic fluid. Gallbladder wall thickness measures up to 4 mm. Common bile duct measures 6 mm at the porta hepatisPANCREAS: Head of the pancreas visualized appears unremarkable. Body and pancreas not visualized due to overlying bowel gas.SPLEEN: Spleen measures 8.1 cm without any focal lesions.RIGHT KIDNEY: Right kidney measures 9.7 cm and left kidney measures 10 cm. No evidence of hydronephrosis or focal lesions. Both kidneys appear mildly echogenic.OTHER: No ascites", "output": "1. Coarse heterogenous echotexture of the liver without any focal lesions.2. Contracted gallbladder with few gallstones within it and possible calcifications along the gallbladder wall. No evidence of acute cholecystitis3. Right pleural effusion. 4. Bilateral echogenic kidneys consistent with chronic medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old male with history of hepatitis C, screening for HCC. LIVER: The liver measures 16.3 cm in length and demonstrates increased echotexture. No focal lesions are identified. Portal vein flow is hepatopetal and measures 0.2 m/sec.BILIARY TRACT: Status post cholecystectomy. The common duct measures 4 mm in diameter.PANCREAS: Limited evaluation of the pancreas due to overlying bowel gas.SPLEEN: The spleen measures 9 cm in length, without significant abnormality.RIGHT KIDNEY: The right kidney measures 11 cm in length and is normal in echotexture and morphology. OTHER: The left kidney measures 10.6 cm in length, and has normal echotexture and morphology.", "output": "Hepatic steatosis, without focal mass or other significant abnormality."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male with known renal mass and IVC thrombus presents for evaluation of liver vasculature patency. LIMITED ABDOMENLIVER: The liver measures 16.5 cm. There is coarse increased echogenicity of the liver parenchyma. No parenchymal mass. No ductal dilation.BILIARY TRACT: The gallbladder wall measures 0.3 cm. No stones. No pericholecystic fluid. The common bile duct measures 2.6 mm.PANCREAS: Evaluation limited by overlying bowel gas.SPLEEN: The spleen measures 9.9 cm. No significant abnormalities noted. RIGHT KIDNEY: Right kidney measures 14.4 cm. As seen on CT there is infiltrative tumor involving the right renal parenchyma.LEFT KIDNEY: Left kidney measures 14.0 cm. As seen on CT, there is tumor extending into the left renal vein.OTHER: There is free fluid in the abdomen.", "output": "1. Occlusion of the inferior vena cava with tumor thrombus which extends to involve the right and left renal veins, right hepatic vein and extends to the right cardiac atrium.2. Infiltrating mass of the right kidney as seen on prior CT.3. Coarse echogenic liver consistent with chronic liver disease/parenchymal dysfunction.4. Echogenic kidneys consistent with chronic medical renal disease/parenchymal dysfunction.5. Free fluid in the abdomen."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old male patient with history of tobacco use. Screening examination. The proximal aorta measures 2.0 x 2.1 cm. The mid aorta measures 2.6 x 2.0 cm. The distal aorta measures 2.0 x 1.7 cm. The left common iliac artery measures 1.5 x 1.7 cm. The right common iliac artery measures 1.4 x 1.7 cm.", "output": "No evidence of abdominal aortic aneurysm."}
{"instruction": "Generate impression based on findings.", "input": "UTI with sepsis RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. No perinephric collection. 10.1 cm in lengthLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. No perinephric collection. 10.4 cm in length.OTHER: Bladder nondistended. Ascites noted. Right pleural effusion.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis. No perinephric collection."}
{"instruction": "Generate impression based on findings.", "input": "59 year old female with history of viral hepatitis C, cirrhosis. LIVER: Cirrhotic morphology with coarse heterogeneous echogenic liver parenchyma, unchanged. No identifiable mass lesion. Liver length 18.5 cm. Main portal vein is patent, with flow at approximately 0.2 m/secGALLBLADDER, BILIARY TRACT: Stable cholelithiasis without findings of cholecystitis or biliary obstruction.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Increased echogenicity of renal parenchyma unchanged without mass, stone, or hydronephrosis. 8.8 cm in lengthOTHER: Increased echogenicity of left renal parenchyma, unchanged without obstruction. Left kidney 9 cm in length. Spleen 10.7 cm in length. Worsening moderate ascites.", "output": "1.Cirrhotic liver morphology, without mass or ductal dilatation. 2.Improved mild abdominal ascites. 3.Hyperechoic renal parenchyma, consistent with medical renal disease/parenchymal dysfunction without obstruction. "}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain and elevated bilirubin. LIVER: The liver measures 19.5 cm in length. Mildly increased parenchymal echogenicity is suggestive of fatty infiltration/parenchymal dysfunction. No focal hepatic lesions or masses are identified. There is hepatopetal flow in the main portal vein 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.SPLEEN: No significant abnormalities noted.The spleen measures 11.3 cm in length. RIGHT KIDNEY: Kidney measures 13.0 cm in length. Normal echotexture. LEFT KIDNEY: Kidney measures 13.5 cm in length. Normal echotexture. OTHER: No significant abnormalities noted.", "output": "1.Hepatomegaly.2.No sonographic evidence of acute cholecystitis or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Papillary thyroid carcinoma RIGHT LOBE MEASUREMENTS: 7.4 x 2 x 2 cmLEFT LOBE MEASUREMENTS: 6.1 x 2 x 1.6 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: 1.5 x 1.1 x 1 cm solid left upper pole thyroid nodule with internal coarse calcificationsISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Abnormal appearing lymph nodes from level 1B to level 4 on the left. A representative left level 1B lymph node measures 1.9 x 1.9 x 1.9 cm. A representative left level 2 lymph node measures 3.6 x 1.4 x 0.8 cm. A representative left level 3 lymph node measures 1.8 x 1.2 x 0.8 cm. Multiple subcentimeter abnormal appearing lymph nodes within left level 4 are also appreciated.OTHER: No significant abnormality noted.", "output": "Solitary solid nodule with internal coarse calcifications left thyroid gland consistent with known papillary thyroid carcinoma primary. Associated with extensive left cervical regional metastatic adenopathy as described from left level 1B to left level 4."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Outside Request: 30 y/o female w/hx goiter eval. RIGHT LOBE MEASUREMENTS: 5.1 cm x 1.9 cm x 1.5 cm.LEFT LOBE MEASUREMENTS: 5.2 cm x 1.8 cm x 1.4 cm. ISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: Mildly coarse echotexture with no discrete nodules identified.LEFT LOBE: Mildly coarse echotexture with no discrete nodules identified.ISTHMUS: Mildly coarse echotexture with no discrete nodules identified.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing right neck lymph node measures 1.5 cm x 0.4 cm x 1.2 cm. Benign-appearing left neck lymph node measures 0.9 cm x 1.0 cm x 0.4 cm.OTHER: No significant abnormality noted.", "output": "Mildly coarse echotexture of the thyroid gland with no discrete nodules identified."}
{"instruction": "Generate impression based on findings.", "input": "83-year-old male with prostate cancer, HIV and abnormal liver function. LIVER: Liver is normal in size and appears mildly echogenic which is non-specific. Scattered calcifications due to previous granulomatous disease. In any of the liver there is a septated cystic mass measuring 4.8 x 7.8 x 8.5 cm with a small amount of septal calcification.BILIARY TRACT: The biliary tract is normal in caliber. The gallbladder appears unremarkable without stones, wall thickening or pericholecystic fluid.PANCREAS: The head and body appear normal. The tail was not well seen due to bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 11 cm in length without gross abnormality. OTHER: The left kidney measures 11.8 cm in length with minimally complex 1.9-cm cyst.", "output": "Echogenic liver.Mildly complex cystic mass left lobe of the liver. If there is prior outside imaging this would be most helpful for comparison.Minimally complex left renal cyst requires no follow-up."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female with right upper quadrant and flank pain. Evaluate LIVER: Liver is homogeneous in echotexture and measures 20 cm in length. Main portal vein is patent with hepatopetal flow and peak systolic velocity of 0.2 m/s.BILIARY TRACT: No evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid to suggest cholecystitis. Negative sonographic Murphy's sign. Common bile duct measures 0.3 cm in diameter.PANCREAS: No significant abnormalities noted.SPLEEN: Spleen is homogeneous in echotexture and measures 14 cm in length.RIGHT KIDNEY: No evidence of hydronephrosis bilaterally. The right kidney measures 12.7 cm and the left kidney measures 14.2 cm in length. OTHER: No significant abnormalities noted.", "output": "1.No evidence of cholecystitis or hydronephrosis. 2.No specific sonographic findings to account for patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Male 54 years old; Reason: 54 yo with abnl LFT History: none LIVER: The liver measures 23.0 cm in length. There is 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 20.0 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.6 mm. No stones are seen. There is a small amount of sludge present. No pericholecystic fluid. The common bile duct measures 3.5 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 12.8 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.0 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.7 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. Hepatomegaly is present.2. The liver has increased echogenicity compatible with fatty infiltration/hepatocellular dysfunction. Although no new worrisome masses are seen, the liver's significant degree of echogenicity decreases the sensitivity for detecting masses on ultrasound. If clinically indicated may consider further cross-sectional imaging for evaluation of any hepatic masses.3. No evidence of cholelithiasis or acute cholecystitis. No intrahepatic ductal dilation."}
{"instruction": "Generate impression based on findings.", "input": "Male 68 years old; Reason: history of familial non-medullary thyroid carcinoma, personal history of microcarcinoma History: none RIGHT LOBE MEASUREMENTS: The right lobe is surgically absent.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 1.8 x 2.4 x 5.7 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.3 cm.RIGHT THYROIDECTOMY BED: No lesions within the thyroidectomy bed suspicious for recurrence.LEFT LOBE: No significant abnormality noted. No nodules are identified.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted.", "output": "Stable exam status post right thyroidectomy. No lesions suspicious for recurrence. No suspicious adenopathy or new nodules are identified."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for hydronephrosis History: left sided abdominal pain, left sided renal graft. RENAL TRANSPLANT:LOCATION: Left iliac fossa.PERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: Transplant kidney measures 11.3 cm in length and demonstrates normal cortical echotexture. COLLECTING SYSTEM/URETER: No hydronephrosis. URINARY BLADDER: Ileal conduit with no significant abnormality identified.OTHER: No significant abnormality noted", "output": "Transplant kidney without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Leukocytosis LIVER: No significant abnormalities noted. Liver length 16.7 cmGALLBLADDER, BILIARY TRACT: Gallbladder not visualized. Mildly prominent extrahepatic bile duct with maximal diameter of 0.7 cm. No intrahepatic ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma without obstruction. Right kidney 9.7 cm in length.OTHER: Spleen 12.4 cm in length. 2-cm low attenuation focus within the spleen; favor benign etiology. Trace ascites. Bilateral pleural effusions.", "output": "Mildly prominent extrahepatic bile duct. Gallbladder not visualized. Unremarkable liver without evidence for intrahepatic ductal dilatation. Echogenic right renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without obstruction. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "History of renal cell carcinoma status post right partial nephrectomy. RIGHT KIDNEY: The right kidney measures 9.3 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion.LEFT KIDNEY: The left kidney measures 13.3 cm in length without hydronephrosis, shadowing nephrolithiasis or suspicious lesion. Note is made of a 1.7 cm left superior pole simple cyst.OTHER: Contracted bladder. Partially imaged echogenic liver.", "output": "No suspicious renal lesion is evident."}
{"instruction": "Generate impression based on findings.", "input": "43 years old, Female, Reason: concern for cholangitis History: as above LIVER: The liver measures 19.6 cm in length. Echogenicity of the liver is within normal limits. 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 sludge within the gallbladder and a small stone. The gallbladder wall is mildly thickened secondary to nondistention. 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 9.4 cm in length. RIGHT KIDNEY: Kidney measures 11.2 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass. Simple cysts are seen in the right kidney, similar to prior exam.LEFT KIDNEY: Kidney measures 11.5 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass. Simple cysts are seen in the left kidney, similar to prior exam.OTHER: No significant abnormalities noted.", "output": "Cholelithiasis and gallbladder sludge in a nondistended gallbladder without evidence of biliary dilatation or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: RUQ pain LIVER: The liver measures 21.5 cm in length, enlarged. The hepatic parenchymal echogenicity and echotexture is normal. There is no focal mass. There is no biliary ductal dilatation. The main portal vein is patent with normal directional hepatopedal flow and waveform, peak velocity 26.2 cm/s.BILIARY TRACT: There is a small amount of intraluminal sludge within the gallbladder however there are no echogenic stones. There is no pericholecystic fluid. The gallbladder wall measures 0.2 cm. There is no biliary ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen measures 11.1 cm.RIGHT KIDNEY: The right kidney measures 11.8 cm. There is no focal mass or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.9 cm. There is no focal mass or hydronephrosis. OTHER: No ascites.", "output": "1. Gallbladder sludge without evidence of acute pericholecystic inflammation.2. Hepatomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. History of left breast lumpectomy in 2014 for IDC followed by adjuvant chemotherapy and radiation. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. There is no solid mass or suspicious finding identified.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old male with history of elevated alk phos. Evaluate liver/gallbladder. LIVER: Small amount of perihepatic ascites. Subtle heterogeneity of the liver may represent chronic liver disease versus fatty infiltration.GALLBLADDER, BILIARY TRACT: Gallbladder wall is slightly thickened, which may be related to the patient's ascites.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Splenic granulomata.", "output": "Gallbladder wall is slightly thickened, which can be seen in patients with ascites and/or chronic liver disease, however cannot exclude cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "History of multinodular goiter, evaluate for change in nodules. RIGHT LOBE MEASUREMENTS: 6.9 x 3.4 x 3.1 cm.LEFT LOBE MEASUREMENTS: 5.6 x 2.2 x 2.3 cm.ISTHMUS MEASUREMENTS: Up to 0.6 cm in thickness.RIGHT LOBE: Heterogeneous echotexture with multiple nodules. Dominant mixed solid and cystic nodule centered in the mid pole measures 3.3 x 2.0 x 2.5 cm, unchanged.LEFT LOBE: Heterogeneous echotexture with multiple nodules. Dominant mixed solid and cystic inferior pole nodule measures 2.2 x 2.2 x 1.4 cm, previously 1.9 x 1.8 x 1.6 cm, perhaps minimally increased in size when allowing for differences in technique.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 appearing similar to prior examination. Minimal increase in size of benign-appearing left inferior pole dominant nodule."}
{"instruction": "Generate impression based on findings.", "input": "Reason: history of right nodule + FNA for papillary carcinoma, need for lymph node mapping (central and lateral neck) RIGHT LOBE MEASUREMENTS: 4.8 x 1.5 x 1.4 cm.LEFT LOBE MEASUREMENTS: 3.0 x 1.0 x 1.0 cm.ISTHMUS MEASUREMENTS: No significant abnormality noted.RIGHT LOBE: Right inferior pole nodule measuring 2.0 x 1.7 x 1.2 cm which demonstrates irregular margins, heterogeneous internal echotexture, microcalcifications, and internal vascularity. This nodule is compatible with reported history of papillary carcinoma. LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There are several abnormal morphology lymph nodes which are suspicious for metastatic disease, many of which contain microcalcifications. Abnormal lymph nodes are located within the right level 2, right level 3, right level 4, and bilateral level 6 stations. Furthermore, the abnormal level 6 lymph nodes extend inferior to the sternal notch, and the inferior extent is not visualized.No abnormal lymph nodes are identified within the left level 2, left level 3, left level 4, or bilateral level 5 stations.OTHER: No significant abnormality noted.", "output": "Right inferior pole dominant nodule compatible with history of papillary thyroid carcinoma. Associated lymphadenopathy suspicious for metastatic disease in the right level 2, right level 3, right level 4, and bilateral level 6 stations. The abnormal level 6 lymph nodes extend inferior to the sternal notch, and the inferior extent is not visualized."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old male status post liver transplantation on August 15, 2016. Evaluate hepatic vasculature. LIMITED ABDOMENLIVER: Increased and coarse echogenicity. No intrahepatic biliary dilation, focal mass, or ascites.BILIARY TRACT: The gallbladder is not visualized on this study. The common duct measures 0.6 cm.PANCREAS: None visualized on this study.SPLEEN: Spleen measures 17.9 cm. Unremarkable echotexture. OTHER: There is a right-sided pleural effusion.", "output": "1. Patent hepatic vasculature. Main hepatic artery is patent.2. Coarse echogenicity of the liver suggestive of chronic liver disease/parenchymal dysfunction.3. Splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "History of left breast biopsy in the past 6 months, pathology results showed fibroadenoma, patient presents for follow-up left breast ultrasound. A targeted left ultrasound was performed for the palpable area of concern. Palpable mass in the left breast 3:00 position which has been previously biopsied and consistent with a fibroadenoma measures 2 x 1.4 x 2 cm, previously measured 2.2 x 1.3 x 1.9 cm, mostly unchanged from prior study. Lateral to it are 2 adjacent small hypoechoic masses, largest measuring 5 x 3 x 7 mm, mostly unchanged from prior study. At 2:00 position of the left breast there is another benign morphology mass that measures 10 x 6 x 9 mm, that previously measured 10 x 5 mm, unchanged from prior study.", "output": "No sonographic evidence for malignancy. Stable size of multiple benign morphology masses in the left breast one of which has been previously biopsied with benign results.Six-month follow-up left breast ultrasound is recommended to confirm stability.Surgical consultation is also recommended.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male with fever, bandemia, elevated bilirubin and ALT. Evaluate for biliary source of sepsis. LIVER: Measures 17.1 cm in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Cholelithiasis, without 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": "1. Cholelithiasis without evidence of acute cholecystitis or other finding to explain the patient's infectious symptoms. 2. Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease, without discrete focal lesion. "}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female patient with elevated AST/ALT. LIVER: The liver measures 18.5 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is slightly contracted. 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 8.8 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.2 cm in length. No evidence of hydronephrosis.The spleen measures 7.3 cm in length.", "output": "No acute sonographic abnormality in the abdomen."}
{"instruction": "Generate impression based on findings.", "input": "Nocturnal enuresis. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. No residual urine within the bladder on post void ultrasound. 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: 0 Left: 0  Length*** Right: 10.2 cm Left: 11.0 cm   Mean for age: 9.2 cm  Range for age: 7.4 - 10.6 cmADDITIONAL OBSERVATIONS: None", "output": "Normal ultrasound of the kidneys and bladder.*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": "Female 34 years old Reason: known stable goiter - evaluate for nodules etc History: goiter present for 12 years- family history of thyroid disease RIGHT LOBE MEASUREMENTS: 7.8 x 3.2 x 2.7 cm.LEFT LOBE MEASUREMENTS: 6.6 x 3.3 x 2.7 cm.ISTHMUS MEASUREMENTS: 0.7 cm.RIGHT LOBE: Heterogeneous and multinodular right thyroid lobe. Largest heterogeneous nodule on the right in the inferior right thyroid lobe measures 3.9 x 3.0 x 2.8 cm.LEFT LOBE: Heterogeneous and multinodular left thyroid lobe. Largest heterogeneous left thyroid nodule measures 2.9 x 2.9 x 2.9 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Findings most compatible with multinodular goiter."}
{"instruction": "Generate impression based on findings.", "input": "Left upper quadrant pain and shortness of breath. Further history obtained upon discussion with the patient reveals progressively worsening intermittent sharp left chest pain, which on occasion \"takes her breath away\". LIVER: The liver measures 15 cm in length. Mildly increased parenchymal echogenicity is suggestive of fatty infiltration. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of .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 7 cm in length. RIGHT KIDNEY: Kidney measures 9.6 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 9.6 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: Evidence of a left pleural effusion. Superficial evaluation of the left chest wall reveals no abnormalities", "output": "1.Left pleural effusion.2.Increased echogenicity of the liver suggest hepatic steatosis.These findings were discussed with the ordering service at time of dictation who agreed to order chest x-ray while patient is in radiology department."}
{"instruction": "Generate impression based on findings.", "input": "20 year-old male with acute pancreatitis and right upper quadrant pain. Evaluate for biliary duct stone or biliary ductal dilatation. LIVER: The liver is normal in morphology, echogenicity and size, measuring 18 cm in craniocaudal dimension. Normal hepatopetal portal venous blood flow with velocity measuring 20 cm/sec. No intrahepatic biliary ductal dilatation.BILIARY TRACT: A normally distended gallbladder is present without wall thickening, gallstones, pericholecystic fluid, or focal tenderness. No extrahepatic biliary ductal dilatation with the common bile duct measuring 5 mm.PANCREAS: Evaluation of the pancreas is limited to the pancreatic head due to overlying bowel gas shadowing. The visualized portion of the pancreas is unremarkable.SPLEEN: The spleen is normal in morphology, echogenicity and size, measuring 11.5 cm in length.RIGHT KIDNEY: The right kidney measures 10.5 cm in length without hydronephrosis or shadowing calculus. OTHER: The left kidney measures 12 cm in length without hydronephrosis or shadowing calculus.", "output": "No biliary ductal dilatation or other specific finding to account for the patient's right upper quadrant pain. Limited evaluation of the pancreas due to overlying bowel gas."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Anderson is a 71 year old female with a personal history of right breast DCIS/IDC status post mastectomy in 2005 with adjuvant Arimidex therapy. She had a recent US-guided biopsy of right axillary mass on 5/28/2015 complicated by hematoma formation. Upon physical exam of the right axillary region, there is overlying skin discoloration and minor swelling. However, the area is soft and tender.Targeted right axillary ultrasound was performed of this area. The previously identified hematoma in the right axillary region now measures 3.6 x 2.3 x 1.5 cm, compared to 5.4 x 3.1 x 5.4 cm. There is overlying skin thickening and parenchymal edema.", "output": "Decreasing size of venous hematoma in the right axillary region. Patient is scheduled for a duplex ultrasound for formal evaluation of the axillary artery and vein after this appointment. She will also get a repeat H&H to ensure stability of her hemoglobin levels. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old presents for diagnostic mammogram for a focal asymmetry noted in the left breast. Mammogram:  Left ML and four spot compression views of 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. A focal asymmetry noted in the slightly medial, upper left breast at posterior depth mostly dispersed into normal appearing glandular tissue with spot compression views. Ultrasound:A targeted left ultrasound was performed for the mammographic area of concern. There is no solid or cystic mass identified.", "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": "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. Distended without gallstones, 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 9.3 cm in length. The left kidney is 8.4 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 11.7 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No significant upper abdominal fluid identified.", "output": "No sonographic findings to account for the patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "Renal stone 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": "Reason: Assess for hydronephrosis in setting of AKI History: AKI RIGHT KIDNEY: The right kidney measures 9.4 cm in length. Normal renal parenchymal echogenicity. Anechoic cyst in the midpole measures 1.1 x 0.9 x 0.9 cm. No shadowing renal calculi or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.2 cm in length. Normal renal parenchymal echogenicity. Multiple anechoic cysts, with reference upper pole lesion measuring 1.9 x 1.6 x 2.0 cm. No shadowing renal calculi or hydronephrosis.OTHER: The bladder is decompressed by Foley catheter and is not visualized.", "output": "Stable bilateral simple renal cysts. No acute renal abnormality, specifically no hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with uncontrolled hypertension. RIGHT KIDNEY: The right kidney measures 10.4 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 10.8 cm in length. Echotexture is normal. There may be a very small cyst in the upper pole. No hydronephrosis, shadowing calculus or solid mass.OTHER: Limited views of the bladder demonstrate no abnormality.", "output": "Normal-appearing kidneys."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Larson is a 61-year-old woman with metastatic breast cancer. She presents today with clinician- and self-palpated left cervical nodes. The clinical team requests biopsy of one of these nodes for ER/PR/HER-2 receptor status to guide treatment planning. On physical exam, there are two palpable nodes in the left cervical region, superficial to the sternocleidomastoid muscle. No abnormality is palpated in the supraclavicular region.Targeted left cervical ultrasound was performed for the palpable and clinical areas of concern. There is no lymphadenopathy visualized by ultrasound in the supraclavicular region.The first and superior most palpable left cervical node corresponds to a 12 x 5 x 10 mm isoechoic node without increased vascular. The second and inferior most palpable cervical node corresponds to a 8 x 6 x 10 mm hypoechoic node without increased vascularity.", "output": "Left cervical lymphadenopathy. Ultrasound-guided core biopsy of the superior most node was performed during today's visit and will be reported under a separate accession.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Amal is a 42 year old woman with biopsy proven right breast cancer. Family history of breast carcinoma in two paternal cousins. No current breast complaints. Three standard views of both breasts as well as 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 (BiRADS Density Category C). A biopsy clip is associated with a 15 mm mass in the right outer inner breast. An additional focal asymmetry in the right breast upper outer quadrant disperses on spot compression views. Prominent left axillary lymph nodes are noted, measuring up to 15 mm in diameter.ULTRASOUND", "output": "Biopsy clip associated with a right breast mass corresponding with the patient's known cancer.No abnormality noted in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Hypermetabolic left parotid gland lesion seen on PET/CT 1.2 x 0.8 x 0.8 cm peripheral hypoechoic nodule arising from the anterior left parotid gland corresponding to the lesion seen on PET/CT", "output": "Peripheral hypoechoic nodule arising from the anterior left parotid gland corresponding to lesion seen on the recent PET/CT. Would favor a benign etiology such as intraparotid lymph node versus Warthin's tumor. This lesion will be biopsied later today."}
{"instruction": "Generate impression based on findings.", "input": "Neck pain and snapping when turning head. The parotid and submandibular glands are clear. Patient is edentulous. Dystrophic calcifications are identified in the tonsils. The carotid arteries are tortuous but there is no focal stenotic lesion identified. Small shotty lymph nodes are present, none are enlarged by size criterion. Small lucencies are present in the thyroid gland, this may be further evaluated with ultrasound if warranted clinically.There are mild degenerative findings present in the cervical spine with decreased disk height and spurs, this is most marked at C6-7 and this results in mild central and foraminal stenosis. Note is also made of a small sclerotic focus in the T2 or vertebral body on the left side. This has a benign appearance suspicious for a bone island, if there is history of neoplasm follow up bone scan is suggested. There are nonspecific patchy opacities probably scarring at the lung apices.", "output": "Unremarkable CT study of the soft tissues of the neck. There are mild degenerative findings present in the cervical spine which could be better described as a dedicated study. There is sclerotic focus in the T4 vertebral body on the left side and although the appearance is benign a follow up bone scan may be helpful if warranted clinically."}
{"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": "65-year-old male with elevated PSA. No other history provided or available. RIGHT KIDNEY: Right kidney measures approximately 11.3 cm in length. Echotexture appears normal. There is mild deformity of the lower pole which may be due to prior gunshot wound as described by the patient. There are small, simple-appearing cysts present, the largest measuring 2 cm in diameter There is no hydronephrosis, shadowing calculus or solid mass.LEFT KIDNEY: The left kidney measures 12.5 cm in length. Echotexture appears normal. There is no hydronephrosis, shadowing calculus or mass.OTHER: Bladder is almost completely empty.", "output": "Mild deformity of the right kidney with right renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "Reason: size of know cysts History: abdominal pain LIVER: The liver measures 19.1 cm in length and nodular in contour. The liver parenchymal echotexture is coarse. Right lobe dominant hepatic cyst measures 3.4 x 4.2 x 3.9, previously 2.6 x 3.9 x 4.1 cm. There is a less well-defined rounded, hypoechoic subcapsular structure in the right lobe measuring 1.9 x 2.1 x 2.1 cm, previously 1 x 1 x 1.2 cm which does have some cystic characteristics such as posterior acoustic enhancement. Additional hepatic cysts, some of which contain fine septations, appear not significantly changed.The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s.BILIARY TRACT: A hyperechoic focus measuring up to 6 mm along the gallbladder fundus wall may reflect a calcification and appears unchanged. 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 10 cm in length. RIGHT KIDNEY: Kidney measures 10.4 cm in length. Normal echotexture. LEFT KIDNEY: Kidney measures 10 cm in length. Normal echotexture. OTHER: No significant abnormalities noted.", "output": "Cirrhotic liver with heterogeneous echotexture. Subcapsular structure in the right lobe which has some cystic characteristics has increased in size. Additional hepatic cysts not significantly changed. Echogenic focus along gallbladder wall which may reflect calcification, not significantly changed."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old male presents with sepsis and elevated AST/ALT and bilirubin. Evaluate for biliary source of infection. LIVER: Increased echogenicity in the liver, which is nonspecific, but can be seen in hepatic steatosis. Hepatomegaly. The liver measures 19.9 cm in length. The portal vein flow is hepatopetal.GALLBLADDER, BILIARY TRACT: Note is made of multiple punctate shadowing dependent gallstones. No evidence of acute cholecystitis. Sonographic Murphy sign is negative. No common duct stones are seen.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Note is made of a 12-mm shadowing nonobstructing renal calculus in the inferior pole of the right kidney.OTHER: No significant abnormalities noted.", "output": "1. Increased echogenicity in the liver, which is nonspecific, but can be seen in hepatic steatosis.2. Hepatomegaly. 3. Gallstones without evidence of acute cholecystitis.4. 12-mm nonobstructing renal calculus in the inferior pole of the right kidney."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant abdominal pain LIVER: Normal echogenicity without mass. Liver length 16.7 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11 cm in length OTHER: Left kidney 11.2 cm in length. Spleen 8.8 cm in length. No ascites.", "output": "Negative right upper quadrant ultrasound. No hepatobiliary abnormality noted."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male with small bowel obstruction secondary to adhesions with possible choledocholithiasis and cholelithiasis. LIVER: The liver is only partially visualized on this study with cirrhotic morphology seen on prior studies. There is no intrahepatic ductal dilation. The portal vein is patent with hepatopetal flow.BILIARY TRACT: The common bile duct measures 3 mm. The gallbladder wall measures 0.2 cm. Few small stones are seen within the gallbladder and minimal sludge. Negative sonographic Murphy sign. No pericholecystic fluid is seen.", "output": "Cholelithiasis without evidence of acute cholecystitis. No intrahepatic ductal dilation."}
{"instruction": "Generate impression based on findings.", "input": "26 year old female with thyroid nodule. RIGHT LOBE MEASUREMENTS: 5.2 cm x 1.6 cm x 1.5 cm LEFT LOBE MEASUREMENTS: 4.9 cm x 1.3 cm x 0.9 cmISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: Multiple subcentimeter hypoechoic nodules with internal echogenic foci, largest in the inferior pole measures 2 mm x 3 mm x 2 mm.LEFT LOBE: Complex nodule in the superior pole measures 4 mm x 2 mm x 4 mm.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 nodules."}
{"instruction": "Generate impression based on findings.", "input": "Male 68 years old; Reason: Change in nodule History: thyroid cancer s/p thyroidectomy and I131 RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENT: Status post thyroidectomy.RIGHT LOBE: The thyroid gland is surgically absent, with no focal lesion in the thyroid bed.LEFT LOBE: Thyroid gland is surgically absent, with no focal lesion in the thyroid bed.ISTHMUS: Thyroid gland is surgically absent, with no focal lesions in the thyroid bed.LYMPH NODES: No significant lymphadenopathy.OTHER: Surgical clips are noted in the thyroid bed.", "output": "Status post thyroidectomy with no sonographic evidence of residual or recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "Acute onset abdominal pain LIVER: Non-cirrhotic liver morphology. 16.5 cm in length. Normal parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Moderate to large amount of biliary sludge with a 1-2 cm gallstone noted. No gallbladder wall thickening 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 10.1 cm in length. The left kidney is 11.8 cm in length, with a 3.2 cm simple appearing cyst in the midpole. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid identified.", "output": "Gallbladder sludge and cholelithiasis, without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with elevated creatinine. RIGHT KIDNEY: The right kidney measures 10.4 cm in length. Mild parenchymal hyperechogenicity. No evidence of renal stone, mass, or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.0 cm in length. Mild parenchymal hyperechogenicity. No evidence of renal stone, mass, or hydronephrosis.OTHER: Bladder decompressed, limiting evaluation.", "output": "Normal exam."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for routine screening mammography.History of ovarian cancer in her mother and breast cancer in grandmother. 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, unchanged in pattern and distribution. Focal asymmetries in the right central breast are more prominent from prior study and need further evaluation with spot compression views and possible ultrasound. Repeat left MLO view is recommended due to a skin fold.", "output": "Focal asymmetries in the right central breast are more prominent from prior study and need further evaluation with spot compression views and possible ultrasound. Repeat left MLO view is recommended due to a skin fold.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "82 year-old female with HBV, evaluate for HCC. LIVER: Coarse echotexture and nodular contour of the liver measuring 13.5 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.4 m/sec.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. Sonographic Murphy's sign is negative. Common duct measures 6 mm in caliber. No intra-or extrahepatic biliary duct dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Measures 6.6 cm in length and is increased in echogenicity. No hydronephrosis or shadowing calculi are noted. OTHER: Left kidney measures 8.5 cm in length and is increased in echogenicity. Multiple cysts are noted, one of which measures 1.3 cm x 1.0 cm x 0.7 cm. No hydronephrosis or shadowing calculi are noted. Normal echogenicity of the spleen measuring 7.9 cm in length.Small amount of perihepatic fluid and in Morrison's pouch.", "output": "1. Cirrhotic liver morphology with no focal hepatic lesions.2. Small amount of perihepatic fluid and in Morrison's pouch. 3. Increased echogenicity of the kidneys suggestive of or obstruction. Left renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "19 year-old female. History of right breast fibroadenoma that was excised. New palpable lump in the right breast for 1 month. RIGHT BREAST ULTRASOUND: Physical examination demonstrated a small palpable lump in the inferior right breast just below the nipple. A targeted ultrasound of this area at the 6 o'clock position 1 cm from the nipple showed a 1.8 x 0.9 x 1.3 cm parallel circumscribed, oval hypoechoic mass with internal vascularity.", "output": "Patient's palpable site in the inferior right breast corresponds to a benign morphology mass, likely a fibroadenoma. Surgical consultation is recommended for its clinical management.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old female patient with right upper quadrant discomfort and liver lesion. LIVER: The liver measures 14.8 cm in length. There is at least two hypoechoic lesions within the right hepatic lobe which do not meet criteria for simple cysts. The largest of these measures 0.9 x 0.8 x 1.0 cm. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is surgically absent. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 4 mm in diameter.PANCREAS: The pancreas is poorly visualized secondary overlying bowel gas. Gas.RIGHT KIDNEY: The right kidney measures 9.0 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 8.7 cm in length. No evidence of hydronephrosis. There is a 4 mm nonobstructing stone within the mid to lower pole.The spleen measures 8.8 cm in length.", "output": "1. Hypoechoic liver lesions which are not definitely cysts; dedicated contrast enhanced CT/MRI of the liver may be considered for further evaluation.2. Non-obstructing left nephrolithiasis. "}
{"instruction": "Generate impression based on findings.", "input": "Left testicular pain for several days RIGHT TESTIS: 4.4 x 3.6 x 2.4 cm. No intratesticular massLEFT TESTIS: 4.6 x 3 x 2.2 cm. No intratesticular massRIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: No significant abnormalities noted.DOPPLER: Doppler interrogation of scrotal vessels demonstrates unremarkable bilaterally symmetric Doppler flow characteristics.", "output": "Negative scrotal ultrasound. No intratesticular mass, acute inflammatory process, or torsion. Bilaterally symmetric Doppler flow characteristics."}
{"instruction": "Generate impression based on findings.", "input": "Male 23 years old Reason: s/p renal transplant History: elevated cr Ultrasound guidance and technical assistance was provided for a renal allograft in the left iliac fossa. 3 passes were made. The procedure was successfully completed.", "output": "Successful ultrasound guided biopsy of the renal allograft in the left iliac fossa"}
{"instruction": "Generate impression based on findings.", "input": "39-year-old female with right quadrant pain, evaluate for gallstones. LIVER: Extremely coarse, hyperechoic parenchyma. Liver is enlarged, measuring 18 cm in length. Contour normal.GALLBLADDER, BILIARY TRACT: A single 9 mm gallstone is identified. No gallbladder wall thickening, pericholecystic fluid, intra or extrahepatic biliary dilatation.PANCREAS: Pancreatic body and tail are obscured by overlying bowel gas. No significant abnormality is noted.KIDNEYS: The right kidney measures 11 cm in length. The left kidney measures 12 cm in length. No hydronephrosis, renal mass, or stone is identified.OTHER: Spleen measures 12.1 cm in length.", "output": "1.Cholelithiasis without evidence of cholecystitis.2.Hepatic steatosis with mild hepatomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Cirrhosis History: hx of hepatitis C with high viral load LIVER: The liver measures 20.3 cm in length and is mildly 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 0.37 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: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 11.4 cm in length. RIGHT KIDNEY: Kidney measures 10.1 cm in length. Increased cortical echogenicity. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.6 cm in length. Increased cortical echogenicity. No hydronephrosis. Renal cyst measuring up to 2.2 cmOTHER: Trace ascites.", "output": "1.Cirrhotic liver without focal lesions identified. Trace ascites.2.Increased renal echogenicity raising possibility of medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Male 57 years old; Reason: thyroid nodule History: thyroid nodule RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.7 x 1.6 x 1.6 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 5.3 x 1.5 x 1.6 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.30 cm.RIGHT LOBE: There is a small subcentimeter round hypoechoic lesion consistent with a simple thyroid cyst that appears similar to the prior study.LEFT LOBE: Lesion #1: There is a anechoic, cystic lesion that measures approximately 8mm x 3 mm with ring down artifact suggestive of a colloid cyst.ISTHMUS: There is a 5mm x 2mm hypoechoic lesion in the isthmus of the thyroid without posterior acoustic enhancement, microcalcifications, or internal vascularity. This lesion appears similar to the the prior study.LYMPH NODES: There is minimal a slight interval increase in size of a right level 3 lateral neck lymph node which now measures approximately 9mm x 6 mm. Correlate with CT neck soft tissues performed today (08/01/16).OTHER: No significant abnormality noted.", "output": "1.Stable thyroid nodule and cysts.2.Of note there is been a slight increase in size of a right lateral level 3 lymph node with no definite suspicious features. Attention to this lymph node on subsequent imaging."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male patient with hepatitis C. Assess for liver damage and HCC. Limited study secondary to patient body habitus and patient inability to cooperate with examination.LIVER: The liver is partially imaged and inadequately evaluated on this examination. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There is cholelithiasis without significant gallbladder wall thickening or pericholecystic fluid. Comet tail artifact noted within the gallbladder wall is indicative of adenomyomatosis. The common duct measures 4 mm in diameter.PANCREAS: The pancreas is not visualized on this examination.RIGHT KIDNEY: The right kidney measures 10.8 cm in length. No evidence of hydronephrosis. There is a non-obstructing right mid pole renal stone.OTHER: The left kidney measures 11.5 cm in length. No evidence of hydronephrosis.The spleen measures 10.7 cm in length.There is a right pleural effusion. No ascites.", "output": "1. Limited evaluation with inadequate evaluation of the liver.2. Cholelithiasis without sonographic evidence of acute cholecystitis. 3. Adenomyomatosis of the gallbladder.4. Non-obstructing subcentimeter right renal stone. 5. Right pleural effusion. "}
{"instruction": "Generate impression based on findings.", "input": "44-year-old female states she has extremely sensitive breast. Requisition states right breast nodule in the right upper quadrant for which patient presents for a right breast ultrasound. Family history of breast cancer in sister at the age of 44 and cousin at the age of 48 A targeted right ultrasound was performed for the patient\u2019s area of concern from 9 to 12:00 position. Patient indicates pain off-and-on shooting towards the arm. There is no solid or cystic mass identified. Normal glandular tissue noted.", "output": "No sonographic evidence for malignancy corresponding to patient's area of pain in the right breast 9 to 12:00 position.Annual screening mammogram is recommended.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "84-year-old female with bilateral axillary lymphadenopathy presents for bilateral axillary ultrasound A targeted bilateral axillary ultrasound was performed. Multiple prominent right axillary lymph nodes noted, largest measuring 1.9 x 1.2 x 0.8 cm. An enlarged left axillary lymph node with abnormal morphology identified measuring 1.4 x 1.2 x 1.5 cm with nonhilar blood flow. Adjacent to it is a normal morphology lymph node.", "output": "Abnormal left axillary lymph node for which ultrasound-guided core biopsy is recommended.Prominent right axillary lymph nodes with normal morphology.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain. LIVER: Non-cirrhotic liver morphology. Unremarkable parenchymal echogenicity. No focal hepatic lesions. Normal portal venous direction of flow, with pulsatility compatible with right heart failure.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. The left kidney is 8.0 cm in length. The renal parenchyma is echogenic bilaterally. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.1 cm in length, without focal lesions evident.OTHER: Left pleural effusion, partially imaged. Trace ascites.", "output": "1. No specific findings to account for the patient's right upper quadrant abdominal pain.2. Left pleural effusion, trace ascites, and portal vein pulsatility, compatible with congestive heart failure.3. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "46 year old male with cirrhosis. Evaluate for HCC. LIVER: Cirrhotic liver morphology measuring 14.7 m in length. No focal hepatic lesions. Portal vein is patent with appropriate direction of flow; peak velocity measures 0.5 m/sec.GALLBLADDER, BILIARY TRACT: Several small shadowing stones within the gallbladder. No gallbladder thickening. No pericholecystic fluid. Common bile that measures 4 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are normal in echogenicity.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 12.5 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the left kidney measuring 12.4 cm in length. No hydronephrosis or shadowing calculi are noted.Normal echogenicity of the spleen measuring 14.8 cm in length.", "output": "1. Cirrhotic liver morphology with no focal hepatic lesions.2. Cholelithiasis with no evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old male patient with systemic amyloid with cholestatic transaminitis. Assess for portal vein thrombosis. The patient has abdominal situs inversus.LIVER: The liver measures 21.7 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.1 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder contains sludge. The gallbladder wall measures 4 mm in thickness, which is borderline though nonspecific in the setting of ascites.. The common duct measures 12 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 11.2 cm in length. No evidence of hydronephrosis. Renal cortical echogenicity is increased.OTHER: The left kidney measures 11.2 cm in length. No evidence of hydronephrosis. Renal cortical echogenicity is increased.The spleen measures 14.1 cm in length. A cystic area in the spleen measures 7.7 x 6.0 x 3.5 cm, not significantly changed in size.There are bilateral pleural effusion and mild ascites.", "output": "1. Abdominal situs inversus.2. Hepatomegaly, mild ascites, and biliary sludge.3. Unchanged cystic area in the spleen.4. Medical renal disease. 5. Pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female with right upper quadrant pain in the context of a recent cholecystectomy. LIVER:Measures 14.9 cm. Increased, coarse echogenicity of the liver parenchyma. No ascites, focal mass. No intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. The common hepatic duct measures 0.5 cm.PANCREAS: Evaluation the pancreas is limited by overlying bowel gas.SPLEEN: Measures 5.6 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 10.9 cm. Left kidney measures 10.4 cm. The cortices have normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "1. Coarse, echogenic liver consistent with chronic liver disease/parenchymal dysfunction. No focal mass or ascites.2. Surgical changes of a prior cholecystectomy."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female with renal cyst for follow-up. RIGHT KIDNEY: The right kidney measures 11.2 cm in length. No hydronephrosis, shadowing calculus or mass. LEFT KIDNEY: The left kidney measures 11.5 cm in length. There is a 1.6 cm simple cyst in the upper pole of left kidney as seen on remote CT. No hydronephrosis, shadowing calculus or solid mass.OTHER: Echogenic liver which may be due to fatty infiltration.Limited views of the bladder demonstrate no abnormality.", "output": "Stable left renal cyst requires no follow-up.Likely fatty liver."}
{"instruction": "Generate impression based on findings.", "input": "Reason: known cirrhosis, hx of stones, now with nausea and vomiting. LIVER: The liver measures 12.7 cm in length and is cirrhotic in morphology. The liver parenchymal echotexture is course. 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: Cholelithiasis and layering sludge. Mild gallbladder distention and diffuse nonspecific wall thickening. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 6 mm in diameter.PANCREAS: Not visualized.SPLEEN: The spleen measures 13.5 cm in length. RIGHT KIDNEY: Kidney measures 10.0 cm in length. Normal echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 9.7 cm in length. Normal echotexture. No hydronephrosis.OTHER: Large ascites.", "output": "1.Cirrhotic liver. Ascites.2.Cholelithiasis. Mild gallbladder wall thickening which is nonspecific in the setting of ascites. Clinical correlation is recommended for acute cholecystitis. HIDA scan could be considered for additional evaluation as clinically indicated. No biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "The patient submitted outside mammogram dated 10/30/2013 and outside right breast ultrasound 3/28/2011, from Northwestern Memorial Hospital. Submitted outside study was compared to the current mammogram dated 3/16/2015. There is no significant change between these two studies.The ultrasound was submitted for comparison only, no official interpretation will be performed.", "output": "No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Epigastric pain LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.OTHER: No ascites", "output": "Negative for acute hepatobiliary abnormality. Specifically, normal gallbladder without ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Elevated liver enzymes LIVER: Coarse echogenic liver echotexture without worrisome mass. Hepatic cyst. Liver length 14.9 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.1 cm in lengthOTHER: Left kidney 10.7 cm in length. Spleen 10.9 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture consistent with fatty infiltration/parenchymal dysfunction without mass or duct dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "75-year-old male with hepatitis B cirrhosis. LIVER: Measures 13.7 cm in length. Cirrhotic liver morphology and increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow measures 0.2 m/s.BILIARY TRACT: Gallbladder polyp in the neck measuring 4 mm, other smaller polyps seen previously not clearly visualized. No gallbladder wall thickening, pericholecystic fluid, or sonographic Murphy's sign. No biliary ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "1. Cirrhotic liver with increased echogenicity consistent with chronic liver disease, without superimposed discrete lesion. 2. Patent portal vein with normal directional flow. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: liver lesion, ? cyst, renal cysts LIVER: The liver measures 14.3 cm in length. The liver parenchymal echotexture is normal. Two hyperechoic sharply marginated lesions are present within the right hepatic lobe. The first measures 0.9 x 1.0 x 0.7 cm and the second measures 1.8 x 1.2 x 1.2 cm which appear to correspond to hypoattenuating lesions on 2014 CT and appear similar in size. These are most compatible with a benign etiology such as hemangiomas. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.17 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 1 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 6 cm in length. RIGHT KIDNEY: Kidney measures 11.1 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.9 cm in length. Normal cortical echotexture. No hydronephrosis. Subcentimeter interpolar simple cyst.OTHER: No significant abnormalities noted.", "output": "Two hyperechoic hepatic lesions, favor benign etiology such as hemangiomas given apparent stability compared to 2014 CT. Left simple renal cyst."}
{"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: Not identified.LYMPH NODES: The previously described prominent right level 2/3 lymph node is decreased in size, measuring 13 x 5 x 9 mm, previously 17 x 12 x 8 mm on 7/25/2014. The lymph node continues to have a thickened cortex though maintains a fatty hilum. OTHER: No significant abnormality noted.", "output": "1. No evidence of recurrent disease in the thyroid bed.2. Decreased size of the prominent right level 2/3 lymph node. Continued attention to this on follow-up examination is recommended."}
{"instruction": "Generate impression based on findings.", "input": "63 year old female who was recalled from screening mammogram for focal asymmetry in the right breast at the 12:00 position. Mammogram: An ML 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 composed of scattered fibroglandular density(BiRads Density Category B), unchanged in pattern and distribution. Focal asymmetry in the right breast 12:00 position disperses into normal breast tissue. Benign subcentimeter oval focal asymmetry in the retroareolar region is unchangedUltrasound: Targeted right breast 12:00 position ultrasound was performed. No suspicious abnormality corresponding to the mammographic area in question. A benign oval hypoechoic mass measuring 6 x 4 mm was identified at the 12:00 position 1 cm from the nipple corresponding to the benign morphology stable oval mass seen on mammogram. This most likely represents a benign fibroadenoma.", "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: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Campbell is a 25 year old female presenting with a nontender palpable mass in the right breast for the past 2-3 months. Targeted right breast ultrasound was performed for the patient's area of concern.In the right breast 3:00 location, approximately 3 cm from the nipple, there is an oval lobulated mass identified measuring approximately 1.6 x 0.5 x 1.2 cm.", "output": "High probability benign mass of the right breast, likely representing a fibroadenoma. As long as the patient's physical examination remains normal, right unilateral ultrasound is recommended in 6 months in order to ensure stability of these findings. Results and recommendation 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": "Left testicular pain RIGHT TESTIS: 3.2 x 1.5 x 2.5 cm. No intratesticular massLEFT TESTIS: 3.3 x 1.6 x 2.7 cm. No intratesticular massRIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: No significant abnormalities noted.DOPPLER: Bilaterally symmetric normal appearing Doppler flow characteristics", "output": "Negative scrotal ultrasound. No intratesticular mass, acute inflammatory process, or torsion. Unremarkable bilaterally symmetric Doppler flow characteristics."}
{"instruction": "Generate impression based on findings.", "input": "Female 51 years old Reason: 12 month f/u on known colloid thyroid nodules History: Thyroid Nodule Colloid RIGHT LOBE MEASUREMENTS: 5.3 x 1.3 x 1.4 cmLEFT LOBE MEASUREMENTS: 6.1 x 1.9 x 1.9 cm.ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: Unchanged multiple subcentimeter nonspecific hypoechoic nodules in the right thyroid lobe. Background echogenicity of the thyroid is relatively homogeneous and normal in appearance.LEFT LOBE: Within the left thyroid lobe there is an unchanged cystic nodule measuring 2.9 x 1.3 x 1.9 cm. This nodule appears to have 2 small peripheral punctate calcifications.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality notedOTHER: No significant abnormality noted.", "output": "Unchanged cystic left thyroid nodule representing a benign cyst."}
{"instruction": "Generate impression based on findings.", "input": "Female; 41 years old. Reason: evaluate for hydronephrosis History: recent kidney stone diagnosis The exam is somewhat limited due to patient body habitus.RIGHT KIDNEY: The right kidney measures 13.0 cm in length. The renal parenchyma is normal in echogenicity. There is no hydronephrosis or shadowing renal stone identified.LEFT KIDNEY: The left kidney measures 13.7 cm in length. There is normal echogenicity. There is a hydronephrosis or shadowing renal stone identified.URINARY BLADDER: The bladder is nondistended.", "output": "No hydronephrosis or shadowing renal stone."}
{"instruction": "Generate impression based on findings.", "input": "Female 45 years old; Reason: r/o adenopathy, recurrence History: h/o thyroid cancer, with recurrences in the past. This is a follow up ultrasound The patient is status post total thyroidectomy.RIGHT THYROIDECTOMY BED: Several hypoechoic nodules are seen in the right thyroidectomy bed. Inferiorly, a nodule is revisualized and measures 0.5 x 0.4 x 0.2 cm. This measured 0.7 x 0.5 x 0.3 cm on the prior study. A second inferior hypoechoic nodule is visualized measuring 0.7 cm x 0.5 cm x 1.1 cm. This previously measured 0.5 cm x 0.6 cm x 0.7 cm. Another hypoechoic nodule inferiorly is reidentified measuring 0.4 cm x 0.2 cm x 0.5 cm. This nodule previously measured 0.5 cm x 0.3 cmLEFT THYROIDECTOMY BED: In the left thyroid bed a hypoechoic nodule near the superior aspect is reidentified measuring 0.8 cm x 0.5 cm x 1.0 cm. This previously measured 0.8 cm x 0.7 cm x 0.9 cmLYMPH NODES: No suspicious adenopathy noted.", "output": "Several hypoechoic nodule seen in the right and left thyroidectomy bed, as above, appear to be relatively stable in size. No suspicious regional adenopathy is identified."}
{"instruction": "Generate impression based on findings.", "input": "Gallbladder distension seen on CT. 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. Distended gallbladder, without wall thickening, stones, 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 12.3 cm in length. The left kidney is 12.5 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 9.2 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.", "output": "Persistently hydropic gallbladder, without evidence of cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Herts is a 27-year-old female with a personal history of Crohn's disease on immunosuppressant therapy, complaining of new palpable tender right breast lump. No family history of breast cancer. A targeted right ultrasound was performed for the patient\u2019s area of concern.In the right breast 8:00 location, approximately 2 cm from the nipple, there is a thick-walled unilocular hypoechoic lesion with floating internal debris, posterior acoustic enhancement and peripheral vascularity, measuring approximately 1.3 x 0.8 x 0.9 cm.", "output": "Sonographic findings are compatible with a right periareolar abscess. No sonographic evidence of malignancy. Patient should be seen by a breast surgeon for further evaluation and treatment. All results and recommendations were discussed with patient and Dr. Bao at time of dictation. The patient was subsequently seen by Dr. Bao and immediately redirected for a surgical consult.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Esophageal varices on recent EGD LIVER: Coarse echogenic liver echotexture without mass. Liver length 16.3 cm. Limited Doppler interrogation of 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. 5.5 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.4 cm in lengthOTHER: Left kidney 10.3 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Limited Doppler interrogation of main portal vein demonstrates a patent main portal vein with normal directional flow. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "77 year old female who was recalled from screening mammogram for right lower inner quadrant cluster of increasing calcifications and partially circumscribed subcentimeter mass in the right central outer breast. Family history of breast carcinoma in her mother at age 70. An ML view and two spot compression and two spot magnification 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. The previously seen lower inner quadrant calcifications are vascular in etiology on spot magnification compression images. The previously seen partially circumscribed subcentimeter mass in the right central outer breast persists on spot compression images.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: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain LIVER:Mildly coarse and echogenic liver echotexture without mass. Liver length 15.4 cm.GALLBLADDER, BILIARY TRACT: No significant abnormality noted.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. Spleen 8.3 cm in lengthKIDNEYS: Benign bilateral renal cysts. Right kidney 12.1 cm in length; left kidney 13.1 cm in length. ABDOMINAL AORTA: Proximal abdominal aorta not visualized due to overlying gas. Mid and distal aorta are unremarkable.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted. No ascites", "output": "Mildly coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal swelling, evaluate for ascites Limited 4-quadrant ultrasound of the abdomen shows no ascites. Coarsened hepatic echotexture suggests fatty infiltration.", "output": "Limited exam without ascites."}
{"instruction": "Generate impression based on findings.", "input": "Assess for abnormalities including changes in nodules/progressive disease RIGHT LOBE MEASUREMENTS: 5.8 x 3.1 x 2.4 cmLEFT LOBE MEASUREMENTS: 5.3 x 2.1 x 2 cmISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: Multiple mixed cystic and solid nodules identified throughout the thyroid gland, largest nodule in the lower pole measures 2.8 x 2.4 x 2 cm, previously measured 3.4 x 2.8 x 3 cm, mostly unchanged in size and morphology.Inferior to the right thyroid gland that appears to be a hypoechoic solid nodule that measures 3.2 x 2.3 x 2.6 cm, previously measured 2.6 x 2 x 2.9 cm, mostly unchanged from prior study in morphology and size, this could represent a parathyroid nodule.LEFT LOBE: Multiple mixed cystic and solid nodules identified throughout the thyroid gland, representative upper pole nodule measures 1.3 x 1 x 1.3 cm, previously measured 3.8 x 0.5 x 0.6 cm, mostly unchanged.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: As aboveLYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple mixed cystic and solid nodules in both thyroid lobes are mostly unchanged. Along the inferior aspect of the right thyroid gland there appears to be a exophytic thyroid nodule versus parathyroid nodule which is unchanged in size and morphology from prior exam."}
{"instruction": "Generate impression based on findings.", "input": "Question of thrombus or abscess in the left groin after dialysis catheter removal. No specific abnormality is noted in the subcutaneous soft tissues. No fluid collection or mass effect is noted.", "output": "No sonographic findings in the left groin to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Previous history of right breast cancer now with right inferior breast pain and possible mass. Area marked by the clinical service. A targeted right ultrasound was performed for the patient\u2019s area of concern. There is no solid or cystic mass identified. Dense parenchyma is noted, and appears similar to comparison images obtained of the left breast.", "output": "No sonographic evidence for malignancy. An annual diagnostic mammogram will be due for this patient in May 2016.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "40 year-old female with a renal transplant presents with fevers and AKI. LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No perinephric fluid noted.KIDNEY: Transplant kidney measures 12.1cm. No significant abnormality notedCOLLECTING SYSTEM/URETER: No hydronephrosis.URINARY BLADDER: Bladder is nondistended.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels and demonstrate patent vasculature.OTHER: No significant abnormality noted", "output": "Normal ultrasound of kidney transplant without hydronephrosis or a perinephric fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "Male 69 years old Reason: please evaluate for abscess around J site insertion History: pus, erythema around insertion site Ultrasound attention to the J-tube site and surrounding abdominal wall soft tissues showed no measurable fluid.", "output": "No evidence of abscess."}
{"instruction": "Generate impression based on findings.", "input": "Male, 68 years old. Rising Cr RIGHT KIDNEY: The right kidney measures 9.8 cm in length, with lobular contour, focal parenchymal loss, and additional focal areas of parenchymal thickening. No definite mass lesion is identified. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 8.8 cm in length, with lobular contour. No shadowing stones or hydronephrosis.OTHER: The bladder is decompressed. Diffusely increased hepatic echogenicity is noted.", "output": "1.Lobulated contour of the kidneys, without hydronephrosis.2.Increased hepatic echogenicity, compatible with fatty infiltration or parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid carcinoma status post resection RIGHT LOBE: Status post resection without worrisome massLEFT LOBE: Status post resection without worrisome massISTHMUS: Status post resection without worrisome 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": "61 year old female patient with abnormal LFT's. Evaluate liver. LIVER: The liver measures 12.9 cm in length and demonstrates increased parenchymal echogenicity. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.25 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 8.9 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.0 cm in length. No evidence of hydronephrosis.The spleen measures 7.1 cm in length.", "output": "Increased hepatic echogenicity likely representing hepatic steatosis. "}
{"instruction": "Generate impression based on findings.", "input": "Elevated ammonia. LIVER: The liver is normal in morphology, size and contour. It is heterogeneous and mildly echogenic in echotexture. It measures 15.5 cm in craniocaudal dimension. No focal lesion. Normal hepatopedal portal venous blood flow at 22 cm/s.BILIARY TRACT: Normally distended gallbladder without wall thickening, pericholecystic fluid or focal tenderness. No gallstones. No biliary ductal dilatation. PANCREAS: The visualized portions of the pancreatic head and body are unremarkable.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Mild right-sided pelvocaliectasis. No shadowing nephrolithiasis or focal lesion. 11.4 cm in length.OTHER: The left kidney measures 10.3 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. The spleen is 9 cm in length.", "output": "Mildly coarse echogenic liver parenchyma may reflect parenchymal dysfunction and/or fatty infiltration.Mild right-sided pelvocaliectasis without shadowing nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "31 year old female with history of epigastric pain and cramping. LIVER: The liver measures 11.8 cm in length, and is within normal limits.GALLBLADDER, BILIARY TRACT: No biliary dilatation, no gallstones and the findings of cholecystitis.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. The right kidney measures 8.9 cm.OTHER: No significant abnormalities noted. The left kidney measures 9.7 cm. Negative Murphy sign. Extensive bowel gas limits exam.", "output": "No significant acute abnormality to explain the patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "Female; 40 years old. Reason: immobile mass in the left thoracolumbar area History: See Attached Outside Orders. In the midline soft tissues of the mid back is a 8.4 x 9.6 x 3.1 cm fusiform, well circumscribed, solid lesion that is isoechoic to the surrounding fat. There is trace flow on color Doppler.", "output": "Solid soft tissue mass in the mid back could represent lipoma however other etiologies are not excluded."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old male status post LVAD with drainage around the drive line. Evaluate for fluid collection. A targeted portable ultrasound was performed of the left lower quadrant along the course of the LVAD drive line. There is no discrete fluid collection.", "output": "No discrete fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male with history of thyroid cancer. Evaluate for recurrence. RIGHT LOBE MEASUREMENTS: Surgically absentLEFT LOBE MEASUREMENTS: Surgically absentISTHMUS MEASUREMENTS: Surgically absentRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered lymph nodes with overall benign morphologic features are not significantly changed compared with the prior study. The previously measured lymph node on the left is not clearly identified on this examination.OTHER: No significant abnormality noted.", "output": "No evidence of recurrent or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Status post right thyroid lobectomy for goiter LEFT LOBE MEASUREMENTS: 8.9 x 9.4 x 4.3 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Status post right thyroid lobectomyLEFT LOBE: Diffusely heterogeneous enlarged left thyroid gland. Dominant mixed cystic and solid nodule mid pole measuring 5.7 x 3.3 x 3.4 cm.ISTHMUS: Diffusely heterogeneous gland.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Status post right thyroid lobectomy. Diffusely heterogeneous enlarged left thyroid gland with dominant mixed cystic and solid nodule as described."}
{"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 a vague hypoechoic area lateral to the right nipple near the 9:00 position at posterior depth. There is no solid or cystic mass identified in the left breast.", "output": "Right breast hypoechoic area for which further evaluation with hand held targeted diagnostic ultrasound is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "Stage V chronic kidney disease now requiring hemodialysis. Study limited by poor soft tissue penetration.RIGHT KIDNEY: Atrophic echogenic kidney measuring 9 cm in length without hydronephrosis, nephrolithiasis or discrete lesion. LEFT KIDNEY: The left kidney is not visualized.URINARY BLADDER: Normally distended urinary bladder.OTHER: No significant abnormalities noted.", "output": "Atrophic echogenic right kidney without hydronephrosis, compatible with chronic medical renal disease. The left kidney is not visualized."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old female. Callback from 4/28/2015 screening mammogram for focal asymmetries in the right breast. RIGHT BREAST DIAGNOSTIC MAMMOGRAM: A standard 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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Multiple circumscribed masses are seen in the right outer upper breast, for which ultrasound was done for further evaluation. A coarse cluster of calcifications in the right upper outer breast are likely within a degenerating fibroadenoma.RIGHT BREAST ULTRASOUND: An oval circumscribed parallel mass with coarse calcifications 3 cm from the nipple at 11 o'clock is consistent with a fibroadenoma. Immediately next to this fibroadenoma is a 1.3 x 0.8 x 1.3 cm circumscribed oval parallel hypoechoic mass without internal vascularity that may represent a complicated cyst or a noncalcified fibroadenoma. Similar appearing benign morphology two adjacent masses are identified at 11 o'clock 1 cm from the nipple. They measure 1.6 x 0.8 x 1.3 cm and 1 x 0.6 x 0.9 cm.", "output": "Multiple benign morphology masses in the right upper outer breast that most likely represent noncalcified fibroadenomas or complicated benign cysts. No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Male 34 years old; Reason: cholestatic pattern on LFTs, pls assess for evidence of biliary obstruction History: biliary obstruction? LIVER: The liver measures 19.6 cm in length. Numerous masses are seen all throughout the liver as demonstrated on prior CT. The main portal vein is patent with normal hepatopetal flow measured at 38.9 cm/s. GALLBLADDER/BILIARY TRACT: Evaluation of gallbladder is limited due to infiltration of liver metastasis. The common bile duct measures 2.4 mm in diameter. No extrahepatic or intrahepatic ductal dilation is seen.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen was not able to be visualized on this study.RIGHT KIDNEY: The right kidney measures 13.7 cm in length. The kidney appears collapsed and elongated, pushed to the periphery by the enlarged liver. The cortex has normal echogenicity. Mild hydronephrosis is seen but no stones, or worrisome masses.LEFT KIDNEY: The left kidney was not able to be visualized on this study.", "output": "1. As visualized on prior CT, the liver is extensively infiltrated with metastatic disease. No intrahepatic or extrahepatic ductal dilation is seen.2. The gallbladder is not well-visualized due to infiltration of the liver with metastasis.3. Mild hydronephrosis of the right kidney. Left is not well visualized. "}
{"instruction": "Generate impression based on findings.", "input": "33 year old female with history of thyroid cancer status post thyroidectomy. Evaluate for adenopathy, recurrence. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: No discrete nodules or masses are noted in the thyroidectomy bed.LEFT LOBE: Hypoechoic nodular focus within or adjacent to the thyroidectomy bed measures 6 mm x 2 mm x 4 mm and is unchanged. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right neck level 2 benign-appearing lymph node measures 1.6 cm x 0.5 cm. No pathologic lymphadenopathy. OTHER: No significant abnormality noted.", "output": "Unchanged hypoechoic nodular focus within or adjacent to the left thyroidectomy bed. "}
{"instruction": "Generate impression based on findings.", "input": "67-year-old female with thyroid nodules noted on outside CT scan. RIGHT LOBE MEASUREMENTS: 4.7 x 2.1 x 1.4 cmLEFT LOBE MEASUREMENTS: 3.9 x 2.3 x 1.4 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: 0.7 cm nodule in the right lower pole with spongiform features, most likely benign.LEFT LOBE: 1.1 x 1.0 x 0.6 cm mildly hypoechoic solid nodule in the left inferior pole/isthmus.ISTHMUS: 1.0 x 1.3 x 0.7 cm nodule in the right inferior pole/isthmus with spongiform features, most likely benign.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Thyroid nodules as described above."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Simpson is a 47 year old female recalled from screening mammogram for a right focal asymmetry. Family history of breast cancer in maternal great aunt. 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 heterogeneously dense, unchanged in pattern and distribution. The previously described focal asymmetry in the right inner lower breast disperses on spot compression views.Ultrasound: Targeted ultrasound of the right inner lower breast at 4:00, 3 cm from the nipple demonstrates normal glandular tissue without suspicious mass.", "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": "Enlarged thyroid gland RIGHT LOBE MEASUREMENTS: 6.2 x 2.4 x 2.6 cmLEFT LOBE MEASUREMENTS: 5 x 1.8 x 2 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Diffusely heterogeneous gland with reticular background. No discrete nodule.LEFT LOBE: Diffusely heterogeneous gland with reticular background. No discrete noduleISTHMUS: Diffusely heterogeneous gland with reticular background. No discrete nodulePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland with reticular background raises the possibility of chronic thyroiditis. No discrete nodule or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female patient with abdominal pain, worsening right upper quadrant. Evaluate for biliary pathology. LIVER: The liver measures 16.2 cm in length. Hepatic parenchymal echogenicity is increased. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There are numerous shadowing gallstones without pericholecystic fluid or gallbladder wall thickening. Sonographic Murphy's sign is negative. No intrahepatic biliary ductal dilatation is identified. The common duct is slightly dilated and measures 9 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 8.9 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 8.6 cm in length. No evidence of hydronephrosis.The spleen measures 8.7 cm in length.The right and middle hepatic veins are patent.", "output": "1. Cholelithiasis without sonographic evidence of acute cholecystitis. 2. Hepatic steatosis. "}
{"instruction": "Generate impression based on findings.", "input": "Call back from screening mammogram for a mass in the left breast. An ML view and two spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. There is an oval focal asymmetry in the upper inner quadrant in the left breast.On ultrasound, there is a circumscribed, mixed hyper-/iso-echoic mass, with minimal blood flow in the left 10:00 position.", "output": "A mixed hyper-/iso-echoic mass in the left 10:00 position. Old mammogram of Northwestern Memorial Hospital has been requested. If this mass is not confirmed on old mammogram, follow up in 6 months with left unilateral diagnostic mammogram is recommended. 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": "Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. Personal history of bilateral saline implants. Family history of breast cancer maternal great aunt. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. Bilateral saline implants are identified. 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": "Female; 30 years old. Reason: please evaluate for kidney stones or hydronephrosis History: flank and ureter pain in pregnant patient. RIGHT KIDNEY: The right kidney measures 12.1 cm in length. The renal parenchyma is normal in echogenicity. There is minimal caliectasis and hydronephrosis. Within the right kidney is a 6 x 4 x 2 mm nonobstructing renal stone. No suspicious renal mass is identified. LEFT KIDNEY: The left kidney measures 12.6 cm in length. The renal parenchyma is normal in echogenicity. There is minimal caliectasis and hydronephrosis. No shadowing renal stone or suspicious renal mass is identified.OTHER: The bladder is partially distended and incompletely evaluated.", "output": "1.Nonobstructing right renal stone.2.Minimal caliectasis and hydronephrosis bilaterally."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Mary Shade is a 63 years old female with a palpable mass in the right breast. MAMMOGRAM: Three standard views and additional spot compression views of both breasts and the right axilla (a total of 14 images) 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). A partially visualized spiculated mass with few possible faint calcifications is identified in the upper inner right breast far posterior depth. This mass measures 3 cm anteroposteriorly on the ML view. A prominent 12 mm intramammary lymph node is identified in the right axillary tail. In addition, a 12 mm focal asymmetry is identified in the upper outer left breast which persists with spot compression.Prominent right axillary lymph node noted.ULTRASOUND:On physical examination, an fixed mass is palpated in the right upper inner breast.A targeted right ultrasound was performed for the mammographic and palpable area of concern. In the right breast, 2:00 position, 5 cm from the nipple, there is a heterogeneously hypoechoic mass with irregular margin which measures 2.6 x 2.1 x 2.3 cm. There is increased vascular flow to this mass. In addition, a 1.1 x 0.7 x 1 cm hypoechoic mass is identified in the right breast 11:00 position, 8 cm from the nipple, which correlates with the low lying intramammary lymph node on the mammogram. A lymph node is identified in the right axilla measuring 1.4 x 1.2 x 0.5 cm, which has diffuse cortical thickening (3 mm) and nonhilar flow.A targeted left ultrasound was performed for the mammographic area of concern. In the left breast, 2:00 position, 3 cm from the nipple, there is a 1.2 x 0.5 x 1.3 cm lobulated hypoechoic correlation mass, which corresponds to the mammographic finding. There is no definite vascular flow associated with this mass.", "output": "--2.6 cm palpable right breast mass concerning for malignancy. Ultrasound-guided biopsy or FNA is recommended.--1.1 cm suspicious right intramammary lymph node concerning for metastatic disease. Ultrasound-guided biopsy is recommended.--Borderline suspicion of right axillary lymph node.--1.3 cm lobulated mass in the left breast with low suspicion for malignancy, this could represent a benign fibroadenoma. Ultrasound-guided biopsy is recommended.Surgical consultation is recommended.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old with biopsy proven left breast cancer, left breast ultrasound requested to evaluate interval change in size of the known cancer. A targeted left ultrasound was performed. 10 o'clock position of the left breast. There is a iso-to hypoechoic, irregular mass with internal calcifications that appears unchanged from prior study, measures 3.4 x 1.5 by 3.1 cm, mostly unchanged from prior study, when it measured 3.4 x 1.5 x 3.2 cm.", "output": "No interval change in size of known left breast cancer on ultrasound.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Female 61 years old; Reason: history of papillary thyroid carcinoma with local lymph node involvement, please evaluate for interval change History: no new symtpoms in the neck The patient is status post total thyroidectomy.RIGHT THYROIDECTOMY BED: No lesions are seen which are suspicious for recurrence.LEFT THYROIDECTOMY BED: No lesions are seen which are suspicious for recurrence.LYMPH NODES: No suspicious regional adenopathy noted. A right level 1B lymph node is seen with a fatty hilum measuring 1.5 cm x 0.8 cm x 1.3 cm. This previously measured 1.6 cm x 1.4 cm x 0.8 cm. A left liver 1B lymph node is seen with a fatty hilum measuring 1.5 cm x 0.7 cm x 1.1 cm. This previously measured 1.2 cm x 0.8 cm x 1.6 cm.", "output": "Negative thyroid exam status post total thyroidectomy. No lesions suspicious for recurrence in the thyroid bed. No suspicious regional adenopathy is identified."}
{"instruction": "Generate impression based on findings.", "input": "18-year-old female with biopsy-proven fibroadenoma in the left breast and ultrasound detected right breast benign morphology masses most likely a fibroadenoma presents for a six-month follow-up. A targeted bilateral breast ultrasound was performed for the patient\u2019s area of concern. Biopsy-proven fibroadenoma in the left breast 12:00 position measures 1.4 x 2.1 x 1.2 cm, previously measured 1.7 x 2 x 1.3 cm, mostly unchanged from prior study. This masses palpable. Another benign morphology masses in the right breast 10:00 position measures 1.2 x 0.7 x 1.4 cm, previously measured 1.2 x 0.6 x 1 cm, mostly unchanged from prior study.", "output": "No sonographic evidence for malignancy. Stable benign morphology masses in both breast as described above, mostly unchanged from prior studyBIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain and transaminitis LIVER: No significant abnormalities noted. 14.3 cm in length BILIARY TRACT: Distended gallbladder associated with gallbladder wall thickening and trace pericholecystic fluid. Gallbladder sludge. Positive Murphy's sign. No ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 8.7 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.5 cm in lengthOTHER: Stable left renal cyst. Left kidney 9.6 cm in length. No ascites.", "output": "Distended gallbladder with gallbladder wall thickening and pericholecystic fluid associated with positive Murphy's sign consistent with acute cholecystitis. No ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old male with cholangiocarcinoma and prior removal of cholecystostomy tube. Now with sepsis. Evaluate for biliary dilatation or fluid collection. LIVER: Liver is normal in size but highly echogenic due to parenchymal disease. There are scattered masses present within the liver which have a \"target\" appearance with an echogenic center and hypoechoic rim. Although not specific, findings should be worrisome for metastatic disease. Infection is considered unlikely. Main portal vein is taking by color and spectral Doppler with appropriate flow direction.BILIARY TRACT: No biliary dilatation. The gallbladder is significantly thick-walled with a small amount of pericholecystic fluid. This could be related to prior cholecystostomy tube but certainly cholecystitis cannot be excluded. No shadowing gallstones are identified, and the wall does not appear hypervascular.PANCREAS: Limited by bowel gas.SPLEEN: Limited but normal in size.RIGHT KIDNEY: 14.5 cm in length including a 4 cm cyst in the upper pole. Kidney is echogenic consistent with parenchymal disease. No hydronephrosis. OTHER: Left kidney measures approximately 12.3 cm in length. Kidney is echogenic consistent with parenchymal disease with at least one cyst in the midportion.Trace of perihepatic fluid.", "output": "1. Trace of perihepatic fluid. Thick gallbladder wall. This could be related to prior drainage tube but cannot exclude acalculus cholecystitis.2. Presumed metastatic disease involving the liver.3. Echogenic kidneys with cysts.4. Echogenic liver"}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: Mildly coarse echogenic and heterogeneous liver echotexture without mass. Liver length 17.4 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.7 cm in lengthOTHER: Left kidney 11.7 cm in length. Spleen 11.7 cm in length. No ascites", "output": "Mildly coarse echogenic and heterogeneous liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female status post left lumpectomy and undergoing radiation presents for a left breast ultrasound to evaluate any underlying mass. A whole left breast ultrasound was performed. On physical examination, redness and erythema/swelling of the left breast noted compatible with radiation induced change. Scarring noted in the left upper-outer quadrant with underlying seroma cavity that measures 2.5 x 1.9 x 2 cm. No evidence of skin thickening. There is no suspicious solid mass identified.", "output": "Post radiation and postsurgical changes in form of a seroma cavity in the lumpectomy bed.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Ms. ARLYNE MARKS is a 86 years old female with a personal history of status post left mastectomy in 1987 and right breast benign biopsy in 1999. She currently has no breast related complaints. MAMMOGRAM: Three standard views of the right breast as well as spot magnification views and additional MLO view 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 are new loosely grouped calcifications in the upper outer right breast, which measure up to 2 cm in extent, with arterial calcifications noted within the vicinity. Note is made of an associated focal asymmetry/density on the spot magnification ML view which was further evaluated with ultrasound to look for invasive component.A scar marker overlies the right breast, indicating location of prior benign biopsy. There is a stable focal asymmetry in the lower right breast. A low-lying right axillary lymph node is unchanged. ULTRASOUND:A targeted right ultrasound was performed for the mammographic area of concern in the upper outer quadrant. There is no solid or cystic mass identified in the region of asymmetry/density seen on the spot magnification view.", "output": "New grouped calcifications in the upper outer left breast. The possibility of stereotactic biopsy was discussed; however, the patient was unable to tolerate the prone position, due to pain. Therefore, a referral was made to Weiss Hospital for an upright stereotactic biopsy. These findings were relayed to Dr. Avit Kapur from Weiss Hospital via telephone at the time of consultation. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for gallstones History: pain after eating fatty foods LIVER: The liver measures 13.6 cm in length. Unremarkable hepatic parenchymal echotexture and echogenicity. The portal vein is patent with normal directional hepatopedal flow, peak velocity 26.1 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. No cholelithiasis or gallbladder sludge. The common bile duct measures 0.2 cm. The gallbladder wall measures 2 cm. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 9.8 cm in length. Unremarkable renal parenchyma. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.1 cm in length. Unremarkable renal parenchyma. No shadowing stones or hydronephrosis.OTHER: No significant abnormalities noted.", "output": "No acute hepatobiliary abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Female; 68 years old. Reason: Evaluate gallbladder sludge vs stones History: abdominal pain, not related to activity LIVER: The liver measures 16.5 cm the length. The contour is smooth and the parenchyma demonstrates normal echotexture. No focal lesions are identified. The main portal vein is patent and demonstrates normal direction of flow with a peak velocity 20 cm/sec.BILIARY TRACT: The gallbladder is contracted and not well visualized. It is filled with shadowing stones. The patient is tender when scanning over the gallbladder. The common bile duct measures 3 mm. There is no intrahepatic biliary ductal dilatation.PANCREAS: Pancreatic head is unremarkable. The body and tail are obscured by overlying bowel gas.SPLEEN: 10.2 cm in length.RIGHT KIDNEY: 9.5 cm in length. Several simple cysts are redemonstrated, the largest measures 3.6 x 4.0 x 4.1 cm . There is no hydronephrosis. The renal parenchyma is mildly echogenic.LEFT KIDNEY: 10.0 cm in length with a 2.1 x 2.2 x 1.7 cm simple cyst. There is no hydronephrosis. The renal parenchyma is mildly echogenic..OTHER: There is no ascites.", "output": "1.Contracted gallbladder with multiple gallstones. No intra-or extrahepatic biliary ductal dilatation.2.Bilateral simple renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "Possible hepatitis C and thrombocytopenia with edema LIVER: 6.1 x 4.1 x 5.2 cm heterogeneous solid mass arising from segments 2/3 left lobe of the liver. Multiple well-circumscribed bilobar echogenic foci; the largest within the right lobe measures 3.2 x 3.6 x 3 cm.Background liver demonstrates normal morphology without cirrhosis. Limited main portal vein Doppler interrogation demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 11.5 cm in lengthRIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. Right kidney 8.1 cm in length. OTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. Left kidney 9 cm in length. No ascites.", "output": "Heterogeneous mass arising from left lobe of the liver; a malignant etiology, either primary or metastatic, must be considered. Would recommend correlation with contrast CT examination.Multiple bilobar well-circumscribed echogenic foci; favor hemangiomas.Background liver morphology unremarkable. Gallbladder sludge without acute inflammation or ductal dilatation. No ascites.Echogenic kidneys consistent with medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis.Results communicated to Dr. Frohne 12/20/2016; 13:30."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain, evaluate area around G-tube to exclude abscess Sonographic interrogation of soft tissues surrounding percutaneous gastrostomy tube within normal limits. No evidence of fluid or organizing collection.", "output": "Unremarkable exam."}
{"instruction": "Generate impression based on findings.", "input": "Follow-up left renal mass RIGHT KIDNEY: Stable right renal cyst. No worrisome mass, stone, or hydronephrosis. 10.6 cm in length.LEFT KIDNEY: Stable exophytic partially calcified renal lesion measuring 2.3 x 1.6 cm. Minimal prominence of left collecting system unchanged. Left kidney 10.1 cm in length.OTHER: Bladder nondistended", "output": "Stable exophytic partially calcified left renal lesion. Stable minimal prominence of left collecting system."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female with a history of thyroid cancer status post thyroidectomy. Evaluate for recurrence. RIGHT LOBE, LEFT LOBE, ISTHMUS MEASUREMENTS: The thyroid is absent.RIGHT LOBE: There is an approximately 0.2 x 0.3 hypoechoic area in the right thyroid bed without vascularity. Although not seen on the most recent exam, this was present on the thyroid ultrasound dated June 2015 and is unchanged. This focus may represent a scar. LEFT LOBE: The thyroid is absent.ISTHMUS: The thyroid is absent.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: OTHER: No significant abnormality noted.", "output": "Small hypoechoic area in the right thyroid bed which is unchanged from the June, 2015 exam."}
{"instruction": "Generate impression based on findings.", "input": "23-year-old female presents to evaluate a self palpated mass in the left breast 12:00 position 1.5 cm from the nipple. Patient indicates it has increased in size and is palpable since 2011. No prior workup has been performed at University of Chicago. No family history of breast cancer A targeted left ultrasound was performed for the palpable area of concern. On physical examination, a 2 cm mobile palpable nontender mass is identified in the left breast 12:00 position. Ultrasound demonstrates an oval lobulated hypoechoic mass measuring 2.2 x 1.5 x 2 cm with minimal peripheral blood flow most likely a fibroadenoma.", "output": "Palpable abnormality in the left breast 12:00 position most likely a benign fibroadenoma however given that the mass has increased in size as per the patient, surgical consultation with possible FNA is recommended. Findings and recommendations were discussed with the patient in detail.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Benign-appearing renal cysts. Right kidney 15 cm in lengthLEFT KIDNEY: Atrophic left kidney with echogenic parenchyma without mass or hydronephrosis.OTHER: Bladder nondistended", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or obstruction. Atrophic left kidney."}
{"instruction": "Generate impression based on findings.", "input": "Suspected metastatic lesion in the brain. Evaluate for testicular neoplasm. RIGHT TESTIS: 4.2 x 2.7 x 3.4 cm. Normal parenchymal echotexture and vascularity. No focal mass is evident.LEFT TESTIS: 2.9 x 3.4 x 3.2 cm. Normal parenchymal echotexture and vascularity. No focal masses evident.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Small bilateral hydroceles are present.", "output": "Small bilateral hydroceles, without suspicious testicular lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "Ms. O'Connell is a 38-year-old female with a personal history of metastatic left breast cancer diagnosed in 2011. Patient now feels a pea-sized mass in the left lower inner breast for the past one week. Upon physical exam at patient's area of concern, a superficial pea-sized mass is appreciated.A targeted left breast ultrasound was performed for the patient\u2019s area of concern. In the left breast 7:00 location, approximately 6 cm from the nipple, there is an irregular hypoechoic mass identified measuring 0.9 x 0.7 x 0.7 cm. There is minimal associated vascularity. The current sonographically identified mass is in a similar location to previously identified mass in April 2015.", "output": "0.9 cm mass in the left lower inner breast, at the approximate location of previously identified suspicious mass in April 2015. An ultrasound-guided biopsy with clip placement can be performed if clinically warranted.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old male with worsening renal function. Evaluate for obstruction. RIGHT KIDNEY: Right kidney measures 10.5 cm in length and is highly echogenic consistent with parenchymal disease. This has progressed when compared to the prior exam. There are several simple cysts present the largest measuring 3.1 cm in greatest diameter. In the lower pole, there is a complex appearing and slightly hypoechoic area within the cortex measuring 1.1 cm in greatest diameter. Review of the prior study there was a simple cyst in this location and therefore this likely represents a complex cyst.LEFT KIDNEY: The left kidney measures 10.5 cm in length and is highly echogenic consistent with parenchymal disease. This has progressed when compared to the prior study. There are multiple exophytic and small cortical cysts present. Largest cyst measures 2.6 cm in diameter. There is mild fullness of the collecting system which likely is due to associated parenchymal volume loss rather than obstruction.OTHER: Patient voided prior to the procedure and therefore the bladder is almost empty and appears very thick-walled.", "output": "Progressive increase in echogenicity the kidneys.Bilateral renal cysts with likely complex cyst on the right.Fullness of left renal collecting system with associated parenchymal loss. No gross evidence for hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old male with a history of hepatitis C presents for HCC screening. LIVER: The liver parenchyma is coarse and echogenic. No focal hepatic lesion or intrahepatic biliary ductal dilatation. It is normal in size, measuring 15.5 cm in the craniocaudal dimension. Normal hepatopetal portal venous blood flow at 30 cm/sec.GALLBLADDER, BILIARY TRACT: Small gallstone without gallbladder wall thickening, pericholecystic fluid, or focal tenderness. No extrahepatic biliary ductal dilatation with the common duct measuring 6 mm.PANCREAS: The poorly visualized pancreatic body and head are unremarkable.RIGHT KIDNEY: The right kidney is normal in size, measuring 10.1 cm without hydronephrosis, or shadowing nephrolithiasis. 1.1 cm hypoechoic lesion, compatible with a probable simple cyst as seen on CT 3/6/2015.OTHER: The spleen is normal in size, measuring 10.9 cm in length. The left kidney measures 10 cm in length without hydronephrosis, shadowing nephrolithiasis, or suspicious lesion. There is a 2.0 cm bilobed inferior pole probable cyst as seen on prior CT.", "output": "Echogenic liver parenchyma consistent chronic liver disease without a focal lesion.Cholelithiasis without evidence of acute cholecystitis.Bilateral renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "Nausea vomiting LIVER: Mildly enlarged liver with mildly heterogeneous echotexture without mass. Liver length 19.2 cm.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. Minimal extrahepatic ductal prominence without distal obstructing lesion; favor benign chronic etiology.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.6 cm in lengthOTHER: Left kidney 9.6 cm in length. Spleen 8.6 cm in length. No ascites.", "output": "Mild hepatomegaly with mildly heterogeneous echotexture suggestive for parenchymal dysfunction without mass or significant ductal dilatation status post cholecystectomy. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Reason: MYH-associated polyposis associated with increased risk thyroid cancer; mother with thyroidectomy History: surveillance; none RIGHT LOBE MEASUREMENTS: 5.8 x 2.3 x 2.4 cm.LEFT LOBE MEASUREMENTS: 4.9 x 1.8 x 1.9 cm.ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: Right mid pole nodule is heterogeneous and predominantly solid and measures 1.5 x 1.0 x 0.9 cm. No internal vascularity or microcalcifications.Right inferior pole nodule demonstrates similar characteristics, measuring 1.7 x 1.3 x 1.8 cm. No internal vascularity or microcalcifications.LEFT LOBE: The left thyroid is heterogeneous with numerous nodules which are predominantly cystic without internal vascularity or calcifications. Reference nodule measures 0.8 x 0.5 x 0.9 cm.ISTHMUS: Hypoechoic nodule in the junction of the stenosis in the left medial thyroid lobe measures 1.1 x 0.8 x 0.9 cm. This nodule is more solid with punctate hyperechoic foci which could be secondary to motion artifact, as on subsequent images it has a more spongiform appearance. Close attention on follow-up examinations is recommended. No significant internal vascularity.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted. No cervical lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Nodule at the junction of the isthmus and the left medial thyroid lobe warrants attention on follow-up examinations as described above. Other bilateral nodules without definite suspicious features."}
{"instruction": "Generate impression based on findings.", "input": "Hydronephrosis seen on outside imaging RIGHT KIDNEY: 11.3 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 12.8 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.NEOBLADDER: Collapsed. OTHER: No significant abnormality noted.", "output": "No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old female presents with persistent sensation of swelling/mass in her right lateral neck. Right level IB round hypoechoic lymph node corresponds to patient's sensation of swelling/mass and measures 2.1 x 0.9 x 0.6 cm. There is minimal vascularity which is unchanged. The node has increased in length but remains within normal limits for short axis dimension. There is lack of a fatty hilum.", "output": "Right cervical lymph node corresponds to patient's sensation of swelling/mass. The lymph node lacks a fatty hilum which is non-specific, but may be infectious/inflammatory in etiology. However, a neoplastic process remains on the differential. "}
{"instruction": "Generate impression based on findings.", "input": "36-year-old female for follow-up thyroid nodules. RIGHT LOBE MEASUREMENTS: 4.7 x 1.3 x 1.6 cmLEFT LOBE MEASUREMENTS: 5.1 x 2.5 x 2.4 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: In the right lobe there is again noted a predominantly hypoechoic but mildly heterogeneous solid nodule measuring 1 x 1.1 x 1.4 cm without interval change. This appears slightly less spongiform than on the prior exam. No new nodules are identified.LEFT LOBE: Again noted in the left lobe is a large complex nodule with a slightly greater than 50% solid component. Remainder is complex cystic. There are at least 2 large shadowing calcifications within this nodule, and smaller calcifications as well. The nodule measures 2.2 x 2.3 x 3.6 cm without significant interval change. No new nodules are identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable, bilateral thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules and history of Hashimoto's RIGHT LOBE MEASUREMENTS: 3.5 x 1.4 x 1.3 cmLEFT LOBE MEASUREMENTS: 3.9 x 1.6 x 1.5 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Increasing heterogeneity in the right lobe. Relatively stable subcentimeter hypoechoic nodules. Reference upper pole nodule measures 0.8 x 0.4 x 0.7 cm, stable. Reference lower pole nodule measures are 1.1 x 0.7 x 0.7, minimally larger.LEFT LOBE: Diffusely and increasingly heterogeneous echotexture with reticular background consistent with chronic thyroiditis. No discrete nodule appreciated.ISTHMUS: Increasingly diffuse heterogeneous echotexture PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Regional benign appearing lymph nodesOTHER: No significant abnormality noted.", "output": "Thyroid appears increasingly heterogeneous which presumably reflects patient's underlying Hashimoto's thyroiditis. No dominant nodules. Existing reference nodules of been relatively stable with minimal enlargement of one of the reference nodules. These findings were discussed with the patient at the time of the examination."}
{"instruction": "Generate impression based on findings.", "input": "61 year-old female with left breast mass on prior ultrasound examination from 2014 with increasing calcifications on recent mammogram. Left breast ultrasound:Targeted left breast ultrasound examination was performed for the patient's mammographic area of concern and area of previously seen left breast mass. Note is made of a normal morphology intramammary lymph node at the 3:00 position of the left breast approximately 2 cm from the nipple. Note is made of a heterogeneous but predominantly hypoechoic irregular mass at the 3:00 position of the left breast approximately 3 cm from the nipple, measuring approximately 1.4 x 0.4 x 1.0 cm with internal vascularity on Doppler interrogation, previously 1.1 x 0.6 x 1.0 cm, increased in size. Targeted left breast ultrasound examination was performed for the area of increasing calcification seen on recent mammogram. Note is made of an irregular heterogeneous but predominantly hypoechoic mass measuring 1.8 x 0.8 x 1.3 cm at the 12:00 position of the left breast approximately 1 cm from the nipple. There is extensive peripheral and internal vascularity on Doppler interrogation.", "output": "Multiple left breast masses with the largest measuring 1.8 cm at the 12 o'clock position of the left breast. Further evaluation with ultrasound-guided core needle biopsy is recommended. These findings and recommendation were discussed directly with the patient.BIRADS: 5 - Highly suggestive of malignancy. RECOMMENDATION: H - Percutaneous Biopsy/Aspiration. "}
{"instruction": "Generate impression based on findings.", "input": "82-year-old male with hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 4.2 cm x 2.0 cm x 2.2 cmLEFT LOBE MEASUREMENTS: 4.1 cm x 1.6 cm x 1.5 cmISTHMUS MEASUREMENTS: 5 mm in thicknessRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Ovoid hypoechoic nodule inferior to the left thyroid lobe is seen measuring 8 mm x 5 mm. This is more heterogeneous than is typical for a parathyroid adenoma, but does not have the appearance of a normal lymph node.LYMPH NODES: Right neck level 2 benign-appearing lymph node measures 1.3 cm x 0.6 cm x 0.2 cm. No pathologic lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Hypoechoic nodule inferior to the left thyroid lobe appears to correspond to the focus of increased activity seen on prior parathyroid SPECT CT scan on 10/31/2013 which was noted to be a parathyroid adenoma."}
{"instruction": "Generate impression based on findings.", "input": "Female; 74 years old. Reason: 74yp F w/ adenocarcinoma, evaluate for cholestasis/transaminitis cause History: as above LIVER: The liver is enlarged measuring 20.8 cm in length. There is an ill-defined 4.8 x 2.0 by 2.5 cm heterogeneous but predominantly hypoechoic focus near the gallbladder fossa. There is some internal vascularity within this focus which may represent the course of normal vessels. Please refer to the recent CT for additional findings. The main portal vein is not definitely seen but appeared patent on CT. There is portal venous branch flow suggested with a somewhat decreased velocity of 10 to 20 cm/sec.BILIARY TRACT: The gallbladder is nondistended. There is no cholelithiasis or gallbladder wall thickening. The gallbladder wall measures 3 mm. There is no intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 7.6 cm in length.RIGHT KIDNEY: The right kidney measures 9.2 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone. LEFT KIDNEY: The left kidney measures 10.9 cm in length. There is no hydronephrosis or shadowing renal stone. In the superior pole of the kidney is a 2.7 x 2.4 x 2.7 cm predominantly cystic lesion with nodular components along the wall. This lesions correlates with that seen on the recent CT.", "output": "1.Hepatomegaly and increased parenchymal echogenicity suggestive of underlying parenchymal dysfunction/steatosis. Ill-defined, heterogenous, hypoechoic focus near the gallbladder fossa could represent an area of focal fatty sparing but this finding is nonspecific. MRI is recommended for further characterization.2.2.7 cm left renal mass has an ultrasound appearance concerning for primary renal neoplasm."}
{"instruction": "Generate impression based on findings.", "input": "Female 40 years old Reason: 2 weeks post uterine artery embolization with painful bulge midline upper abdomen,?ventral hernia also with epigastric pain History: see above No evidence of ventral hernia. The bulge is broad-based with no neck no bowel seen in the hernia sac. No evidence of intraperitoneal fluid.", "output": "No ventral incisional hernia seen."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Ciochina is a 58 year old female presenting from outside hospital with a questionable sonographic lesion in the right periareolar region. She presents today for repeat ultrasound evaluation of this area. On physical examination, no discrete mass is palpated at the right breast periareolar region.A targeted right breast ultrasound was performed for the periareolar area of concern. There is no suspicious solid or cystic mass identified. Heterogenous shadowing from the nipple is seen, corresponding to the images obtained at the outside hospital.A targeted left breast periareolar ultrasound was performed solely for comparison. Very similar heterogenous shadowing from the nipple is again seen.", "output": "No sonographic evidence for malignancy. No additional workup is necessary for the right periareolar region. Of note, patient does have two clusters of calcifications in the right breast, for which stereotactic biopsy continues to be recommended for. All results and recommendations were discussed with the patient and Dr. Henry in the breast surgical clinic. The patient will follow up with Dr. Jaskowiak later today. BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain with leukocytosis LIVER: Coarse echogenic liver echotexture without mass. Liver length 16.1 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic renal parenchyma without mass or stone. Minimal hydronephrosis. Right kidney 9.4 cm in lengthOTHER: Echogenic left renal parenchyma without worrisome mass or stone. Minimal hydronephrosis. Left renal cyst. Left kidney 12.2 cm in length. Spleen 9.5 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Unremarkable gallbladder.Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass or stone. Minimal bilateral hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Pancreas transplant with abnormal serum enzymes LIVER: Mildly coarse echogenic liver echotexture without mass. Liver length 15.8 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Atrophic right kidney without mass, stone, or hydronephrosis. Right kidney 6 cm in length.OTHER: Atrophic left kidney without mass, stone, or hydronephrosis. Left kidney 5.5 cm in length. Spleen 11.9 cm in length. No ascites.Left iliac fossa renal transplant demonstrates minimal hydronephrosis. Left iliac fossa renal transplant 13.4 cm in length.", "output": "Mildly coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Native renal atrophy. Left iliac fossa renal transplant unremarkable with expected minimal hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "46 year old female with epigastric pain LIVER: Normal in size with echogenic parenchyma likely due to fatty infiltration.GALLBLADDER, BILIARY TRACT: Gallbladder is mildly distended with wall thickening and a hypoechoic rim in the surrounding parenchyma. Non--- mobile stone in the gallbladder neck. Findings consistent with acute cholecystitis. Patient not tender over the gallbladder but has received pain medication.PANCREAS: Limited due to bowel gas.RIGHT KIDNEY: Small cyst.OTHER: No significant abnormalities noted.", "output": "Findings consistent with acute cholecystitis. Emergency room notified at 8:50 a.m."}
{"instruction": "Generate impression based on findings.", "input": "42 years old, Female, Reason: Abnormal nodes? History: THyrodi cancer s/p surgery MEASUREMENTS: Patient is status post thyroidectomy.RIGHT LOBE AREA: No significant abnormality noted. No evidence of local recurrence.LEFT LOBE AREA: Asymmetry in the area of the left thyroidectomy bed. No focal mass.ISTHMUS AREA: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign appearing left level 2 lymph node with a fatty hilum measuring 0.6 x 0.2 x 0.8 cm.OTHER: No significant abnormality noted.", "output": "Asymmetry in the area of the left thyroidectomy bed without focal mass. No definite evidence of recurrence or lymphadenopathy. However follow up imaging of the thyroid is recommended to ensure stability."}
{"instruction": "Generate impression based on findings.", "input": "58 years Female with left sided thyroid fullness. RIGHT LOBE MEASUREMENTS: 4.2 x 1.7 x 1.5 cmLEFT LOBE MEASUREMENTS: 5.0 x 1.4 x 1.4 cmISTHMUS MEASUREMENTS: 0.2 cm in thickness. RIGHT LOBE: Normal echotexture without discrete nodules. LEFT LOBE: Normal echotexture. A few scattered subcentimeter cystic nodules are present which probably represent colloid cysts. A non-specific hypoechoic nodule is present along the posterior aspect of the midpole of the left thyroid measuring 0.3 x 0.3 x 0.5 which demonstrates questionably increased vascularity but does not contain suspicious microcalcifications.ISTHMUS: Normal echotexture with single subcentimeter cystic lesion which probably represents a colloid cyst.PARATHYROID GLANDS: No significant abnormalities.LYMPH NODES: A left level 2 lymph node measures 2.3 x 0.5 x 1.3 cm and lacks suspicious morphologic features. OTHER: No significant abnormalities.", "output": "1.Normal thyroid size and echotexture.2.Subcentimeter thyroid nodules as described above. "}
{"instruction": "Generate impression based on findings.", "input": "44-year-old male patient with CVID, persistent left anterior cervical node. Evaluate thyroid and left anterior cervical lymph node. RIGHT LOBE MEASUREMENTS: 3.9 x 1.2 x 1.3 cm.LEFT LOBE MEASUREMENTS: 4.0 x 1.1 x 1.3 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: The right thyroid lobe is homogeneous in echogenicity without thyroid lesion.LEFT LOBE: The left thyroid lobe is homogeneous in echogenicity without thyroid lesion.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is a 2.3 x 1.2 x 0.5 cm right level two lymph node and a 2.1 x 1.0 x 0.4 cm right level three lymph node. There is an enlarged node in the region of the left submandibular gland measuring 2.2 x 1.4 x 3.0 cm.OTHER: No significant abnormality noted.", "output": "1. Enlarged left submandibular region lymph node.2. No dominant thyroid lesion."}
{"instruction": "Generate impression based on findings.", "input": "Pain with palpable abnormality in left groin At site of clinical concern in left inguinal region is ill-defined soft tissue hypoechogenicity with mild adjacent vascularity. Focus measures approximately 0.7 x 0.4 cm. May reflect site of focal cellulitis or a tiny abscess, no drainable fluid is seen. On the contralateral side, nonenlarged benign appearing inguinal lymph nodes seen.", "output": "Subcentimeter focus of ill-defined soft tissue hypoechogenicity with mild adjacent vascularity, may reflect site of focal cellulitis or a tiny abscess, no drainable fluid seen."}
{"instruction": "Generate impression based on findings.", "input": "Male; 81 years old. Reason: Evaluation for Diaphragmatic Hernia/Abdominal Wall Hernia. History: Abdominal Wall Hernia. Scanning of the left upper quadrant abdominal wall reveals no evidence of abdominal wall hernia at rest or with Valsalva.", "output": "No evidence of abdominal wall hernia."}
{"instruction": "Generate impression based on findings.", "input": "MS. Emily Ginger is a 29 year old female with a palpable concern in the right breast. On physical examination, a small mobile superficially located mass is palpated in the right far inner breast.A targeted right ultrasound was performed for the palpable area of concern. In the right breast, 4:00 position, 6 cm from the nipple, there is a heterogeneously hypoechoic area within the skin measuring 7 x 2 x 8 mm, which likely represents a benign dermal cyst.", "output": "No sonographic evidence for malignancy. A benign dermal cyst corresponding to patient's palpable concern in the right breast is seen. The patient should follow up with her primary care physician as clinically warranted, presuming these results are concordant with the physical exam findings. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Rule out hydronephrosis History: AKI Nondiagnostic exam secondary to patient body habitus and bowel gas.RIGHT KIDNEY: Not visualized secondary to body habitus and bowel gas.LEFT KIDNEY: Not visualized secondary to body habitus and bowel gas.OTHER: No significant abnormalities noted.", "output": "Nondiagnostic exam secondary to patient body habitus and bowel gas."}
{"instruction": "Generate impression based on findings.", "input": "Renal stones. History of right ureteral stone lithotripsy in November, per patient. RIGHT KIDNEY: 10.3 cm in length. Normal renal parenchymal echogenicity. No focal lesions or hydronephrosis. No renal stones are evident.LEFT KIDNEY: 12.0 cm in length. Normal renal parenchymal echogenicity. No focal lesions or hydronephrosis. Subcentimeter nonobstructing renal stone noted in the inferior pole.BLADDER: No significant abnormality noted.OTHER: No significant abnormalities noted.", "output": "Left sided nephrolithiasis. No hydronephrosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old male with epigastric pain after fatty foods, rule out gallstones or other etiology. LIVER: Diffuse increased echogenicity of the liver measuring 16.2 cm in length suggestive of fatty infiltration. No focal hepatic lesions. No intrahepatic biliary ductal dilatation.GALLBLADDER, BILIARY TRACT: Scattered echogenic foci throughout the gallbladder wall with comet tail artifact compatible with adenomyomatosis. No sludge or gallstones. No pericholecystic fluid or gallbladder wall thickening is noted. Sonographic Murphy's sign is negative. The common duct measures 2 mm in caliber.PANCREAS: The distal body and tail of the 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 10.0 cm in length with no hydronephrosis or nephrolithiasis.OTHER: The left kidney measures 12.4 cm in length. There is an exophytic cyst measuring 6 mm x 6 mm x 5 mm. Otherwise the kidney is normal in echogenicity with no hydronephrosis or nephrolithiasis. The spleen measures 11.8 cm in length and is normal in echogenicity..", "output": "1. Findings suggestive of hepatic steatosis. 2. Adenomyomatosis of the gallbladder. 3. Exophytic left renal cyst. "}
{"instruction": "Generate impression based on findings.", "input": "Epigastric abdominal pain LIVER: No significant abnormalities noted. Liver length 14.9 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis associated with diffuse gallbladder wall thickening and positive Murphy's sign. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.3 cm in length.OTHER: Left kidney 9.5 cm in length. Spleen 8.3 cm in length. No ascites", "output": "Cholelithiasis associated with diffuse gallbladder wall thickening and positive Murphy's sign. Findings suggestive for acute or chronic cholecystitis without ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "86-year-old male with left parotid mass. Evaluate and compare with prior imaging. In the left lower parotid gland, the known lesion with prominent rim calcification measuring 0.8 x 0.8 x 0.7 cm in size shows no significant interval change. The prominent posterior shadowing from the rim calcification obscures the underlying tissue. The remainder of the left parotid gland has a homogeneous echotexture.", "output": "Stable size and appearance of the known subcentimeter peripherally calcified lesion of the left inferior parotid gland."}
{"instruction": "Generate impression based on findings.", "input": "Chronic renal disease RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 8.7 cm in lengthLEFT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Minimally complex upper pole cyst measuring 1.9 x 2.1 cm. Left kidney 8.3 cm in lengthOTHER: Bladder nondistended", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "69 year old female who was recalled from screening mammogram for multiple focal asymmetries in the central to inferior right breast. Family history of ovarian or uterine cancer in sister. Personal history of benign breast biopsy. Mammogram: An ML view and 4 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. Out of 3 focal asymmetries in the right lower, inner quadrant, only one oval 7 mm focal asymmetry persists on spot compression views. The other two focal asymmetries, most likely look like glandular tissue.Ultrasound: Targeted right lower, inner quadrant Ultrasound is performed. Oval, benign morphology, mass, with possible central fatty hilum measuring 7 x 3 mm is identified at 4 o'clock position of the right breast mostly corresponding to the mammographic abnormality. No definite hilar blood flow 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: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "History gallbladder polyp LIVER: Mildly coarse and echogenic liver echotexture without worrisome mass. 1.4 x 0.7 cm hypoechoic focus anterior to the falciform ligament corresponding to a stable benign-appearing lesions seen on the outside chest CT from 4/15/2014. Liver length 16.5 cm.GALLBLADDER, BILIARY TRACT: Stable subcentimeter gallbladder polyp measuring 0.4 cm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.5 cm in lengthOTHER: Left kidney 10.8 cm in length. Spleen 8.6 cm in length. No ascites", "output": "Stable subcentimeter gallbladder polyp.Mildly coarse and echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without worrisome mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "82-year-old female presents for further characterization with thyroid nodule seen on prior CT. RIGHT LOBE MEASUREMENTS: 4.7 x 2.1 x 1.6 cm.LEFT LOBE MEASUREMENTS: 6.2 x 2.9 x 1.9 cm.ISTHMUS MEASUREMENTS: 0.7 cm.RIGHT LOBE: There are multiple nodules in the right lobe. The largest is in the right inferior aspect measuring approximately 1.1 x 0.8 x 0.8 cm. It is mixed cystic-solid, predominantly solid, well-defined, with possible spongiform components.LEFT LOBE: There are multiple nodules in the left lobe. The largest is in the left inferior aspect measuring approximately 1.9 x 1.7 cm. It is predominantly solid, well-defined, with possible spongiform components.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Multinodular thyroid as described above. Favor benign etiologies."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Williams is a 19 year old female presenting with a palpable mass in the right breast. Per patient, she has felt it for the past one week. No history of trauma or pain. Upon physical exam at the patient's area of concern, a vague mobile nodular mass is appreciated. A targeted right breast ultrasound was performed for the palpable area of concern. In the right breast, 5:00 position, no suspicious cystic or solid was identified. Normal dense parenchymal breast tissue was identified.", "output": "No sonographic evidence for malignancy. The patient should follow up with her primary care physician as clinically warranted. All results and recommendations were relayed to the patient.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "History of multiple kidney stones. RIGHT KIDNEY: The right kidney measures 13 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.LEFT KIDNEY: The left kidney measures 13 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.URINARY BLADDER: Normally distended urinary bladder.OTHER: No significant abnormalities noted.", "output": "No hydronephrosis or shadowing nephrolithiasis."}
{"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": "20 year-old female patient with the left breast mass x 4 years. Family history of breast cancer in mother at 59 years of age. A targeted left breast ultrasound was performed. There is an oval parallel hypocholic mass in the 8 o'clock position of the left breast 3 cm from the nipple that measures 3.1 x 1.1 x 2.4 cm.", "output": "The palpable lump is due to a 3.1 x 1.1 x 2.4 cm mass with generally benign sonographic features in the inner left breast. This is most likely a fibroadenoma, however based on the size, surgical consultation is recommended. Recommend consultation with breast surgeon, which patient scheduled immediately after discussion.BIRADS: 3 - Probably benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old woman with strong family history of breast cancer presents with a palpable mass in the left breast. MAMMOGRAM", "output": "1.9 cm left breast mass corresponding to palpable abnormality, with imaging features suggestive of fibroadenoma. Given this is a new finding and strong family history of cancer, an FNA or percutaneous ultrasound-guided biopsy recommended for definite diagnosis. Other much smaller masses are presumed benign as long as tissue diagnosis is benign for the largest of the masses. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Liver dysfunction LIVER: Mildly coarse echogenic liver parenchyma without mass. Liver length 14.3 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Mildly echogenic renal parenchyma without mass, stone, or obstruction. 9.5 cm in lengthOTHER: Mildly echogenic left renal parenchyma without obstruction. 10.7 cm in length. Spleen 13.1 cm in length. No ascites. Bilateral pleural effusions.", "output": "Congenital coarse liver parenchyma raises the possibility of fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites.Mildly echogenic renal parenchyma raises the possibility of medical renal disease/parenchymal dysfunction without obstruction."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old male with elevated LFTs, history of renal transplant LIVER: The liver measures 15.2 cm. Doppler of the portal vein demonstrates hepatopedal flow of 41.2 cm/s.BILIARY TRACT: There is sludge seen within the gallbladder. Gallbladder wall measures 2.4 mm. The common bile duct measures 4.1 mm.PANCREAS: The pancreas head and proximal body are visualized, no abnormalities noted.SPLEEN: The spleen measures 11.4 cm. No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 6.8 cm, and has increased echogenicity, compatible with medical renal disease. LEFT KIDNEY: The left kidney shows increased echogenicity, and measures 7.5 cm, compatible with medical renal disease. OTHER: Renal transplant is visualized and measures 14.0 cm. No masses or hydronephrosis are visualized.", "output": "1. Sludge is seen within the gallbladder without evidence of stones or acute cholecystitis.2. No renal transplant abnormalities visualized."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with history of thyroid cancer, status post thyroidectomy. THYROID: The patient is status post thyroidectomy. RIGHT THYROIDECTOMY BED: Status post thyroidectomy with no evidence of residual or recurrent disease. LEFT THYROIDECTOMY BED: Within the superior left thyroidectomy bed there is a 5 x 4 x 4 mm hypoechoic focus which is not clearly demonstrated on the recent prior study. No evidence of calcifications or hypervascularity. Focus is non-specific and indeterminate in appearance. The 12/05/2012 study demonstrated a similar appearing focus measuring 5 x 5 x 5 mm, however, the anatomic location cannot be confirmed with certainty. Attention to this region on subsequent follow-up imaging is recommended. ISTHMUS BED: Status post thyroidectomy with no evidence of residual or recurrent disease. LYMPH NODES: Bilateral morphologically unremarkable and normal-sized lymph nodes are identified.PARATHYROID GLANDS: No significant abnormality noted.OTHER: At level 4 of the left side of the neck there is a 9 x 8 x 7 mm hypoechoic focus which appears to connect to adjacent vasculature, and may represent a small tributary vessel. Attention to this region on subsequent follow up is recommended.", "output": "1. Indeterminate 5-mm focus within the superior left thyroidectomy bed, not noted on the immediate prior study, but may correspond to a 2012 study finding although the anatomic location cannot be confirmed with certainty. Attention to this area on subsequent follow-up ultrasound is recommended.2. 9-mm hypoechoic focus at level for the left side of the neck; favor a small tributary vessel as opposed to a small lymph node. Attention to this region on subsequent imaging is recommended."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female with although unusual in thyroiditis and myalgia. RIGHT LOBE MEASUREMENTS: 2.6 x 1.4 x 0.6 cm LEFT LOBE MEASUREMENTS: Difficult to marginate. 1.9 x 1.2 x 0.5 cmISTHMUS MEASUREMENTS: 0.1 cmRIGHT LOBE: Atrophic, heterogeneous in echotexture and lobulated. No mass identified.LEFT LOBE: Atrophic, heterogeneous in echo texture and lobulated. No mass identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Prominent right cervical node with a normal morphology.OTHER: The esophagus appears to be to the right of midline of uncertain significance.", "output": "Atrophic thyroid without mass. Patient has had an outside study, would be happy to review for comparison."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old female with large oval breast mass in the right upper mid breasts at least 5 cm, which was first noticed a month ago, and has significantly and quickly grown. Patient denies history of trauma or fevers/chills. History of benign right breast biopsy 20 years ago. Family history of breast cancer diagnosed in mother age 73. Three standard views of both breasts 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. A linear scar marker was placed over the right breast. Triangular palpable marker was placed over the right upper, slightly inner breast, mid depth partially obscured masses or large lobulated mass are noted under the palpable marker. Total extent measures 74 x 69 x 52 mm (AP X TR X CC). The patient cannot tolerate spot compression views due to pain.ULTRASOUND", "output": "Large complex solid and cystic mass in the right 12 o'clock breast, for which biopsy and surgical consultation are recommended. The patient was discussed with Donna Christian and an appointment with Dr. Swati Kulkarni was arranged. She is also scheduled for ultrasound guided biopsy that day. Results and recommendations were discussed with the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: Mildly echogenic liver echotexture without mass. Liver length 22 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Atrophic right kidney with echogenic parenchyma without hydronephrosis. Right kidney 10.1 cm in lengthOTHER: Echogenic left renal parenchyma without worrisome mass. Left renal cyst. Left kidney 10 cm in length. Spleen 14.7 cm in length. No ascites.", "output": "Hepatosplenomegaly with mildly echogenic liver echotexture suggestive for parenchymal dysfunction/fatty infiltration without mass or ductal dilatation. No ascites.Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old female presents for evaluation of her thyroid. RIGHT LOBE MEASUREMENTS: 5.2 x 1.8 x 1.8 cm.LEFT LOBE MEASUREMENTS: 6.7 x 3.4 x 3.0 cm.ISTHMUS MEASUREMENTS: 0.9 cm.RIGHT LOBE: The right lobe is very heterogenous. Multiple nodules, the largest measures 1.9 x 0.9 x 1.2 cm in the superior aspect of the right lobe; is solid with mixed echogenicity. Other scattered subcentimeter nodules throughout the right thyroid.LEFT LOBE: Left lobe is very heterogenous. Multiple nodules, the largest measuring approximately 4.2 x 2.7 x 2.4 cm; is solid with mixed echogenicity. Other scattered subcentimeter nodules throughout the left thyroid.ISTHMUS: Very heterogeneous parenchyma without discrete nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Multinodular goiter as described above.2. Asymmetrically smaller right lobe nonspecific but may represent postsurgical appearance."}
{"instruction": "Generate impression based on findings.", "input": "Female 54 years old Reason: AKI RIGHT KIDNEY: Right kidney measures 10.9 cm in length. The right kidney appears minimally increased in echogenicity which may be seen in the setting of medical renal disease. Subcentimeter, simple-appearing right renal cysts are present. Inferior pole cyst measures 8 x 7 x 6 mm. No hydronephrosis or shadowing calculi.LEFT KIDNEY: Left kidney measures 10.4 cm. There is also minimally increased echotexture of the left kidney which may be seen in the setting of medical renal disease. No hydronephrosis or shadowing calculi.BLADDER: No significant abnormalities noted.", "output": "Minimally increased echogenicity of the kidneys bilaterally can be seen in the setting of medical renal disease. No hydronephrosis. Simple appearing subcentimeter right renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "Intermittent testicular pain for 7 days. RIGHT TESTIS: 3.7 x 3.1 x 4.9 cm, previously 3.6 x 2.9 x 5.4 cm. The right testis is heterogeneous without any detectable vascular flow. There remains a large volume complex hydrocele, likely with a component of hematoma.LEFT TESTIS: 3.7 x 2.9 x 3.9 cm. No focal lesions are identified. Normal vascular flow is noted. A small associated hydrocele is noted, which is partially complex with septation.RIGHT EPIDIDYMIS: 11 x 18 x 23 mm, with normal vascular flow.LEFT EPIDIDYMIS: 8 x 3 x 7 mm with normal vascular flow.OTHER: No significant abnormalities noted.", "output": "1. Right testicular torsion.2. Complex bilateral hydrocele, right greater than left, with suspected hematoma.Findings discussed with Dr. Aizen by telephone at 0900 on 12/15/15"}
{"instruction": "Generate impression based on findings.", "input": "24-year-old female with thyromegaly on exam. RIGHT LOBE MEASUREMENTS: 5.4 x 1.9 x 2.5 cm with homogeneous echogenicity and normal parenchymal vascularity.LEFT LOBE MEASUREMENTS: 6.1 x 2.4 x 2.1 cm with homogeneous echogenicity and normal parenchymal vascularity.ISTHMUS MEASUREMENTS: 0.6 cm in AP dimension.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualizedLYMPH NODES: Mildly prominent lymph nodes bilaterally, which are nonspecific.", "output": "Mildly prominent thyroid gland, without suspicious features or nodules."}
{"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. A few scattered round anechoic lesions are seen bilaterally, compatible with simple cysts. No suspicious cystic or solid mass is identified .", "output": "Bilateral simple breast cysts. No sonographic evidence for malignancy.BIRADS: 2 - Benign.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"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": "82-year-old female with sepsis. Evaluate the liver and gallbladder. LIVER: The liver measures 14.2 cm in length. It is mildly coarse and echogenic. No intrahepatic biliary ductal dilatation or focal hepatic lesion is evident. Normal hepatopetal portal venous blood flow at 23 cm/sec.GALLBLADDER, BILIARY TRACT: A normally distended gallbladder is present with mild diffuse wall thickening/pericholecystic fluid measuring 4.3 mm without gallstones. Evaluation for focal tenderness was limited due to the patient's decreased awareness. No extrahepatic biliary ductal dilatation with the common bile duct measuring 5 mm.PANCREAS: The suboptimally visualized pancreatic body and head is grossly unremarkable.SPLEEN: The poorly visualized spleen measures 7 cm in length.KIDNEYS: The right kidney measures 9.6 cm in length without hydronephrosis. The left kidney measures 9.6 cm without hydronephrosis.ABDOMINAL AORTA: Only the proximal aorta is visualized and is not aneurysmally dilated, measuring 2.2 cm in AP dimension.INFERIOR VENA CAVA: The visualized inferior vena cava is patent.", "output": "1. Normally distended gallbladder with mild diffuse wall thickening/pericholecystic fluid. Evaluation for focal tenderness was unreliable given the patient's decreased awareness. Overall, there is no specific evidence of acute cholecystitis. If there is continued clinical concern, a HIDA scan may be considered.2. Coarse and mildly echogenic liver parenchyma may represent diffuse fatty infiltration/parenchymal dysfunction. "}
{"instruction": "Generate impression based on findings.", "input": "58-year-old female with history of multinodular thyroid presents for evaluation of nodules. RIGHT LOBE MEASUREMENTS: 4.9 x 2.1 x 2.7 cm.LEFT LOBE MEASUREMENTS: 4.0 x 1.4 x 1.9 cm.ISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: Nodule 1: Measures approximately 3.0 x 1.4 cm. Appears stable in comparison to the prior study.Nodule 2: Measures approximately 1.3 x 0.9 x 1.5 cm. Appears stable in comparison to the prior study.The parenchyma appears slightly hypervascular.LEFT LOBE: Nodule 1: Measures approximately 1.2 x 1.0 x 1.1 cm. Appears stable in comparison to the prior study.Nodule 2: Measures approximately 0.9 x 0.8 x 1.4 cm. Appears stable in comparison to the prior study.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Multinodular goiter as described above. Appears stable in comparison to the prior study.2. Hypervascular parenchyma on the right; cannot exclude underlying component of thyroiditis."}
{"instruction": "Generate impression based on findings.", "input": "Female 63 years old Reason: thyroid nodules History: thyroid nodules RIGHT LOBE MEASUREMENTS: 6.0 x 1.7 x 1.7 cmLEFT LOBE MEASUREMENTS: 7.5 x 3.1 x 3.3 cm.ISTHMUS MEASUREMENTS: 0.6 cm.RIGHT LOBE: Normal appearance of the right thyroid lobe.LEFT LOBE: Mildly heterogeneous background left thyroid lobe echogenicity. Heterogeneous solid-appearing nodule which is slightly increased in size compared to the prior exam measuring 4.0 x 3.1 x 4.2 cm, previously 3.1 x 3.5 x 2.5 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Heterogeneous solid-appearing left thyroid nodule slightly increased in size compared to the prior exam."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old male with history of hepatitis C. LIVER: Measures 14.8 cm in length. Normal hepatic morphology and echogenicity. 1 cm cyst in the right hepatic lobe without specific suspicious features.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.KIDNEY: 2.6 x 2.9 x 2.3 cm right renal cyst with a thin peripheral septation but no suspicious nodular or vascular component. Unremarkable left kidney.OTHER: No significant abnormalities noted.", "output": "1. Unremarkable sonographic examination of the liver. 2. 2.9 cm right renal cyst with a thin septation but no suspicious solid or nodular component. "}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male heart failure and cardiogenic shock. Elevated total bilirubin. Examination is limited by inability to reposition the patient due to medical condition and early truncation by the clinical service.LIVER: Non-cirrhotic liver morphology. Increased parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood direction with pulsatile flow, likely reflecting the patient's heart failure.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Distended gallbladder with biliary sludge. No specific evidence of cholecystitis.PANCREAS: The pancreas is obscured by bowel gas.KIDNEYS: The right kidney is 9.1 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen. The left kidney was not examined due to inability to position the patient.SPLEEN: The spleen was not examined due to inability to position the patient.OTHER: Small right pleural effusion identified. No ascites identified.", "output": "1. Truncated examination due to inability to reposition the patient due to medical condition and by request of the clinical service. 2. Increased hepatic echogenicity, compatible with parenchymal dysfunction.3. Small right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate vessels. Known medial and lateral lymphocele status post IR drainage of the lateral lymphocele. Evaluate compression of the iliac vein either by the allograft or lymphocele. Leg swelling. RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: Since prior examination, the superior collection has undergone percutaneous drainage and is no longer visible. The inferior collection appears unchanged. KIDNEY: No significant abnormality notedCOLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vesselsPatent vasculature without evidence for inflow or outflow compromise. Both main renal arteries and veins appear patent.OTHER: No significant abnormality noted", "output": "Status post percutaneous drainage of superior lymphocele. Patent vasculature without evidence for inflow or outflow compromise. No hydronephrosis. "}
{"instruction": "Generate impression based on findings.", "input": "79-year-old female status post thyroidectomy presents for follow-up. RIGHT LOBE, LEFT LOBE, ISTHMUS MEASUREMENTS: The thyroid has been surgically removed.RIGHT LOBE: The thyroid has been surgically removed.LEFT LOBE: The thyroid has been surgically removed.ISTHMUS: The thyroid has been surgically removed.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Surgical changes of a thyroidectomy without evidence of recurrence or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Coarse echogenic liver parenchyma again noted. No mass. Liver length 13.9 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Stable right renal cyst. Right kidney 10.1 cm in length.OTHER: Left kidney 10.4 cm in length. Spleen 9.6 cm in length. No ascites.", "output": "Stable 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 female presents for evaluation of a multinodular thyroid. RIGHT LOBE MEASUREMENTS: 5.2 x 2.1 x 1.9 cm.LEFT LOBE MEASUREMENTS: 6.5 x 1.8 x 2.3 cm.ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: There are numerous nodules of cystic and cystic-solid composition with benign morphology. A representative lesion measures approximately 1.5 x 1.3 x 1.2 cm in the inferior, posterior right thyroid.LEFT LOBE: There are numerous nodules with cystic and cystic-solid composition with benign morphology. A representative lesion measures approximately 1.2 x 0.7 x 1.3 cm in the superior, anterior left thyroid.ISTHMUS: There is a well-defined round solid lesion measuring approximately 1.6 x 1.2 x 1.3 cm in the left aspect of the isthmus superior.", "output": "1. Well-defined solid lesion in the left aspect of the isthmus as described above. Correlate with prior biopsy to see if this was the nodule that was sampled. If this is not available, this lesion is amenable to ultrasound-guided percutaneous biopsy.2. Numerous nodules of cystic and cystic-solid composition; benign etiology is favored."}
{"instruction": "Generate impression based on findings.", "input": "32 year-old female with history of hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 5.6 x 2.5 x 1.5 cmLEFT LOBE MEASUREMENTS: 4.9 x 1.8 x 1.5 cmISTHMUS MEASUREMENTS: 0.4 cm in thickness. RIGHT LOBE: Mildly heterogenous echotexture without nodules. LEFT LOBE: Mildly heterogenous echotexture without nodules. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Multiple hypoechoic, oval shaped lesions are present compatible with parathyroid adenomas.The first is posterior to the midpole of the right thyroid gland and measures 1.4 x 1.2 x 0.7 cm. The medial edge of this lesion is approximately 2 mm from the trachea.The second is posterior to the inferior pole of the right thyroid gland and measures 1.5 x 0.4 x 0.6 cm. The medial edge of this lesion is approximately 2 mm from the trachea and the inferior edge is approximately 4 mm cephalad to the inferior tip of the thyroid.The third is posterior to the inferior one third of left lobe of the thyroid gland and measures 1.8 x 0.7 x 0.8 cm. The inferior tip of the lesion extends to the inferior tip of the thyroid gland. LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple lesions compatible with parathyroid adenomas as described above."}
{"instruction": "Generate impression based on findings.", "input": "Interval change of infrarenal abdominal aortic aneurysm. The proximal aorta measures approximately 2.1 cm in AP dimension. The mid abdominal aorta measures approximately 4.6 cm in AP dimension with suspected mural partial thrombus versus thrombosed dissection.The distal abdominal aorta measures approximately 6.2 cm in AP dimension with suspected mural partial thrombus versus thrombosed dissection.The left common iliac artery measures 1.6 cm in AP dimension. The right common iliac artery measures 1.3 cm in AP dimension.", "output": "The infrarenal abdominal aortic aneurysm measures up to 6.2 cm in AP dimension, significantly progressed from the prior 2011 study."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Victorya Harlan is a 29 year old female presents for evaluation of a palpable and painful concern in her right breast. As she has a strong family history of breast cancer in her mother (diagnosed at the age of 32), maternal great aunt, maternal great great aunt, paternal great aunt, paternal grandmother, and paternal great grandmother. ULTRASOUND:On physical examination, no discrete mass is palpated.A targeted right ultrasound was performed for the palpable area of concern, which is at the 6:00, 7 cm from the nipple.. There is no solid or cystic mass identified.", "output": "No mammographic evidence of malignancy. Further evaluation of a clinically suspicious abnormality should not delayed by negative imaging. Rather, negative imaging may serve to reinforce a negative clinical impression. Therefore, continued clinical management is recommended. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually at age of 40 or based on patient's risk assessment. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Palpable abnormality noted by patient in the right lateral breast. Bilateral painful breasts, right greater than left. Physical examination revealed a diffusely tender right breast without palpable mass or notable skin changes.A whole right breast ultrasound was performed with special attention paid to the patient\u2019s area of concern. There is no solid or cystic mass identified. There is no sonographic abnormality noted otherwise.", "output": "No sonographic abnormality identified. Clinical follow-up is recommended. Results and recommendations were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male with high bilirubin, concern for cholangitis or a biliary source. Evaluate. LIVER: The hepatic parenchyma is normal in echotexture with the liver measuring approximately 20 cm. Portal venous flow is hepatopetal with the velocities measuring 15.8 cm/s in the main portal vein.BILIARY TRACT: Cholelithiasis, mildly distended gallbladder, gallbladder wall thickening and evidence of submucosal edema. Findings would be consistent with cholecystitis in appropriate clinical setting.No intra or extra hepatic biliary ductal dilatation. The common bile duct measures approximately 3 mm in diameter. No evidence of choledocholithiasis.PANCREAS: Mildly dilated pancreatic duct. SPLEEN: No significant abnormalities noted.KIDNEYS: The kidneys are mildly echogenic in echotexture. Right kidney measures 9.9 cm in length and the left kidney measures 9.7 cm in length. No evidence of hydronephrosis.OTHER: Small right pleural effusion. Moderate volume ascites.", "output": "1.Cholelithiasis, mildly distended gallbladder, gallbladder wall thickening and evidence of submucosal edema. Findings would be consistent with cholecystitis in appropriate clinical setting. Please note that gallbladder wall thickening is nonspecific in setting of ascites. 2.No intra or extrahepatic biliary ductal dilatation. No evidence of choledocholithiasis.3.Mildly distended pancreatic duct. A discrete stone is not definitely delineated, may be further evaluated with ERCP or MRCP. 4.Moderate volume ascites and small right pleural effusion.5.Hepatomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Male 82 years old Reason: splenomegaly History: please assess for splenomegaly Normal-appearing spleen measures 10 cm in length. Limited color Doppler shows blood flow to the spleen and in the splenic hilus. No perisplenic fluidPossible left pleural effusion", "output": "No evidence of splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with incidental thyroid nodule on CT. TSH normal RIGHT LOBE MEASUREMENTS: 5.3 x 1.5 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.6 x 1.3 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Ovoid, hyperechoic nodule in the mid pole of the right lobe measuring 0.9 x 1.2 x 1.4 cm. Small spongiform nodule and small cystic nodule also visualized in the right lobe.LEFT LOBE: In the medial, upper pole of the left lobe there is a mildly echogenic nodule with a hypoechoic rim measuring 0.3 x 0.4 x 0.5 cm. This could even represent an intrathyroidal lymph node.ISTHMUS: There is a 0.8 x 1.4 x 1.5 cm hyperechoic and minimally heterogeneous solid nodule to the left of midline.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Solid, echogenic Isthmus nodule.Hyperechoic right lobe nodule. Other small and benign-appearing nodules bilaterally."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid thyroid carcinoma 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 mass or regional adenopathy"}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male with proteinuria and hematuria. RIGHT KIDNEY: The right kidney measures 10.9 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 11.2 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.URINARY BLADDER: Large central rounded mass in the inferior, central bladder may represent enlarged prostate. However there is a somewhat ovoid mass arising from the anterior bladder wall measuring 0.8 x 1.8 cm. There is an irregular mass confluent with the central mass arising from the posterior right bladder wall measuring at least 4.6 x 1.8 cm. There is a third mass extending from the lateral left bladder wall, measuring approximately 1.2 x 1.9 cm.OTHER: Echogenic liver may be due to fatty infiltration.", "output": "Multiple bladder masses suspicious for bladder carcinoma.Normal kidneys.Echogenic liver.Report text paged to Dr. Paige Kennedy, pager 2702 at 9:10 AM."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old patient presents with possible abnormality in the right breast. Patient reports history of left fibroadenoma diagnosed 10 years ago at an outside hospital, however the patient does not remember which hospital. A left total breast ultrasound was performed. On physical exam there is a questionable palpable abnormality in the left upper inner quadrant localized upper inner to the 10:00 o'clock position 4 cm from nipple. On grayscale and color Doppler sonography, this corresponds to normal dense fibroglandular tissue. No solid or cystic masses are identified throughout the breast.A right total breast ultrasound was performed. On physical exam there is a questionable palpable abnormality the upper outer quadrant at the 10:00 position 4 cm from nipple. On grayscale and color Doppler ultrasound, this corresponds to normal dense fibroglandular tissue. No solid or cystic masses are identified throughout the breast.", "output": "No solid or cystic mass in the right or left breast. No sonographic evidence for malignancy. Palpable areas in both breasts should be managed clinically. Findings were discussed with the patient at the time of the exam.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "sacral cellulitis concern for abscessVIEW: Ultrasound of the gluteal region Dedicated ultrasound of the gluteal region superior to the gluteal cleft was performed. There is a small hypoechoic area measuring 2.2 x 1 cm at this region. There is marked soft tissue edema.", "output": "Hypoechoic area superior to the gluteal cleft which may represent a phlegmon. There is no drainable fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "2-year-old male with history of bilateral hydronephrosis and bladder wall thickening. Status post valve resection. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. Distal Ureter -- SFU Grade**  Right: 0  Left: 0   Ureteral Jets Right: Not observed  Left: Within normal limitsKIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 1 Left: 1  Length*** Right: 7.6 cm Left: 7 cm   Mean for age: 7 cm  Range for age: 6 - 8 cmADDITIONAL OBSERVATIONS: None", "output": "Grade 1 pelvic caliectasis bilaterally, without additional abnormality.*SFU grading system: Grade 0: No hydronephrosis.: 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": "Ovarian malignancy status post ureteral lysis RIGHT KIDNEY: No significant abnormalities noted. Specifically, no worrisome mass, stone, or hydronephrosis. 10.4 cm in length.LEFT KIDNEY: No significant abnormalities noted. Specifically, no worrisome mass, stone, or hydronephrosis. 9.8 cm in length.OTHER: Bladder collapsed", "output": "Negative renal ultrasound. Specifically, no hydronephrosis, worrisome mass, or stone."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old male with history of NASH. LIVER: The liver parenchyma is moderately coarse and echogenic. It is normal in size, measuring 15.5 cm in craniocaudal dimension. No intrahepatic biliary ductal dilatation or focal lesion is identified. There is normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: There is a normally distended gallbladder without wall thickening, pericholecystic fluid, gallstones or focal tenderness. No extrahepatic biliary ductal dilatation with the common bile duct, measuring 2 mm.PANCREAS: The suboptimally visualized pancreatic head and body are unremarkable.SPLEEN: The spleen is normal morphology, echogenicity and size, measuring 10.6 cm in length without a discrete lesion.RIGHT KIDNEY: The right kidney measured 11.3 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow.OTHER: The left kidney measures 10.6 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow.", "output": "Coarse and echogenic liver parenchyma compatible with diffuse fatty infiltration without a focal lesion evident."}
{"instruction": "Generate impression based on findings.", "input": "42 year-old female with small palpable nodule in the subcutaneous tissues of the right shoulder. Ultrasound evaluation in the region of the palpable abnormality demonstrates a very small immediately subcutaneous hypoechoic nodule. Differential considerations include small lipoma or sebaceous cyst, measuring 6 mm in maximum diameter.", "output": "Small, superficial nodule, likely sebaceous cyst or lipoma."}
{"instruction": "Generate impression based on findings.", "input": "22 year old female with right-sided constant abdominal pain, per patient in the right upper quadrant, no right lower quadrant pain. LIVER: Normal echogenicity of the liver measuring 15.3 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate directional flow; peak velocity at 35.9 cm/sec.BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening or pericholecystic fluid. No shadowing stones or sludge. Sonographic Murphy sign is negative. Common bile duct measures 2 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Normal echogenicity of the visualized pancreas.SPLEEN: Normal echogenicity of the spleen measuring 11.8 cm in length.RIGHT KIDNEY: The right kidney is rotated anteriorly measuring 12.6 cm in length. No hydronephrosis or shadowing calculi.OTHER: Left kidney measures 12.1 cm in length and is normal in echogenicity. No hydronephrosis or shadowing calculi.", "output": "Unremarkable examination."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs. LIVER: The liver is mildly coarse and increased in echogenicity. No focal liver lesion or biliary ductal dilatation. Normal hepatopedal portal venous blood flow of 0.2 mm/s.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 4 mm. Normally distended gallbladder. The wall thickness is normal measuring 2 mm. No pericholecystic fluid or focal tenderness. Note is made of gallbladder sludge.PANCREAS: The visualized portion of the pancreatic head is unremarkable. Otherwise the pancreas is obscured by overlying bowel gas.SPLEEN: The spleen measures 7 cm in length.RIGHT KIDNEY: The right kidney measures 10.9 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 11.2 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.", "output": "1. Gallbladder sludge without evidence of acute gallbladder inflammation.2. Coarse and mildly echogenic liver parenchyma suggestive of parenchymal dysfunction, including fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "Reason: History of multinodular goiter RIGHT LOBE MEASUREMENTS: 4.3 x 1.2 x 1.9 cm (previously 5.8 x 2.2 x 1.4 cm).LEFT LOBE MEASUREMENTS: 4.3 x 1.6 x 1.8 cm (previously 5.1 x 1.4 x 2.0 cm).ISTHMUS MEASUREMENTS: 0.4 cm (previously 0.4 cm) in the AP dimension.RIGHT LOBE: Dominant right upper pole predominantly solid, hypoechoic nodule measures 2.5 x 1.2 x 1.5 cm, previously 2.0 x 1.5 x 1.3 cm. No definite microcalcifications. Some internal vascularity is noted.LEFT LOBE: Dominant left lower pole predominantly solid, heterogeneous nodule with internal hyperechoic foci measures 2.3 x 1.8 x 1.6 cm, previously 2.4 x 1.2 x 1.1 cm. No definite microcalcifications. Some internal vascularity is noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: None visualized.LYMPH NODES: No significant abnormality noted. No cervical lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Multiple thyroid nodules as above, with mild interval increase in size of dominant right upper pole nodule."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female complains of right leg pain the context of a recent lipoma excision. No discrete soft tissue mass or fluid collection seen.", "output": "No discrete mass or fluid collection seen. "}
{"instruction": "Generate impression based on findings.", "input": "Male 38 years old; history of a left thyroid nodule biopsied in 2009 which showed possible colloid nodule. RIGHT LOBE MEASUREMENTS: 4.2 x 1.4 x 2.2 cmLEFT LOBE MEASUREMENTS: 4.5 x 1.5 x 1.7 cmISTHMUS MEASUREMENT: No significant abnormality noted. 0.4 cm AP.RIGHT LOBE: The small cystic nodule seen on the prior study is not visualized today. The right thyroid lobe is normal in appearance.LEFT LOBE: A solid, hypoechoic nodule in the lower pole of the left lobe measures 1.2 x 1.2 x 1.0 cm and contains internal vascularity. This previously measured 1.5 x 1.2 x 1.0 cm.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.", "output": "Stable appearance of the left lower pole thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Byrd is a 43-year-old female presenting for short term ultrasound follow-up for a high probability benign fibroadenoma of the right breast. On physical exam, an oval mobile mass is palpated inferior to the nipple.Targeted right ultrasound of the right breast, 6:00 position 3 cm from the nipple, reveals an oval circumscribed parallel hypoechoic shadowing mass measuring 2.4 x 1.2 x 2.1 cm and demonstrating mild internal vascularity, stable in size and sonographic appearance dating back to ultrasound study of 2009.", "output": "Stable right breast mass, with imaging appearance most characteristic of a fibroadenoma. Considering the stable imaging appearance of this mass dating back to 8/17/2009, patient may return for a bilateral diagnostic mammogram in April 2017. No need for repeat ultrasound evaluation.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female with neurogenic bladder due to multiple sclerosis. Evaluate for hydroureteronephrosis. RIGHT KIDNEY: Right kidney measures 10.8 cm in length and is normal in echogenicity. No evidence of hydronephrosisLEFT KIDNEY: Left kidney measures 10.5 cm in length and is normal in echogenicity. No hydronephrosis.BLADDER: No significant abnormalities noted.", "output": "No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate RUQ History: elevated LFTs LIVER: The liver measures 15.1 cm in length. Unremarkable hepatic parenchyma. The portal vein is patent with normal directional hepatopedal flow, peak velocity 28.6 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. The common bile duct measures 0.5 cm. The gallbladder wall measures 0.2 cm. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 12.2 cm in length. Small upper pole cyst measures 1.2 x 1.1 x 1.1 cm. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 12.1 cm in length. No shadowing stones or hydronephrosis.OTHER: The spleen measures 9.4 cm in length. No ascites.", "output": "No acute abnormality. No findings to account for patient's abdominal pain."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate right neck and right upper chest wall for retained line/object History: palpable object right neck. Corresponding to the superficial linear palpable structure in the right lateral neck, there is a corresponding tubular predominantly hypoechoic structure within the superficial subcutaneous soft tissues which measures approximately 2 mm in diameter and may reflect a retained catheter fragment.", "output": "Suspected retained catheter fragment within the superficial segment tissues of the right lateral neck. Soft tissue neck radiography recommended for confirmation (pager #1032 contacted, awaiting response; recommendation also entered into the follow-up tool)."}
{"instruction": "Generate impression based on findings.", "input": "Female; 27 years old. Reason: VP shunt, evaluate abdomen shunt tubing and placement /status/connectivity History: pain to abdomen The shunt tubing was identified in the mid abdomen but could not be traced throughout its course due to overlying bowel gas.", "output": "Limited exam due to bowel gas. The status of the shunt tubing can not be commented on based on this study."}
{"instruction": "Generate impression based on findings.", "input": "57 year old male patient with history of thyroid cancer and SCC of the neck status post surgery, radiation therapy, and iodine therapy. RIGHT LOBE: Status post thyroidectomy without residual parenchymal tissue identified.LEFT LOBE: Status post thyroidectomy without residual parenchymal tissue identified.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is a left level III 0.5 x 0.5 x 0.6 cm round hypoechoic nodule with slightly increased vascularity and a 0.7 x 0.5 cm left level IV hypoechoic nodule with questioned microcalcification. Additional benign morphology lymph nodes are noted in the left neck.OTHER: No significant abnormality noted.", "output": "Two hypoechoic nodules within the left neck which are suspicious for metastatic disease; ultrasound guided biopsy is recommended for further evaluation. "}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female with cardiomyopathy. Preheart transplant evaluation. LIVER:Liver is normal in size and echotexture. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder is adequately visualized and appears normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: No significant abnormality noted.SPLEEN: Normal in size.KIDNEYS: Right kidney measures 8.7 cm in length and the left 8.4 cm. The kidneys are mildly echogenic consistent with parenchymal disease. No hydronephrosis, shadowing calculus or mass. ABDOMINAL AORTA: Normal in caliber.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Small and mildly echogenic kidneys."}
{"instruction": "Generate impression based on findings.", "input": "Acute cystitis with hematuria RIGHT KIDNEY: Echogenic atrophic right kidney again noted. No mass, stone, or hydronephrosis. Right kidney 7.1 cm in length.LEFT KIDNEY: Echogenic left kidney without mass, stone, or hydronephrosis. 7.3 cm in length.OTHER: 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": "55-year-old female patient with primary hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 4.7 x 2.0 x 1.8 cm.LEFT LOBE MEASUREMENTS: 4.9 x 1.6 x 1.4 cm.ISTHMUS MEASUREMENTS: 3 mm in thickness.RIGHT LOBE: The right thyroid lobe is heterogeneous in echogenicity. No discrete nodule is identified.LEFT LOBE: The left thyroid lobe is heterogeneous in echogenicity. No discrete nodule is identified.ISTHMUS: The isthmus is heterogeneous in echogenicity.PARATHYROID GLANDS: No definite parathyroid adenoma candidate is identified.LYMPH NODES: There is a benign morphology right level four lymph node.OTHER: No significant abnormality noted.", "output": "Heterogeneous thyroid without parathyroid adenoma candidate identified."}
{"instruction": "Generate impression based on findings.", "input": "79-year-old female with acute renal failure and right upper quadrant pain. Pancreatitis on recent noncontrast CT. Evaluate biliary tract. The exam is somewhat limited by patient motion.LIVER:Liver appears somewhat heterogeneous in echogenicity which may be due to irregular fatty infiltration. There is no focal hepatic abnormality.GALLBLADDER, BILIARY TRACT: Gallbladder appears normal without cholelithiasis, wall thickening or pericholecystic fluid. Biliary tract appears normal in caliber.PANCREAS: Limited due to bowel gas.SPLEEN: No significant abnormality noted.KIDNEYS: The right kidney measures 9.4 cm in length. There is no hydronephrosis, shadowing calculus or mass. Echotexture appears normal.Left kidney is less well-visualized measuring at least 8.6 cm in length. No hydronephrosis.ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Small amount of ascites adjacent to the left lobe of the liver as well as the inferior right lobe.Right pleural effusion.", "output": "Irregular fatty liver. Small amount of ascites.Right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "34-year-old male with right upper quadrant pain. LIVER: Normal in size, contour and echogenicity. No masses. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Normal right upper quadrant ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "Female 61 years old; Reason: Evaluate for HCC History: HCV LIVER: The liver measures 18.3 cm in length. There is mild coarse echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent. GALLBLADDER/BILIARY TRACT: The gallbladder is not well visualized on this study. The common bile duct measures 4.1 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 6.7 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 12.0 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.", "output": "1. Mild coarse echogenicity of liver consistent with chronic liver disease/parenchymal dysfunction. No masses or ascites.2. Mild hepatomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate AKI, or obstruction RIGHT KIDNEY: The right kidney measures 9.5 cm in length. There is mildly increased renal parenchymal echogenicity. There is no hydronephrosis, focal mass, or stone.LEFT KIDNEY: The left kidney measures 10.5 cm in length. There is mildly increased renal parenchymal echogenicity. There is no hydronephrosis, focal mass, or stone.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Mildly echogenic renal parenchyma, which can be seen in the setting of medical renal disease. No obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Chronic kidney disease. Acute kidney injury. RIGHT KIDNEY: 11.3 cm in length. Markedly echogenic renal parenchyma. No suspicious lesions, stones, or hydronephrosis. Extra-renal pelvis noted.LEFT KIDNEY: 10.8 cm in length. Markedly echogenic renal parenchyma. No suspicious lesions, stones, or hydronephrosis.BLADDER: Partially collapsed with Foley catheter in place. No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Markedly echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Increased creatinine. Low urine output. RIGHT KIDNEY: 11.3 cm in length. Increased echogenicity of the renal parenchyma, with cortical thinning. No focal lesions or hydronephrosis.LEFT KIDNEY: 10.9 cm in length. Increased echogenicity of the renal parenchyma, with cortical thinning. No hydronephrosis. 2.2 cm benign-appearing cyst in the inferior pole.BLADDER: Contracted with Foley catheter in place.OTHER: No significant abnormalities noted.", "output": "Findings suggestive of medical renal disease, without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "History of duplicated renal system status post ureterocele incision x2. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. A small ureterocele is present on the right measuring approximately 1 x 2 cm, decreased in size from prior outside examination.  Distal Ureter -- SFU Grade**  Right: 3  Left: 0   Ureteral Jets Right: Not observed  Left: Not observedKIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: Grade 2 upper, grade 1 lower.  Left: 0  Length*** Right: 6.6 cm Left: 6.0 cm   Mean for age: 6.2 cm  Range for age: 4.8 - 7.6 cmADDITIONAL OBSERVATIONS: Small left adnexal cyst.", "output": "Right kidney upper pole grade 2 pelvicaliceal dilation, right grade 3 ureteral dilatation, and persistent small right ureterocele with duplicated right collecting system.*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": "57-year-old male with a history of hepatitis to follow up gallbladder polyps. LIVER:Measures 16.5 cm. Increased echogenicity of the parenchyma. No focal masses, ascites, or intrahepatic biliary dilatation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. There are numerous foci within the lumen inferior to the wall that are nondependent, consistent with gallbladder polyps. The largest of these measures approximately 0.6 x 0.4 x 0.6 cm which is an interval increase in size.PANCREAS: Evaluation of the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 8.8 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 10.7 cm. Left kidney measures 11.5 cm. Normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "1. Multiple gallbladder polyps as described above. There is been an interval increase in the largest polyp now measuring approximately 0.6 x 0.4 x 0.6 cm.2. Increased echogenicity of the liver consistent with chronic liver disease/parenchymal dysfunction. No focal masses or ascites."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old with history of abnormal liver function tests and hepatic steatosis. LIVER: The liver measures 16.9 cm in length. Mildly increased parenchymal echogenicity is suggestive of fatty infiltration/parenchymal dysfunction. Region of focal sparing is again present adjacent to the gallbladder fossa. 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 diameterPANCREAS: No significant abnormalities noted in visualized portions.SPLEEN: The spleen measures 10.4 cm in length. RIGHT KIDNEY: Kidney measures 10.6 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.OTHER: No significant abnormalities noted.", "output": "Hepatic steatosis, similar to prior. No new abnormalities. "}
{"instruction": "Generate impression based on findings.", "input": "Rectal carcinoma with renal insufficiency and leukocytosis RIGHT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. Nephrostomy tube removed. Right kidney 10.5 cm in lengthLEFT KIDNEY: Atrophic and echogenic renal parenchyma without mass, stone, or hydronephrosis. 6.3 cm in length.OTHER: Bladder nondistended.", "output": "Echogenic renal parenchyma bilaterally and left renal atrophy consistent with medical renal disease/parenchymal dysfunction without 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. 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. There is no solid mass or suspicious lesion identified. A simple cyst is present in the right breast.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Palpable area of concern appreciated by the patient's massage therapist in the right axilla. Personal history of left breast cancer status post lumpectomy in 2012. A targeted right ultrasound was performed for the area of concern. Several normal morphology right axillary lymph nodes are present. There is no suspicious solid or cystic mass identified.", "output": "No sonographic evidence for malignancy. Normal right axillary lymph nodes. Correlation with physical exam is recommended, and the patient will see Dr. Jaskowiak today for that.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Male 53 years old; Reason: r/o thyroid nodules History: hyperthyroidism, with asymmetry on exam R>L, though no clear nodules palpated. However, patient notes that this side of is thyroid is growing RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 2.5 x 2.0 x 6.1 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 3.0 x 1.9 x 6.3 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.6 cm.RIGHT LOBE: The right lobe is heterogeneous. No dominant nodules identified.LEFT LOBE: The left lobe is heterogeneous. No dominant nodules identified.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted. There is a left level 2 lymph node identified with a fatty hilum measuring 1.0 cm x 0.4 cm x 2.3 cm.", "output": "The thyroid gland appears diffusely heterogeneous compatible with chronic thyroiditis. No dominant nodules or suspicious adenopathy is identified."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter RIGHT LOBE MEASUREMENTS: 7 x 4.2 x 2.8 cmLEFT LOBE MEASUREMENTS: 7.1 x 2.3 x 1.8 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: No significant change in appearance or size of multiple predominately solid right thyroid nodules. The largest within the mid pole measures 3.3 x 3.7 x 2.1 cm. This is in comparison to 3.2 x 3 x 2 cm in 2009.LEFT LOBE: Interval increase in size of mixed cystic and solid lower pole nodule now measuring 2.2 x 1.5 x 1.4 cm; this is in comparison to 0.5 x 0.5 x 0.3 cm in 2009. Other subcentimeter hypoechoic left thyroid nodules relatively stable.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Interval increase in size of mixed cystic and solid lower pole left thyroid nodule. Other nodules bilaterally relatively stable. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "40 year old female with a personal history of call back from screening mammography for left axillary tail mass lesion. A targeted left ultrasound was performed for the mammographic area of concern in the left axilla. There is a circumscribed, oval, hypoechoic mass with an echogenic, fatty hilum consistent with lymph node measuring 8 x 3 x 11 mm. Otherwise there is no solid or cystic mass identified.", "output": "Normal morphology lymph node in the left axilla corresponding to the area of interest on mammogram. No sonographic evidence for malignancy. Annual screening mammogram is recommended. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "12-year-old male patient with hematuria and concern for infection. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. 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: 0 Left: 2  Length*** Right: 12.7 cm Left: 13.5 cm   Mean for age: 10.4 cm  Range for age: 8.7 - 12.2 cmADDITIONAL OBSERVATIONS: Intra-abdominal ascites.", "output": "Grade 2 hydronephrosis on the left and intra-abdominal ascites.*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": "Thyroid carcinoma RIGHT LOBE: Status post thyroidectomy without massLEFT LOBE: Status post thyroidectomy without worrisome mass. Stable hyperechoic focus within the left thyroid bed measuring 0.8 x 0.5 x 0.7 cm.ISTHMUS: 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": "68-year-old female with history of right mastectomy for IDC 22 years ago followed by left prophylactic mastectomy in 2010 with a reconstruction presents with right lateral chest wall pain for one month. Area has been marked by Joly Jose for targeted ultrasound. A targeted right lower axilla ultrasound was performed for the patient\u2019s area of concern. On physical examination, a 1 cm ridge of mobile tissue is noted in the lower axillary region. A parallel oriented possibly encapsulated mixed echogenic hypoechoic mass is noted corresponding to the marked area measuring 2.9 x 0.7 x 2.6 cm, most likely representing a fibroadenolipoma or area of fat necrosis. No suspicious solid mass noted.", "output": "Area of concern in the right lower axillary region most likely corresponds to a benign fibroadenolipoma or areas of fat necrosis. Findings conveyed to Joly Jose at the time of dictation. FNA will be performed for confirmation.BIRADS: 3 - Probably benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "The patient submitted outside mammogram dated 12/18/12, 12/14/11. Submitted outside study was compared to the current mammogram dated 2/16/15. A 1.0 cm mass in the left upper outer breast is new when compared to the prior studies. Recommend ultrasound guided needle biopsy for this mass.", "output": "A 1.0 cm mass in the left upper outer breast is new when compared to the prior studies. Recommend ultrasound guided needle biopsy for this mass.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"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 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": "Reason: evaluate for cholecystitis, cholelithiasis History: elevated alkaline phosphatase, abdominal pain Examination mildly limited due to constraints positioning patient.LIVER: The liver measures 18.3 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 0.36 m/s.BILIARY TRACT: Cholelithiasis. Mild gallbladder wall thickening measuring up to 3 mm. Probable trace 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 within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 10.2 cm in length. RIGHT KIDNEY: Kidney measures 7.5 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 8.0 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: Bilateral pleural effusions.", "output": "1.Cholelithiasis. Mild gallbladder wall thickening and trace pericholecystic fluid, early cholecystitis cannot be excluded. 2.Bilateral pleural effusions.Discussed with FERNANDES, CHRISTOPHER at 11:11 AM on 12/13/2016"}
{"instruction": "Generate impression based on findings.", "input": "31-year-old female with right upper quadrant pain, nausea/vomiting. 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. 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": "1.Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease.2.No evidence of cholelithiasis or acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": " RIGHT LOBE MEASUREMENTS: 5.8 x 2.0 x 1.8 cmLEFT LOBE MEASUREMENTS: 6.0 x 2.6 x 4.5 cmISTHMUS MEASUREMENTS: 7 mmRIGHT LOBE: Multiple predominantly subcentimeter nodules are present. Spongiform 7 x 5 x 8 mm interpolar nodule is unchanged. Within the inferior pole in the posterior aspect of the gland is a 1.3 x 1.1 x 0.7 cm solid nodule with small cystic components with a spongiform appearance. No increased vascularity or calcifications. The margins are relatively well defined. LEFT LOBE: The left thyroid lobe is mostly replaced by a 4.8 x 2.3 x 4.1 cm complex predominantly isoechoic solid nodule. No suspicious calcifications or hypervascularity. The nodule margins are relatively well-defined.ISTHMUS: Heterogeneously thickened isthmus.PARATHYROID GLANDS: No parathyroid adenoma candidate was visualized.FINE NEEDLE ASPIRATION REPORT:OPERATORS: Doctors Patel and Trilisky; The attending physician, Dr. Patel, was present for theentire procedure.TECHNIQUE: Following a discussion of the procedure with the patient, including its risks (pain, bleeding, infection, and adequate sample), benefits, alternatives and steps to prevent infection, an informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure.Localizing US demonstrated at the target dominant 1.3-cm inferior left pole posteriorly located nodule. The skin over the target area was cleansed with Betadine. Transducer was sterilely sheathed. Local anesthesia was obtained using 1% lidocaine, superficially and at depth. Using aseptic technique, and continuous ultrasound guidance, several attempts were made to aspirate the nodule, however, the patient expressed significant discomfort during the procedure in-spite of additional local anesthetic, the deep location of the nodule made visualization difficult and the medial to lateral approach was complicated by the patient's musculature. The procedure was discontinued with the patient's consent before adequate sampling was obtained. The patient tolerated the procedure well without immediate complications. Routine post procedure instructions were communicated to the patient.COMPLICATIONS: NoneESTIMATED BLOOD LOSS: Less than 1 cc. An adhesive bandage was placed on the patient\u2019s skin.", "output": "1.Multinodular goiter. The dominant left nodule was reportedly previously biopsied and confirmed to be a colloid nodule. The dominant right 1.3 cm nodule has a spongiform appearance and is felt to most likely represent a colloid nodule.2.Attempted ultrasound guided fine needle aspiration of the dominant left 1.3 cm nodule was unsuccessful due to the deep location of the nodule limiting visibility and patient discomfort as described above."}
{"instruction": "Generate impression based on findings.", "input": "Papillary thyroid carcinoma 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: Multiple round hypoechoic mildly hypervascular lymph nodes left level 3 and 4 again noted. The largest again measures approximately 0.8 x 0.9 x 0.6 cm. In addition, multiple round hypoechoic subcentimeter nodules within the submental region level 1 are noted.OTHER: No significant abnormality noted.", "output": "Abnormal appearing left level 3 and 4 as well as submental level 1 lymph nodes noted. Would recommend correlation with ultrasound guided percutaneous FNA biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain. LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. Subcentimeter anechoic hepatic lesions, likely representing cysts. No suspicious hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. 2 mm hyperechoic focus along the nondependent gallbladder wall, possibly representing a polyp. Otherwise unremarkable 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. The left kidney is 9.5 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9.1 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.", "output": "No cholelithiasis. No specific findings to account for the patient's right upper quadrant abdominal pain."}
{"instruction": "Generate impression based on findings.", "input": "69 year-old female with encephalopathy status post TIPS LIMITED ABDOMENLIVER: Heterogeneous echotexture with nodular contour measuring 17.5 cm in length. There is a hypoechoic lesion in the deep hepatic lobe which was not seen on prior study.BILIARY TRACT: Status-post cholecystectomy. Common duct measures 1.0 cm in caliber likely related to cholecystectomy. No intrahepatic biliary ductal dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: Normal echogenicity of the spleen measuring 15.3 cm in length.RIGHT KIDNEY: Measures 10.7 cm in length. Cyst at the upper pole measures 3.5 cm x 3.2 cm x 3.6 cm. No hydronephrosis or shadowing calculi is noted.OTHER: Left kidney measures 10.9 cm in length. No hydronephrosis or shadowing calculi are noted.No ascites.", "output": "1. Cirrhotic liver morphology. Hypoechoic lesion in the deep right hepatic lobe is suspicious for an infarct, however cannot exclude a mass in this region. Recommend dedicated liver CT study for further evaluation.2. Patent TIPS with expected hepatofugal flow in the left portal vein. No ascites. 3. Right renal cyst not significantly changed. Findings were discussed with Dr. Laura Carlson by phone on 4/2/2015 9:20 a.m.."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female with point tenderness in the right thoracic paraspinal region. Evaluate for cyst. Focused ultrasound examination in the region of symptoms as described by the patient demonstrates no underlying abnormality. In particular, no cyst or other mass is seen.", "output": "No mass identified in region of symptomatology."}
{"instruction": "Generate impression based on findings.", "input": "Upper abdominal wound. Question of abdominal wall abscess. No definite drainable fluid collection is identified in the subcutaneous soft tissues at the area of interest.", "output": "No drainable fluid collection identified."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for gallstones, liver parenchyma History: Acute pancreatitis, elevated transaminases LIVER: The liver measures 14.7 cm in length. Coarse, heterogeneous hepatic parenchyma. The portal vein is patent with normal directional hepatopedal blood flow, peak velocity 20.5 cm/s. No focal masses.GALLBLADDER, BILIARY TRACT: The gallbladder is distended with layering intraluminal sludge. No shadowing stones. The gallbladder wall measures 0.1 cm. The proximal common bile duct measures 0.2 cm. The distal common bile duct is obscured by bowel gas. No intrahepatic or extrahepatic biliary ductal dilatation. Negative sonographic Murphy's sign.PANCREAS: Obscured by bowel gas. The pancreatic duct measures 0.1 cm.KIDNEYS: The right kidney measures 10.5 cm in length. The left kidney measures 12.0 cm in length. No hydronephrosis or shadowing stones.OTHER: Moderate volume ascites.", "output": "1. Distended gallbladder with intraluminal sludge without evidence of cholecystitis.2. Moderate volume ascites.3. Findings consistent with hepatic parenchymal dysfunction or hepatic stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Coarse heterogeneous echotexture without mass. Liver length 18 cmGALLBLADDER, BILIARY TRACT: Mildly distended gallbladder with sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 14.2 cm in lengthOTHER: Spleen 12 cm in length. No ascites. Left pleural effusion", "output": "Coarse heterogeneous echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Mildly distended gallbladder with sludge without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with history of chronic kidney disease, hypertension, CAD who presented with hypertensive emergency. Evaluate RIGHT KIDNEY: Right kidney is markedly echogenic and measures 10.2 cm in length. There is a hypoechoic right mid pole lesion measuring 3.1 x 2.3 x 2.8 cm, likely benign cyst. No evidence of hydronephrosis or obstruction. LEFT KIDNEY: Nonvisualization of the left kidney.OTHER: No significant abnormalities noted.", "output": "1.Markedly echogenic right kidney consistent with medical renal disease. 2.Nonvisualization of the left kidney."}
{"instruction": "Generate impression based on findings.", "input": "AKI in the context of renal transplant. RENAL TRANSPLANT: The renal transplant measures 11.0cm. Normal echogenicity without stone or mass.PERITRANSPLANT TISSUES: No perinephric fluid collection.COLLECTING SYSTEM/URETER: Expected mild prominence of the collecting system and ureter without hydronephrosis.URINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels. Vessels are patent.OTHER: Heterogeneous echotexture of the liver.", "output": "Normal ultrasound of kidney transplant without hydronephrosis, stone, or mass."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for fluid collection in between the VAD and Drive line site and upper abdominal wound, status post LVAD No complex fluid collection/abscess identified along the LVAD drive line.Few areas of scarring/post procedural changes noted with evidence of subcutaneous edema and skin thickening.", "output": "No evidence of complex fluid collection/abscess along the LVAD drive line."}
{"instruction": "Generate impression based on findings.", "input": "Known right breast cancer with additional focal asymmetry in the right breast 6:00 position on mammogram. Few asymmetric right axillary lymph nodes. Patient presents for right breast and axillary ultrasound. A targeted right breast and axillary ultrasound was performed for the mammographic area of concern. Irregular hypoechoic taller than wide suspicious mass measuring 1.1 x 0.8 x 1.2 cm identified in the right breast 6:00 position, 3 cm from the nipple with apical blood flow.4 normal morphology right axillary lymph nodes are identified.", "output": "1. Suspicious mass right breast 6:00 position needs ultrasound-guided core biopsy.2. Normal morphology right axillary lymph nodes identified.BIRADS: 6 - Known cancer.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "History of diabetic ketoacidosis and choledocholithiasis on CT. The study was severely limited due to poor ultrasound penetration and patient confusion.LIVER: The liver measures 17.3 cm in craniocaudal dimension. Normal hepatopedal portal venous blood flow at 0.3 cm/s.Partially distended gallbladder with sludge and small layering gallstones. Minimal nonspecific wall thickening. No pericholecystic fluid.BILIARY TRACT: The common bile duct measures 5 mm. No choledocholithiasis is identified, but the study is limited as described above.PANCREAS: The pancreas was not visualized due to overlying bowel gas shadowing.SPLEEN: The spleen is not visualized.RIGHT KIDNEY: The right kidney is atrophic measuring 6.6 cm without hydronephrosis. OTHER: The left kidney is atrophic measuring 6.4 cm without hydronephrosis.", "output": "Very limited study as described above. The choledocholithiasis identified on the recent CT is not visualized. Cholelithiasis without specific evidence of acute cholecystitis. If cholecystitis is of clinical concern a HIDA scan may be considered as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "89-year-old male with thyroid mass on CT.] Weight loss. RIGHT LOBE MEASUREMENTS: 4.6 x 2.2 x 2.4 cmLEFT LOBE MEASUREMENTS: 8.0 x 3.4 x 3.4 cm. This underestimates the size of the left lobe which extends far into a substernal location.ISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Multiple small, cystic and benign nodules. A spongiform nodule in the upper pole measures 0.5 x 0.8 x 0.8 cm.LEFT LOBE: There are small benign cystic nodules identified. There is a large, solid, heterogeneously echogenic mass extending below the level of the clavicle and therefore incompletely measured. This approximates 3.6 x 3.8 x 5.3 cm.ISTHMUS: Left mass extends to the level of the left isthmus where there is some lobularity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Substernal thyroid as noted above. The large left nodule cannot be adequately evaluated.Otherwise, small, benign nodules bilaterally."}
{"instruction": "Generate impression based on findings.", "input": "Recurrent emesis LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. Several 1-2 cm simple cysts noted. No suspicious hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Normal appearance of the gallbladder, without gallstones.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 10.7 cm in length. The left kidney is 10.4 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 10.7 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites.", "output": "No acute abnormality identified. No specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female patient with history of thyroid nodules. RIGHT LOBE MEASUREMENTS: 6.0 x 3.0 x 2.1 cm.LEFT LOBE MEASUREMENTS: 9.0 x 4.4 x 3.2 cm.ISTHMUS MEASUREMENTS: 2 cm in thickness.RIGHT LOBE: The right thyroid lobe is diffusely heterogeneous containing multiple nodules some of which are spongiform in appearance. A dominant heterogeneous solid nodule within the right lower pole measures 1.3 x 0.7 x 1.6 cm. This nodule demonstrates internal vascularity. There is no shadowing calcifications within it.LEFT LOBE: The left thyroid lobe is predominantly replaced by two large nodules. The first nodule is within the midpole and is predominantly solid with cystic spaces measuring 5.0 x 2.8 x 4.0 cm. There is some internal vascularity and no shadowing calcifications within it. The second nodule within the lower pole is heterogeneously solid with cystic spaces measuring approximate 4.3 x 3.6 x 5.2 cm. There is some peripheral vascularity of this nodule and no shadowing internal calcifications.ISTHMUS: The isthmus is diffusely heterogeneous in echogenicity without discrete nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral thyroid nodules with two large, predominately solid left thyroid nodules which are amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old female with right upper quadrant pain. LIVER: Normal in size, contour and echogenicity. No masses.GALLBLADDER, BILIARY TRACT: Dependent gallstone within the gallbladder without wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Gallstones without complication."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old male patient with pain to right abdomen/liver. LIVER: The liver measures 14.2 cm in length. Multiple cystic lesions are noted within both hepatic lobes, some of which have septations. The largest within the right hepatic lobe near the hilum measures 3.2 x 4.1 x 4.3 cm. The largest within the left liver measures 2.5 x 2.1 x 2.0 cm. Main portal vein flow is hepatopetal and measures 0.1 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 8 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 10.5 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.5 cm in length. No evidence of hydronephrosis.The spleen measures 8.5 cm in length.", "output": "Multiple cystic lesions within both hepatic lobes, some of which are septated."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male with hepatitis C and ascites. Evaluate for cirrhosis. LIVER: The liver parenchyma is mildly coarsened. The liver measures 18.3 cm in craniocaudal dimension. The liver capsule is nodular consistent with cirrhosis. No intrahepatic biliary ductal dilatation or focal hepatic lesion is identified. There is normal hepatopetal portal venous blood flow at 20 cm/sec. The common bile duct is 2 mm at the hepatic hilum, within normal limits.BILIARY TRACT: A partially distended gallbladder is present with diffuse wall thickening up to 7 mm which is nonspecific in the setting of hepatitis/cirrhosis. There are no gallstones, pericholecystic fluid, or focal tenderness.The common bile duct measures 4 mm at the pancreatic head, within normal limits.PANCREAS: Limited evaluation of the pancreatic body/head is unremarkable. SPLEEN: The spleen measures 11.8 cm in length, at the upper limits of normal.RIGHT KIDNEY: The right kidney measures 7.9 cm. It is atrophic with cortical thinning and hyperechogenicity compatible with chronic medical renal disease. No hydronephrosis or shadowing calculus is identified. Color Doppler demonstrates hilar blood flow.OTHER: There is a moderate amount of ascites.The left kidney measures 7.6 cm. It is atrophic with cortical thinning and hyperechogenicity compatible with medical renal disease. Note is made of a 9-mm simple-appearing cyst. No hydronephrosis or shadowing calculus is identified. Color Doppler demonstrates hilar blood flow.", "output": "1. Cirrhotic liver morphology without a discrete focal lesion.2. Diffuse gallbladder wall thickening is nonspecific in the setting of chronic liver disease and without associated specific findings of acute cholecystitis.3. Findings consistent with chronic medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old female who presents for evaluation of the right inferior breast palpable lump by physician. Patient currently cannot palpate a lump. On physical examination, no right inferior breast lump is palpated.A targeted right ultrasound was performed for the palpable area of concern. There is no solid or cystic mass identified.", "output": "No sonographic evidence of solid or cystic mass.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "History of rising creatinine over the past 6 months to one year. RIGHT KIDNEY: Kidney measures 11.3 cm in length. Heterogeneous echotexture of the right kidney. Numerous cysts within the right kidney. No definite solid lesions are identified. No hydronephrosis. Calcifications are present in the right kidney.LEFT KIDNEY: Kidney measures 10.0 cm in length. Heterogeneous echotexture and numerous cysts are noted within the left kidney without evidence of solid mass lesion. No hydronephrosis. Calcifications are present in the left kidney.OTHER: No significant abnormalities noted.", "output": "1.Kidneys have increased echogenicity and calcifications bilaterally consistent with medical renal disease.2.Numerous bilateral renal cysts. No focal solid mass lesions."}
{"instruction": "Generate impression based on findings.", "input": "79 year-old female with a history of thyroid carcinoma status post thyroidectomy. RIGHT LOBE MEASUREMENTS: Surgically absent.LEFT LOBE MEASUREMENTS: Surgically absent.ISTHMUS MEASUREMENTS: Surgically absent.RIGHT LOBE: Surgically absent.LEFT LOBE: Surgically absent. Linear echogenic foci in the surgical bed of the left thyroid gland, likely representing surgical clips, when compared to recent CT chest examination dated 4/15/14.ISTHMUS: Surgically absent.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal morphology right level 2 cervical lymph node.", "output": "Postsurgical changes of prior thyroidectomy. No suspicious nodule or mass identified."}
{"instruction": "Generate impression based on findings.", "input": "History of multiple bilateral fibroadenomas status post surgery in feb 2015 now with new masses. On physical exam there are multiple palpable masses in both breasts.A right grayscale and color Doppler whole breast ultrasound was performed for the palpable areas of concern. There are multiple well-circumscribed hypoechoic masses demonstrating posterior acoustic enhancement, some of which have internal vascularity. All of the masses identified as follows as referenced on the ultrasound images: -Mass #1 at the 11:00 position 3 cm from nipple measures 4.4 x 2.4 cm-Mass #2 at the 12:00 position 3 cm from nipple measures 3.8 x 1.3 cm-Mass #3 at the 12:00 position 3 cm from the nipple measures 1.4 x 1.0 cm-Mass #4 at the 12:00 position 3 cm from nipple measures 1.2 x 1.0 cm-Mass #5 at 12:00 position 3 cm from nipple measures 1.3 x 1.0 cm- Mass #6 at the 3:00 position 3 cm from nipple measures 1.3 x 0.6 cm-Mass #7 at 6:00 position 3 cm from nipple measures 2.0 x 1.0 cm-Mass #8 at the 6:00 position 3 cm from nipple measures 1.5 x 0.8 cm-Mass #9 at the 7:00 position 3 cm the nipple measures 0.8 x 0.6 cm -Mass #10 at the 9:00 position 1 cm from nipple measures 1.2 x 0.7 cm-Mass #11 at the 9:00 position 1 cm from nipple measures 1.8 x 0.9 cmAll the masses are most likely benign fibroadenomas.A left grayscale and color Doppler flow breast ultrasound was performed. There are multiple well-circumscribed predominantly hypoechoic masses demonstrating posterior acoustic enhancement some of which have internal vascularity. All of the masses identified are swallows as referenced on the ultrasound images: -Mass #1 at the 12:00 position 3 cm from the nipple measures 1.2 x 0.7 cm-Mass #2 at the 12:00 position 3 cm from nipple measures 1.3 x 0.9 cm-Mass #3 at the 12:00 position 3 cm from nipple measures 0.7 x 0.5 cm-Mass #4 at the 1:00 position 1 cm from nipple measures 3.2 x 1.4 x 4.0 cm -Mass #5 at the 2:00 position 5 cm from nipple measures 3.4 x 2.1 x 3.6 cm-Mass #6 at the 2:00 position 7 cm the nipple measures 3.2 x 1.8 x 3.5 cm-Mass #7 at the 5:00 position 5 cm from the nipple measures 2.0 x 1.1 cm -Mass #8 at the 6:00 position 1 cm the nipple measures 2.2 x 1.1 x 2.3 cm-Mass #9 at the 8:00 position 4 cm from nipple measures 2.2 x 0.7 cm-Mass #10 at the 10:00 position 4 cm from nipple measures 1.5 x 0.7 cm -Mass #11 at the 10:00 position 4 cm from the nipple measures 1.6 x 1.0 cm. All the masses are most likely benign fibroadenomas.", "output": "Multiple bilateral breast masses, the largest in the right breast 11:00 position measuring up to 4.5 cm, with imaging characteristics suggestive of fibroadenomas. Outside pathology reports from previous surgical excision show all lesions to represent benign fibroadenomasBIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "61 years old, Male, Reason: anisarca, heavy EtOH drinker, check liver History: anisarca LIVER: The liver is enlarged measuring 24.4 cm in length. There is mildly increased echogenicity of the liver parenchyma No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of velocity m/s.BILIARY TRACT: The gallbladder is nondistended. 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: The spleen is difficult to visualize on this ultrasound examination. No significant abnormalities noted. The spleen measures 9.9 cm in length. RIGHT KIDNEY: Kidney measures 11.7 cm in length. Normal echotexture. Nohydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 11.0 cm in length. Normal echotexture. Nohydronephrosis or shadowing calculus.OTHER: No definite evidence of ascites in this exam.", "output": "1.Hepatomegaly with mild to moderately increased echogenicity of the liver consistent with fatty infiltration.2.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Kasper is a 41 year old female presenting with a palpable lump in the left collar bone area. Personal history of right breast lumpectomy in 8/2016 for IDC/DCIS treated with chemotherapy and radiation. Targeted left ultrasound was performed for the patient's area of concern.In the left supraclavicular region, there is a superficially located, reniform shaped hypoechoic lesion identified with hilar vascular flow measuring approximately 0.7 x 0.4 cm. Sonographic findings are compatible with a benign supraclavicular lymph node.", "output": "Benign lymph node of the left supraclavicular region. No sonographic evidence of malignancy. Patient should continue to follow up with her breast surgeon as clinically warranted. All results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male. Right upper quadrant tenderness. LIVER: Normal echogenicity and echotexture of the liver with no focal mass. Liver length is 18 cm.GALLBLADDER, BILIARY TRACT: No cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No biliary ductal dilatation. The common duct is 6 mm in diameter, within normal limits.PANCREAS: The visualized pancreatic head is normal in echogenicity. The remainder of the pancreas is obscured by bowel gas.RIGHT KIDNEY: Right kidney is 9.8 cm in length. No hydronephrosis or focal mass.OTHER: Spleen is 8.8 cm in length. Left kidney is 10.3 cm in length. No focal mass or hydronephrosis.", "output": "Unremarkable right upper quadrant ultrasound with no specific findings to explain patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "AML with elevated LFTs LIVER: Coarse echogenic liver parenchyma again noted without mass. Liver length 17.3 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy; no ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.6 cm in lengthOTHER: Left kidney 13.1 cm in length. Spleen 11.9 cm in length. No ascites.", "output": "Coarse echogenic liver parenchyma again noted consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "65 year-old male, precardiac transplant evaluation. LIVER: Coarse architecture of the liver measuring 15.4 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. There is a cystic structure measuring 4.7 cm x 5.3 cm x 4.7 cm which appears to arise from the common bile duct near the confluence of the common bile duct with the cystic duct consistent with a choledochocele and appears stable compared to prior CT study dated 3/11/2013. No intrahepatic biliary ductal dilatation. PANCREAS: Not well visualized in its entirety due to overlying bowel gas.SPLEEN: Normal echogenicity of the spleen measuring 10.4 cm in length.KIDNEYS: Right kidney measures 11.4 cm in length. No hydronephrosis or shadowing calculi are noted.Left kidney measures 11.8 cm in length. No hydronephrosis or shadowing wire noted.ABDOMINAL AORTA: Proximal aorta measures 2.8-cm x 2.6-cm. INFERIOR VENA CAVA: The visualized IVC is patent with appropriate directional flow.OTHER: No significant abnormality noted.", "output": "1. Coarse echotexture of the liver suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesions. 2. Findings are consistent with a choledochocele arising from the proximal common bile duct; stable. "}
{"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 suspicious solid or cystic mass identified. This examination was also double-read by Dr. Kulkarni.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "16 female complains of pain in the left lower axillary/upper outer quadrant area of the breast. On physical examination, the doctor felt some fluid in the breast as per the patient. Patient never felt a lump in the breast. No family history of breast cancer. A targeted left ultrasound was performed for the patient\u2019s area of concern. On physical examination, no discrete palpable lump noted in the left lower axillary/upper outer quadrant. Normal glandular tissue identified in the left upper-outer quadrant/lower axillary region. Normal morphology lymph nodes identified in the left axillary region. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy corresponding to patient's area of concern in the left lower axillary/upper outer quadrant of the breast..Clinical correlation is recommended.BIRADS: 2 - Benign finding. RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "77 years old, Female, Reason: Thyroid nodules History: Pt is having dysphagia RIGHT LOBE MEASUREMENTS: 3.9 x 1.3 x 0.8 cmLEFT LOBE MEASUREMENTS: 3.7 x 1.9 x 1.8 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: There is heterogeneity of the right lobe of the thyroid. The largest thyroid nodule in the right is solid and slightly hypoechoic to thyroid tissue measuring 0.8 x 0.5 cm.LEFT LOBE: The largest left thyroid nodule has components of cystic and solid nature, most of which is slightly hypoechoic to the thyroid tissue with punctate hyperechoic foci which are suspicious for microcalcifications. This nodule measures 1.6 x 1.2 cm. No apparent vascular flow within this nodule.ISTHMUS: In the inferior portion of the isthmus there is a solid appearing nodule measuring 1.9 x 0.9 cm which is slightly hypoechoic to the thyroid tissue.LYMPH NODES: No significant abnormality noted.", "output": "1. Left thyroid lobe mixed solid/cystic nodule with questionable microcalcifications. This nodule is indeterminate by ultrasound and would be amenable to future biopsy/FNA.2. Solid appearing inferior isthmus nodule which is amenable to future biopsy/FNA."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old male with pain surrounding left internal jugular dialysis catheter. Evaluate for fluid collection or evidence of infection. Grayscale and color ultrasound of the left neck soft tissues demonstrates a left internal jugular central venous catheter with mild edema of the surrounding soft tissues, however no fluid collections are identified. The left jugular vein is patent.", "output": "No abscess or specific evidence of infection surrounding the left internal jugular catheter. Patent left jugular vein. "}
{"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 an oval hypoechoic lesion at 12:00 position in the right breast, measuring 8 mm.", "output": "An oval hypoechoic lesion at 12:00 position in the right breast, measuring 8 mm. Diagnostic ultrasound study for right breast is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "25 year-old female with right upper quadrant pain, nausea, and vomiting. Evaluate for cholelithiasis versus cholecystitis versus liver abnormality. LIVER: The liver is homogeneous in echotexture and measures 15 cm in length. No focal hepatic lesions. Main portal vein is patent with hepatopedal flow and peak velocity of 0.3 m/sec.BILIARY TRACT: No cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. Common bile duct measures 0.3 cm in diameter. No intra-or extrahepatic biliary ductal dilatation. Sonographic negative Murphy's sign.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen is homogeneous in echotexture and measures 8.2 cm in length. No focal splenic lesions.RIGHT AND LEFT KIDNEY: Right kidney is homogeneous in echotexture and measures 10 cm in length. Left kidney is normal in echotexture and measures 10 cm in length. No hydronephrosis bilaterally.OTHER: No significant abnormalities noted.", "output": "1.No evidence of cholelithiasis or specific findings to suggest cholecystitis. 2.Liver is normal in echotexture and size without evidence of focal hepatic lesions."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for biliary distention, jaundice LIVER: Liver measures 18.2 cm appears coarse, heterogenous, with nodular surface, and perihepatic fluid noted. Irregular hypoechoic area in the right lobe of the liver near the dome is identified that measures 1.2 x 0.9 cmFoci of air artifact are present in the biliary system with intrahepatic biliary ductal dilatation. Stent visualized in the common bile duct.Portal vein demonstrates normal flow directionality and patency.BILIARY TRACT: Gallbladder is mildly distended with few gallstones within it. Irregular septated heterogenous appearance of the gallbladder is noted. Gallbladder wall is thickened. PANCREAS: In the region of the head of the pancreas heterogenous hypoechoic mass is identified. Pancreatic duct does not appear to be dilated. Limited evaluation of the pancreatic head mass due to overlying bowel gas.SPLEEN: Spleen measures 11.9 cm without any focal lesions.RIGHT KIDNEY: Both kidneys measure 11 cm, normal echotexture. No hydronephrosis or hydroureter. No focal lesions noted.OTHER: Moderate ascites noted.", "output": "1. Coarse heterogenous echotexture of the liver with perihepatic fluid. Stent noted within the common bile duct with mild intrahepatic biliary ductal dilatation and pneumobilia.2. Indeterminate hypoechoic area in the right lobe of liver for which cross-sectional CT liver protocol is recommended for further evaluation.3. Distended gallbladder with septations heterogenous appearance with wall thickening suspicious of an infiltrative neoplastic process versus acalculous cholecystitis.4. Moderate ascites5. Pancreatic head mass is incompletely evaluated."}
{"instruction": "Generate impression based on findings.", "input": "Female 68 years old Reason: Change in nodule History: thyroid cancer s/p surgery and I131 RIGHT LOBE: Status post right thyroidectomy with small amount of residual thyroid tissue measuring 4 x 4 millimeter, stable.LEFT LOBE: Status post left thyroidectomy.ISTHMUS: Post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Again noted are benign-appearing lymph nodes at level 2 and level for on the right side. These are all stable in size. Another lymph node in the left lateral neck area is also stable. No definite lesion is noted in the left supraclavicular area.OTHER: No significant abnormality noted.", "output": "No significant change from previous study."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male with history of thyroid cancer and treated recurrence with possible cystic structure in the thyroid bed. Rule out growth. RIGHT LOBE MEASUREMENTS: Post thyroidectomy changes again seen.LEFT LOBE MEASUREMENTS: Post thyroidectomy changes again seen.ISTHMUS MEASUREMENTS: Post thyroidectomy changes again seen.RIGHT LOBE: No mass is identified.LEFT LOBE: The reference lesion is a hypoechoic, round cystic lesion in the left thyroidectomy bed measures 0.3 x 0.1 x 0 .2 cm, previously 0.2 x 0.3 x 0.3. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal appearing right level 2 cervical lymph node.OTHER: No significant abnormality noted.", "output": "No significant interval change in the reference subcentimeter hypoechoic focus left thyroid bed.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Obesity unspecified long QT syndrome, nontoxic single thyroid nodule RIGHT LOBE MEASUREMENTS: 6.7 x 2.5 x 2.5 cm, heterogenous echotexture, mildly enlarged in sizeLEFT LOBE MEASUREMENTS: 6 x 2.7 x 2.6 cm, heterogenous echotexture, mildly enlarged in sizeISTHMUS MEASUREMENTS: 10 mmRIGHT LOBE: Along the posterior inferior aspect of the right thyroid gland there is extrathyroidal tissue with a hypoechoic nodule within it that measures 0.9 x 1 x 0.9 cm. This is less likely to be a parathyroid lesion.LEFT LOBE: Small hypoechoic nodule in the inferior pole of the left thyroid gland measures 0.4 x 0.7 x 0.5 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Mildly enlarged thyroid gland with a subcentimeter right thyroid nodule. Follow-up ultrasound is recommended in 6 months."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male with hepatitis C, worsening thrombocytopenia. LIVER: Measures 17.7 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: No hydronephrosis, nephrolithiasis, or solid mass. Lobulated contour of the left kidney again noted correlating with prior studies.OTHER: No significant abnormalities noted.", "output": "Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease, without discrete focal lesion. "}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis of liver LIVER: Heterogeneous and coarse echotexture unchanged. No worrisome mass. Stable benign-appearing subcentimeter cyst. Liver length 17.9 cmGALLBLADDER, BILIARY TRACT: Stable adenomyomatosis.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.6 cm in lengthOTHER: Minimal prominence of left renal collecting system. Spleen 7.6 cm in length. No ascites.", "output": "Stable heterogeneous and coarse liver echotexture without worrisome mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Thrombocytopenia with regional enteritis LIVER: Mildly heterogeneous liver echotexture without mass. Liver length 18.8 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.1 cm in lengthOTHER: Left kidney 11.1 cm in length. Spleen 11.4 cm in length. No ascites. Limited Doppler interrogation of the main portal vein demonstrates main portal vein patency with normal directional flow. Main portal vein velocity 36 cm/s.", "output": "Mild hepatomegaly with mild heterogeneous liver echotexture suggestive for parenchymal dysfunction without mass or ductal dilatation. Patent main portal vein with normal directional flow. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female with history of left thyroid nodule. RIGHT LOBE MEASUREMENTS: 5.6 x 2.3 x 2.0 cmLEFT LOBE MEASUREMENTS: 5.5 x 2.3 x 1.8 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Subcentimeter cystic nodules measuring up to 0.4 cm are not significantly changed.LEFT LOBE: Coarsely calcified nodule in the mid left thyroid gland measuring 0.6 cm is without significant interval change, as are adjacent subcentimeter cystic and spongiform nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered cervical lymph nodes with benign morphologic features.OTHER: No significant abnormality noted.", "output": "Bilateral thyroid nodules without significant interval change."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old female with left lower quadrant palpable lipoma near hip Mild prominence of left upper thigh musculature anteriorly in comparison to the right hip/upper thigh region. No cystic or solid mass noted in this region.", "output": "Mild prominence of left upper thigh musculature with no mass identified. "}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female with neutropenia and fever during chronic healing wound on the left forearm, concern for infection. Over the area of concern on the right forearm, the subcutaneous soft tissues appears enlarged and edematous. There are no drainable fluid collection seen.", "output": "Subcutaneous edema in the area of concern over the right forearm. These findings can be seen in cellulitis. No drainable fluid collection is visualized. "}
{"instruction": "Generate impression based on findings.", "input": "Female 88 years old Reason: Evaluate for obstruction History: worsening AKI RIGHT KIDNEY: Measures 8.5 cm in length. MIldly increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. Inferior pole right renal cyst 0.6 x 0.5 x 0.5 cm.LEFT KIDNEY: Measures 9.1 cm in length. MIldly increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.", "output": "1. Mildly Increased renal echogenicity consistent with medical renal disease. 2. No nephrolithiasis, hydronephrosis, or suspicious mass lesion. "}
{"instruction": "Generate impression based on findings.", "input": "Renal transplant RENAL TRANSPLANT: LOCATION: Left iliac fossaPERITRANSPLANT TISSUES: 5.2 x 3.5 x 2.9 cm hypoechoic focus anterior to the iliac vessels on the left separate from the transplanted kidney. This lesion demonstrates internal vascularity.KIDNEY: The transplanted left iliac fossa kidney could not be evaluated due to extensive overlying gas.COLLECTING SYSTEM/URETER: Not visualized due to overlying gasURINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels Vessels could not be interrogated due to extensive overlying gasOTHER: No significant abnormality noted", "output": "Left iliac fossa renal transplant could not be visualized and vessels could not be interrogated due to persistent extensive overlying bowel gas.Indeterminate hypoechoic lesion anterior to the iliac vessels. This lesion could not be fully characterized due to overlying gas."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for whole breast ultrasound for dense breast screening. Family history of breast cancer in mother and maternal aunt. 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. Multiple bilateral simple cysts were identified, including one in the left breast measuring up to 0.7 cm.This exam was interpreted by two radiologists.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Fever and sepsis RIGHT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. LEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 13 cm in length.OTHER: Bladder nondistended", "output": "Echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or obstruction. No loculated collection or abscess. No evidence for acute parenchymal edema."}
{"instruction": "Generate impression based on findings.", "input": "Transaminitis, fever LIVER: Cirrhotic morphology with perihepatic ascites. No biliary dilation. The main portal vein is patent.GALLBLADDER, BILIARY TRACT: Gallbladder is contracted. The common bile duct is normal in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Measures 8.5 cm. No hydronephrosis.OTHER: The left kidney and spleen are not visualized. Ascites.", "output": "1.Cirrhosis. 2.Ascites."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old male LIVER:Measures 25.1 cm. Mildly coarse echotexture. No focal mass, ascites, or intrahepatic biliary dilation. There is prominence of the hepatic veins and inferior vena cava without evidence of thrombus. There is a pulsatile waveform to the portal vein with hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. Wall measures 0.2 cm. No pericholecystic fluid, stones, or sludge. Common bile duct measures 0.4 centers. Negative sonographic Murphy's sign.PANCREAS: Evaluation the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 11.6 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 13.7 cm. Left kidney measures 12.6 cm. Unremarkable echogenicity. No hydronephrosis, shadowing calculi, or focal mass.OTHER: No significant abnormality noted.", "output": "1. Prominent inferior vena cava and hepatic veins as well as pulsatile portal vein consistent with congestive heart failure. No evidence of thrombus.2. Hepatomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Male 72 years old Reason: evaluate for thrombus v progressing hematoma v abscess in painful R forearm in the setting of cell line dysfunction due to ALL History: red circular area of induration, erythema, and warmth on R forearm volar surface Subcutaneous tissues are mildly edematous. Nonspecific edema and induration around vein in forearm. No drainable fluid collection. No hematoma.", "output": "Nonspecific edema and induration around a vein in the forearm. No drainable fluid collection or hematoma."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female with low TSH. Evaluate for nodules. RIGHT LOBE MEASUREMENTS: 4.2 x 1.6 x 1.3 cmLEFT LOBE MEASUREMENTS: 3 x 1.5 x 1.5 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Homogeneous without massLEFT LOBE: Homogeneous without massISTHMUS: Homogeneous without massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Negative exam for thyroid abnormality."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old male patient with history of cirrhosis. Evaluate for HCC. LIVER: The liver measures 15.1 cm in length. Hepatic parenchymal echogenicity is heterogeneous/coarsened and the liver is nodular in contour. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is not visualized on this examination. 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 12.5 cm in length. No evidence of hydronephrosis. A nonobstructing subcentimeter right lower pole stone is again noted.OTHER: The left kidney measures 14.3 cm in length. No evidence of hydronephrosis.The spleen measures 17.2 cm in length.", "output": "1. Cirrhotic morphology of the liver without focal hepatic lesion. 2. Non-obstructing right nephrolithiasis. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Eich is a 28 year old female with a biopsy-proven fibroadenoma of the left breast. She presents today for short term 6 month follow-up to confirm stability. Upon physical exam of the left medial breast, a soft mobile mass is appreciated.In the left breast 8:00 location, approximately 3 cm from the nipple, there is a lobulated hypoechoic mass measuring 2.3 x 1.2 x 2.2 cm, compared to 2.3 x 1.4 x 2.1 cm (from ultrasound dated 12/11/2014). No suspicious sonographic findings are identified.", "output": "Stable benign fibroadenoma of the left breast. Patient should follow up with Dr. Chhablani as clinically warranted. 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": "Ultrasound guided biopsy Ultrasound guidance was provided for the nephrology services for biopsy of the lower pole of the native left kidney. 3 passes were performed.", "output": "Ultrasound guidance for native left kidney biopsy"}
{"instruction": "Generate impression based on findings.", "input": "Patient presents for a left breast diagnostic mammogram after screening mammogram was read abnormal at an outside institution. The patient notes a palpable area that she stated at the time of the clinic appointment has only been present since she had the outside screening exam. Three standard views of the left breast and multiple 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. Under the area of palpable concern, a mixed echogenicity superficially located area is suggestive of fat necrosis measures 9 mm. It is noted that if anything, the area appears less prominent on this exam compared to the screening exam, suggesting some interval resolution. Elsewhere, a few round benign scattered asymmetries are present. Note is made that these largely compress with spot views, a finding which we have observed with cysts. ULTRASOUND", "output": "Probable fat necrosis at the site of palpable concern and scattered cysts in the left breast. No suspicious findings on mammography or ultrasound. Though the patient states her palpable concern occurred only after her outside screening mammogram, that finding in fact appears present on the outside screening exam from this year. Therefore, it would be safest to ensure that this continues to resolve at a 6 month interval mammogram. The patient has been seen in surgical clinic for correlation with physical exam. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "62 year old female who was recalled from screening mammogram for calcifications and focal asymmetry in the right breast. An ML view and three spot 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. Focal asymmetry in the right outer breast persists with benign morphology. The right outer breast calcifications are linear in distribution and pleomorphic in morphology. These are discontinuous but span 4-5 cm. ULTRASOUND", "output": "1. Right breast calcifications for which stereotactic biopsy is recommended. The patient should hold her aspirin 5 days before the biopsy is performed, if possible. Recommendation was discussed with the patient.2. Simple cysts in the right breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male for follow-up thyroid nodules. Thyroiditis. RIGHT LOBE MEASUREMENTS: 2.4 x 2.8 x 6.9 cmLEFT LOBE MEASUREMENTS: 2.8 x 2.4 x 6.1 cmISTHMUS MEASUREMENTS: 0.8 cmRIGHT LOBE: Heterogeneous echotexture. There is again noted in the medial right lobe/isthmus a complex cystic nodule which is unchanged in size, measuring 0.4 x 0.8 x 1 cm with eccentric, moderately echogenic material and focal reflectors, likely, tail artifact.LEFT LOBE: Heterogeneous echotexture. Within the left lobe there is a spongiform nodule which is not significantly changed measuring 0.5 x 0.6 x 0.7 cm.ISTHMUS: As abovePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Thyromegaly with heterogeneous thyroid parenchyma.Stable complex cystic right isthmus nodule likely benign.Spongiform, small left lobe nodule, benign."}
{"instruction": "Generate impression based on findings.", "input": "51 years old, Male, Reason: Assess for cirrhosis, PH? History: HepC, ascites, lower extremity edema LIVER: The liver measures 17 cm in length. Mildly increased hepatic parenchymal echogenicity. 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. No nodularity or widening of the fissures to suggest cirrhosis.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. Mild prominence of intrahepatic biliary ductal system. No extrahepatic biliary ductal dilatation is present. The common bile duct measures 5 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 11.3 cm in length. RIGHT KIDNEY: Kidney measures 9.3 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No evidence of ascites.", "output": "1.Mildly increased hepatic parenchymal echogenicity without evidence of focal lesion.2.No parenchymal nodularity or widening of the fissures to suggest cirrhosis."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female with history of thyroid cancer for follow-up. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: In the right thyroid bed there is again noted a rounded hypoechoic region measuring 0.5 x 0.7 x 0.6 cm. When measured similar to the prior study there is been no interval change.LEFT LOBE: There is some asymmetry in the left thyroid bed when compared to the right, and this appears unchanged from prior exam. The smaller hypoechoic area identified on the prior study inferior to the left bed measures 3 to 4 mm in greatest diameter and is unchanged. Is unchanged. This may represent vasculature.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal-appearing, small lymph nodes bilaterallyOTHER: No significant abnormality noted.", "output": "No interval change in the appearance of the thyroid beds."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are digital mammographic images (4/5/16, 4/28/16), post procedural bilateral digital mammographic images (5/3/16) performed at St. James Olympia Fields. For comparison, ultrasound images (4/28/16, 5/3/16) are available (dictated separately). DIGITAL MAMMOGRAPHIC IMAGES (4/5/16, 4/28/16):The breast parenchyma is composed of scattered fibroglandular elements (BiRADS Density Category B). There are 2 spiculated masses in the right breast at upper inner quadrant; anteriorly located mass measures 11 mm, and posteriorly located mass measures 19 mm. In the left breast, there is a spiculated mass at upper outer quadrant measuring 15 mm.Multiple benign appearing calcifications are seen in both breasts. 3 linear scar markers overlie left breast.POST PROCEDURAL BILATERAL DIGITAL MAMMOGRAPHIC IMAGES (5/3/16):Images are obtained after ultrasound-guided biopsy of the right breast (2 sites) and left breast (one site).A marker clip is placed approximately 1 cm lateral to the spiculated mass at anterior upper inner quadrant in the right breast. A marker clip is placed within the spiculated mass at posterior upper inner quadrant in the right breast and a spiculated mass at upper outer quadrant in the left breast. Per outside pathology report, all 3 lesions are malignant.", "output": "Known right and left breast cancer (2 sites in right breast, and one site in the left breast). Given multiple synchronous breast cancers, recommend bilateral breast MRI.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female with acute liver failure. LIMITED ABDOMENLIVER: The liver measures 19.6 cm. Coarse echotexture and nodular margin is compatible with chronic liver disease. Weakly echogenic lesion in segment 7 with subtle hypoechoic halo measures 1.4 x 1.5 x 1.6 cm.BILIARY TRACT: No shadowing gallstones or pericholecystic fluid. Gallbladder wall measures 6 mm in thickness, which may represent chronic liver disease. No biliary ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. Spleen measures 9.9 cm. KIDNEYS: Right kidney measures 12.0 cm. No focal renal lesions or hydronephrosis. Left kidney measures 10.3 cm. No focal renal lesions or hydronephrosis.OTHER: No ascites.", "output": "1.Chronic liver disease with weakly echogenic lesion seen in segment 7 as described above. While imaging features could represent a hemangioma in a noncirrhotic liver, HCC should be excluded given the patient's chronic liver disease.2.Patent hepatic vasculature.3.Nonspecific gallbladder wall thickening in the setting of chronic liver disease."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with alcoholic cirrhosis. The noted for hepatocellular carcinoma. Known liver lesion. LIVER: Liver is coarsely echogenic and normal in size. In the left lobe there is a hypoechoic 1.5 x 1.7 x 1.9 cm rounded mass. Although the mass measures larger than on the prior exam, is better seen on today's study and is unchanged from prior ultrasounds. No new hepatic abnormality.Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Shadowing in the dependent gallstones within the gallbladder without complication. The biliary tract is normal in caliber. PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: Trace ascites.", "output": "Stable liver mass. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "Goiter RIGHT LOBE MEASUREMENTS: 7.3 x 4.3 x 2.5 cmLEFT LOBE MEASUREMENTS: 7.1 x 5.7 x 4.9 cmISTHMUS MEASUREMENTS: 2 cmRIGHT LOBE: Diffusely enlarged heterogeneous gland. Multiple spongiform-appearing nodules. A representative lower pole nodule measures 3.5 x 3 x 2 cmLEFT LOBE: Diffusely enlarged heterogeneous gland without obvious discrete noduleISTHMUS: Diffusely enlarged heterogeneous gland without discrete nodulePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely enlarged heterogeneous gland consistent with goiter. Multiple benign-appearing spongiform right lobe nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Goiter RIGHT LOBE MEASUREMENTS: 7.7 x 3.4 by 3.6 cmLEFT LOBE MEASUREMENTS: 5.6 x 3.6 by 3.7 cmISTHMUS MEASUREMENTS: 2.8 cmRIGHT LOBE: Diffusely heterogeneous gland without discrete measurable noduleLEFT LOBE: Diffusely heterogeneous gland without discrete measurable noduleISTHMUS: Solid exophytic nodule arising from the isthmus measuring 2.5 x 4.7 x 2.9 cmPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland. Solid exophytic nodule arising from the isthmus. This lesion is amenable to ultrasound guided percutaneous biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Alcohol abuse. Right upper quadrant epigastric pain. LIVER: Non-cirrhotic liver morphology. 14 cm in length. Normal parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Subcentimeter gallstones are noted, without wall thickening or pericholecystic fluid to suggest cholecystitis. No sonographic Murphy's sign.PANCREAS: Calcifications throughout the pancreas, compatible with the patient's known history of chronic pancreatitis. The main pancreatic duct is dilated up to 14 mm, similar to the prior CT in 2013. KIDNEYS: The right kidney is 9.5 cm in length. The left kidney is 8.8 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 8.9 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal fluid collections are identified.", "output": "1. Cholelithiasis without specific evidence of cholecystitis.2. Calcifications throughout the pancreas compatible with chronic pancreatitis, with stable pancreatic ductal dilation."}
{"instruction": "Generate impression based on findings.", "input": "Left testicular mass RIGHT TESTIS: 4.6 x 2.3 x 2.7 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristicsLEFT TESTIS: 4.5 x 2.2 x 3.4 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristics.RIGHT EPIDIDYMIS: Stable epididymal cyst.LEFT EPIDIDYMIS: Stable epididymal cyst.OTHER: Subcentimeter left mobile benign-appearing scrotal pearl again noted", "output": "Stable subcentimeter mobile left benign scrotal pearl. No worrisome intratesticular mass. Bilaterally symmetric Doppler flow characteristics. Bilateral epididymal cysts."}
{"instruction": "Generate impression based on findings.", "input": "Elevated bilirubin LIVER: Mild intrahepatic bilobar ductal dilatation, left greater than right associated with pneumobilia. The known central mass is not well visualized on the current examination due to overlying gas. Limited Doppler interrogation of main portal vein again demonstrates portal vein thrombosis. Liver length 15.9 cm.GALLBLADDER, BILIARY TRACT: Gallbladder not visualized. Mild intrahepatic bilobar ductal dilatation, left greater than right associated with pneumobiliaPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.8 cm in length OTHER: Left kidney 11.3 cm in length. Spleen 13.5 cm in length. Mild ascites.", "output": "No significant change in bilobar intrahepatic ductal dilatation with pneumobilia. Known central hepatic mass seen on CT not visualized due to overlying gas. Main portal vein thrombosis again noted. Mild ascites."}
{"instruction": "Generate impression based on findings.", "input": "History A thyroid carcinoma status post resection with PET-positive right supraclavicular lymph node. 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: At least 2 subcentimeter hypoechoic foci within the right supraclavicular region posterior and in between the right jugular and carotid, just superior to the right subclavian artery. These hypoechoic foci correspond to the PET-positive focus.OTHER: No significant abnormality noted.", "output": "At least 2 subcentimeter hypoechoic foci within the right supraclavicular region posterior and in between the right jugular carotid, just superior to the right subclavian artery. These hypoechoic foci correspond to the PET-positive focus and will be biopsied today."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old male patient with elevated creatinine status post kidney transplant. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No perirenal fluid collection is identified.KIDNEY: The transplant kidney measures 14.6 cm in length.COLLECTING SYSTEM/URETER: No evidence of hydronephrosis.URINARY BLADDER: No significant abnormality noted.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels. The transplant renal artery and vein are patent. Peak systolic velocity at the origin of the transplant renal artery measures 0.9 m/s with a RI of 0.77. The intrarenal resistive indices range from 0.64 to 0.78 with normal spectral waveforms. OTHER: No significant abnormality noted.", "output": "1. No hydronephrosis.2. Patent transplant renal artery and vein."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female with right upper quadrant pain, chills. LIVER: Measures 18.0 cm in length. Unremarkable echogenicity and morphology.GALLBLADDER, BILIARY TRACT: Cholelithiasis with marked gallbladder wall thickening measuring up to 12 mm and a positive sonographic Murphy's sign, consistent with acute cholecystitis. No biliary ductal dilation.PANCREAS: Portions of the pancreas not well visualized due to bowel gas.KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Findings consistent with acute cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: Day8 post ASCT, neutropenic. LUE Abscess vs muscular inflammation. History: Localized swelling to left forearm, with warmth to touch, febrile There is mild edema of the subcutaneous tissues of the left upper extremity without focal fluid collection or abscess.", "output": "Mild left upper extremity subcutaneous edema, which can be seen in cellulitis. No focal fluid collection or abscess."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old female patient with upper quadrant pain, ascites. LIVER: The liver measures 14.1 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/s.GALLBLADDER, BILIARY TRACT: The gallbladder is not visualized. There is no intra- or extrahepatic biliary ductal dilatation. The common bile duct measures 3 mm in diameter.PANCREAS: There is a 2.9 x 2.1 x 2.9 cm cystic lesion near the head of the pancreas with thick walls and dependent debris within it.RIGHT KIDNEY: The right kidney measures 10.1 cm in length. No evidence of hydronephrosis.OTHER: The left kidney measures 9.7 cm in length. No evidence of hydronephrosis.The spleen measures 7.3 cm in length.", "output": "Cystic lesion near the head of the pancreas for which dedicated contrast enhanced CT is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain and fever. LIVER: The liver parenchyma is mildly heterogeneous and echogenic without a focal abnormality.BILIARY TRACT: The gallbladder is distended with wall thickening up to 3 mm and pericholecystic fluid, similar to prior study.No focal tenderness may be secondary to medication. Cholelithiasis is present.PANCREAS: Not evaluated.SPLEEN: Not evaluated.RIGHT KIDNEY: Not evaluated. OTHER: No significant abnormalities noted.", "output": "Dilated gallbladder with sludge and gallstones. Gallbladder wall thickening and pericholecystic fluid appearing similar to the prior study and again suspicious for acute cholecystitis in the correct clinical context. Fatty liver. "}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Right renal cyst. Right kidney 10.9 cm in lengthLEFT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. 11.3 cm in length.OTHER: Bladder nondistended. Trace ascites.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with transaminitis. LIVER: The liver measures 17.2 cm. There is increased and coarse echogenicity of the parenchyma. No masses or ascites. No intrahepatic ductal dilation. The main portal vein is patent.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended and the wall measures 2.2 mm. No stones or sludge. The common bile duct measures 2.7 mm. No pericholecystic fluid.PANCREAS: The pancreas is obscured by bowel gas.SPLEEN: The spleen measures 8.9 cm. No abnormalities noted.KIDNEYS: The right kidney measures 12.2 cm. The cortex is echogenic. No shadowing calculi, hydronephrosis, or worrisome masses. There are minimally complex cysts, the largest of which measures 3.5 x 2.6 x 2.8 cm.The left kidney measures 10.9 cm. The cortex is echogenic. No shadowing calculi, hydronephrosis, or worrisome masses. OTHER: No significant abnormality noted.", "output": "1. Coarse, echogenic liver consistent with chronic liver disease/parenchymal dysfunction. No masses, ductal dilation, or ascites.2. Echogenic kidneys consistent with chronic medical renal disease/parenchymal dysfunction. No hydronephrosis or stones.3. Minimally complex right renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "Primary hyperparathyroidism. Assess for renal stones. RIGHT KIDNEY: 11.0 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 11.8 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: No significant abnormality noted.OTHER: Trace ascites identified.", "output": "No nephrolithiasis identified. Echogenic renal parenchyma without hydronephrosis, suggestive of medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female with history of biliary cirrhosis now with pulmonary hypertension. Evaluate for ascites. Moderate volume ascites is present in all 4 quadrants. Liver is noted to be coarse in echotexture and nodular in contour consistent with known cirrhosis.Spleen is enlarged.", "output": "Moderate volume 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 suspicious solid mass identified. Numerous bilateral simple and complicated cysts are present.Screening ultrasound exams are optimally performed when prior breast imaging studies are available to compare. If the patient's prior studies can be submitted, then an addendum to this report will be made.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "36 years old, Female, Reason: r/o adenopathy, recurrence History: h/o thyroid cancer. most recent US suggested benign nodes, but one was slightly larger. This is a 6-month follow-up study MEASUREMENTS: Patient status post thyroidectomyRIGHT LOBE AREA: No evidence of local recurrence.LEFT LOBE AREA: No evidence of local recurrence. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Previously seen level IV right lymph node measures 1.3 x 0.5 x 0.9 cm which is unchanged from prior study. A fatty hilum is not definitely identified within this lymph node.Level 2 benign-appearing left lymph node measures 0.9 x 0.2 by 0.5 cm. OTHER: No significant abnormality noted.", "output": "1. No definite evidence of local recurrence.2. Level 4 right lymph node is unchanged from prior exam. Continued surveillance is recommended."}
{"instruction": "Generate impression based on findings.", "input": "History of left thyroidectomy. Multinodular goiter. RIGHT LOBE MEASUREMENTS: 7.7 x 4.4 x 2.5 cm compared to 8.0 x 3.2 x 1.8 cm previously.LEFT LOBE MEASUREMENTS: Status post left thyroidectomy.ISTHMUS MEASUREMENTS: No significant abnormality noted.RIGHT LOBE: Heterogeneous nodular right thyroid lobe. The reference superior pole nodule measures 3.3 x 1.2 x 2.5 cm compared to 3.1 x 1.4 x 2.0 cm previously. The nodule is heterogeneous and well defined with minimal vascularity without discrete microcalcifications or other specific suspicious sonographic features.LEFT LOBE: Status post left thyroidectomy.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Several benign morphology and size cervical lymph nodes are noted.OTHER: No significant abnormality noted.", "output": "Multinodular right thyroid lobe appearing similar to the prior study."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old male with acute renal failure. Evaluate for obstruction. RIGHT KIDNEY: The right kidney measures 7.9 cm in length. The kidney is echogenic consistent with parenchymal disease and there is parenchymal loss. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 10.2 cm in length. The kidney is echogenic consistent with parenchymal disease and there is parenchymal loss. There is a 1.5 cm cyst arising from the left kidney which appears simple on today's study. Second cyst is not identified. There is also a small amount of perinephric fluid on the left.URINARY BLADDER: No significant abnormalities noted.OTHER: Varices noted in the splenic hilum.", "output": "Echogenic kidneys bilaterally with parenchymal loss and no hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old male with history of cirrhosis, evaluate for HCC. LIVER: Measures 13.8 cm in length. Cirrhotic morphology with increased hepatic echogenicity, without focal lesion.BILIARY TRACT: No significant abnormalities noted.PANCREAS: 1.0 x 0.7 x 0.6 cm cystic structure in the proximal pancreatic body with a thin internal septation, not seen on prior studies. No pancreatic ductal dilation. The pancreatic tail is not clearly visualized due to bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Right renal cyst measuring 7.8 x 7.3 x 6.1 cm, and left renal cyst measuring 1.8 x 1.8 x 2.3 cm, without internal septation or solid component, not significantly changed compared to prior studies. OTHER: No significant abnormalities noted.", "output": "1. Cirrhotic liver with increased hepatic echogenicity consistent with chronic liver disease, without discrete lesion identified. 2. 1.0 cm septated cystic lesion in the pancreatic body not seen on prior studies is nonspecific and may represent a side branch IPMN. Further imaging with MRCP may be considered for further characterization as warranted clinically. "}
{"instruction": "Generate impression based on findings.", "input": "Increasing LFTs with shock LIVER: Coarse echogenic liver parenchyma without mass. Liver length 16.3 cm. Limited evaluation of the main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: Possible cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11 cm in lengthOTHER: Left kidney 10.6 cm in length. Spleen 9.9 cm in length. No ascites.", "output": "Coarse echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without worrisome mass or ductal dilatation. Possible cholelithiasis without acute inflammation."}
{"instruction": "Generate impression based on findings.", "input": "Multiple thyroid nodules RIGHT LOBE MEASUREMENTS: 3.7 x 1.6 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.2 x 1.8 x 2.2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Diffusely heterogeneous gland without discrete noduleLEFT LOBE: Diffusely heterogeneous gland. No change in multiple left thyroid nodules. Mid pole nodule measures 0.9 x 1.1 x 0.8 cm. Lateral midpole nodule measures 0.9 x 1 x 1.5 cm. Lower pole nodule measures 1.4 x 1.3 x 0.9 cm.ISTHMUS: Diffusely heterogeneous gland without discrete nodulePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable examination. Diffusely heterogeneous gland unchanged. No change in multiple left thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "HCC screening. Cirrhosis. LIVER: Grossly unremarkable liver morphology. 12.3 cm in length. Slightly coarsened hepatic echogenicity, compatible with parenchymal dysfunction. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. 14 mm gallstone noted. Otherwise unremarkable appearance of the gallbladder.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. A 3.7 cm cyst is noted in the inferior pole, with an echogenic focus, possibly representing a calcified septation.The left kidney is 10.6 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 12.5 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid is identified.", "output": "1. No suspicious hepatic lesions identified.2. Cholelithiasis."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old male patient with hepatitis B carrier. HCC screening. LIVER: The liver measures 16 cm in length. Hepatic parenchymal echogenicity is increased. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.1 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 pancreas is poorly visualized on this examination.RIGHT KIDNEY: The right kidney measures 10.9 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.2 cm in length. No evidence of hydronephrosis.The spleen measures 12.3 cm in length.", "output": "Increased hepatic echogenicity which can be seen with hepatic steatosis/hepatic parenchymal dysfunction. No focal hepatic lesion is identified."}
{"instruction": "Generate impression based on findings.", "input": "Elevated transaminases LIVER: Mildly coarse echogenic liver echotexture without mass. Liver length 16.3 cm.GALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Minimal right hydronephrosis. Right kidney 12 cm in length.OTHER: Left kidney 10.6 cm in length. Spleen 13.9 cm in length. Trace ascites.", "output": "Mildly coarse echogenic liver echotexture raises the possibility of fatty infiltration/parenchymal dysfunction without mass. Cholelithiasis without acute inflammation or ductal dilatation. Trace ascites. Minimal right hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "21-year-old male with history of left varicocele and pain. RIGHT TESTIS: Right testes measures 2.6 x 2.3 x 6.0 cm parenchymal texture is normal.LEFT TESTIS: Left testes measures 3.2 x 2.2 x 5.8 cm parenchymal echotexture is normal.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: Subcentimeter left epididymal simple cysts.OTHER: Bilateral varicocele, with small left hydrocele.", "output": "Bilateral varicocele and small left hydrocele."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male with left upper pole renal mass for further evaluation. RIGHT KIDNEY: The right kidney measures approximately 12.1 cm in length. No hydronephrosis, shadowing calculus or mass. Echotexture is normal.LEFT KIDNEY: The left kidney measures 12.3 cm in length. Echotexture is normal. No hydronephrosis or shadowing calculus. There is a very small cyst in the lower pole of left kidney. The mass identified on CT cannot be seen on today's ultrasound study due to position of the left kidney.OTHER: Large focus of accessory splenic tissue in the left upper quadrant.", "output": "Left renal mass not adequately visualized between ribs."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Abdominal fullness in RLQ with history of multiple abdominal surgeries. Within the superficial soft tissues of the lower anterior abdominal wall, there is a large ovoid hypoechoic collection with thin internal septations as well as low level internal echoes. Overall, the collection measures approximately 28 x 5 cm. The collection is composed of a larger right component measuring approximately 17.8 cm in length and is smaller left component measuring 9.6 cm in length. The collection lacks internal vascularity or surrounding increased vascularity.", "output": "Large collection within the anterior abdominal wall measuring up to 28 cm, favor postoperative collection such as seroma."}
{"instruction": "Generate impression based on findings.", "input": "50 year-old female with a history of thyroid cancer. Status post thyroidectomy in October of 2014 and I-131 therapy. RIGHT LOBE MEASUREMENTS: Surgically absent.LEFT LOBE MEASUREMENTS: Surgically absent.ISTHMUS MEASUREMENTS: Surgically absent.RIGHT LOBE: Surgically absent. There is a 4 x 3 x 5 mm heterogeneous, but predominantly hypoechoic nodule in the inferior surgical bed of the right lobe of the thyroid gland. There is no internal vascularity or calcification. Additionally, there is a 4 x 3 x 5 mm, hypoechoic nodule in the midportion of the surgical bed of the right lobe of the thyroid gland. There is no internal vascularity or calcification. There is a 4 x 6 x 6 mm round hypocholic nodule in the superior pole of the surgical bed of the right lobe of the thyroid gland, without internal vascularity or calcification.LEFT LOBE: Surgically absent. There is a normal morphology lymph node identified in the surgical bed of the left lobe of the thyroid gland.ISTHMUS: Surgically absent.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Note is made of a left level 2 cervical lymph node. While there is a suggestion of a normal fatty hilum, close attention on follow up examination is recommended to evaluate for interval change. OTHER: No significant abnormality noted.", "output": "1. Multiple subcentimeter nodules in the surgical bed of the right lobe of the thyroid gland are nonspecific. Submission of prior examinations for comparison, if available, is recommended to exclude the possibility of residual or recurrent disease. Follow up examination is recommended.2. Nonspecific left level 2 cervical lymph node for which follow up examination is recommended to evaluate for interval change. "}
{"instruction": "Generate impression based on findings.", "input": "51 year-old female with right upper quadrant pain. LIVER: The liver is normal in morphology, echogenicity and size, measuring 13.3 cm in craniocaudal dimension. No intrahepatic biliary ductal dilatation or focal hepatic lesion is evident. There is normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: A normally distended gallbladder is present without wall thickening, pericholecystic fluid, focal tenderness or gallstones. No extrahepatic biliary ductal dilatation with the common bile duct measuring 3 mm in caliber.PANCREAS: The visualized portions of the pancreatic body and head are normal in appearance.SPLEEN: The poorly visualized spleen measures 7 cm in length.RIGHT KIDNEY: The right kidney measures 9.6 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 10.7 cm in length with no hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow.", "output": "No gallstones or evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female with enlarged cervical lymph nodes and parathyroid glands on prior ultrasound. RIGHT LOBE MEASUREMENTS: 3.9 x 1.1 x 1.1 cmLEFT LOBE MEASUREMENTS: 3.8 x 0.9 x 0.9 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Small and diffusely heterogeneous without mass.LEFT LOBE: Small and diffusely heterogeneous without mass.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Again noted inferior to the right lobe of the thyroid are too hypoechoic nodules a smaller measures 0.2 x 0.3 x 0.4 cm and has an appearance suggestive of lymph node. The larger measures 0.5 x 1.1 x 0.5 cm, decreased when compared to prior exam. On the left, there is a 0.3 x 0.4 x 0.9 cm hypoechoic-isoechoic area at the inferior aspect of the left lobe which is stable. The hypoechoic nodule inferior to the left lobe described on the prior study is no longer seen. LYMPH NODES: No enlarged or morphologically abnormal lymph nodes.OTHER: No significant abnormality noted.", "output": "Small, heterogeneous thyroid.2 extrathyroidal nodules on the right are stable and one has an appearance of lymph node.A nodular focus which is inseparable from the inferior left lobe of the thyroid is stable. Previously described left hypoechoic mass inferior to the thyroid is not visualized.No abnormal lymph nodes in the neck."}
{"instruction": "Generate impression based on findings.", "input": "Male 84 years old Reason: r/o obstruction, assess kidney size and post void residual History: rising creatinine longstanding dm and well controlled hypertension RIGHT KIDNEY: The right kidney measures 9.5 cm. No shadowing calculi or hydronephrosis is present. LEFT KIDNEY: The left kidney measures 9.2 cm. No shadowing calculi or hydronephrosis is present. BLADDER: Underdistended bladder without significant abnormality. Patient had voided just prior to examination, with a postvoid residual of approximately 9.5 mL, however we cannot compare prevoid volume.OTHER: No significant abnormalities noted.", "output": "1.No hydronephrosis or shadowing renal calculus.2.Patient voided just prior to examination, no significant post void residual, however, there is no prevoid volume to compare. "}
{"instruction": "Generate impression based on findings.", "input": "31 years old, Female, Reason: Left Thyroid nodule FNA positive PTC. Please perform lymph node mapping. RIGHT LOBE MEASUREMENTS: 5.2 x 2.2 x 1.4 centimetersLEFT LOBE MEASUREMENTS: 5.2 x 2.3 x 2.1 cmISTHMUS MEASUREMENTS: 0.3 centimetersRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Single solid-appearing left thyroid nodule measures 2.7 x 1.8 x 2.0 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Enlarged left level 1b lymph node near the submandibular gland most likely reflects a reactive lymph node however special attention to this area should be paid on future surveillance scans.OTHER: No significant abnormality noted.", "output": "1.Solid thyroid nodule consistent with known history of papillar thyroid cancer.2.No significant lymphadenopathy. Enlarged left level 1b lymph node near the submandibular gland is favored to represent a reactive lymph node, however special attention to this area should be paid on future surveillance scans."}
{"instruction": "Generate impression based on findings.", "input": "Female, 21 years old. Proteinuria RIGHT KIDNEY: The right kidney measures 12.3 cm in length, with normal echotexture. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.3 cm in length, with normal echotexture. No shadowing stones or hydronephrosis.OTHER: The bladder is nondistended.", "output": "Normal sonographic appearance of the kidneys. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "45 year old female presents for follow-up of known left breast cysts. Previously had pain associated with these cysts, however has no complaints of pain today. No family history of breast cancer. On physical examination, no discrete palpable abnormality is identified.A targeted left ultrasound was performed for the patient's area of concern. Multiple tiny (<0.5 cm) benign cysts are visualized, unchanged from prior examination. No ultrasound features are present to suggest malignancy. No increased vascularity. No solid mass is appreciated.", "output": "Multiple tiny, benign left breast cysts, unchanged from prior examination. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually, for which the patient is due in September 2015. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female with history of left mastectomy and left breast reconstruction. Now feels palpable lumps in left medial and inferior breast. A targeted left breast ultrasound was performed for the palpable areas of concern. At the 9:00 position, there are 2 circumscribed lesions without internal blood flow. The larger predominantly anechoic lesion measures 1.7 x 1.1 x 2.2 cm, and the smaller mixed echogenicity lesion measures 0.6 x 1.1 x 1.2 cm. Findings are compatible with fat necrosis/oil cyst formation.At the 6:00 position, there is skin thickening measuring 7 mm. No solid or cystic mass is identified.", "output": "Fat necrosis/oil cyst formation and skin thickening in the left breast. Surgical follow-up is recommended to direct subsequent management and the patient will see Donna Christian today. BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old male with thrombocytopenia. Evaluate for hepatomegaly and splenomegaly. LIVER: Increased echogenicity of the liver measuring 16.0 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: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. Common duct measures 4 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Not well assessed.RIGHT KIDNEY: Right kidney measures 12.0 cm in length. No hydronephrosis or shadowing calculus are noted.OTHER: Spleen is mildly enlarged measuring 12.1 cm in length.Left kidney measures 12.2 cm in length. No hydronephrosis or shadowing calculus are noted.", "output": "1. Increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. 2. Borderline splenomegaly. "}
{"instruction": "Generate impression based on findings.", "input": "43 year old male with HTN, renal failure. Evaluate for etiology for HTN, assess for renal artery stenosis. ULTRASOUND KIDNEYSRIGHT KIDNEY: Increased in echogenicity measuring 9.9 cm in length. No hydronephrosis or shadowing calculi are noted. LEFT KIDNEY: Increased in echogenicity measuring 10.9 cm in length. No hydronephrosis or shadowing calculi are noted. OTHER: Fluid containing structure adjacent to the bladder presumably represents fluid containing bowel.", "output": "1. Increased echogenicity of the kidneys suggestive of parenchymal dysfunction. No hydronephrosis. 2. No evidence of renal artery stenosis. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Nuilachae is a 26-year-old with known bilateral breast cysts and masses likely representing fibroadenomas presents for follow-up. RIGHT BREAST ULTRASOUND:On physical exam, there is a palpable mass in the upper outer quadrant of the right breast.A whole breast ultrasound was performed for the palpable and clinical areas of concern. -In the right breast 10:00 position 4 cm from nipple, there is an 8 x 3 x 9 mm circumscribed mass, with sonographic features favoring a benign fibroadenoma. This mass previously measured 9 x 3 x 9 mm and has not significantly changed in size. -In the right breast 12:00 position, 3 cm from nipple there is a 9 x 7 x 11 mm circumscribed anechoic lesion with posterior acoustic enhancement consistent with a simple cyst. -In the right breast 8:00 position 3 cm from nipple, there is an anechoic circumscribed parallel lesion with posterior acoustic enhancement measuring 11 x 5 x 11 mm, consistent with a simple cyst.LEFT BREAST ULTRASOUND: On physical exam there is a palpable mass in the inferior left breast.A whole breast ultrasound was performed for the palpable and clinical areas of concern. -In the left breast 11:00 position 6 cm from nipple, posterior depth there is a parallel circumscribed mass measuring 10 x 5 x 10 mm, suggestive of benign fibroadenoma. This mass previously measured 9 x 3 x 13 mm and has not significantly changed in size. -In inferior left breast near the 6:00 position there is an area of focal fibrocystic change containing innumerable number of cysts measuring up to 6 mm, corresponding to the palpable abnormality.-In the left breast 12:00 position 1 cm from the nipple, there is a cluster of cysts measuring 8 x 6 x 8 mm.", "output": "Stable high probability benign bilateral fibroadenomas. Extensive fibrocystic change in the inferior left breast. Bilateral simple cysts. As long as the patient's physical examination remains normal, bilateral ultrasound can be performed in one year to document stability of these findings. At that time, assuming all findings are stable, the patient will have had 2 years of stability and can discontinue annual imaging follow-up as clinically warranted. Results and recommendation 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": "Acute renal sufficiency RIGHT KIDNEY: Mildly echogenic renal parenchyma without mass, stone, or hydronephrosis. 12 cm in lengthLEFT KIDNEY: Mildly echogenic renal parenchyma without worrisome mass, stone, or hydronephrosis. Large left renal cyst again noted. Left kidney 11 cm in lengthOTHER: Bladder nondistended", "output": "Mildly echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Acute pancreatitis. Rule out cholecystitis. Gallstones. LIVER: Liver is markedly echogenic compatible fatty infiltration. Portal vein is patent with flow toward the liver on color Doppler imaging. No focal liver lesions were identified.BILIARY TRACT: Gallstones. Gallbladder wall is minimally thickened. There is no evidence of a sonographic Murphy sign. No significant pericholecystic fluid.PANCREAS: Partially visualized and difficult to evaluate.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Gallstones with minimal thickening of the gallbladder wall. Fatty infiltration of the liver."}
{"instruction": "Generate impression based on findings.", "input": "Epigastric pain LIVER: Coarse echogenic liver echotexture without mass. Liver length 17.4 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.9 cm in length.OTHER: Left kidney 9.7 cm in length. Spleen 10 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Unremarkable gallbladder. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Male 25 years old Reason: Patient with mother with ADPKD. Please complete full renal and liver ultrasound to screen for ADPKD. Please provide maximum length width and depth on ultrasound images History: elevated BP LIVER: Liver is normal in homogeneous echotexture measuring 15.3 cm.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Gallbladder is normal. No gallstones or gallbladder wall thickening.PANCREAS: The visualized portions of the pancreas are normal in appearance.SPLEEN: The spleen is normal in appearance measuring 10.9 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. No cysts are present in the kidneys bilaterally. OTHER: No significant abnormalities noted.", "output": "Normal appearance of the kidneys. No cysts."}
{"instruction": "Generate impression based on findings.", "input": "35 year old female with right upper quadrant abdominal pain LIVER: Normal echogenicity of the liver measuring 13.6 cm in length. Portal vein is patent with appropriate hepatopetal flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No pericholecystic fluid. No gallbladder wall thickening. Common bile duct measures 3 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 11.2 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the left kidney measuring 10.3 cm in length. No hydronephrosis or shadowing calculi are noted.Normal echogenicity of the spleen measuring 12.4 cm in length.", "output": "Unremarkable examination."}
{"instruction": "Generate impression based on findings.", "input": "Minimally complex right lower pole cyst RIGHT KIDNEY: Stable minimally complex lower pole right renal cyst measuring 1.6 x 1.3 x 1.2 cm. No hydronephrosis. Right kidney 8.7 cm in length.LEFT KIDNEY: No significant abnormalities noted. 10.8 cm in lengthOTHER: No significant abnormalities noted.", "output": "Stable minimally complex lower pole right renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old male with new acute kidney injury, question of hydronephrosis. LIVER: Portions of the liver is visualized with coarse increased echogenicity comparable to prior ultrasound.RIGHT KIDNEY: The right kidney measures 12 cm in length. No significant abnormalities are noted.LEFT KIDNEY: The left kidney measures 11.7 cm in length. No significant abnormalities are noted. There is an anechoic cyst redemonstrated in the upper pole measuring 1.7 cm x 1.8 cm x 2.4 cm, relatively stable in size from prior ultrasound.OTHER: The bladder Foley catheter is not well-visualized. Trace amount of free fluid seen in the pelvis.", "output": "1. Negative renal ultrasound. No hydronephrosis is seen.2. Redemonstrated increased echogenicity within the liver compatible with fatty liver/parenchymal dysfunction from prior ultrasound. Only portions of the liver are visualized but no worrisome masses are seen."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male, evaluate for growth of right posterior neck mass for extension into deeper tissues, malignant features as well as tissue composition. Along the right posterior neck in the region of the palpable area is a subcutaneous heterogeneous solid mass measuring 3.9 cm x 1.9 cm.", "output": "Right posterior neck subcutaneous mass corresponding to the palpable area noted by the patient. While this has characteristics compatible with a lipoma, note that the specificity of ultrasound for characterizing subcutaneous masses is relatively poor and correlation with MRI is recommended if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old female patient with thyroid cysts, isthmus nodule. RIGHT LOBE MEASUREMENTS: 5.1 x 1.3 x 1.6 cm, previously 4.2 x 1 x 1.9 cm.LEFT LOBE MEASUREMENTS: 5.1 x 1.2 x 2 cm, previously 4.8 x 1.9 x 1.0 cm.ISTHMUS MEASUREMENTS: 5 mm in thickness.RIGHT LOBE: There are multiple nodules within the right thyroid lobe. The largest is an anechoic lesion measuring approximately 1.0 x 0.6 x 1.3 cm, previously 1.2 x 1.6 x 1.1 cm, and contains an echogenic focus in the wall.LEFT LOBE: There are multiple nodules within the left thyroid lobe. The largest is an anechoic lesion measuring 1.4 x 0.6 by, previously 1.2 x 0.6 x 1.1 cm.ISTHMUS: A mixed echogenicity nodule within the left isthmus measures 1.2 x 0.5 x 0.7 cm, previously 1.0 x 0.4 x 0.8 cm.  PARATHYROID GLANDS: A hypoechoic nodule posterior to the left thyroid lobe measures 1.0 x 0.5 x 0.4 cm, previously 0.7 x 0.5 x 0.5 cm. LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Bilateral thyroid nodules, the majority with an appearance consistent with colloid cysts or colloid nodules without significant interval increase in size.2. Possible parathyroid adenoma posterior to the left thyroid lobe."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old male patient with abdominal pain and acute pancreatitis. LIVER: The liver measures 15.0 cm in length. Hepatic parenchymal echogenicity is slightly increased. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.5 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 pancreas is not well assessed, however, the visualized portions appear hypoechoic. No definite peripancreatic fluid collection is seen.RIGHT KIDNEY: The right kidney measures 11.0 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.6 cm in length. No evidence of hydronephrosis.The spleen measures 8.0 cm in length.", "output": "1. The pancreas is not well assessed on this examination, however, appears hypoechoic suggesting underlying inflammation/pancreatitis.2. Mildly echogenic liver which may be seen with hepatic steatosis/hepatic parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Congestive heart failure ascites LIVER: Mildly heterogeneous liver echotexture without mass. Liver length 18.5 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.5 cm in lengthOTHER: Left kidney 9.8 cm in length. Spleen 7.4 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": "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. Images were double read by Dr. Kulkarni and Dr. Schacht.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid carcinoma status post resection RIGHT LOBE: Status post thyroidectomy. Stable hyperechoic focus within the right thyroid bed measuring 0.4 x 0.5 x 0.9 cm.LEFT LOBE: Status post thyroidectomy without mass. Status post thyroidectomy without mass.ISTHMUS: Status post thyroidectomy without massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable examination without worrisome mass or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Low urine output. RIGHT KIDNEY: 11.0 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 10.3 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: No significant abnormality noted.OTHER: Cirrhotic liver morphology with mild to moderate ascites, partially imaged.", "output": "1. No hydronephrosis. 2. Cirrhosis with ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 58 years old Reason: Evaluate for right thyroid nodule History: Patient with ?hx of Autoimmune thyroid disease vs. Graves RIGHT LOBE MEASUREMENTS: 6.2 x 2.2 x 1.9 cmLEFT LOBE MEASUREMENTS: 4.5 x 1.2 x 1.0 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Predominantly solid right thyroid nodule with cystic components, demonstrating hypervascularity on color Doppler images measuring 3.0 x 2.0 x 2.1 cm.LEFT LOBE: Hypoechoic, primarily solid left mid thyroid nodule with somewhat ill-defined borders, and small cystic component measuring 0.5 x 0.4 x 0.3 cm. No definite microcalcifications. The vascularity on color Doppler images.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Dominant right hypervascular thyroid nodule. Recommend further evaluation with ultrasound-guided biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Male 57 years old; Reason: History of Hep C. R/O Hepatic Lesion. History: History of Hep C. R/O Hepatic Lesion. LIVER: The liver measures 18.2 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 20.0 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.1 mm. No stones are seen. No pericholecystic fluid. Negative sonographic Murphy sign. The common bile duct measures 2.3 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 12.6 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 12.1 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 13.5 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. The liver has coarse increased echogenicity compatible with fatty infiltration/hepatocellular dysfunction. No worrisome masses seen.2. Mild hepatomegaly is present."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female with thyroid cancer status post resection and radioablation. RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomy RIGHT LOBE: Mildly echogenic focus in the right thyroid bed measures 0.6 x 0.4 cm, favor benign.LEFT LOBE: Circumscribed round homogeneously hyperechoic focus in the left thyroid bed measuring 0.5 x 0.4 x 0.8 cm, favor benign.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered cervical lymph nodes with benign morphologic features.OTHER: No significant abnormality noted.", "output": "No evidence of recurrent or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Renal transplant with hyperparathyroidism with elevated parathyroid hormone RIGHT LOBE MEASUREMENTS: 4.2 x 1.8 x 1.5 cmLEFT LOBE MEASUREMENTS: 3.9 x 1.2 x 1.7 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: 0.4 x 0.3 x 0.3 cm hypoechoic focus unchanged from prior study.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: 0.7 x 0.5 x 0.5 cm hypoechoic extrathyroidal focus projecting inferior and posterior to the left thyroid glandLYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Subcentimeter hypoechoic extrathyroidal focus projecting inferior and posterior to the left thyroid gland consistent with suspected parathyroid adenoma. Subcentimeter hypoechoic right thyroid nodule unchanged from prior study. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain and elevated white count LIVER: Mildly coarse echogenic liver parenchyma without mass. Liver length 17.3 cm.GALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic renal parenchyma without worrisome mass, stone, or hydronephrosis. Right renal cyst. Right kidney 13.4 cm in lengthOTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. Left kidney 14.1 cm in length. Spleen 17.1 cm in length. Mild ascites.", "output": "Mildly coarse echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Gallbladder sludge without acute inflammation. Echogenic kidneys consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction. Mild ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female, 57 years old. Worsening renal function. RIGHT KIDNEY: The right kidney measures 11.7 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.0 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The bladder is incompletely distended.", "output": "Increased renal cortical echogenicity compatible with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Female; 47 years old. Reason: HCC screening History: hepatitis B LIVER: The liver measures 15.2 cm in length. The liver surface is smooth, the parenchyma demonstrates a mildly coarsened echotexture. No worrisome hepatic lesion is identified. There is no ascites. The main portal vein is patent with hepatopetal flow and a peak velocity of 0.3 m/sec. BILIARY TRACT: The gallbladder is unremarkable. There is no cholelithiasis or gallbladder wall thickening. The common duct measures 0.3 cm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 9.7 cm in length.KIDNEYS: The right kidney measures 11.1 cm in length. There is mild dilation of the renal collecting system, new from the prior study. The cortex is normal in echogenicity. There is no shadowing renal stone identified. The left kidney measures 10.9 cm in length. There is no hydronephrosis or shadowing renal stone identified. OTHER: The bladder is not distended.", "output": "1.No evidence of cirrhosis or focal hepatic mass.2.Mild dilation of the right renal collecting system is new from the prior study, an underlying obstructing stone is not entirely excluded with this study, correlation with patient history is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for cirrhosis. LIVER: The liver is slightly nodular in contour and coarse in echogenicity suggesting chronic liver disease/cirrhosis. It is normal in size measuring 17.7 cm in craniocaudal dimension. There is a 3.3 x 2.8 x 3.4 cm well-defined heterogeneously hypoechoic lesion with posterior through enhancement, suggesting a cystic component, with mild vascularity. Normal hepatopedal portal venous blood flow at 0.2 cm/s.BILIARY TRACT: No biliary ductal dilatation. Normally distended gallbladder containing several small gallstones. 4 mm nondependent echogenic focus may represent an adherent small stone or polyp. No gallbladder wall thickening.PANCREAS: Limited evaluation of the pancreas.SPLEEN: The spleen measures 10.8 cm in length without a focal lesion.RIGHT KIDNEY: The right kidney measures 12 cm in length without hydronephrosis, shadowing nephrolithiasis or suspicious lesion. There is a 2.4 cm right superior pole simple cyst.OTHER: The left kidney measures 10.3 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion.", "output": "Chronic liver disease with a 3.3 cm mass. Further characterization with a dedicated liver MR or CT is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Patient with AML status post chemo with elevated bilirubin LIVER: Echogenic and coarse liver echotexture again noted without mass. Liver length 18.8 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 14 cm in lengthOTHER: Left kidney 13.4 cm in length. Spleen 14.4 cm in length. No ascites", "output": "Coarse and echogenic liver echotexture again noted consistent with fatty infiltration/parenchymal dysfunction without mass or duct dilatation. Mild hepatomegaly. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Fever and renal transplant patient RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality noted. 12.1 m 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 transplant vascular without inflow or outflow compromise.OTHER: No significant abnormality noted", "output": "Unremarkable right iliac fossa renal transplant without evidence for perinephric collection, abscess, or hydronephrosis. Patent transplant vasculature."}
{"instruction": "Generate impression based on findings.", "input": "Goiter RIGHT LOBE MEASUREMENTS: 5.4 x 2.1 x 2.3 cmLEFT LOBE MEASUREMENTS: 9.2 x 5.2 x 4.4 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Predominately solid right nodule measuring 3.6 x 2.2 x 1.9 cm; favor benign etiology.LEFT LOBE: Left lobe replaced by predominates solid dominant nodule corresponding to the lesion seen on MR measuring approximately 5.2 x 4.4 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 thyroid nodules. Dominant left thyroid nodule corresponds to the lesion seen on the recent MR. This lesion will be biopsied today. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old female with history of thyroid cancer. Evaluate RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: No evidence of recurrent disease.LEFT LOBE: Hyperechoic focus in the left thyroid bed measuring 0.4 x 0.5 x 0.7 cm without internal vascularity. Allowing for differences in technique, in retrospect this was likely present on the previous examination as noted on image time stamped 04/11/2013 2:42:55 PMISTHMUS: No evidence of recurrent disease.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing left neck lymph node measures 1.1 x 0.6 x 0.3 cm.OTHER: No significant abnormality noted.", "output": "Stable hypoechoic focus in the left thyroid bed as above."}
{"instruction": "Generate impression based on findings.", "input": "26 year old female with a history of hypothyroidism. RIGHT LOBE MEASUREMENTS: 4.8 x 1.6 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.2 x 1.5 x 1.3 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: Heterogeneous thyroid parenchyma with hyperechoic fibrous bands compatible with thyroiditis. Coarse shadowing calcification within the superior pole.6 x 5 x 7 mm hyperechoic well defined hypervascular nodule in the inferior pole.LEFT LOBE: Heterogeneous thyroid parenchyma with hyperechoic fibrous bands compatible with thyroiditis. 3-mm hyperechoic well defined nodule in the inferior pole.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal morphology and size cervical lymph nodes.OTHER: No significant abnormality noted.", "output": "1. Heterogeneous thyroid parenchyma compatible with history of thyroiditis.2. Hyperechoic subcentimeter nodules are classically benign in the setting of thyroiditis. "}
{"instruction": "Generate impression based on findings.", "input": "41-year-old male with history of kidney stones, please assess for stones/obstruction. RIGHT KIDNEY: Kidney measures 11.7 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.9 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass. Stable left benign cyst.BLADDER: No significant abnormalities. OTHER: No significant abnormalities noted.", "output": "1.No hydronephrosis. Previously seen nonobstructive renal calculi not well-visualized on this exam."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury. Evaluate for obstruction. RIGHT KIDNEY: Right kidney is normal in size measuring 8.8 cm in length. The renal parenchymal echotexture is mildly increased suggestive of medical renal disease. No hydronephrosis. No nephrolithiasis.LEFT KIDNEY: Left kidney is normal in size measuring 9.1 cm in length. The renal parenchymal echotexture is mildly increased suggestive of medical renal disease. No hydronephrosis. No nephrolithiasis.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Echogenic renal parenchyma compatible with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female with a perinephric hematoma seen on CT results for further evaluation. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: Again seen is a large complex hematoma measuring approximately 12.7 x 8.8 x 24.2 cm. Doppler flow shows active bleeding from upper midportion of kidney.KIDNEY: Normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass.COLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: The urinary bladder is nondistended.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels No significant abnormality notedOTHER: No significant abnormality noted", "output": "1. Large complex perinephric hematoma with active bleeding from renal transplant as described above. "}
{"instruction": "Generate impression based on findings.", "input": "Male 65 years old Reason: assess for liver lesions History: hx of HCV with SVR; cirrhosis per biopsy LIVER: Coarse and mildly nodular appearance of the liver consistent with history of cirrhosis. Liver measures 18.4 cm. Nonspecific hypoechoic area adjacent to the gallbladder may represent a focus of fat sparing. No focal hepatic mass. Main portal vein is patent with normal directional flow and a peak velocity of 17.2 cm/s.BILIARY TRACT: Gallbladder is normal in appearance. No gallstones. No intra or extrahepatic biliary ductal dilatation. The common bile duct measures 3 mm.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 10.0 cm.KIDNEYS: Right kidney measures 11.6 cm in length. Normal cortical medullary differentiation. No hydronephrosis or shadowing calculi. In the upper pole there is a cystic lesion with a thin septation and no internal vascularity, similar to the prior exam measuring 0.8 x 1.0 x 1.1 cm. Another cyst with a thin septation in the mid pole measures 2.0 x 1.6 x 1.6 cm.Left kidney measures 10.8 cm in length. Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Left upper pole cyst which may have a septation, however is difficult to characterize measures 1.0 x 0.8 x 1.1 cm, appearing similar to the prior exam. Another anechoic cyst in the midpole of the left kidney measures 1.4 x 0.7 x 0.9 cm.OTHER: No significant abnormalities noted.", "output": "1.Coarsened and mildly nodular appearance of the liver consistent with history of cirrhosis. No focal hepatic mass.2.Multiple probable renal cysts bilaterally, which do not appear significantly changed."}
{"instruction": "Generate impression based on findings.", "input": "Hydronephrosis status post stents, removed in October. RIGHT KIDNEY: 12.2 cm in length. Mildly increased renal parenchymal echogenicity. No suspicious lesions are evident. Mild hydronephrosis is new compared to prior.LEFT KIDNEY: 12.5 cm in length. Mildly increased renal parenchymal echogenicity. No suspicious lesions are evident. Moderate hydronephrosis is unchanged compared to prior.BLADDER: Collapsed.OTHER: No significant abnormality noted. No perinephric fluid collections identified.", "output": "Bilateral hydronephrosis, new on the right and unchanged on the left."}
{"instruction": "Generate impression based on findings.", "input": "21-year-old female with history of thyroid cysts, enlarged thyroid on exam RIGHT LOBE MEASUREMENTS: 4.4-cm x 2.0 x 1.1 cmLEFT LOBE MEASUREMENTS: 5.1 cm x 1.6 cm x 0.6 cmISTHMUS MEASUREMENTS: 3 mm in thicknessRIGHT LOBE: Hypoechoic nodule in the upper pole measures 3 mm x 2 mm x 2 mm containing echogenic foci likely inspissated colloid.LEFT LOBE: Hypoechoic cystic appearing nodule at the inferior pole measures 3 mm x 3 mm x 4 mm containing internal echogenic foci likely inspissated colloid.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right neck level 3 benign-appearing lymph node measures 6 mm x 2 mm x 9 mm.OTHER: No significant abnormality noted.", "output": "Findings suggestive of bilateral colloid nodules. "}
{"instruction": "Generate impression based on findings.", "input": "Cardiac arrest. Hemodynamic instability. Concern for Graves' disease. RIGHT LOBE MEASUREMENTS: 8.6 x 5.3 x 5.6 cm. LEFT LOBE MEASUREMENTS: 7.0 x 2.8 x 3.7 cm. ISTHMUS MEASUREMENTS: 10 mm in AP dimension.RIGHT LOBE: The right lobe is markedly enlarged, nearly completely comprised of heterogeneous nodules. While some of these nodules appear to be spongiform colloid nodules, others are indeterminate. There is normal to slightly decreased background vascularity.LEFT LOBE: The left lobe is markedly enlarged, nearly completely comprised of heterogeneous nodules. While some of these nodules appear to be spongiform colloid nodules, others are indeterminate. There is normal to slightly decreased background vascularity.ISTHMUS: Enlarged.PARATHYROID GLANDS: Not identified.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multinodular goiter. If there is concern for toxic multinodular goiter, nuclear scintigraphy may be helpful if clinically feasible. These findings would be atypical for Graves' disease, per clinical query.Findings discussed with the covering endocrinology fellow at 3:30 PM on 4/21/2015."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: No significant abnormalities noted. 13.6 cm in length BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 11.9 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 9.1 cm in lengthOTHER: Left kidney 9.7 cm in length. No ascites. Trace left pleural effusion", "output": "Gallbladder sludge without acute inflammation or ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Renal insufficiency RIGHT KIDNEY: Atrophic echogenic parenchyma without mass, stone, or hydronephrosis. 9 cm in lengthLEFT KIDNEY: Atrophic echogenic parenchyma without mass, stone, or hydronephrosis. 10.9 cm in length. OTHER: Bladder nondistended", "output": "Atrophic echogenic parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for nephrolithiasis RIGHT KIDNEY: Unremarkable echogenicity without mass, stone, or hydronephrosis. Right kidney 11.4 cm in lengthLEFT KIDNEY: Unremarkable echogenicity without mass, stone, or hydronephrosis. The left kidney 11 cm in lengthOTHER: Bladder nondistended", "output": "Negative renal ultrasound. No evidence for mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Reason: check liver size, rule out cirrhosis History: portal hypertension, gastropathy and anemia, elevated AST LIVER: The liver measures 11.4 cm in length. Limited evaluation due to poor windows, however hepatic parenchyma appears coarse and echogenic with a peripheral nodular contour. The portal vein is patent with normal directional hepatopedal portal venous blood flow, peak velocity 19.7 cm/s. No focal masses.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. The common bile duct measures 0.7 cm, within normal limits for age. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 10.6 cm in length. No hydronephrosis or shadowing stones.LEFT KIDNEY: The left kidney measures 10.6 cm in length. No hydronephrosis or shadowing stones.OTHER: Moderate volume ascites. The spleen measures 13.2 cm in length. The bladder is poorly distended, limiting evaluation.", "output": "1. Findings consistent with hepatic steatosis and suspicious for cirrhosis. No biliary ductal dilatation.2. Moderate volume ascites."}
{"instruction": "Generate impression based on findings.", "input": "Painless jaundice LIVER: Coarse echogenic liver echotexture without mass. 20.8 cm in lengthGALLBLADDER, BILIARY TRACT: Sludge and stones within the gallbladder without acute inflammation. Moderately severe bilobar intrahepatic ductal dilatation associated with abnormal extrahepatic ductal dilatation. Maximal diameter of common bile duct 1.6 cm. The distal aspect of the common bile duct is obscured by overlying gasPANCREAS: Obscured by overlying gasRIGHT KIDNEY: No significant abnormalities noted. 11 cm in lengthOTHER: Left kidney 12.8 cm in length. Spleen 11.8 cm in length. No ascites.", "output": "Moderately severe bilobar intrahepatic ductal dilatation associated with abnormal extra hepatic duct dilatation. The distal aspect of the common bile duct is obscured by overlying gas as is the pancreas; a distal obstructing lesion must be excluded. Would recommend correlation with CT or MR.Hepatomegaly with coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without discrete mass. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Hyperthyroidism RIGHT LOBE MEASUREMENTS: 6.4 x 2.5 x 1.9 cmLEFT LOBE MEASUREMENTS: 5.9 x 1.9 x 1.2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: 4 x 1.8 x 2.4 cm predominant solid nodule within the right thyroid gland. Background thyroid parenchyma appears unremarkable.LEFT LOBE: 2.3 x 0.9 x 1.6 cm predominant solid left thyroid nodule. Subcentimeter solid upper pole nodule with renal calcification measuring 0.6 x 0.5 x 0.4 cm. Background thyroid parenchyma appears unremarkable.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 predominantly solid thyroid nodules. These are amenable to ultrasound-guided percutaneous biopsy as clinically warranted. Background thyroid parenchyma appears unremarkable. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: hydronephrosis. History: UTI, CKD, incontinence, urgency. RIGHT KIDNEY: The right kidney measures 12.1 cm in length. No hydronephrosis or shadowing stones. Multiple simple and minimally complex cysts are noted in the right kidney, some with internal debris.Upper pole cyst measures 5.1 x 4.2 cmLower pole cyst measures 3.9 x 3.2 x 3.5 cmLEFT KIDNEY: The left kidney measures 13.8 cm. No hydronephrosis or shadowing stones. Multiple cysts with septations are noted in the left kidney, some of which may be confluent.Cyst in the upper pole with thin septation measures 4.0 x 4.0 x 5.0 cm.Lower pole cyst with thin septation measures 4.4 x 2.9 x 4.2 cm.Additional simple lower pole cyst measures 4.1 x 2.6 cm.OTHER: The urinary bladder is decompressed, limiting evaluation. The renal ducts are visualized.", "output": "1. Bilateral simple to minimally complex renal cysts, stable in appearance.2. No evidence of hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old female with history of partial thyroidectomy for thyroid cancer, now with prior slight increase in right complex thyroid nodule previously biopsied as colloid nodule. Assess stability. RIGHT LOBE MEASUREMENTS: 5.2 x 2.1 x 2.3 cmLEFT LOBE MEASUREMENTS: 1.1 x 1.5 x 3.2 cmISTHMUS MEASUREMENTS: 0.2 cm RIGHT LOBE: Solid and almost isoechoic superior pole nodule measuring 1 x 0.9 x 1.2 cm, slightly smaller than prior exam .Second solid and heterogeneously hyperechoic nodule in the midportion of the right lobe measures approximately 1.3 x 1.5 x 1.3 cm without change. Third complex cystic nodule with a spongiform appearance measures 1.8 x 1.9 x 2 cm without interval 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 nodules right lobe thyroid."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with hydronephrosis. RIGHT KIDNEY: Measures 8.8 cm in length. Increased echogenicity and mild hydronephrosis, improved compared with the prior study.LEFT KIDNEY: Measures 9.3 cm in length. Increased echogenicity and mild hydronephrosis, improved compared with the prior study.URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.", "output": "Mild hydronephrosis is improved since the prior study. Persistent increased renal echogenicity consistent with medical renal disease. "}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with gram-negative bacteremia, evaluate for possible infectious source. LIVER: Measures 15.7 cm in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Cholelithiasis without acute inflammation. Mild bilobar intrahepatic as well as extra hepatic ductal dilatation again noted.PANCREAS: The pancreas is incompletely imaged due to bowel gas. Dilated main pancreatic duct measures 0.9 cm.SPLEEN: Unremarkable in size and echogenicity. KIDNEY: 2.1 cm simple right renal cyst and 5.9 x 5.5 x 4.7 cm left renal cyst with thin internal peripheral septations. Increased renal echogenicity without hydronephrosis, nephrolithiasis, or solid mass. OTHER: 2.6 x 2.3 cm lesion adjacent to the pancreatic head correlates with tumor seen on recent CT.", "output": "1.Cholelithiasis but no evidence of acute cholecystitis. No specific findings to account for the patient's bacteremia. No change in mild intrahepatic and intrahepatic ductal dilatation.2.Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease.3.Increased renal echogenicity consistent with medical renal disease without hydronephrosis. Renal cysts as described above.4.Peripancreatic tumor and pancreatic ductal dilation correlate with findings from recent CT examination."}
{"instruction": "Generate impression based on findings.", "input": "47 years old, Female, Reason: r/o growth of nodules, adenopathy. compare to US 1 year ago History: multinodular goiter. Some subjective increase in size of thyroid RIGHT LOBE MEASUREMENTS: 2.2 x 1.9 x 6.1 cmLEFT LOBE MEASUREMENTS: 3.0 x 3.0 x 7.7 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Right mid nodule measures 1.3 x 1.0 x 1.5 cm, previously measuring 1.0 x 0.8 x 1.2 cm. Another spongiform nodule adjacent to the isthmus measures 1.2 x 0.5 x 1.0 cm, previously measuring 0.8 x 0.6 1.0 cm.LEFT LOBE: Dominant partially cystic lower pole nodule measures 2.8 x 2.4 x 3.6 cm, previously measuring 2.3 x 2.1 x 2.9 cm. Posterior mid left thyroid nodule measures 0.8 x 0.5 x 1 .1 cm, previously measuring 0.8 x 0.8 x 0.5 cm.ISTHMUS: Isthmus nodule which appears partially cystic measures 1.2 x 1.0 x 1 .3 cm, previously measuring 1.2 x 0.8 x 1.2 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Slight interval increase in size of multiple bilateral thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "Hematuria and pyuria with increasing creatinine RIGHT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 12.9 cm in lengthLEFT KIDNEY: Normal echogenicity without stone or hydronephrosis. 13.7 cm in length. Increased prominence of parenchyma mid poleOTHER: Bladder nondistended", "output": "Increased prominence of mid pole left renal parenchyma. A subtle mass lesion cannot be excluded. Would pay special attention to this region on future scans; alternatively, correlation with dedicated cross sectional renal study would be helpful."}
{"instruction": "Generate impression based on findings.", "input": "Dysuria and right flank pain RIGHT KIDNEY: No significant abnormalities noted. Specifically, no mass, stone, or hydronephrosis. No perinephric collection. 9.4 cm in lengthLEFT KIDNEY: No significant abnormalities noted. Specifically, no mass, stone, or hydronephrosis. No perinephric collection. 10.6 cm in length.OTHER: Bladder collapsed", "output": "Negative renal ultrasound without evidence for mass, stone, hydronephrosis, or perinephric collection."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female with history of right sided neck mass/cyst. RIGHT LOBE MEASUREMENTS: 5.9 x 2.7 x 3.3 cm.LEFT LOBE MEASUREMENTS: 6.1 x 3.9 x 4.0 cm.ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: Dominant nodule in the right upper pole measures 3.8 x 2.5 x 1.8 cm and is primarily solid with both hyperechoic and hypoechoic solid components as well as large cystic components centrally. A 5 mm right lower pole hypoechoic nodule is also present.LEFT LOBE: Dominant left thyroid nodule measures 2.6 x 3.0 x 2.5 cm and is primarily solid with both hyperechoic and hypoechoic solid components and macrocalcifications peripherally, as well as small cystic components centrally.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral predominantly solid thyroid nodules as described above are amenable to biopsy. "}
{"instruction": "Generate impression based on findings.", "input": "39-year-old female with known papillary thyroid cancer. RIGHT LOBE MEASUREMENTS: 4.2 x 1.1 x 1.7 cmLEFT LOBE MEASUREMENTS: 5.6 x 1.1 x 1.9 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: In the midportion of the right lobe there are likely due to: ST nodules which are hypoechoic, heterogeneous, relatively well-demarcated with internal calcification. Measurement is 1.0 x 1.7 x 0.8 cm. Echotexture otherwise appears normal, and no other masses are seen.LEFT LOBE: Normal in echotexture without evidence for mass.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal-appearing right cervical lymph nodes. On the left at level II, there is a somewhat rounded 0.7 x 0.9 x 0.7 cm lymph node, but this has very normal morphology with normal hilum.OTHER: No significant abnormality noted.", "output": "Right thyroid mass corresponding to the patient's known papillary carcinoma.Single left level 2 node which is a somewhat rounded appearance but morphologically is otherwise normal."}
{"instruction": "Generate impression based on findings.", "input": "History diabetes with cellulitis Examination of the right axillary subcutaneous tissues demonstrate diffuse edema. There is a 1 x 0.5 x 1.2 complex loculated fluid collection within the subcutaneous tissues.Examination of the subcutaneous tissues of the right buttocks demonstrates the presence of a 2 x 1.2 x 1.4 cm complex loculated fluid collection. Surrounding edema is also noted.", "output": "Complex loculated fluid collections within the subcutaneous tissues of the right axillary and right buttocks regions; residual abscesses are suspected. Associated with surrounding edema/cellulitis."}
{"instruction": "Generate impression based on findings.", "input": "female presents with swelling around the right areolar area. Evaluate for abscess. An approximately 3.8 x 2.4 cm well-defined hypoechoic lesion with internal echoes and posterior acoustic enhancement is present in the subareolar area. No internal septations. There is internal complexity.", "output": "Findings consistent with breast abscess."}
{"instruction": "Generate impression based on findings.", "input": "Transaminitis LIVER: Normal parenchymal echogenicity and morphology without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 16.7 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 7.9 cm in lengthRIGHT KIDNEY: Mildly echogenic renal parenchyma without mass, stone, or hydronephrosis. 10.2 cm in lengthOTHER: Mildly echogenic left renal parenchyma without mass, stone, or hydronephrosis. Left kidney 11.6 cm in length. Moderate ascites again noted.", "output": "Unremarkable liver morphology without mass or ductal dilatation. Moderate ascites again noted. 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": "70-year-old male patient with recent testicular pain. Evaluate hydrocele. RIGHT TESTIS: The right testicle measures 3.3 x 1.4 x 3.6 cm. A subcentimeter simple right testicular cyst is unchanged.LEFT TESTIS: The left testicle measures 4.1 x 1.7 x 3.7 cm and is homogeneous in echogenicity.RIGHT EPIDIDYMIS: The right epididymis measures 0.8 x 0.3 x 0.9 cm.LEFT EPIDIDYMIS: The left epididymis is poorly visualized.OTHER: Again seen is a large multiseptated left-sided hydrocele measuring approximately 13.1 x 10.5 x 8 cm, previously 12.2 x 8.7 x 6.7 cm.", "output": "Large septated left-sided hydrocele without significant interval change."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old female patient with history of medullary thyroid cancer, MEN2a RIGHT LOBE: Status post thyroidectomy with a 0.6 x 0.5 x 0.4 cm hypoechoic focus in the right thyroid which is not significantly changed from prior studies.LEFT LOBE: Status post thyroidectomy without residual or recurrent tissue identified. ISTHMUS: Status post thyroidectomy without residual or recurrent tissue identified. PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A benign morphology lymph node is noted in the right neck.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy without specific evidence of recurrence or lymphadenopathy. Stable hypoechoic focus in the right thyroidectomy bed."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male patient with history of hepatitis C, prekidney transplant evaluation. LIVER: The liver measures 17.0 cm in length and is mildly nodular in contour. 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 gallbladder wall thickening or pericholecystic fluid is identified. 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. A peripancreatic lymph node measures 1.4 x 1.2 x 1.2 cm.RIGHT KIDNEY: The right kidney measures 7.9 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. There is a 1.6 x 1.2 x 1.4 cm mid to lower pole exophytic renal cyst.OTHER: The left kidney measures 9.0 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. There is a 2.3 x 2.2 x 2.5 cm cystic lesion within the mid left kidney with a few internal echogenic foci but no significant internal vascularity. An additional 1.1 x 1.3 x 1.3 cm lower pole renal cyst is noted.", "output": "1. Mildly nodular liver contour consistent with cirrhosis. 2. Cholelithiasis without sonographic evidence of acute cholecystitis.3. Bilateral simple renal cysts and minimally complex left midpole renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female with history of stem cell transplant for evaluation. LIVER: There are a number of highly echogenic foci within the liver with comet tail artifact consistent with embolization clips. No other focal hepatic abnormality. Echotexture is normal. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Biliary tract is normal in caliber. Patient has had a cholecystectomy.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "] Embolization clips identified causing artifact within the liver. Otherwise, normal exam."}
{"instruction": "Generate impression based on findings.", "input": "Small papillary thyroid carcinoma within the left isthmus; surveillance scan RIGHT LOBE MEASUREMENTS: 1.6 x 1 x 4.8 cm LEFT LOBE MEASUREMENTS: 1.4 x 1 x 4.5 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: Slight interval increase in size of nodular component of mixed cystic and solid left isthmic lesion. This nodular component now measures 0.4 x 0.4 x 0.4 cm; this is comparison to 0.2 by by 0.3 x 0.4 cm on 9/9/2015. The entire mixed cystic and solid lesion has not significant changed in size measuring 0.7 x 0.5 x 0.7 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Slight interval increase in size of nodular component of mixed cystic and solid left isthmic nodule. Given that this lesion has been biopsied and represents a papillary thyroid carcinoma, this admittedly slight interval increase in size of the nodular component of the lesion is nevertheless worrisome. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "69 year-old female with abdominal discomfort with known left lower quadrant inguinal hernia. Assess size. In the left lower quadrant there is redemonstration of an inguinal hernia which is accentuated with Valsalva maneuver. No internal peristalsis is noted within the hernia suggestive of fat or collapsed bowel.", "output": "Left inguinal hernia containing fat or collapsed bowel."}
{"instruction": "Generate impression based on findings.", "input": "Male 36 years old Reason: assess for gallstones History: pancreatitis LIVER: Mildly increased echogenicity of the liver can be seen in diffuse parenchymal disease or fatty infiltration. No focal hepatic mass is identified. Portal vein is patent with normal directional flow.BILIARY TRACT: No evidence of gallbladder wall thickening or pericholecystic fluid. No gallstones are identified. No intra or extrahepatic biliary ductal dilatation. Common bile duct measures 2 mm.PANCREAS: Head and body of the pancreas are visualized and normal in appearance. Tail of the pancreas is obscured by overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 11.9 cmKIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 12.9 cm. Left kidney measures 16.1 cm. OTHER: No significant abnormalities noted.", "output": "1.No evidence of cholelithiasis.2.Mildly increased echogenicity of the liver which can be seen in diffuse parenchymal disease or fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "Recurrent UTIs RIGHT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 9.5 cm in lengthLEFT KIDNEY: Mildly echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Left renal cyst. Left kidney 10.8 cm in length.OTHER: Bladder nondistended.", "output": "Mildly echogenic renal parenchyma bilaterally raises the possibility of medical renal disease/parenchymal dysfunction without worrisome mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "29 years old, Female, Reason: kidney injury, assess for hydronephrosis History: cr 3.3 RIGHT KIDNEY: Kidney measures 16.6 cm in length. Increased echogenicity of the right kidney is consistent with medical renal disease. There is moderate right hydronephrosis. Multiple right nonobstructing renal calculi the largest of which measuring up to 1.9 cm. A proximal dilated ureter is noted, however the distal ureter is not well visualized because of overlying bowel gas.LEFT KIDNEY: Kidney measures 13.6 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. Mildly complex cyst measuring up to 1.7 cm noted in the left renal parenchyma. No evidence of hydronephrosis on the left.BLADDER: Incompletely distended. OTHER: No significant abnormalities noted.", "output": "1.Moderate right hydronephrosis with a dilated proximal ureter. Please note that the distal ureter is not visualized due to overlying bowel gas.2.Increased echogenicity of the kidneys bilaterally is consistent with medical renal disease.3. Nonobstructing right nephrolithiasis "}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for evidence of ascites. 78-year-old female with history of metastases breast cancer with liver lesion and recently diagnosed malignant pleural effusion with increased abdominal bloating No definite pocket of free fluid noted. Mild right pleural effusion noted.", "output": "No pocket of ascites."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Mildly coarse echogenic echotexture without worrisome mass. Liver length 18.5 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.5 cm in length OTHER: Left kidney 12.5 cm in length. Spleen 10 cm in length. No ascites", "output": "Mildly coarse echogenic liver echotexture consistent with chronic liver disease without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Reason: HCV, evaluate for HCC. LIVER: The liver measures 13.9 cm in length and demonstrates a nodular contour. The liver parenchymal echotexture is coarse. 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. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3.2 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 10.4 cm in length. RIGHT KIDNEY: Kidney measures 10.1 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or massLEFT KIDNEY: Kidney measures 11.6 cm in length. Normal echotexture. There is a questionable solid mass in the mid to lower pole of the left kidney.OTHER: No significant abnormalities noted.", "output": "1.Cirrhotic liver morphology without focal lesions identified.2.Questionable mass in the left kidney; dedicated contrast-enhanced cross-sectional imaging is recommended for further evaluation. Recommendation entered into the Follow-Up Tool. "}
{"instruction": "Generate impression based on findings.", "input": "22-year-old female with proteinuria RIGHT KIDNEY: 12.2 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis. Trace nonspecific perinephric fluid identified.LEFT KIDNEY: 11.8 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: Collapsed. Foley catheter identified.OTHER: Bilateral pleural effusions, partially imaged.", "output": "1. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease.2. Bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female with palpable mass right breast underwent ultrasound-guided core biopsy with benign results. Patient presents for a right breast repeat ultrasound A targeted right ultrasound was performed for the palpable area of concern. Redemonstrated is a hypoechoic area with a biopsy clip noted centrally in the right breast on 9 o'clock position 2 cm from nipple corresponding to palpable abnormality. This area measures approximately 10 x 8 x 18 mm (CC by AP by TV), previously measured 10 x 7 x 14 mm (CC by AP by TV) on ultrasound 5/4/2015. No peripheral or internal vascularity.", "output": "Mild interval increase in size of area of concern in the right breast 9:00 position, previously biopsied with pathology showing benign results.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (6 Months)."}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine Right iliac fossa renal transplant demonstrates echogenic renal parenchyma without mass, stone, or hydronephrosis. 12 cm in length.OTHER: Bladder nondistended", "output": "Right iliac fossa renal transplant demonstrates echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old male with elevated liver function tests, right upper quadrant pain, pancreatitis. LIVER: The liver is enlarged measuring 20.4 cm in length. There is mildly increased hepatic echogenicity without discrete focal lesion.GALLBLADDER, BILIARY TRACT: No cholelithiasis, gallbladder wall thickening, sonographic Murphy's sign, or pericholecystic fluid. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: 2.2 x 1.6 x 1.2 cm left renal cyst without septation or suspicious nodular component. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Enlarged liver with increased echogenicity suggestive of hepatic steatosis or diffuse parenchymal disease.2.No evidence of cholelithiasis or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old male with mass over the right hip. Evaluate for abnormalities. Grayscale and color ultrasound performed in the area of the patient's palpable complaint demonstrates a 5.7 x 3.4 x 0.8 cm encapsulated structure which matches the echotexture of the adjacent subcutaneous fat, consistent with a lipoma.", "output": "Right thigh lipoma. "}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with newly diagnosed right breast cancer underwent a staging MRI on 6/23/2015 that showed homogeneously enhancing mass in left breast 3:00 position for which MR directed ultrasound is recommended. A targeted left ultrasound was performed. A lobulated hypoechoic mass is identified in the left breast 3:00 position that measures 10 x 6 x 11 mm with peripheral blood flow. Ultrasound-guided core biopsy is recommended.", "output": "11 mm lobulated mass left breast 3:00 position corresponding to the MRI enhancing mass needs further evaluation with ultrasound-guided core biopsy.BIRADS: 6 - Known cancer.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "54 years old, Male, Reason: neck mass, L History: L neck mass tender to palpation Complex lesion of mixed cystic and solid nature in the left mid level 5 region is identified with mildly increased vascularity. This lesion is indeterminate on this examination. Inflammatory/infectious etiology is favored however a neoplastic etiology should also be considered.", "output": "Complex lesion of mixed cystic and solid nature in the left mid level 5 region with mildly increased vascularity is favored to be of inflammatory/infectious etiology, however a neoplastic etiology cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": "Nonspecific elevation of transaminases and LDH, rule out liver structural abnormalities LIVER: Liver measures 16.4 cm with normal echotexture. No focal lesions noted. Portal vein demonstrates normal flow directionality and patency.BILIARY TRACT: Gallbladder is well-distended without any focal lesions. Gallbladder wall thickness measures up to 3 mm. No evidence of gallstones.PANCREAS: Head and body of pancreas is visualized and appears unremarkable. Tail of pancreas is not visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 9 cmRIGHT KIDNEY: No significant abnormalities noted. Right kidney measures 10 cm and left kidney measures 9.7 cm. No hydronephrosis. Normal echotexture.OTHER: No ascites", "output": "Normal echotexture of the liver and kidneys. Portal vein is patent."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: Mildly coarse liver echotexture without mass. Liver length 18.2 cm.GALLBLADDER, BILIARY TRACT: Gallbladder not visualized. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 12.7 cm in length.OTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. Left kidney 12.9 cm in length. Spleen 14.2 cm in length. No ascites.", "output": "Mildly coarse liver echotexture raises the possibility of fatty infiltration/parenchymal dysfunction associated with mild hepatomegaly. No mass or ductal dilatation. No ascites. Gallbladder not visualized.Echogenic renal parenchyma suggestive of medical renal disease/parenchymal dysfunction without mass or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Bilateral soft breast masses. Known fibroadenolipoma in both breasts. Patient felt a mass in the right breast at upper outer quadrant, and two masses in the left breast; at 12:00 and 2:00 position.Targeted bilateral breast ultrasound examinations were performed for the palpable areas of concern. In the right breast at the 10:00 position 6 cm from the nipple, there is a large encapsulated heterogeneous fat-containing mass over 4 cm in size and compatible with a fibroadenolipoma and seen on the prior mammogram. This large mass is difficult to fully measure by ultrasound.In the left breast at the 2:00 position 5 cm from the nipple, there is a large encapsulated heterogeneous fat-containing mass over 3 cm in size and compatible with a fibroadenolipoma and seen on the prior mammogram. This large mass is difficult to fully measure by ultrasound. At 12:00 position, there are no abnormal sonographic findings.No suspicious masses are identified in either breast.", "output": "Bilateral breast masses compatible with fibroadenolipomas. No sonographic evidence for malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Elevated liver enzymes. LIVER: Non-cirrhotic liver morphology. 20 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. Mildly distended gallbladder, without wall thickening, pericholecystic fluid, or gallstones. No sonographic Murphy 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 11.1 cm in length. The left kidney is 12.0 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 12.5 cm in length, without focal lesions evident.OTHER: Small right pleural effusion, partially imaged. No ascites identified.", "output": "1. Mildly hepatic echogenicity compatible with parenchymal dysfunction and/or steatosis, without biliary ductal dilation.2. Mildly distended gallbladder without evidence of cholecystitis, per clinical query."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old female presents to evaluate referring nurse palpated mass in the left breast 12:00 position. Donna Christian on physical examination has marked with a black marker the palpable area of concern. A targeted left ultrasound was performed for the palpable area of concern. Small 4 x 5 mm complex cyst is identified at 12:00 position corresponding to the palpable abnormality. No suspicious mass noted.", "output": "Complex cyst measuring 5 mm in the left breast 12:00 position corresponding to the palpable abnormality.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Male, 57 years old. OSH RUS note Left kidney with 1cm upper pole lesion RIGHT KIDNEY: The right kidney measures 12.3 cm in length, with normal cortical echotexture. A 1 cm echogenic focus in the midpole has the same echotexture as renal sinus fat. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 13.1 cm in length, with normal cortical echotexture. And upper pole cystic lesion measures 1.4 x 1.4 x 1.5 cm, correlating with a hyperdense cyst seen on prior CT imaging. No shadowing stones or hydronephrosis.OTHER: The urinary bladder is distended, without significant wall thickening.", "output": "1.A 1 cm left upper pole complex renal cyst is noted. Given the hyperdense appearance on CT imaging, this may represent a proteinaceous cyst.2.An echogenic focus in the right midpole likely represents a portion of renal sinus fat."}
{"instruction": "Generate impression based on findings.", "input": "Epigastric pain LIVER: Normal echogenicity. 1 x 0.9 x 1.1 cm echogenic focus within the right lobe of the liver. Liver 13.5 cm in length.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.5 cm in length.OTHER: Left kidney 11.1 cm in length. Spleen 8.7 cm in length. No ascites.", "output": "Echogenic focus within the right lobe of the liver. While this may represent a hemangioma, correlation with dedicated CT would be helpful for further characterization. Otherwise negative right upper quadrant ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old woman BRCA1 mutation carrier with history of bilateral mastectomy presents for further evaluation of a palpable abnormality left reconstructed breast. On physical exam, there is a solid palpable mobile mass in the left breast 1:00 position approximately 5 cm from nipple, at the site of clinical concern.A targeted left grayscale and color Doppler ultrasound was performed for the palpable area of concern. In the left breast 1:00 position 5 cm from the nipple, there is an oval mixed echogenicity mass measuring 1.7 x 1.3 x 1.3 cm with posterior acoustic shadowing, indeterminate. No internal vascularity. Histological sampling is recommended for further evaluation.", "output": "Corresponding to the palpable abnormality in the left reconstructed breast is an indeterminate mass measuring up to 1.7 cm. Percutaneous tissue sampling is recommended. Differential considerations include fat necrosis and malignancy. The findings and recommendation were discussed with the patient at the time of the exam. If clinically needed, the mass would be amenable to ultrasound guided biopsy. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old female with a palpable lump in her right breast 7:00 position for which targeted ultrasound is recommended. Family history of ovarian cancer in paternal grandmother. A targeted right ultrasound was performed for the patient\u2019s area of concern. On physical examination, no discrete palpable mass identified at 7:00 position 2 cm from the nipple. Ultrasound demonstrates normal dense glandular tissue. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy corresponding to physician's palpable area of concern in the right breast 7:00 position. Surgical consultation is recommended.BIRADS: 1 - Negative.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "82-year-old male with acute rise in lactate. Evaluate portal venous system LIVER: Coarse liver echotexture with the liver measuring 19 cm in length. Main portal vein is patent with peak systolic velocity of 0.2 m/s.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.KIDNEY: Mildly echogenic kidneys with a hypoechoic left lower pole lesion measuring 1.9 x 1.8 x 2.0 cm, likely a benign cyst. Left kidney measures 11.8 cm in length and the right kidney measures 11.5 cm in length.OTHER: Moderate volume ascites and bilateral pleural effusions", "output": "1.Patent main portal vein.2.Moderate volume ascites and bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "36 year old female with weight gain, possible right thyroid enlargement. RIGHT LOBE MEASUREMENTS: 2.1 cm x 1.6 cm x 5.1 cmLEFT LOBE MEASUREMENTS: 1.8 cm x 1.3 cm x 4.8 cmISTHMUS MEASUREMENTS: 3 mm in thicknessRIGHT LOBE: Normal echotexture with no discrete nodules or masses identified.LEFT LOBE: Normal echotexture with no discrete nodules or masses identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Unremarkable examination. "}
{"instruction": "Generate impression based on findings.", "input": "28-year-old female presents with right upper quadrant pain. LIVER:Measures 14.5 cm. Normal echogenicity. No intrahepatic biliary dilation, focal mass, or ascites. Portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: Gallbladder is nondistended with an anechoic lumen. Wall measures 0.1 cm. No pericholecystic fluid, stones, or sludge. Negative sonographic Murphy's sign. Common hepatic duct measures 0.2 cm. Common bile duct measures 0.3 cm.PANCREAS: Evaluation the pancreas limited due to overlying bowel gas.SPLEEN: The spleen measures 9.8 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 10.6 cm. Left kidney measures 9.2 cm. Normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "1. Normal ultrasound of the abdomen. No sonographic evidence of cholelithiasis or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status Findings are limited by poor acoustic penetrance and inability to reposition the patient.LIVER: Cirrhotic liver morphology. No focal hepatic lesions. Normal portal venous blood flow direction with pulsatile flow compatible with heart failure.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Status post cholecystectomy.PANCREAS: Obscured by bowel gas.KIDNEYS: The kidneys are not well visualized due to poor acoustic penetration.SPLEEN: Not well visualized due to overlying bandages and left ventricular assist device.OTHER: Large amount of ascites.", "output": "Limited examination. Cirrhosis with large volume ascites."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Mildly coarse liver echotexture without worrisome mass. Hepatic cyst. Liver length 13.9 cm in lengthBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 7.8 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 8.8 cm in lengthOTHER: Left kidney 9.3 cm in length. No ascites.", "output": "Mildly coarse liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without worrisome mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old female patient with four days of nausea/vomiting, complicating pregnancy at 30 weeks. Evaluate for gallstones. LIVER: The liver measures 16.5 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There are small layering gallstones near the gallbladder neck though no gallbladder wall thickening or pericholecystic fluid. Sonographic Murphy's sign is negative. 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 11.7 cm in length. No evidence of hydronephrosis.The spleen measures 12.8 cm in length.", "output": "Cholelithiasis without sonographic evidence of acute cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine RIGHT KIDNEY: Mildly echogenic renal parenchyma without worrisome mass or stone. Minimal hydronephrosis. Right kidney 12.4 cm in lengthLEFT KIDNEY: Mildly echogenic renal parenchyma without worrisome mass or stone. Benign-appearing renal cyst. Minimal hydronephrosis. Left kidney 11.8 cm in length.OTHER: Mildly distended bladder with significant postvoid residual. Minimal hydronephrosis does not resolve post void.", "output": "Mildly echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass or stone. Minimal bilateral hydronephrosis which does not resolve postvoid. Significant postvoid bladder residual."}
{"instruction": "Generate impression based on findings.", "input": "63 years old, Female, Reason: hx anaplastic thyroid cancer, eval for recurrence in surgical bed History: dysphagia Patient is status post thyroidectomy.RIGHT LOBE Area: No definite suspicious mass lesions within the surgical bed.LEFT LOBE Area: No definite suspicious mass lesions within the surgical bed.ISTHMUS Area: No significant abnormality noted.LYMPH NODES: No significantly enlarged lymph nodes.OTHER: No significant abnormality noted.", "output": "No definite suspicious mass lesions within the thyroidectomy bed. Continued follow-up is advised if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male with right upper quadrant pain. Evaluate for cholecystitis. LIVER: Liver is normal in size and echotexture. No focal hepatic abnormality is identified.GALLBLADDER, BILIARY TRACT: The biliary tract is normal in caliber. The gallbladder is not visualized and the patient states has had prior gallstone surgery. Please correlate with surgical history. No fluid collections are seen.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Right kidney measures 11.1 cm in length. Large shadowing calculus or calculi are seen in the midportion of the kidney without hydronephrosis.OTHER: Left kidney measures 11 cm in length without hydronephrosis. Splenic size normal.", "output": "Gallbladder not visualized. See above.Right nephrolithiasis without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 43yo with h/o fatty liver with elevated liver function tests. LIVER: The liver measures 16.3 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 0.24 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 5 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: The spleen is upper normal in size measuring 11.2 cm in length. RIGHT KIDNEY: Kidney measures 11.1 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 12.1 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No ascites.", "output": "Increased hepatic echogenicity suggestive of hepatic steatosis/parenchymal dysfunction without focal lesions identified."}
{"instruction": "Generate impression based on findings.", "input": "Male 57 years old Reason: Patient suspicious liver lesion on MRI; need to know if accessible for IR biopsy History: as above LIVER: Coarse hepatic echotexture and nodular contour of the liver is compatible with cirrhosis. Large volume ascites. No hepatic masses are identified.BILIARY TRACT: No intrahepatic biliary duct dilatation.", "output": "Bilobar hepatic masses seen on MRI are not visualized by ultrasound. Large volume ascites."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal failure RIGHT KIDNEY: Unremarkable echogenicity without mass, stone, or hydronephrosis. Right kidney 14.3 cm in lengthLEFT KIDNEY: Left kidney parenchyma markedly atrophic and associated with massive cystic structure presumably representing severe long-standing hydronephrosis. This finding is unchanged from the prior CT.OTHER: Bladder nondistended", "output": "Markedly atrophic left renal parenchyma associated with massive cystic structure presumably representing severe long-standing hydronephrosis with secondary parenchymal atrophy; finding unchanged from prior CT. Unremarkable right kidney."}
{"instruction": "Generate impression based on findings.", "input": "71 years old, Female, Reason: assess left renal cyst History: assess left renal cyst RIGHT KIDNEY: Kidney measures 9.5 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Previously described left renal mass in the upper/mid kidney is not visualized on this ultrasound examination. Kidney measures 9.3 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus.OTHER: No significant abnormalities noted.", "output": "Previously described left renal mass or cyst is not well visualized on this ultrasound examination. "}
{"instruction": "Generate impression based on findings.", "input": "Female 20 years old Reason: evaluate for gallstones or cholecystitis History: ruq pain LIVER: Liver has normal echogenicity. No focal hepatic mass. Main portal vein is patent with normal directional flow and a peak velocity of 21 cm/s. There are measures 17 cm in length.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. No gallstones. No evidence of acute inflammation of the gallbladder. The gallbladder wall is within normal limits measuring 1 mm. Common bile duct measures 3 mm. Negative sonographic Murphy's sign.PANCREAS: The visualized portions of pancreas are normal.SPLEEN: Spleen is normal in appearance measuring 11.9 cm.KIDNEYS: Normal cortical echogenicity. No hydronephrosis or shadowing stone. Right kidney measures 11.4 cm. Left kidney measures 12.0 cm.OTHER: No significant abnormalities noted.", "output": "No gallstones or evidence of acute inflammation of the gallbladder. No specific sonographic findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with shock liver, recent aortic bifemoral bypass. Limited exam as patient is intubated and unable to lie in decubitus position.LIVER: Coarse heterogeneous echotexture measuring 16.8 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: Collapsed gallbladder filled with stones. 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.RIGHT KIDNEY: Measures 11.7 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney and spleen are not well visualized.Small amount of left upper quadrant ascites.", "output": "1. Cholelithiasis with no evidence of cholecystitis.2. Coarse heterogeneous echotexture of the liver suggestive of parenchymal dysfunction/fatty infiltration.3. Small amount of ascites. "}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for routine screening mammography. Grandmother diagnosed with breast cancer at age 78. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Clustered small masses in the left upper outer quadrant best seen on the CC view needs comparison with prior mammograms and if not available further evaluation with spot compression and ultrasound.", "output": "Clustered small masses in the left upper outer quadrant best seen on the CC view needs comparison with prior mammograms and if not available further evaluation with spot compression and ultrasound.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: OA - OLD FILM FOR COMPARISON"}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain LIVER: No significant abnormalities noted. Liver length is 18.1 cmGALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right kidney 13.5 cm in lengthOTHER: Left kidney 13.6 cm in length. Spleen 11.9 cm in length. No ascites.", "output": "Gallbladder sludge without acute inflammation or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Hepatocellular carcinoma; ultrasound prior to viral vector injection for treatment planning LIVER: No significant change in large confluent left lobe hepatic lesion measuring 13.2 x 6.8 cm", "output": "No significant change in large confluent left lobe hepatic lesion. Measurements and access route determined for tomorrow's therapeutic intervention."}
{"instruction": "Generate impression based on findings.", "input": "Female 65 years old; Reason: goiter, evaluate. History: goiter. Previously with nodules. Euthyroid. RIGHT LOBE MEASUREMENTS: 4.8 x 1.9 x 1.9 cm, previously 5.0 x 1.6 x 1.9 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.6 x 1.6 cm, previously 5.1 x 1.6 x 1.5 cm.ISTHMUS MEASUREMENT: 0.3 cm, previously 0.3 cmRIGHT LOBE: Hypoechoic nodule in the midportion of the right lobe measures 0.9 x 0.9 x 0.8 cm as compared to 1.1 x 1.0 x 0.6 cm on prior exam, essentially unchanged.LEFT LOBE: Multiple hypoechoic nodules with ill-defined border, with the largest measuring 1.1 x 0.8 x 0.6 as compared to 1.3 x 0.6 x 0.5 cm on prior exam, unchanged.ISTHMUS: Hypoechoic and well-defined nodule in the isthmus measuring 0.4 x 0.4 x 0.3 as compared to 0.5 x 0.4 x 0.2 cm on prior exam, unchanged. Additional nodule is also unchanged.LYMPH NODES: No significant lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Stable multinodular thyroid."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess for fluid collection History: swelling around transplanted kidney RENAL TRANSPLANT: 11.3 cmLOCATION: Right iliac fossaPERITRANSPLANT TISSUES: There is a complex appearing perinephric collection with multiple septations along the right lateral aspect of the iliac fossa transplant.. This measures 3.1 cm in width and 5.7 cm in craniocaudal dimension. There is 1 cm simple fluid medial to the transplant.KIDNEY: No parenchymal lesions. Normal cortical medullary differentiation.COLLECTING SYSTEM/URETER: No hydronephrosis.URINARY BLADDER: Not visualized.VASCULAR DOPPLER DATA: Color Doppler were performed on inflow and outflow vessels No significant abnormality notedOTHER: No significant abnormality noted", "output": "Complex perinephric fluid collection measuring up to 5.7 cm, likely a resolving hematoma. "}
{"instruction": "Generate impression based on findings.", "input": "31 years old, Female, Reason: Evaluate for gallstones History: RUQ pain occ associated with meals LIVER: The liver measures 15.1 cm in length. Increased parenchymal echogenicity is 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. There is likely a small calcified granuloma within the hepatic parenchyma.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 diameter.PANCREAS: The pancreas is not well seen due to overlying bowel gas.SPLEEN: No significant abnormalities noted. The spleen measures 9 cm in length. RIGHT KIDNEY: Kidney measures 9.2 cm in length. Normal echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.3 cm in length. Normal echotexture. No hydronephrosis.", "output": "1.Normal gallbladder and biliary tract with no evidence of cholelithiasis or acute cholecystitis.2.Increased hepatic parenchymal echogenicity is consistent with fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old woman history of left breast excisional biopsy in 2013 for intraductal papilloma/atelectasis. Left breast mass was found in 2014, subsequently biopsied and revealed a fibroadenoma. Patient now presents to assess stability of this left breast mass. A targeted grayscale and color Doppler left ultrasound was performed for the area of concern. There is a circumscribed hypoechoic mass in the left breast 12:00 position 3 cm from the nipple measuring 0.9 x 0.5 x 1.2 cm, consistent with the biopsy-proven fibroadenoma. A marking clip is seen slightly inferior and lateral to the mass. There has been no significant change in size of this mass since 11/14/2014 when it measured up to 1.2 cm.", "output": "No change in size of biopsy proven left breast fibroadenoma measuring up to 1.2 cm.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old male with history of HCV, rule out HCC. LIVER: Measures 15.4 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: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease. No focal hepatic lesions identified."}
{"instruction": "Generate impression based on findings.", "input": "Left renal abscess RIGHT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. Right kidney 9.7 cm in length.LEFT KIDNEY: Interval decrease in size of complex cystic focus arising from the mid left kidney now measuring 2.1 x 2.2 x 2.7 cm; this is comparison to 3.7 x 3.7 cm on 6/23/2016. No stone or hydronephrosis. No perinephric collection. Left kidney 10 cm in length.OTHER: Bladder nondistended", "output": "Interval decrease in size of complex left renal cystic focus consistent with interval decrease in size of abscess; continued surveillance monitoring to resolution is suggested. No stone or hydronephrosis. No perinephric collection."}
{"instruction": "Generate impression based on findings.", "input": "s/p liver transplant. Evaluate hepatic vasculature. LIVER:The liver measures 18.0cm. There is increased and course echogenicity. No masses.GALLBLADDER, BILIARY TRACT: No significant abnormality noted.PANCREAS: Not well visualized due to overlying bowel gas.", "output": "1. Patent hepatic vasculature as above though the right hepatic artery is not well visualized on this study.2. Coarse echogenicity suggestive of chronic liver disease / parenchymal dysfunction."}
{"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 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is an asymmetry in the right upper outer breast for which further evaluation with spot compression views and potentially ultrasound is recommended. No suspicious microcalcifications.", "output": "Asymmetry in the right upper outer breast for which further evaluation with spot compression views and potentially ultrasound is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female with gram-negative sepsis, assess for cholecystitis. LIVER: Measures 18.0 cm in length. Coarsened hepatic echotexture without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: The gallbladder is partially collapsed with normal wall thickness. However, there is heterogeneity of the pericholecystic fat with areas of low echogenicity. Additionally, the patient was somewhat tender to palpation during the exam. There is no biliary ductal dilationPANCREAS: The pancreas is incompletely imaged due to bowel gas. The imaged portions of the pancreas appear unremarkable. SPLEEN: Unremarkable in size and echogenicity. KIDNEY: Minimal left hydronephrosis, improved since the prior study. Bilateral renal stents in place.OTHER: No significant abnormalities noted.", "output": "1. The collapsed gallbladder and normal gallbladder wall thickness argue against acute cholecystitis. However, there is heterogeneity of the pericholecystic fat as well as tenderness to palpation, the clinical significance of which is uncertain at this time. If further imaging evaluation is warranted, a nuclear medicine hepatobiliary study may be considered as clinically warranted. 2. Minimal left hydronephrosis is improved since the prior study. Renal stents in place. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: cholelithiasis/cholecystitis History: refractory N/V, history of \"gallbladder inflammation\" BILIARY TRACT: Debris within the gallbladder with scattered echogenic foci, most likely sludge. No associated 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.", "output": "Gallbladder sludge without evidence of acute cholecystitis or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B LIVER: Mildly coarse echotexture again noted without worrisome mass. Stable right lobe subcentimeter cyst. Liver length 14 cmGALLBLADDER, BILIARY TRACT: Possible slight interval increase in size of gallbladder polyp now measuring 0.6 x 0.6 cm; this is in comparison to 0.4 x 0.4 cm on 7/10/2015. No acute inflammation. No significant ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.2 cm in lengthOTHER: Left kidney 10.1 cm in length. Spleen 8.3 cm in length. No ascites", "output": "Stable mildly coarse liver echotexture suggestive for chronic liver disease without worrisome mass or ductal dilatation. No ascites.Possible slight interval increase in size of subcentimeter gallbladder polyp; would recommend special attention to this polyp on future surveillance scans."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid carcinoma RIGHT LOBE MEASUREMENTS: 5.1 x 1.7 x 1.5 cmLEFT LOBE MEASUREMENTS: 5 x 1.6 x 1.3 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Diffusely heterogeneous gland without worrisome nodule. LEFT LOBE: Diffusely heterogeneous gland. 0.4 x 0.3 x 0.2 nodule with coarse calcification within the left thyroid/isthmus.ISTHMUS: 1.2 x 0.9 x 0.6 cm right isthmic nodule with internal calcifications and ill-defined borders. Adjacent smaller equally ill-defined nodule measuring 0.8 x 0.7 x 0.7 cm within the right isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Worrisome right isthmic nodules with internal calcifications and ill-defined borders consistent with known papillary thyroid carcinoma. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old male with elevating LFTs. History of colon cancer. LIVER: The patient is status post right hepatectomy. The residual liver is enlarged, measuring 20 cm in craniocaudal dimension. There are multiple large discrete heterogeneously hyperechoic liver lesions compatible with metastatic disease. The largest measures 6.1 x 5.6 x 7.0 cm. Normal hepatopetal portal venous blood flow at 32 cm/sec. No intrahepatic biliary ductal dilatation.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. No extrahepatic biliary ductal dilatation with the common bile duct measuring 2 mm.PANCREAS: Limited evaluation of the pancreas is unremarkable.RIGHT KIDNEY: The right kidney is enlarged, measuring 14.4 cm with hydronephrosis seen on the prior CT. No shadowing calculi.OTHER: Splenomegaly, measuring 17.7 cm in length. The left kidney is enlarged, measuring 14.3 cm in length with of hydronephrosis.", "output": "1. Multiple large hepatic masses compatible with metastatic disease. No biliary ductal dilatation.2. Bilateral moderate hydroureteronephrosis without shadowing calculus.3. Splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old male with history of right upper quadrant pain, known kidney stones. Evaluate for gallstones or urinary obstruction. LIVER: Unremarkable hepatic echogenicity without discrete focal lesion. Scattered hepatic calcifications consistent with granulomatous disease.GALLBLADDER, BILIARY TRACT: No evidence of cholelithiasis or acute cholecystitis. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.KIDNEY: No renal stones identified. No hydronephrosis.OTHER: Splenic granulomata.", "output": "No evidence of cholelithiasis, cholecystitis, nephrolithiasis, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status. Elevated LFTs. LIVER: Cirrhotic liver morphology. Coarsened parenchymal echogenicity. 10.3 cm in length. No focal hepatic lesions. GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Gallbladder not visualized.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 12.1 cm in length, with a 3.3 cm simple appearing cyst. The left kidney is 12.1 cm in length with a simple appearing cyst. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 12.7 cm in length, without focal lesions evident.OTHER: Moderate ascites is presentDOPPLER", "output": "1. Cirrhotic liver morphology with minimal reversed flow in the left and main portal veins. 2. Moderate ascites.3. Splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Primary sclerosing cholangitis with cholangiocarcinoma status post Roux-en-Y liver resection LIMITED ABDOMENLIVER: Status post resection of right lobe of the liver. No obvious intrahepatic mass appreciated. 3.6 x 2.3 cm loculated fluid collection adjacent to the resection site without increased vascularity. Similar loculated collection measuring 2.6 x 1.6 cm within the gallbladder fossa.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 12.1 cm in length RIGHT KIDNEY: No significant abnormalities noted. 13.1 cm in lengthOTHER: Left kidney 15.8 cm in length. No ascites.", "output": "Status post resection of right lobe of the liver. Loculated collections adjacent to the resection site and gallbladder fossa. While these may represent benign postoperative collections, CT would be helpful for further characterization. No intrahepatic mass or ductal dilatation.Hepatic vessels patent; however the main portal vein now demonstrates hepatofugal flow. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 34 years old Reason: Change in node History: Thyroid cancer with elevated thyroglobulin and previous indeterminate node MEASUREMENTS: Patient is status post thyroidectomy.RIGHT LOBE: A nodule is present within the right thyroidectomy bed. Solid-appearing nodule in the right thyroidectomy bed with homogeneous isoechoic echotexture measures 1.2 x 0.5 x 0.6 cm, previously 1.1 x 0.4 x 0.4 cm. There is a newly recognized hypoechoic nodule posterior to the carotid, which is favored to represent a lymph node measuring 0.6 x 0.6 x 0.9 cm.LEFT LOBE: Unchanged, small hypoechoic nodule in the left thyroid lobe measuring 0.5 x 0.4 x 0.4 cm.ISTHMUS: There is a new hypoechoic nodule in the area of the isthmus, which is favored to represent a small lymph node measuring 1.0 x 0.7 x 0.4 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Unchanged small benign-appearing lymph nodes are present within the right and left neck.OTHER: No significant abnormality noted.", "output": "1.Multiple small thyroid nodules are not significantly changed.2.There is a new hypoechoic nodule in the area of the isthmus. Recommend attention to this area on follow-up exams to ensure stability.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Female 64 years old; Reason: luq pain ?hernia History: patient pain is worse when laying on her side. Patient claims it's worse with situps. Patient also with significant weight loss SOFT TISSUES LEFT UPPER QUADRANT : Soft tissues and abdominal wall are visualized along the area of pain in the left upper quadrant. No fluid collection, hernia, or significant abnormalities are noted.", "output": "No sonographic signs of hernia. If clinically indicated, can obtain cross-sectional imaging such as CT."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old male with history of Kennedy's disease with right flank superficial discomfort and swelling. In the subcutaneous tissues in the region of the patient's discomfort and visible swelling there is an ovoid region which is isoechoic to surrounding fat measuring 0.8 x 3.8 x 3.5 cm. There is no defect in the adjacent abdominal wall nor is or significant change with Valsalva. Findings are most suggestive of lipoma.", "output": "Findings most consistent with lipoma involving the subcutaneous fat of the right flank."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are ultrasound images of right breast (2/16/15) performed at Indiana Breast Center and ultrasound images of left breast (9/5/14) performed at St. Anthony Crown Point. ULTRASOUND IMAGES OF RIGHT BREAST (2/16/15):Sonographic images of right retroareolar region, right upper outer quadrant and axilla are submitted. No abnormal findings including solid or cystic masses are visualized.ULTRASOUND IMAGES OF LEFT BREAST (9/5/14):Sonographic images of left retroareolar region are submitted. No abnormal findings including solid or cystic masses are visualized.", "output": "No sonographic evidence of malignancy. BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Male 40 years old; Reason: RUQ pain, r/o GB stone, renal stone History: RUQ pain LIVER: The liver measures 15.0 cm in length. There is 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 24.7 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 3.2 mm. No stones are seen but there is a small amount of sludge near the neck. No pericholecystic fluid. Negative sonographic Murphy sign. The common bile duct measures 3.8 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9.3 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.7 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.0 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. There is increased echogenicity of the liver parenchyma compatible with fatty infiltration/hepatocellular dysfunction. No worrisome masses are seen.2. No evidence of cholelithiasis or acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter RIGHT LOBE MEASUREMENTS: 2.7 x 2.2 x 6 cmLEFT LOBE MEASUREMENTS: 3.5 x 2.7 x 6.9 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Slight interval increase in size of inferior right solid nodule now measuring 1 x 0.9 x 1.1 cm; this is in comparison to 0.9 x 0.7 x 0.7 cm on 3/4/2014. Other right thyroid nodules relatively stable.LEFT LOBE: Other than interval increase in cystic component, no significant change in multiple left thyroid nodules. The largest again measures 2.6 x 1.7 x 2.7 cm.ISTHMUS: Stable isthmic nodule measuring 0.4 x 0.5 x 0.6 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Slight interval increase in size of predominantly solid right inferior thyroid nodule. This nodule would be amenable to ultrasound-guided percutaneous biopsy. "}
{"instruction": "Generate impression based on findings.", "input": "73-year-old male patient with abdominal distention, prominent abdominal veins. Question of hepatomegaly. LIVER: The liver measures 18 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: 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 pancreas is not visualized on this examination.RIGHT KIDNEY: The right kidney measures 9.3 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.2 cm in length. No evidence of hydronephrosis. There is a 2.2 x 2.1 x 2.1 cm left lower pole renal cyst with a single septation.The spleen measures 10.6 cm in length.No ascites.", "output": "1. Increased hepatic parenchymal echogenicity likely related to hepatic steatosis/hepatic parenchymal dysfunction. No ascites or hepatomegaly.2. Minimally complex left renal cyst. "}
{"instruction": "Generate impression based on findings.", "input": "25-year-old female with bilateral breast masses. A targeted bilateral breast ultrasound was performed at the site of the patient's known breast masses thought to represent fibroadenomas. In the left breast at 10:00, 5 cm from the nipple there is a 1.2 x 0.7 x 1.7 cm hypoechoic smoothly marginated mass which previously measured 1.5 x 0.8 x 1.6 cm.In the right breast at 2:00, 5 cm from the nipple there is a small hypoechoic mass measuring 5 x 5 x 2 mm which previously measured 7 x 4 x 5 mm.", "output": "Bilateral masses likely representing fibroadenomas are stable for least 2 years. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually beginning at age 40. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male. Cirrhosis. Evaluate for lesions. LIVER: Diffusely increased echogenicity and coarse echotexture of the liver consistent with fatty infiltration. No focal lesion. Liver is 19.9 cm in length.GALLBLADDER, BILIARY TRACT: Gallbladder has been surgically resected. No biliary ductal dilatation. The common duct is 5 mm in caliber, within normal limits.PANCREAS: The visualized pancreatic head is normal in echogenicity. The remainder of the pancreas is obscured by bowel gas.SPLEEN: Spleen measures 11.9 cm in length. No focal lesion identified.RIGHT KIDNEY: Right kidney is 11.3 cm in length and contains a 2.8 cm cyst. No hydronephrosis.OTHER: Left kidney is 14 centimeters in length. No hydronephrosis.", "output": "Diffuse fatty infiltration/parenchymal dysfunction of the liver without focal mass."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male patient with abnormal LFTs, weight loss, scleral icterus. Evaluate for cholelithiasis, hepatomegaly, ascites. LIVER: The liver measures 13.9 cm in length. No focal hepatic lesion is identified. The liver is nodular in contour. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder contains biliary sludge and gallstones. 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 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.3 cm in length. No evidence of hydronephrosis. There is a 1.9 x 2.2 cm simple cyst in the left lower pole.The spleen measures 8.5 cm in length.There is mild ascites.Bilateral pleural effusions are noted.The bladder is distended.", "output": "1. Nodular contour of the liver suggestive of cirrhosis2. Cholelithiasis without sonographic evidence of acute cholecystitis.3. Mild ascites and bilateral pleural effusions. "}
{"instruction": "Generate impression based on findings.", "input": "Female 61 years old; Reason: ? gall stones History: RUQ pain 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 21.5 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.8 mm. No stones are seen. No pericholecystic fluid. Negative sonographic Murphy sign. The common bile duct measures 6.6 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9.6 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.1 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.2 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen. A left renal cyst is seen measuring 2.2 cm x 1.5 cm x 1.8 cm. This was visible on prior CT.", "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": "Hepatitis B cirrhosis with hepatocellular carcinoma status post TACE/RFA with new pleural effusion LIVER: Cirrhotic morphology again noted. Right hepatic lobe tumor status post RFA noted. Liver is 13.3 cm in length. Limited Doppler interrogation of the portal veins demonstrates patent portal vasculature with normal directional flowGALLBLADDER, BILIARY TRACT: No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.8 cm in lengthOTHER: Left renal cyst. Left kidney 12.2 cm in length. Spleen 16.2 cm in length. No ascites. Moderate right pleural effusion.", "output": "Cirrhotic morphology with right lobe hepatic tumor status post RFA therapy. No ductal dilatation. Limited Doppler interrogation of the portal vessels demonstrate patent portal vessels with normal directional flow. No ascites. Moderate right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old male with a family history of abdominal aortic aneurysm. The proximal, mid, and distal aorta measure 1.9, 1.8 and 1.6 cm in AP dimension. The right and left common iliac arteries measure 1.1 and 1.3 cm in AP dimension.Atherosclerotic calcification is noted.", "output": "No evidence of aneurysmal dilatation of the aorta."}
{"instruction": "Generate impression based on findings.", "input": "History of hepatitis C. Evaluate for HCC. LIVER: Demonstrated again is a 1 cm hyperechoic lesion in the right posterior hepatic segment which is unchanged in size and appearance.No new suspicious liver lesion. The liver is normal in echogenicity and size, measuring 13.7 cm in craniocaudal dimension. Normal hepatopedal portal venous blood flow at 30 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation with the common duct measuring 2 mm. Normally distended gallbladder without wall thickening pericholecystic fluid or focal tenderness. No cholelithiasis.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen measures 9.1 cm in length. A small splenule is noted.RIGHT KIDNEY: The right kidney measures 10 cm in length without hydronephrosis, shadowing nephrolithiasis order suspicious lesion. OTHER: The left kidney measures 9.3 cm in length without hydronephrosis or shadowing nephrolithiasis. In the posterior cortex there is a hypoechoic incompletely characterized 2.0 cm hypoechoic lesion seen on 2 contiguous images.", "output": "1. Stable 1 cm hyperechoic lesion in the right hepatic lobe.2. 2 cm lesion in the posterior cortex of the left kidney is incompletely characterized. A renal protocol CT is recommended for further characterization."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female with some dysphasia. Rule out thyroid nodules. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.9 x 1.8 x 1.7 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 5.5 x 2.7 x 2.5 cm.ISTHMUS MEASUREMENTS: The isthmus measures 0.6 cm in thickness.RIGHT LOBE: In the right mid thyroid pole, there is a 1.1 x 0.6 x 0.8 cm spongiform nodule.LEFT LOBE: Heterogenous echotexture the left thyroid lobe. In the left mid pole, there is a 2 x 1.8 x 2.3 cm spongiform nodule. In the left lower pole, there is a solid and cystic nodule measuring 1.2 x 0.8 x 0.9 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No suspicious cervical lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Bilateral thyroid nodules with the largest on the left measuring up to 2.3 cm in diameter and has a spongiform appearance, favoring benign etiology"}
{"instruction": "Generate impression based on findings.", "input": "57 years old, Male, Reason: assess for liver cirrhosis History: hepatitis C positive LIVER: The liver measures 17 cm in length. Majority of the hepatic parenchyma normal limits. A focal hypoechoic area may be posttraumatic or represent focal fatty sparing. No nodularity to suggest cirrhosis. No focal hepatic masses. 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 5 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 7.5 cm in length. RIGHT KIDNEY: Kidney measures 8.8 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 9.1 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.No nodularity of the hepatic parenchyma to suggest cirrhosis.2.Anterior hypoechoic region of the liver may be posttraumatic or represent focal fatty sparing. No suspicious focal hepatic masses."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male with history of acute kidney injury. RIGHT KIDNEY: Measures 10.9 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Not clearly seen presumably due to bowel gas.URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: Small left pleural effusion.", "output": "1. Technically limited examination due to bowel gas, with nonvisualization of the left kidney. Unremarkable right kidney.2. Small left pleural effusion. "}
{"instruction": "Generate impression based on findings.", "input": "History thyroid nodules RIGHT LOBE MEASUREMENTS: 5.7 x 2.1 x 2.8 cmLEFT LOBE MEASUREMENTS: 4.5 x 1.8 x 2.7 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: 1 x 0.7 x 0.9 cm spongiform nodule upper pole. Additional subcentimeter hypoechoic benign-appearing nodule.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": "Benign-appearing spongiform nodules right thyroid gland. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "24 year-old female with history of thyroid nodule, patient thinks nodule is larger with increased difficulty swallowing pills. RIGHT LOBE MEASUREMENTS: 4.5 cm x 1.4 cm x 1.3 cmLEFT LOBE MEASUREMENTS: 5.0 cm x 2.3 cm x 1.6 cmISTHMUS MEASUREMENTS: 2 mm in thicknessRIGHT LOBE: Complex nodule in the midpole measures 1.2 cm x 0.7 cm x 0.8 cm.LEFT LOBE: Complex nodule in the upper to midpole measures 3.3 cm x 1.1 cm x 2.5 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral complex nodules, larger on the left."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate palpable soft tissue mass/fullness in left pubic region Several mildly enlarged benign appearing left inguinal lymph nodes are noted, the largest measuring 1.0 x 0.4 x 0.6 cm in the left inguinal region. No significant internal vascularity. No soft tissue masses or visualized. No evidence of inguinal hernia.", "output": "Several mildly enlarged left inguinal lymph nodes with a benign appearance. No visualized soft tissue mass or inguinal hernia."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old male patient with multiple myeloma status post auto stem cell transplant. Elevated liver function tests. LIVER: The liver measures 14.9 cm in length. Hepatic parenchymal echogenicity is increased. 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 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 11.1 cm in length. No evidence of hydronephrosis. There are two hypoechoic regions within the lower pole of the right kidney within the sinus and cortex. These appear to correlate to cysts on a prior CT.OTHER: The left kidney measures 10.1 cm in length. No evidence of hydronephrosis.The spleen measures 11.9 cm in length.", "output": "1. Increased hepatic parenchymal echogenicity which can be seen with hepatic steatosis.2. Right renal lower pole hypoechoic lesions which may correlate to cysts when compared to prior CT."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old female with prior C-section presents for evaluation of a ventral wall hernia on her right inferior abdomen. There is an indeterminate nonvascular hypoechoic focus within the subcutaneous tissue measuring approximately 8.9 x 1.9 mm in the area of the C-section scar without associated fascial defect.", "output": "1. Indeterminate nonvascular hypoechoic focus in the subcutaneous tissue without associated fascial defect."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules RIGHT LOBE MEASUREMENTS: 5.4 x 2.3 x 1.7 cmLEFT LOBE MEASUREMENTS: 5 x 1.3 x 0.8 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Stable dominant inferior pole solid nodule measuring 2 x 1.4 x 1.7 cm. Stable subcentimeter hypoechoic mid pole focus measuring 0.5 x 0.6 x 0.3 cmLEFT 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 nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "63 year old female who was recalled from screening mammogram for right breast calcifications. Family history of breast carcinoma in her mother at age 63 a maternal aunt at age 62. RIGHT DIAGNOSTIC MAMMOGRAM: An ML view and two spot magnification 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 densities. There is redemonstration of pleomorphic, branching calcifications within the upper outer right breast, a middle depth associated with a persistent, partially obscured mass. RIGHT BREAST ULTRASOUND: A targeted right ultrasound was performed for the mammographic area of concern. At the 11 o'clock position, approximately 3 cm from the nipple, there is an irregular hypoechoic mass with internal echogenic foci, and an echogenic halo measuring 1.3 x 1.2 x 2.1 cm. Mild internal vascularity is present.", "output": "Suspicious 2.1 cm mass with associated calcifications at the 11 o'clock position of the right breast for which ultrasound guided core needle biopsy is recommended. Findings and recommendations were discussed with the patient, and all questions were answered.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "History of hepatitis C and cirrhosis. Evaluate for HCC. LIVER: Course liver with nodular contour compatible with history of cirrhosis. The liver measures 14 cm in length. There is a hypoechoic 4.1 x 2.7 x 2.6 vascular hypoechoic mass bulging the hepatic contour.No intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 19 cm/s.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 4 mm. Status post cholecystectomy.PANCREAS: The visualized pancreatic body and head is unremarkable. SPLEEN: The spleen measures 8.2 cm in length without a focal abnormality.RIGHT KIDNEY: The right kidney measures 10.4 cm in length without hydronephrosis. Note is made of a 1.1 cm simple appearing cyst. No shadowing nephrolithiasis. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 10.3 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion.", "output": "Cirrhosis with a 4.1 cm vascular hypoechoic right hepatic lobe mass bulging the contour, suspicious for hepatocellular carcinoma. Further characterization with a dedicated liver protocol CT or MRI is recommended.Discussed with ordering clinic (Maria, to be relayed to Dr. Glick) at 1103 on 04/26/2016."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain, epigastric pain , rule out cholecystitis LIVER: Liver measures 13.2 cm with normal echotexture. No intra or extra hepatic ductal dilatation noted. No focal lesionsGALLBLADDER, BILIARY TRACT: Gallbladder is well distended without any focal lesions. No evidence of gallstones. No pericholecystic fluid collection. Normal gallbladder wall thickness noted. Common hepatic duct measures up to 4 mm.PANCREAS: No significant abnormalities noted.KIDNEY: Right kidney measures 10.8 cm and left kidney measures 10.2 cm. Normal echotexture noted. No hydronephrosis or focal lesions.OTHER: Spleen measures 6.5 cm without any focal lesions. No ascites.", "output": "No evidence of cholecystitis or cholelithiasis"}
{"instruction": "Generate impression based on findings.", "input": "17 y/o female with acute left breast pain and calcification vs. cysts on exam A whole breast ultrasound was performed for the patient\u2019s area of concern. Dense breast tissue is noted. There is no solid or cystic mass identified.", "output": "No sonographic evidence of infection or mass.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Renal transplant with pulmonary edema RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality noted. 11.3 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.Abnormal delay and dampening of arterial systolic waveform noted at renal arterial anastomosis and distally. Measured renal artery velocities are 83.5 cm/s proximally, 56.4 cm/s mid, and 56.4 cm/s distally. OTHER: No significant abnormality noted", "output": "Abnormal delay and dampening of arterial systolic waveform noted at renal arterial anastomosis and distally; findings suggestive for inflow compromise/stenosis. Patent renal veins. No perinephric fluid collection or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "82-year-old female with left lateral calf swelling and pain. Remote fall. No underlying mass or fluid collection identified in region of discomfort. Limited evaluation of the left popliteal region demonstrates patency of the popliteal vein and no fluid collection.", "output": "No mass or fluid collection seen."}
{"instruction": "Generate impression based on findings.", "input": "Reason: History of left testicular cancer. Now pea sized nodule along lower spermatic cord, new and growing per patient, evaluate RIGHT TESTIS: Right testicular microlithiasis without focal mass.LEFT TESTIS: Status post left orchiectomy with placement of testicular implant.RIGHT EPIDIDYMIS: The epididymis measures 0.9 x 0.8 x 1.4 cm. There is a small anechoic epididymal cyst measuring 0.5 x 0.5 x 0.4 cm.LEFT EPIDIDYMIS: Status post left orchiectomy.OTHER: No significant abnormalities noted.", "output": "1. Microlithiasis of the right testicle.2. Subcentimeter right epididymal cyst."}
{"instruction": "Generate impression based on findings.", "input": "Female 15 years old Reason: Any lateral or central neck lymph nodes suspicious for papillary thyroid carcinoma metastasis History: Right 2.6 cm papillary thyroid carcinoma RIGHT LOBE MEASUREMENTS: 6.1 x 2.2 x 1.9 cm.LEFT LOBE MEASUREMENTS: 5.0 x 4.5 x 1.4 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: The midportion of the right thyroid lobe there is a large heterogeneous, primarily hypoechoic nodule with internal punctate calcifications most compatible with known history of papillary thyroid carcinoma.LEFT LOBE: Left thyroid lobe is normal in appearance.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Several small bilateral lymph nodes are present without definite suspicious features.OTHER: No significant abnormality noted.", "output": "Large right thyroid nodule with features consistent with papillary thyroid carcinoma. Several small bilateral lymph nodes without definite suspicious features."}
{"instruction": "Generate impression based on findings.", "input": "History Graves' disease with left superior toxic and cold nodule RIGHT LOBE MEASUREMENTS: 2.7 x 1.3 x 0.9 cmLEFT LOBE MEASUREMENTS: 4.5 x 2.6 x 2.5 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Atrophic right thyroid gland without increased vascularity. 1 x 0.8 x 0.8 cm mixed echogenicity lower pole noduleLEFT LOBE: 2.7 x 3.8 x 2.6 cm mixed cystic solid lower pole nodule corresponding to the cold lesion on radionuclide study.ISTHMUS: 1.3 x 0.6 cm mixed cystic solid right isthmic nodulePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Mixed cystic and solid left lower pole nodule corresponding to cold lesion seen on recent nuclear medicine scan study; favor benign etiology. Atrophic right thyroid gland without increased vascularity. 1 cm mixed echogenicity lower pole nodule. Mixed cystic and solid right isthmic nodule."}
{"instruction": "Generate impression based on findings.", "input": "81-year-old female presents as a callback from screening mammography for a small mass in the right outer breast. Three standard views of both breasts and spot compression views of the right outer 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. A subcentimeter circumscribed mass in the right outer breast superficial depth persists with spot compression. Ultrasound was additionally performed.ULTRASOUND", "output": "Benign cyst in the right outer breast correlating with the mammographic mass. 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": "Right-sided heart failure with dyspnea LIVER: Coarse echogenic liver parenchyma without mass. Liver length 14.4 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: Possible gallbladder sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.9 cm in lengthOTHER: Left kidney 10.7 cm in length. Spleen 12.8 cm in length. Trace ascites.", "output": "Coarse echogenic liver parenchyma suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Farris is a 68-year-old female recalled from screening mammogram for a spiculated mass in the left breast. Patient currently asymptomatic. No family history of breast cancer. An ML view and four spot magnification 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. There is revisualization of a spiculated mass in the left lower outer breast with internal pleomorphic calcifications. Seen posterior to this is an additional 0.9 cm cluster of pleomorphic calcifications. These lesions are separated by approximately 4.5 cm in the AP dimension.LEFT BREAST ULTRASOUND", "output": "Two suspicious lesions in the left lower outer breast with sonographic correlates. An US guided biopsy with clip placement is recommended for both lesions. All results and recommendations were discussed with the patient. Of note patient is on Aspirin and Coumadin for her comorbidities and these will need to be held for at least 3 days prior to the procedure. A message was sent to the patient's primary care physician Dr. Carmela Kiraly via EPIC on 2/8/2015 at 2:30 PM to determine if this is feasible. Above findings and recommendations were also discussed with the patient at time of completion of exam. BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Female 47 years old; Reason: history of multinodular goiter since 2004. History: neck fullness RIGHT LOBE MEASUREMENTS: 4.8 x 1.6 x 1.3 cm.LEFT LOBE MEASUREMENTS: 4.5 x 1.4 x 1.9 cm.ISTHMUS MEASUREMENT: 0.7 cm.RIGHT AND LEFT LOBES: The thyroid has a mildly heterogenous echotexture without mass or lymphadenopathy.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted. OTHER: No significant abnormality noted", "output": "1.Mildly heterogeneous echotexture of thyroid without mass or lymphadenopathy. Specifically, the previously noted nodules on the prior ultrasound are not appreciated on the current examination."}
{"instruction": "Generate impression based on findings.", "input": "Male; 56 years old. Reason: elevated LFTs (AST>ALT), hx EtOH abuse; eval for cirrhotic liver History: see above LIVER: Hepatomegaly with the right lobe of the liver measuring 20.4-cm in length. Diffusely coarsened echotexture of the liver, most suggestive of fatty infiltration. No focal liver lesions. No intrahepatic biliary ductal dilation. Main portal vein is patent with normal directional flow.BILIARY TRACT: Unremarkable appearance of the gallbladder. No extrahepatic biliary ductal dilation. The common bile duct measures 5 mm.PANCREAS: No gross abnormalities of the pancreatic head. The remainder of the pancreas is obscured by overlying bowel gas.SPLEEN: Spleen is 11.4-cm in length. No focal splenic lesions.RIGHT KIDNEY: Right kidney is 9.5-cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: Left kidney is 9.8-cm in length. Normal cortical echotexture. No hydronephrosis.", "output": "Hepatomegaly and fatty infiltration of the liver."}
{"instruction": "Generate impression based on findings.", "input": " RIGHT LOBE MEASUREMENTS: 4 x 1.2 x 2.1 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.5 x 2.2 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Multiple nodules identified. In the extreme upper pole there is a 0.6 x 0.7 x 1.0 cm nodule. This was clearly spongiform in the prior study although the cystic spaces are somewhat less well-visualized on today's exam. Overall this is changed little in size. Large complex cystic nodule with thick septation and slight wall irregularity measures 0.7 x 1.1 x 1.6 cm, without change. There are several, small colloid nodules with comet tail artifact. LEFT LOBE: Multiple nodules identified. In the midportion of the left lobe there is a predominantly solid nodule with some spongiform characteristic. This measures 0.7 x 1.6 x 1.6 cm without change. There is a second, inferior spongiform nodule measuring 1.3 x 1.7 x 1.6 cm also unchanged. There is some coarse calcification associated with the rim of this nodule, but there is also clear comet tail artifact. Smaller colloid nodules are identified as well as.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: The patient complained of an enlarging nodular density slightly to the right at the base the neck. Scanning demonstrates this to be an asymmetric clavicular head. There is, however, suggestion of a rounded nodular density more caudally and at midline which cannot be adequately visualized. If further information is needed, recommend CT of the neck.OTHER: No significant abnormality noted.", "output": "Bilateral thyroid nodules which are mixed cystic and solid, are similar in size to prior study, most low suspicion. However, a single right superior thyroid nodule previously spongiform, now appears more solid.See above discussion of rounded nodular density in the substernal region.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "65 year-old female with hepatitis C, assess for HCC. LIVER: Mildly echogenic measuring 15.6 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: Gallbladder is normal in echogenicity. No gallbladder wall thickening. No pericholecystic fluid. Common duct measures 3 mm in caliber. No intra-or extrahepatic ability ductal location.PANCREAS: Pancreas is not well seen due to overlying bowel gas.RIGHT KIDNEY: Measures 10.6 cm in length. There is mild pelvocaliectasis. No shadowing calculi are noted.OTHER: Left kidney measures 10.7 cm in length. No hydronephrosis or shadowing calculi are noted.Normal echogenicity of the spleen measuring 10.4 cm in length.", "output": "1. Mildly echogenic liver parenchyma suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesion.2. Nonspecific right mild pelvocaliectasis."}
{"instruction": "Generate impression based on findings.", "input": "23-year-old female with history of thyroid cancer status post thyroidectomy and iodine-131 ablation. Thyroid measurements are not obtained as this patient is status post thyroidectomy.RIGHT THYROID BED: There are 2 hypoechoic nodules seen in the right thyroid bed. The first is located inferiorly and measures 0.3 cm x 0.3 cm x 0.4 cm. The second is also located at the inferior portion measuring 0.8 cm x 0.5 cm x 0.4 cm. Both of these nodules were identified on the prior study and appear stable in size.LEFT THYROID BED: There is a hypoechoic nodule seen in the left thyroid bed inferiorly. This measures 1.2 cm x 0.6 cm x 0.7 cm. This was seen on prior ultrasound and appears stable in size.PARATHYROID GLANDS: Not visualized on this study.RIGHT LYMPH NODES: There is a level 2 lymph node identified measuring 0.7 cm x 0.8 cm x 1.7 cm. This is hypoechoic and has a fatty hilum. There is also a level 3 lymph node measuring 0.3 cm x 0.5 cm x 1.4 cm. This is slender and hypoechoic.LEFT LYMPH NODES: No suspicious adenopathy seen.", "output": "Previously seen hypoechoic nodules in the thyroidectomy bed are stable in appearance from prior ultrasound. No suspicious adenopathy is identified."}
{"instruction": "Generate impression based on findings.", "input": "The lung cancer status post surgery and tracheostomy. Localized swelling. There is marked soft tissue edema with hypervascularity along the anterior neck at midline. No fluid collection to suggest abscess is seen.", "output": "Soft tissue edema without abscess."}
{"instruction": "Generate impression based on findings.", "input": "24 year old female with right upper quadrant pain, nausea, emesis. Evaluate for GI pathology. LIVER: Heterogeneous echotexture of the liver measuring 16.3 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: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. Common bile duct measures 4 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Not well-visualized.RIGHT KIDNEY: Measures 11.8 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 11.9 cm in length. No hydronephrosis or shadowing calculi are noted.Spleen measures 10.8 cm in length.", "output": "1. Heterogeneous echotexture of the liver suggestive of parenchymal dysfunction/fatty infiltration. 2. No evidence of cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with recent pancreatitis and elevated LFTs. LIVER: The liver measures 17.2 cm. Parenchyma is mildly echogenic, compatible with fatty infiltration. The main portal vein is patent and exhibits hepatopedal flow with velocity of 0.2 m/s. No suspicious hepatic lesions or biliary ductal dilatation.GALLBLADDER, BILIARY TRACT: No shadowing gallstones or sonographic evidence of cholecystitis.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Right kidney measures 11.2 cm. Increased cortical echogenicity is suggestive of medical renal disease. Right renal midpole cyst measures 1.4 x 1.6 x 1.2 cm. No hydronephrosis.OTHER: The spleen measures 12.2 cm and is within normal limits. The left kidney measures 10.0 cm. Increased cortical echogenicity is suggestive of medical renal disease. Midpole cyst measures 1.8 x 1.4 x 1.4 cm. No hydronephrosis. No ascites.", "output": "1.Findings compatible with fatty liver infiltration. 2.Echogenic renal cortices, consistent with medical renal disease. No hydronephrosis. "}
{"instruction": "Generate impression based on findings.", "input": "Subclinical hypothyroidism RIGHT LOBE MEASUREMENTS: 1.2 x 2.7 x 2 cm. Right thyroid volume is 3 mLLEFT LOBE MEASUREMENTS: No significant abnormality noted.ISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: Multiple solid thyroid nodules identified within the mid and inferior pole, largest thyroid nodule measures 6.9 x 1.3 x 0.9 cm with multiple hyperechoic foci most likely colloid nodules.LEFT LOBE: Status post thyroidectomyISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple right thyroid nodules most likely colloid in nature. Follow-up ultrasound is recommended in 6 months to confirm stability."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old male patient with HCV, cirrhosis. Evaluate for HCC. LIVER: The liver measures 19 cm in length and demonstrates increased, coarsened echogenicity. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.4 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. There is no intrahepatic biliary ductal dilatation. The common duct measures 10 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 10.2 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 12.7 cm in length. No evidence of hydronephrosis.The spleen measures 19.3 cm in length.", "output": "1. Increased, coarsened hepatic echogenicity consistent with chronic liver disease.2. Hepatomegaly without focal lesion."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess for thyroid nodules History: asymmetric thyroid on clinical exam RIGHT LOBE MEASUREMENTS: 1.8 x 1.8 x 6.7 cmLEFT LOBE MEASUREMENTS: 1.7 x 1.5 x 5.5 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Hypoechoic, predominantly cystic nodule in the mid right thyroid measures 1.0 x 0.5 x 1.1 cm. A hyperechoic focus in the inferior right thyroid measures 0.5 x 0.2 x 0.6 cm, likely a focal calcification.LEFT LOBE: A hypoechoic, predominantly cystic nodule in the mid left thyroid measures 0.6 x 0.4 x 0.4 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Multiple predominantly cystic thyroid nodules, probably benign."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female with abdominal pain, question of common bile duct dilation on CT. LIVER: Measures 20.0 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: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "1. Hepatomegaly with increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease, without discrete focal lesion. 2. No evidence of intrahepatic or extrahepatic biliary ductal dilation."}
{"instruction": "Generate impression based on findings.", "input": "History of right lower extremity swelling and pain. Limited evaluation of the right knee infrapatellar region demonstrates significant subcutaneous soft tissue edema. Deep to the patellar tendon and there is a poorly defined hypoechoic avascular focus, suspicious for a small fluid collection. There is surrounding soft tissue hyperemia.", "output": "Evidence of cellulitis and small fluid collection deep to the distal patellar tendon with surrounding hyperemia, appearance suspicious for a small abscess. Clinical correlation and additional imaging should be considered."}
{"instruction": "Generate impression based on findings.", "input": "36 year old female with fibrolamellar HCC. Evaluate for ascites prior to paracentesis. Mild/moderate ascites noted within the abdomen and pelvis with extensive bowel.", "output": "Mild/moderate ascites without large, focal pocket."}
{"instruction": "Generate impression based on findings.", "input": "49 year old female with history of MRSA spinal abscess and worsening LFTs. LIVER: Mildly coarse and increased echogenicity of the liver measuring 13.6 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: Minimal sludge in the gallbladder. No cholelithiasis. No pericholecystic fluid. No gallbladder wall thickening. Common bile duct measures 3 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas is unremarkable.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 10.3 cm in length. 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.Normal echogenicity of the spleen measuring 8.1 cm in length.", "output": "1. Mild coarse and increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration.2. Sludge within the gallbladder, no cholelithiasis or evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male with a history of hepatitis C presenting for HCC screening. LIVER: The liver capsule is relatively smooth. The parenchyma is coarse in echotexture. No focal hepatic lesion or intrahepatic biliary ductal dilatation. Normal hepatopetal portal venous blood flow at 30 cm/sec.GALLBLADDER, BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common bile duct measuring 2 mm at the pancreatic head. Normally distended gallbladder without wall thickening, pericholecystic fluid, or focal tenderness. Cholelithiasis. 6-mm gallbladder polyp.PANCREAS: The visualized pancreatic body and head are normal in appearance.RIGHT KIDNEY: The right kidney is normal in size, measuring 11.5 cm without hydronephrosis or shadowing nephrolithiasis. There is a 10 mm inferior pole probable cyst.OTHER: The spleen is normal in size, measuring 10.5 cm. The left kidney is normal in size, measuring 12.3 cm, without hydronephrosis, shadowing nephrolithiasis, or discrete lesion evident.", "output": "1. Coarse hepatic echotexture compatible with parenchymal disease without a focal lesion identified.2. Cholelithiasis without evidence of acute cholecystitis.3. 6-mm gallbladder polyp."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain and abnormal LFTs LIVER: No significant abnormalities noted. 17.9 cm in lengthGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 13 cm in lengthOTHER: Left kidney 11.9 cm in length. Spleen 8 cm in length. No ascites", "output": "Cholelithiasis without acute inflammation or ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old male with chronic mild elevated ALT. Evaluate for NASH versus inflammation/scarring. LIVER: Measures 16.1 cm in length and is diffusely increased in echogenicity suggestive of fatty infiltration.BILIARY TRACT: Gallbladder is normal in echogenicity. No gallbladder wall thickening. No pericholecystic fluid. No gallbladder wall thickening. 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.SPLEEN: Measures 14.5 cm in length, upper limits of normal, and is normal in echogenicity.RIGHT KIDNEY: The right kidney measures 10.7 cm in length and is normal in echogenicity with no evidence of hydronephrosis. OTHER: Left kidney measures 11.3 cm in length and is normal in echogenicity with no evidence of hydronephrosis.", "output": "Findings suggestive of hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "Male; 67 years old. Reason: Does this patient have hepatosplenomegaly and ascites? History: 67 year old man with insulin dependent diabetes mellitus and recent 20 pound weight loss. History of hepatitis about 30 years ago. Evaluate liver and spleen. LIVER: The liver measures 13.0 cm in length. The liver contour is smooth. The liver parenchyma is coarse and echogenic. Within the left lobe of the liver, adjacent to the gallbladder fossa is an ill-defined hypoechoic area with increased vascularity on color Doppler. There is no ascites.The main portal vein is patent with a peak velocity of 0.31 m/sec.BILIARY TRACT: A large, non-mobile mass (4.8 x 1.9 cm) with internal vascularity occupies much of the gallbladder lumen. This mass is inseparable from the hypoechoic hepatic lesion described above. The common duct measures 5 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 13.4 cm in length and contains a 2.4 x 2.1 x 2.4 cm hypodense lesion.RIGHT KIDNEY: The right kidney measures local 11.2 cm in length. The cortex is normal in echogenicity. There is no hydronephrosis, shadowing renal stone, or worrisome mass identified. OTHER: The left kidney measures 11.3 cm in length. The cortex is normal in echogenicity. At least two simple cysts are seen within the kidney. The cyst in the upper pole measures 2.7 x 1.7 x 2.1 cm, the lower pole cyst measures 1.8 x 1.6 x 1.9 cm. There is no hydronephrosis, shadowing renal stone, or worrisome mass identified.", "output": "1.Large, nonmobile, vascular mass occupying much of the gallbladder lumen inseparable from hypoechoic adjacent liver lesion. These findings are concerning for gallbladder carcinoma with possible hepatic invasion. Follow up with cross-sectional imaging is recommended.2.Mild splenomegaly with indeterminate 2.4 cm hypodense splenic lesion. 3.Coarse, echogenic liver compatible with hepatic steatosis.These findings were discussed by telephone with Dr. Rogers on 2/18/2015 at 12:00 pmI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Hyperthyroidism RIGHT LOBE MEASUREMENTS: 1.9 x 1.6 x 5 cm. LEFT LOBE MEASUREMENTS: 1.8 x 1.3 x 4.7 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Diffusely heterogeneous gland without increased vascularity. 0.4 x 0.2 x 0.3 cm lower pole hypoechoic focus; favor benign etiology.LEFT LOBE: Diffusely heterogeneous gland without mass. No increased vascularity.ISTHMUS: Diffusely heterogeneous gland without mass. No increased vascularity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland without increased vascularity. Subcentimeter benign-appearing right thyroid hypoechoic focus. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: No significant abnormalities noted. Liver length 12.4 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Right renal cyst. Right kidney 10 cm in lengthOTHER: Left kidney 11.2 cm in length. Spleen 9.2 cm in length. No ascites.", "output": "Negative right upper quadrant ultrasound. No hepatobiliary abnormality. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Increasing bilirubin LIVER: Mildly heterogeneous liver echotexture without mass. Liver length 18 cm.GALLBLADDER, BILIARY TRACT: Gallbladder wall thickening which is a nonspecific sign in the context of ascites.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10 cm in length OTHER: Left kidney 9.6 cm in length. Spleen 13.7 cm in length. Mild ascites.", "output": "Mildly heterogeneous liver echotexture suggestive for parenchymal dysfunction/fatty infiltration without mass or ductal dilatation. Nonspecific gallbladder wall thickening in the context of mild ascites."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old male with nodular liver concerning for cirrhosis. History of right upper quadrant pain. LIVER: Measures 15.0 in length. Cirrhotic morphology with increased hepatic echogenicity but no discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Cholelithiasis with gallbladder wall thickening. Choledocholithiasis better appreciated on recent MRCP examination. Dilation of the common bile duct to 0.8 cm.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: 1.2 cm right renal cyst without septation or solid component. No hydronephrosis, nephrolithiasis, or solid mass. OTHER: Small pleural effusions.", "output": "1. Cirrhotic liver morphology with increased echogenicity consistent with chronic liver disease.2. Cholelithiasis and gallbladder wall thickening with common bile duct dilation. Choledocholithiasis is better appreciated on recent MRCP examination.3. Small pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Positive ANA and persistent transaminitis LIVER: Markedly coarse echogenic liver echotexture without mass. Liver length 17.3 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 7.9 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 9.8 cm in lengthOTHER: Left kidney 10.4 cm in length. No ascites.", "output": "Markedly coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female with lump in the right breast. Three standard views of the right breast with spot compression 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 palpable marker is placed over an asymmetry in the right breast which persists with spot compression, for which ultrasound was subsequently performed.ULTRASOUND", "output": "Circumscribed mass in the right breast is most consistent with a benign fibroadenoma. A six-month follow-up ultrasound examination 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": "67 year old female with history of thyroid cancer status post surgery, I-131. Evaluate for abnormal masses/nodes. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: No evidence of nodules masses in the thyroidectomy bed.LEFT LOBE: No evidence of nodules masses in the thyroidectomy bed.ISTHMUS: No evidence of nodules masses in the thyroidectomy bed.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Bilateral neck benign appearing lymph nodes, for example in the left neck a lymph node measures 5 mm x 4 mm x 9 mm.OTHER: No significant abnormality noted.", "output": "No evidence of residual or recurrent disease in the thyroidectomy bed. "}
{"instruction": "Generate impression based on findings.", "input": "51 year old female epigastric pain after eating. LIVER: The liver measures 17 cm in length and has increased echogenicity. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/s.GALLBLADDER, BILIARY TRACT: There are no gallstones, pericholecystic fluid, or gallbladder wall thickening. There is no intra or extrahepatic biliary ductal dilatation. The common bile duct measures 4 mm in diameter. Sonographic Murphy's sign is negative.PANCREAS: The visualized proximal pancreas is normal in 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 9.9 cm in length. No evidence of hydronephrosis.", "output": "1. Increased hepatic echogenicity consistent with hepatic steatosis.2. No cholelithiasis. "}
{"instruction": "Generate impression based on findings.", "input": "Female; 43 years old. Reason: large gallstone on bedside US, eval for acute cholecystitis History: RUQ abdominal pain LIVER: The liver measures 18.2 cm in length. Liver contour is smooth. The parenchyma demonstrates a coarsened echotexture. No worrisome hepatic mass is identified. There is no ascites.The main portal vein is patent with hepatopetal flow and a peak velocity of 0.27 m/sec.BILIARY TRACT: Gallbladder is not distended. There is a 2 x 3 cm shadowing stone within the body of the gallbladder. The gallbladder wall is thickened measuring 6 mm. There is no pericholecystic fluid. Sonographic Murphy's sign was not elicited. The common duct measures 3 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreas is not well visualized due to overlying bowel gas.SPLEEN: The spleen measures 7.9 cm in length.RIGHT KIDNEY: Right kidney measures 10.5 cm in length. The cortex is normal in echogenicity. There is no hydronephrosis, shadowing renal stone, or worrisome mass identified. OTHER: The left kidney measures 10.1 cm in length. The cortex is normal in echogenicity. There is no hydronephrosis, shadowing renal stone, or worrisome mass identified.", "output": "Cholelithiasis without acute inflammation or ductal dilatation. Coarsened echogenic liver parenchyma suggestive for fatty infiltration/parenchymal dysfunction without mass. No ascites.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Female 63 years old Reason: history of thyroid cancer s/p total thyroidectomy and RAI with previous left level III lymph node measuring 4 mm History: history of thyroid cancer s/p total thyroidectomy and RAI with previous left level III lymph node measuring 4 mm MEASUREMENTS: Patient is status post thyroidectomy.RIGHT LOBE: No residual or recurrent thyroid nodulesLEFT LOBE: No residual or recurrent thyroid nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Hypoechoic left level 2 nodule with internal echogenicity, possibly representing a small lymph node measures 2 x 2 x 3 mm. Unchanged left level 3 node measures 3 x 3 x 4 mm with internal echogenicity, possibly presenting calcifications remain suspicious.OTHER: No significant abnormality noted.", "output": "Unchanged left level 3 lymph node with suspicious features, recommend continued interval follow-up. Newly measured left level 2 nodule, possibly representing a small lymph node."}
{"instruction": "Generate impression based on findings.", "input": "Male; 71 years old. Reason: assess for AAA History: ex smoker Aortic measurements are as follows:Proximal aorta: 2.8 x 2.3 x 2.4 cm.Mid aorta: 2.1 x 2.1 x 2.1 cm.Distal aorta: 1.7 x 2.0 x 1.7 cm.Right common iliac artery 0.9 cm.Left common iliac artery 1.1 cm. In", "output": "Normal caliber of the aorta without evidence of aneurysm."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old female patient with right upper quadrant pain worse after eating. Question of cholecystitis. LIVER: The liver measures 22.1 cm in length and demonstrates mildly increased parenchymal echogenicity. No focal hepatic lesion is identified. Main portal vein is patent with hepatopetal flow.BILIARY TRACT: There is no intra or extrahepatic biliary ductal dilatation. The common bile duct is nondilated measuring 3 mm in diameter. No gallstones, pericholecystic fluid, or gallbladder wall thickening.PANCREAS: The body and tail of the pancreas is obscured by overlying bowel gas.SPLEEN: The spleen measures 11.6 cm in length.RIGHT KIDNEY: The right kidney measures 10.2 cm in length. No evidence hydronephrosis. There is a subcentimeter right renal cyst. OTHER: The left kidney measures 10.4 cm in length. No evidence hydronephrosis.", "output": "1. No sonographic evidence of acute cholecystitis.2. Increased hepatic parenchymal echogenicity suggestive of hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules RIGHT LOBE MEASUREMENTS: 6.7 x 3.3 x 3.7 cmLEFT LOBE MEASUREMENTS: 4.6 x 2.2 x 1.5 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: No significant change in right lobe cystic and spongiform nodules. Mid gland cystic focus measures 1.3 x 0.8 x 1.4 cm. Spongiform lower pole nodule measures 4.9 x 2 x 3.5 cm.LEFT LOBE: No significant change in left lobe cystic and spongiform nodules. A representative lower pole spongiform nodule measures 1.7 x 1.2 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": "Stable right lateral benign-appearing cystic and spongiform nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old with history of excisional biopsy of papilloma in the right breast in 2010. BILATERAL DIGITAL DIAGNOSTIC MAMMOGRAPHY: Three standard views of both breasts and 2 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. Stable postsurgical changes in the right retroareolar region. There are 3 new clustered asymmetries in the left upper outer quadrant, which persist on spot compression. No suspicious microcalcifications in either breast. TARGETED LEFT BREAST ULTRASOUND: Targeted left upper outer quadrant ultrasound demonstrated a cluster of circumscribed anechoic to hypoechoic foci measuring up to 7 x 5 x 5 mm without internal vascularity; findings compatible with multiple simple cysts.", "output": "Findings consistent with left upper outer quadrant multiple simple cysts. 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": "79 years old, Female, Reason: NASH evaluate for HCC History: NASH LIVER: The liver measures 12 cm in length. Increased hepatic echogenicity is consistent with fatty infiltration. 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. Anechoic subcentimeter focus in the right hepatic lobe likely representing a cyst is not significantly in size measuring 0.8 x 0.9 x 1.1 cm.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 5.4 cm in length. RIGHT KIDNEY: Kidney measures 10.1 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 9.6 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Increased hepatic echogenicity with unchanged anechoic focus favored to represent a cyst.2.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Normal echogenicity without mass. Liver length 12.6 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10 cm in lengthOTHER: Left kidney 10.8 cm in length. Spleen 7.3 cm in length. No ascites", "output": "Negative right upper quadrant ultrasound. No hepatobiliary abnormality."}
{"instruction": "Generate impression based on findings.", "input": "47 year old female with acute on chronic kidney disease. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 9.9 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. The renal cortex is moderately hyperechogenic. Color Doppler demonstrates hilar blood flow.LEFT KIDNEY: The left kidney measures 10.3 cm in length without hydronephrosis or shadowing calculus. Note is made of a 1.3-cm superior pole near anechoic lesion, probably a benign cyst. The renal cortex is moderately hyperechogenic. Color Doppler demonstrates hilar blood flow.URINARY BLADDER: The urinary bladder is normally distended with anechoic urine.", "output": "No hydronephrosis. Findings compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old male with hypercalcemia. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.9 x 2.1 x 2.2 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.4 x 2.3 x 2.3 cm.ISTHMUS MEASUREMENTS: The thyroid isthmus measures 0.3 cm in thickness.RIGHT LOBE: Subcentimeter hypoechoic foci with the largest measuring 0.5 x 0.4 x 0.5 cm.LEFT LOBE: Subcentimeter hypoechoic foci. The largest measures 0.4 x 0.3 x 0.5 cm and has a spongiform appearance.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No parathyroid candidates appreciated."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old female with chronic kidney disease Ultrasound guidance was provided for biopsy of right kidney.", "output": "Ultrasound guidance."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Haberlin is a 55 year old female with known left breast malignancy, currently on Letrozole therapy. She presents today for ultrasound evaluation to assess for therapy response. A targeted left ultrasound was performed in the region of known malignancy. In the left breast 1:00 position, approximately 9 cm from the nipple, is an irregular, hypoechoic mass which measures 1.2 x 1.0 x 1.2 cm, previously 2.5 x 1.8 x 1.3 cm on the outside prior dated 05/05/16. The clip is well visualized within the mass.", "output": "Slight interval decrease in size of known malignancy in the left breast at the 1:00 position.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "27-year-old female with chronic nausea/vomiting and elevated alkaline phosphatase. LIVER: Measures 19.1 in length. Markedly increased hepatic echogenicity without discrete focal lesion. Mild intrahepatic biliary ductal dilation. Patent portal vein with antegrade flow. BILIARY TRACT: No cholelithiasis. No gallbladder wall thickening, pericholecystic fluid, or extrahepatic 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: Markedly increased renal echogenicity and atrophy. No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "1.Markedly increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease. Mild intrahepatic biliary ductal dilation. Mild hepatomegaly.2.Atrophic kidneys with markedly increased renal echogenicity consistent with chronic kidney disease."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid carcinoma status post thyroidectomy 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": "Elevated LFTs LIVER: Coarse echogenic liver echotexture without mass. Liver length 21.3 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.1 cm in lengthOTHER: Left kidney 11.1 cm in length. Spleen 11.9 cm in length. No ascites", "output": "Moderate hepatomegaly with coarse echogenic liver echotexture consistent with fatty infiltration/parenchymal dysfunction without mass or duct dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "History of regional enteritis with abnormal liver enzymes LIVER: Mildly coarse and echogenic liver parenchyma without mass. Liver length 16.5 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.7 cm in lengthOTHER: Left kidney 12.3 cm in length. Spleen 9.3 cm in length. No ascites.", "output": "Mildly coarse and echogenic parenchyma raises the possibility of fatty infiltration/parenchyma dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "26 year old female with history of renal stone. RIGHT KIDNEY: The right kidney measures 10.3 cm, and has mild hydronephrosis. Multiple small right renal stones are seen, the largest of which measures approximately 6 mm in diameter.LEFT KIDNEY: The left kidney measures 10.2 cm, and also has mild hydronephrosis. Multiple small left renal stones are seen.OTHER: Incidentally noted right adnexal physiologic cyst.", "output": "Bilateral mild hydronephrosis, with small renal stones."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female has SIRS and positive Murphy sign. Evaluate for hepatobiliary pathology. LIVER:The liver measures 26 cm in length. There is coarse, increased, and heterogeneous echotexture of the parenchyma. There is a 1.5 x 1.1 x 1.2 cm round anechoic lesion in segment 3 of the liver that is consistent with a simple cyst. No masses or ascites. No intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended without evidence of sludge or stones. The gallbladder wall measures 0.2 cm. No pericholecystic fluid. The common bile duct measures 0.7 cm. Negative sonographic Murphy's sign.PANCREAS: Evaluation is limited due to overlying bowel gas, however the visualized portions appear normal.SPLEEN: The spleen measures 18.0 cm. Otherwise, no abnormalities noted.KIDNEYS: Left kidney measures 12.9 cm. The cortex has normal echogenicity. No shadowing calculi are seen. No hydronephrosis noted. Right kidney measures 13.0 cm. The cortex has normal echogenicity. No shadowing calculi are seen. No hydronephrosis noted. ABDOMINAL AORTA: Patent without aneurysm.INFERIOR VENA CAVA: Patent without thrombus.OTHER: No significant abnormality noted.", "output": "1. Coarse, increased, and heterogeneous echotexture of the liver consistent with chronic liver disease/parenchymal dysfunction.2. Hepatosplenomegaly.3. No sonographic evidence of gallbladder pathology."}
{"instruction": "Generate impression based on findings.", "input": "65 years old female presenting for annual mammogram, with a personal history of suspected right breast injury from a recent car accident several months ago. The patient reports that her bruise and pain in the right breast have significantly improved since the injury and presents for follow-up. On physical exam, there is no discrete palpable abnormality.A targeted right ultrasound was performed for the patient\u2019s area of concern. The heterogeneous avascular mixed echogenicity area previously seen in the right breast o'clock position 1 cm from nipple measures 1.0 x 0.8 x 1.6 cm, significantly decreased in size since ultrasound 10/21/2015 when it measured 3.9 x 2.5 x 3.0 cm. Findings are consistent with a resolving hematoma/fat necrosis.", "output": "Resolving hematoma/fat necrosis. As long as the patient's physical examination demonstrates continued decrease in size of the clinical area of concern, return to annual screening mammogram is recommended. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Ms. ZELLA HARRIS is a 46 years old female who presents for further evaluation for masses seen in both breasts on screening mammogram. DIAGNOSTIC MAMMOGRAM FOR BILATERAL BREAST:ML and spot compression views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. There is well defined 28 mm mass with a few calcification in the upper outer right breast. There is a 16 mm mass in the posterior left upper outer breast. In addition, another 1.2 cm lobulated mass is noted anterior to 16 mm mass in the left upper outer breast. TARGETED ULTRASOUND OF BOTH BREASTS:Targeted ultrasound of both breasts were performed at the sites of mammographic concerns. In the right breast, 11:00, 12 cm from the nipple, there is a 16 x 16 x 21 mm well-circumscribed hypoechoic mass with internal flow and a few echogenic calcifications. This likely represents a fibroadenoma.In the left breast, 11:00 location, 12 cm from the nipple, there is a 10 x 6 x 10 mm slightly hypoechoic mass parallel to the skin, which correlates with the mammographic finding in the posterior left upper outer breast. The anterior mass in the left upper outer breast found on the mammogram is not seen on the ultrasound.", "output": "Probably benign findings in both breasts as described above. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended in 6 months. 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": "45-year-old male with history of thyroid cancer and resection of previous abnormal nodes. Evaluate.Review of pathology report dated 7/16/2014, patient with interval lymph node dissection with evidence of metastatic papillary thyroid cancer in the left lymph node dissection. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right: There is a benign appearing level 2/3 lymph node measuring 2.7 x 1.2 x 0.4 cm.Left: At the inferior aspect of the left thyroid bed, there is a round hypoechoic focus measuring 1.1 x 0.8 x 0.8 cm with suggestion of fatty hilum; however, the cortex is abnormally thickened.There is benign appearing left level 2/3 lymph node measuring 2.4 x 1.1 x 0.6 cm.OTHER: No significant abnormality noted.", "output": "Round hypoechoic focus at the inferior aspect of left thyroid bed with suggestion of a fatty hilum but thickened cortex. In light of history of interval resection with tumor positive lymph nodes, this is worrisome for additional tumor."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female patient with right substernal goiter. Assess for thyroid nodules in both lobes. RIGHT LOBE MEASUREMENTS: 9.0 x 3.2 x 3.0 cm.LEFT LOBE MEASUREMENTS: 4.0 x 1.6 x 2.0 cmISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: The right thyroid lobe contains a 3.5 x 3.2 x 6.1 cm complex, hypoechoic nodule with internal coarse echogenic foci.LEFT LOBE: The left thyroid lobe is heterogeneous in echogenicity with a more nodular focus of heterogeneity within the inferior pole measuring 1.7 x 1.1 x 1.3 cm. Additional, subcentimeter nodules are 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": "Dominant bilateral thyroid nodules; these were subsequently biopsied per service request. "}
{"instruction": "Generate impression based on findings.", "input": "67 years old, Male, Reason: Abnormal masses or nodes? History: Thyroid cancer s/p surgery and I131 MEASUREMENTS: Patient status post thyroidectomyRIGHT LOBE AREA: No significant abnormality noted. No evidence of local recurrence.LEFT LOBE AREA: No significant abnormality noted. No evidence of local recurrence.ISTHMUS AREA: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No evidence of lymphadenopathy.OTHER: No significant abnormality noted.", "output": "No evidence of local recurrence or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for whole breast ultrasound for dense breast screening. Personal history of benign left breast biopsy in 1992. 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 on the provided images. However, due to a technical error, two columns of images located just lateral to the left nipple were inadvertently not saved. Therefore the patient will need to return for repeat ultrasound. Exam was double read by two attending breast radiologists.", "output": "Technical repeat needed due to missing automated images of the left breast. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: R - Technical Repeat Views."}
{"instruction": "Generate impression based on findings.", "input": "Male 62 years old; Reason: HCC surveillance History: HCV cirrhosis LIVER: The liver measures 14.1 cm in length. There is coarse and increased echogenicity of the liver parenchyma. The liver appears nodular. No focal hepatic lesions are seen. On prior CT multiple subcentimeter hypodensities were present throughout the liver, however these were not seen on this ultrasound. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 14.8 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is surgically absent. The common bile duct measures 2.5 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.3 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 9.1 cm in length. The cortex hasnormal 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.", "output": "The liver is nodular with coarse increased echogenicity compatible with cirrhotic morphology. No ascites is seen. No new worrisome masses. Subcentimeter hypodensities within the liver seen on prior CT were not visualized on this study."}
{"instruction": "Generate impression based on findings.", "input": "Palpable right scrotal mass RIGHT TESTIS: 2.9 x 1.9 x 4 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristics.LEFT TESTIS: 3.9 x 1.8 x 3 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristicsRIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: 0.8 x 0.6 x 0.6 cm left epididymal cyst/spermatoceleOTHER: No significant abnormalities noted.", "output": "No intratesticular mass, acute inflammation, or torsion. Subcentimeter left epididymal cyst/spermatocele."}
{"instruction": "Generate impression based on findings.", "input": "HBV LIVER: Coarse echogenic liver again noted without mass. Liver length 13.1 cm.GALLBLADDER, BILIARY TRACT: Adenomyomatosis again noted without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Stable subcentimeter upper pole echogenic focus; favor benign etiology. Right kidney 9.9 cm in length.OTHER: Left kidney 9.8 cm in length. Spleen 8.6 cm in length. No ascites.", "output": "Stable coarse echogenic liver consistent with chronic liver disease without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old female with elevated creatinine. Liver transplant patient. RIGHT KIDNEY: Right kidney measures 8 cm in length. Echotexture appears normal. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Left kidney measures 7.1 cm in length. Echotexture appears normal. No hydronephrosis, shadowing calculus or mass.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Relatively small kidneys. Otherwise, normal exam."}
{"instruction": "Generate impression based on findings.", "input": "history of obesity presents for evaluation of hepatic steatosis. LIVER:Measures 13.6 cm. Minimally increased echogenicity of the parenchyma. No intrahepatic biliary dilation, ascites, focal mass. The portal vein is patent.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. Wall measures 0.2 cm. No pericholecystic fluid, stones, or sludge. Common bile duct measures 0.3 cm.PANCREAS: Evaluation the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 9.6 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 8.3 cm. Left kidney measures 8.6 cm. Normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "Mild fatty infiltration of the liver."}
{"instruction": "Generate impression based on findings.", "input": "History thyroid cancer 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 mass or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "80-year-old male with elevated creatinine. Rule out hydronephrosis. RIGHT KIDNEY: Measures 9.7 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. Right renal cysts measuring up to 1.4 cm without septation or solid component.LEFT KIDNEY: Measures 9.4 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. Left renal cysts measuring up to 1.2 cm without septation or nodular component.URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: Enlarged prostate measures 4.9 x 4.4 x 4.1 cm.", "output": "1. Increased renal echogenicity consistent with medical renal disease. 2. No nephrolithiasis, hydronephrosis, or suspicious mass.3. Enlarged prostate."}
{"instruction": "Generate impression based on findings.", "input": "Cardiac cirrhosis. Ascites, liver failure and dialysis. LIVER: The liver is nodular in contour and coarse in echogenicity compatible with cirrhosis. No suspicious lesion is evident. The hepatic veins are enlarged compatible with elevated right-sided heart pressure. The liver measures 16.8 cm in length. Pulsatile hepatopedal portal venous blood flow is noted with a PSV of 0.4 m/s. Perihepatic ascites.BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilatation with the common duct measuring 6 mm. Normally distended gallbladder without significant gallbladder wall thickening. Echogenic shadowing focus is most compatible with a gallstone.PANCREAS: Suboptimal visualization of the pancreatic head is unremarkable.SPLEEN: The spleen measures 13 cm without a focal lesion.RIGHT KIDNEY: The right kidney is atrophic and echogenic measuring 8.8 cm in length without hydronephrosis. OTHER: The left kidney is atrophic and echogenic measuring 9.7 cm in length without hydronephrosis. There is a superior pole 1.4 cm simple cyst.Moderate volume ascites.", "output": "1. Cirrhosis without focal liver lesion or biliary ductal dilatation. Moderate volume ascites.2. Cholelithiasis without cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "18 years old, Female, Reason: fluid retention, AKI History: fluid retention, AKI, bilateral back pain RIGHT KIDNEY: Kidney measures 11.7 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. No evidence of hydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 12.8 cm in length. Increased echogenicity of kidneys consistent medical renal disease. No evidence of hydronephrosis or shadowing calculus.BLADDER: The bladder is not completely distended.OTHER: There is a small amount of free fluid in the pelvis, most likely physiologic given the patient's age.", "output": "1.Increased echogenicity of the kidneys consistent with medical renal disease without evidence of hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female with chronic left flank pain. RIGHT KIDNEY: Kidney measures 12.4 cm in length. The renal cortex is of normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.6 cm in length. The renal cortex is of normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: The bladder is visualized with no significant abnormalities noted. Limited views of the liver show possible increase in echogenicity.", "output": "1. Bilaterally negative renal ultrasound. No hydronephrosis, stones, or worrisome masses are seen.2. Limited views of the liver show increased echogenicity which may suggest fatty infiltration/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Reason: ventral hernia History: bloating, pain, nausea The examination is mildly limited by patient body habitus. No hernias or abnormal fluid collections are identified within the visualized anterior abdominal wall.", "output": "Limited exam. No hernia or fascial defect identified. Dedicated cross-sectional imaging can be considered as clinical warranted."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old female patient with bacteremia. Evaluate for abdominal abscess or cholecystitis. LIVER: The liver measures 16.8 cm in length. No focal hepatic lesion is identified. Hepatic parenchymal echogenicity is increased. Main portal vein flow is hepatopetal and measures 0.1 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 bile duct measures 2 mm in diameter.PANCREAS: The imaged portion of the pancreatic head is hypoechoic in echogenicity. The remaining pancreas is not visualized secondary to overlying bowel gas.RIGHT KIDNEY: The right kidney measures 10.1 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.2 cm in length. No evidence of hydronephrosis.The spleen measures 8 cm in length.", "output": "1. No sonographic evidence of acute cholecystitis.2. Increased hepatic parenchymal echogenicity suggestive of hepatic steatosis.3. Hypoechoic pancreatic parenchyma which can be seen with inflammation; correlate with lipase levels."}
{"instruction": "Generate impression based on findings.", "input": "Pregnant patient with right upper quadrant pain LIVER: No significant abnormalities noted. 14.1 cm in lengthGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Minimal prominence of collecting system. No mass or stone. Right kidney 11.8 cm in length.OTHER: Left kidney 11.5 cm in length. Spleen 11.4 cm in length.", "output": "Negative right upper quadrant ultrasound. Specifically, no evidence for significant renal obstruction, acute inflammation, or stone. No hepatobiliary abnormality."}
{"instruction": "Generate impression based on findings.", "input": "61 years old, Female, Reason: eval for cholecystisis History: RUQ pain LIVER: The liver is enlarged measuring 18.6 cm in length. Mildly increased echogenicity of the liver is consistent with fatty infiltration.No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.5 m/s.BILIARY TRACT: The gallbladder is filled with sludge and stones. There is thickening of the gallbladder wall measuring up to 5 mm. Trace pericholecystic fluid is present. A stone is seen in the neck of the gallbladder which may be obstructing. The sonographic Murphy's sign is positive. The gallbladder itself is enlarged measuring up to 12.9 cm. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4.4 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 6.5 cm in length. RIGHT KIDNEY: Kidney measures 10.2 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 11.2 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Findings suggestive of acute cholecystitis in the appropriate clinical setting.These findings were discussed with ordering physician Dr. Turk at 11 a.m. who agreed patient should be sent to the emergency room. Discussed this with the patient who agreed to go straight to emergency room."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess for portal HTN and cirrhosis History: Lower GI bleed LIVER: The liver measures 11.1 cm in length and smooth in contour. The liver demonstrates increased parenchymal echogenicity with coarsened echotexture. Multiple cysts appearing similar to recent CT without suspicious hepatic lesions identified. The portal vein is patent demonstrating normal hepatopetal flow with velocity of 33 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 9.1 cm in length. RIGHT KIDNEY: Kidney measures 12.2 cm in length. Increased cortical echogenicity. No hydronephrosis. Multiple cysts, the largest of which measures 3.7 x 3.3 x 2.9 cm appearing similar to prior.LEFT KIDNEY: Kidney measures 11.9 cm in length. Increased cortical echogenicity. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Increased hepatic echogenicity suggestive of parenchymal dysfunction/fatty infiltration. No ascites. Patent portal vein.2.Increased renal echogenicity suggestive of medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old female with a history of thyroid cancer with indeterminate, possibly new node. Patient presents for 6 month follow-up examination RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: No suspicious lesions in the right thyroid bed.LEFT LOBE: No suspicious lesions in the left thyroid bedISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant interval change in benign-appearing right level 3 lymph node measuring 0.5 x 0.4 x 1.2 cm, previously measuring 0.6 x 0.1 x 2.1 cm.No significant interval change in left level 3 lymph node measuring 0.7 x 0.5 x 0.4 cm, previously measuring 0.7 x 0.5 x 0.3 cm.No significant interval change in the left level 4 lymph node measuring 1.4 x 0.5 x 0.2 cm, previously measuring 1.1 x 0.6 x 0.4 cm.OTHER: No significant abnormality noted.", "output": "Stable bilateral level 3 and left level 4 lymph nodes."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid fullness on exam RIGHT LOBE MEASUREMENTS: 6.1 x 1.2 x 2.2 cmLEFT LOBE MEASUREMENTS: 6.5 x 1.6 x 2.2 cmISTHMUS MEASUREMENTS: 0.5 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 size normal appearing thyroid without worrisome lesion. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "36 year old female at 22 weeks gestation presents for right breast ultrasound. Patient states she had warm, erythematous, and extremely tender right breast two weeks ago, which has somewhat resolved with warm compresses. Physician palpated right breast nodule. On physical examination, there is diffuse nodular pattern of glandular tissue appreciated, compatible with the patients gravid state. No discrete palpable mass is identified.A targeted right ultrasound was performed for the patient\u2019s area of concern. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy. If the patients physical examination remains normal, she should return for annual screening mammograms, beginning at age 40. Result and recommendations were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "75 years old, Female, Reason: Elevated LFTs History: nausea/vomiting Exam is significantly limited by patient's body habitus.LIVER: The liver measures 12 cm in length. The liver parenchymal echotexture is normal. 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 8.2 cm in length. RIGHT KIDNEY: Kidney measures 7.9 cm in length. No evidence of hydronephrosis.LEFT KIDNEY: Kidney measures 6.9 cm in length. No evidence of hydronephrosis.OTHER: Trace left pleural effusion.", "output": "1.Normal gallbladder and biliary tract with no evidence of cholelithiasis or acute cholecystitis.2.Hepatic parenchymal echotexture is within normal limits.3.Trace left pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "History of a multinodular goiter. According to the patient the patient had an indeterminate biopsy on the left. RIGHT LOBE MEASUREMENTS: 5.9 x 2.4 x 2.2 cm LEFT LOBE MEASUREMENTS: 4.7 x 1.2 x 1.9 cmISTHMUS MEASUREMENTS: 1.3 mmRIGHT LOBE: The right thyroid lobe is heterogeneous in echotexture and predominantly replaced with numerous nodules. The largest on the right measures 2.5 x 1.5 x 2.4 cm with well-defined margins, without microcalcifications or hypervascularity. It has features suggestive of a colloid nodule.LEFT LOBE: The left thyroid lobe is heterogeneous in echotexture with numerous nodules. The largest on the left measures 1.7 x 0.9 x 1.3 cm is well-defined, hypoechoic without microcalcifications. It has features suggestive of a colloid nodule.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 with dominant nodules as described above, with features favoring benign colloid nodules. No specific suspicious sonographic features."}
{"instruction": "Generate impression based on findings.", "input": "Thyrotoxicosis RIGHT LOBE MEASUREMENTS: 6 x 1.7 x 2.3 cmLEFT LOBE MEASUREMENTS: 6.2 x 2.3 x 2.4 cmISTHMUS MEASUREMENTS: 0.1 cmRIGHT LOBE: Diffusely heterogeneous gland without increased vascularity. Multiple subcentimeter hypoechoic nodules. A representative mid pole nodule measures 0.7 x 0.5 x 0.7 cm.LEFT LOBE: Diffusely heterogeneous gland without increased vascularity. Multiple subcentimeter hypoechoic nodules. A representative mid pole nodule measures 0.8 x 0.6 x 0.8 cm.ISTHMUS: Diffusely heterogeneous glandPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland. Multiple bilateral subcentimeter hypoechoic nodules; favor benign etiology. Findings raise the possibility of thyroiditis"}
{"instruction": "Generate impression based on findings.", "input": "History of right renal calculus. RIGHT KIDNEY: The right kidney measures 11.3 cm in length with minimal pelvicalyceal fullness and splaying, improved from the prior. No shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.LEFT KIDNEY: The left kidney measures 12.1 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.URINARY BLADDER: Normally distended urinary bladder. A right ureteral jet is noted.OTHER: No significant abnormalities noted.", "output": "Minimal pelvicalyceal fullness and splaying on the right, improved from the prior. No shadowing nephrolithiasis or discrete lesion."}
{"instruction": "Generate impression based on findings.", "input": "18-year-old male patient with heart transplant with a N/V/D. Evaluate for abscess, source of infection. LIVER: The liver measures 18.0 cm in length. No focal hepatic lesion is identified. Main portal vein flow is pulsatile, hepatopetal, and measures 0.3 m/sec. The hepatic veins are prominent.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 10.2 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.2 cm in length. No evidence of hydronephrosis.The spleen measures 13.3 cm in length. A 0.7 x 0.9 x 0.6 cm wedge-shaped subcapsular hypoechoic area within the spleen likely represents an evolving infarct.", "output": "1. No focal hepatic lesion or cholelithiasis.2. Wedge-shaped area of hypoattenuation in the spleen likely represents an evolving infarct."}
{"instruction": "Generate impression based on findings.", "input": "Reason: superficial mass measuring \\R\\3cm in widest diameter above umbilicus underneath skin. DD; lipoma, lymph node History: none There is a small outpouching in the supraumbilical anterior abdominal wall along the midline. This represents a small supraumbilical rectus sheath diastases and fat-containing hernia.", "output": "Small fat-containing supraumbilical hernia."}
{"instruction": "Generate impression based on findings.", "input": "Hemachromatosis LIVER: Coarse echogenic liver echotexture without mass. Liver length 17.9 cm GALLBLADDER, BILIARY TRACT: Gallbladder absent. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.7 cm in lengthOTHER: Left kidney 12.1 cm in length. Spleen 13.2 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture consistent with chronic liver disease without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female presents for ascites check. A large amount of ascites is present in all 4 quadrants.Liver with cirrhotic morphology and splenomegaly, incompletely assessed on this study.", "output": "1. Large amount of ascites in all 4 quadrants.2. Liver with cirrhotic morphology and splenomegaly as above."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old male with known renal mass, new acute kidney injury RIGHT KIDNEY: Measures 11.2 cm. Nephrolithiasis again noted in the right mid polar region. There is no hydronephrosis.LEFT KIDNEY: Measures 10.3 cm in length. An exophytic cystic lesion in the lateral midpole of the left kidney measures 1.7 x 1.2 x 1.0 cm without nodularity or septation, and does not appear significantly changed compared with the prior study from 12/20/2013. No hydronephrosis.OTHER: Increased hepatic echogenicity.", "output": "1.Left renal cyst without suspicious sonographic features or significant interval change since 2013.2.Nonobstructive right renal calculi.3.Increased hepatic echogenicity which may represent diffuse parenchymal disease or hepatic steatosis. "}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: No significant abnormalities noted. Liver length 14.6 cm GALLBLADDER, BILIARY TRACT: Cholelithiasis. Mild gallbladder wall thickening without positive Murphy's sign. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.6 cm in lengthOTHER: Left kidney 11.1 cm in length. Spleen 7.4 cm in length. No ascites", "output": "Cholelithiasis associated with mild gallbladder wall thickening without positive Murphy's sign or ductal dilatation. Mild chronic inflammation cannot be excluded. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "45 years old, Female, Reason: PBC evaluate for HCC History: PBC LIVER: The liver measures 19.0 cm in length. The liver parenchymal echotexture is normal. No focal hepatic lesion identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.3 m/s.BILIARY TRACT: Small gallbladder polyp is unchanged in size measuring 0.3 cm. 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 10.1 cm in length. RIGHT KIDNEY: Kidney measures 10.1 cm in length. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.6 cm in length. No evidence of hydronephrosis. There is a cyst in the left kidney measuring 1.7 x 1.7 x 2.4 cm. There is nonspecific peripheral echogenicity of this cyst which may be related to septation.", "output": "1.Unchanged small gallbladder polyp with no evidence of cholelithiasis or acute cholecystitis.2.The liver parenchymal echotexture is normal. No focal hepatic lesion identified. 3.Unchanged left renal cyst."}
{"instruction": "Generate impression based on findings.", "input": " LIVER: Liver is normal in size and echotexture. No focal hepatic abnormality.GALLBLADDER, BILIARY TRACT: Gallbladder is poorly distended without wall thickening, stones or pericholecystic fluid. Visualized biliary tract is normal in caliber.PANCREAS: Limited exam. Bowel gas precludes full visualization.RIGHT KIDNEY: Small right renal cyst. No hydronephrosis.OTHER: Splenic size normal. Simple left renal cyst. No hydronephrosis.", "output": "Bilateral renal cysts.Normal liver.Poorly distended gallbladder but otherwise normal biliary tract otherwise."}
{"instruction": "Generate impression based on findings.", "input": "Epigastric pain LIVER: No significant abnormalities noted. 12 cm in lengthGALLBLADDER, BILIARY TRACT: 0.6 x 0.6 x 0.5 centimeter gallbladder polyp. Gallbladder otherwise unremarkable. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.7 cm in lengthOTHER: Stable left renal cyst. Left kidney 10.2 cm in length. Spleen 6.1 cm in length. No ascites.", "output": "Subcentimeter gallbladder polyp. Otherwise unremarkable hepatobiliary system. No ascites. Stable left renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old female who stopped breast feeding 11 months ago presents with left breast pain off-and-on. Family history of breast cancer in maternal aunt.Patient indicates off-and-on milky nipple discharge bilaterally. A targeted left ultrasound was performed for the patient\u2019s area of concern. On physical examination, no discrete palpable mass noted. Patient indicates pain in the superior left breast. Targeted ultrasound demonstrates normal glandular tissue. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy corresponding to patient's area of pain in the superior left breast.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis LIVER: Cirrhotic morphology again noted without mass. Liver length 16.9 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation again notedPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.2 cm in lengthOTHER: Nonobstructing lower pole subcentimeter left renal stone. Left kidney 9.2 cm in length. Spleen 12.6 cm in length. No ascites.", "output": "Stable cirrhotic morphology without mass or ductal dilatation. No ascites. Stable cholelithiasis without acute inflammation. Nonobstructing lower pole subcentimeter left renal stone."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female with light-colored stools and abdominal pain. LIVER: Measures 15.9 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: Transplant kidney in the right iliac fossa measures 11.4 cm without hydronephrosis or peritransplant collection.OTHER: No significant abnormalities noted.", "output": "1. Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease. No evidence of cholelithiasis, cholecystitis, or biliary obstruction.2. Transplant kidney in the right iliac fossa without hydronephrosis or perinephric collection."}
{"instruction": "Generate impression based on findings.", "input": "70 years old, Male, Reason: elevated conjugated bilirubin, abdominal pain, evaluate for acute cholecystitis and CBD dilatation LIVER: The liver measures 15.7 cm in length. Multiple hepatic cysts are present the largest of which measures 2.1 x 1.7 x 1.8 cm. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.3 m/s.BILIARY TRACT: There is sludge present within the gallbladder without evidence of gallbladder wall thickening or pericholecystic fluid. Per ultrasound technologist, negative sonographic Murphy's sign. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 5 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 8.7 cm in length. RIGHT KIDNEY: Kidney measures 10.4 cm in length. Mildly increased echogenicity of the kidney. No evidence of hydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 11.7 cm in length. Mildly increased echogenicity of the kidneys. No evidence of hydronephrosis or shadowing calculus.", "output": "1.Gallbladder sludge without evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Female 38 years old Reason: gallstones History: epigastric pain LIVER: Liver measures 16.6 cm. Liver has coarse echogenicity which can be seen in diffuse hepatic dysfunction or fatty infiltration. No focal mass. Main portal vein is patent with normal directional flow and peak velocity of 20 cm/s.BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. Gallbladder is normal in appearance. No gallstones are identified. No gallbladder wall thickening or evidence of cholecystitis. Common bile duct is normal measuring 3 mm. Negative Murphy's sign.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 11.4 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 10.2 cm. Left kidney measures 9.6 cm.OTHER: No significant abnormalities noted.", "output": "1. No evidence of acute cholecystitis. No gallstones are visualized.2.Liver has coarsened echogenicity which can be seen in diffuse hepatic dysfunction or fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "63 years old, Male, Reason: eval for cirrhosis and platelet sequestration History: thrombocytopenia, NASH LIVER: The liver is enlarged measuring 19.2 cm in length. Increased echogenicity is consistent with fatty infiltration. Coarse nodular contour of the liver is consistent with cirrhosis. 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: Patient is status post cholecystectomy. 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: The spleen is enlarged measuring 15.3 cm in length. RIGHT KIDNEY: Kidney measures 11 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 11.3 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Enlarged fatty liver with nodular contour consistent with cirrhosis.2.Splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Fevers LIVER: No significant abnormalities noted. Liver length 15.8 cm GALLBLADDER, BILIARY TRACT: Gallbladder sludge and stones without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.2 cm in lengthOTHER: Left kidney 11.6 cm in length. Spleen 9.9 cm in length. No ascites. Bilateral pleural effusions.", "output": "Gallbladder sludge and stones without acute inflammation or ductal dilatation. No ascites. Bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Male 27 years old; Reason: history of hepatitis B, evaluate for liver abnormality or gall bladder disease History: RUQ pain x 1 month LIVER: The liver measures 15.8 cm in length. There is normal 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 22.1 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.6 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 2.0 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 12.6 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.2 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.1 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.", "output": "1. Normal ultrasound of the liver without evidence of mass or ascites. No hepatobiliary pathology noted."}
{"instruction": "Generate impression based on findings.", "input": "Male; 66 years old. Reason: renal failure History: renal failure RIGHT KIDNEY: Right kidney measures of 10.5 cm in length. The cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone. At the inferior aspect of the right kidney is a 5.2 x 4.7 x 5.5 cm anechoic lesion with posterior enhancement. No internal septations or wall nodularity are visualized. There is no vascular flow on color Doppler.LEFT KIDNEY: The left kidney measures 12.7 cm in length. The cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone.URINARY BLADDER: The bladder is decompressed by Foley catheter.OTHER: No significant abnormalities noted.", "output": "1.5.5 cm simple appearing right renal cyst.2.No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Renal insufficiency. Transplant kidney. Ultrasound guidance provided for one percutaneous biopsy of the right iliac fossa renal transplant. No postbiopsy hematoma is evident.", "output": "Ultrasound guidance for percutaneous transplant renal biopsy."}
{"instruction": "Generate impression based on findings.", "input": "History of chronic hepatitis B on medication. Evaluate for HCC. LIVER: The liver is mildly coarse in echotexture. It is normal in morphology. It measures 14 cm in length. No focal lesion or intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 29 cm/s.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 3 mm.Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid or focal tenderness.PANCREAS: The visualized portions of the pancreatic head and body are unremarkable.SPLEEN: The spleen measures 10.4 cm in length without a focal lesion.RIGHT KIDNEY: The right kidney measures 10.6 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 10.3 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.", "output": "No focal liver lesion or other significant abnormality."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male patient with ALL, LFT changes. Evaluate for obstruction and portal venous thrombosis. LIVER: The liver measures 20.2 cm in length and demonstrates increased, 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 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 13.8 cm in length. No evidence of hydronephrosis. Multiple cysts are again noted with an upper pole cyst measuring 3.6 x 4.0 x 3.6 cm, previously 4.6 x 4.5 x 3.7 cm.OTHER: The left kidney measures 11.9 cm in length. No evidence of hydronephrosis.The spleen measures 17.8 cm in length.There is mild ascites.A stone is noted within the decompressed bladder.Ultrasound performed in the region of the patient's palpable abnormality correlates to a 2.5 cm benign morphology lymph node.", "output": "1. Hepatosplenomegaly and increased hepatic parenchymal echogenicity can be seen with hepatic steatosis/hepatic parenchymal dysfunction.2. Mild ascites.3. Renal cysts and bladder calculus."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old with history of left lumpectomy in 1995. Today, Dr. Chhablani palpates an area of concern in the high left axilla. A targeted left ultrasound was performed for the palpable area of concern. A subcentimeter normal morphology lymph node is found at the site marked by the clinical service. There is no suspicious lymph node, or solid or cystic mass identified.", "output": "No sonographic evidence for malignancy. Normal morphology left axillary lymph node. The patient's next bilateral diagnostic mammogram will be due in December 2015.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Male, 57 years old. History of renal stones. RIGHT KIDNEY: The right kidney measures 9.3 cm in length, with normal echotexture. No shadowing stones or hydronephrosis. The previously seen nonobstructing right lower pole stone is no longer seen.LEFT KIDNEY: The left kidney measures 10.1 cm in length, with normal echotexture. No shadowing stones or hydronephrosis.OTHER: The bladder is nondistended.", "output": "No renal stones or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "16-year-old female presents with spell palpated lump in the right breast for two weeks. Family history breast cancer in maternal grandmother. A targeted right ultrasound was performed for the patient\u2019s area of concern. On physical examination, 2-cm mobile nontender soft, palpable mass noted in the right breast 10 o' clock position. Ultrasound demonstrates a possible bilobed or two adjacent smaller hypoechoic parallel oriented, circumscribed masses in the right breast 10 o'clock position, measuring 2.5 x 0.9 x 2 cm, corresponding to a benign fibroadenoma. No suspicious mass noted.", "output": "Palpable abnormality right breast 10 o'clock position corresponds to benign fibroadenoma based on imaging. Surgical consultation is recommended. Findings and reformations were discussed with the patient and her mother in detail.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Questionable thyroid uptake on recent radionuclide scan RIGHT LOBE MEASUREMENTS: 3.6 x 1.7 x 1.8 cmLEFT LOBE MEASUREMENTS: 0.8 x 1.9 x 1.5 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": "Unremarkable thyroid ultrasound without evidence for mass or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old male with diffuse abdominal pain. LIMITED ABDOMENSPLEEN: The spleen measures 22.1 cm.", "output": "1. Patent portal vein with normal hepatopedal flow. Splenic vasculature with normal directional flow.2. Splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Female, 16 years old. Reason: Bilateral breast pain. Right breast: There is no solid or cystic mass identified. No evidence of abscess.Left breast: There is no solid or cystic mass identified. No evidence of abscess.", "output": "Normal examination. "}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female patient with history of pancreatitis. Evaluate for gallstones, pancreas, biliary ductal dilatation. LIVER: The liver measures 18.0 cm in length and demonstrates a mildly coarsened echotexture. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/s. A trace amount of perihepatic fluid is identified.GALLBLADDER, BILIARY TRACT: There is biliary sludge and small gallstones near the gallbladder neck. There is no intra or extrahepatic biliary ductal dilatation. The common bile duct measures 6 mm in diameter. Sonographic Murphy's sign is negative.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 11.5 cm in length. No evidence of hydronephrosis. A small simple cyst is noted.OTHER: The spleen measures 11.5 cm in length.The left kidney measures 11.5 cm in length. No evidence of hydronephrosis. A small simple cyst is noted.", "output": "1. Cholelithiasis without sonographic evidence of acute cholecystitis.2. Trace perihepatic fluid."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Lucy Peterson Is a 24 years old female with possible palpable lump in her right breast. On physical examination, no discrete mass is palpated.A targeted right ultrasound was performed for the palpable area of concern. There is no solid or cystic mass identified. Incidental note is made of the normal-appearing lymph node in the left breast, 10:00 position, 5 cm from the nipple.", "output": "No sonographic evidence for malignancy. Further evaluation of a clinically suspicious abnormality should not delayed by negative imaging. Rather, negative imaging may serve to reinforce a negative clinical impression. The patient should follow up with her primary care physician as clinically warranted, presuming these results are concordant with the physical exam findings. Therefore, continued clinical management is recommended. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old woman with physician palpated abnormality in the right breast presents for further evaluation. The site of concern at the 1:00 position of the left breast was marked with ink by the surgeon. This area, and the surrounding tissues were examined with ultrasound. There are no solid masses or cysts seen. Unremarkable fibroglandular tissue is demonstrated.", "output": "No sonographic evidence for malignancy, and no sonographic findings to explain the area of palpable concern. Therefore, continued clinical management is recommended. Findings were discussed with Dr. Jaskowiak. Results and recommendation were discussed with the patient at the time of the exam. The patient understood to follow up with Dr. Jaskowiak per her recommendations. The patient's next mammogram is due in March of 2016, and should be performed as a diagnostic mammogram when she sees Dr. Jaskowiak.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old male who presents for preoperative evaluation for bariatric surgery LIVER: Hepatic parenchyma is mildly coarse in echotexture without evidence of focal hepatic masses. Main portal vein is patent with peak velocity of 0.1 m/s.GALLBLADDER, BILIARY TRACT: No cholelithiasis. The gallbladder wall measures 0.1 cm without evidence of pericholecystic fluid.PANCREAS: No significant abnormalities noted.KIDNEYS: The right kidney measures 12.8 cm in length with mild persistent hydronephrosis. Right lower pole hypoechoic focus measures 2.5 x 2.5 x 2.5 cm, consistent with a cyst. The left kidney measures 10.2 cm in length with multiple hypoechoic foci compatible with simple cysts. OTHER: The spleen is normal in echotexture and measures 11.2 cm in length.", "output": "1.Persistent mild right hydronephrosis.2.No cholelithiasis.3.Bilateral simple renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "63 year old female with history of T2N0 SCC vocal cord cancer. Right cervical palpable lymph node on exam which was marked by clinical service. In the region of palpable lesion which was marked by the clinical service in the right neck there is mild asymmetric thickening of the subcutaneous soft tissues in comparison with the left. No cystic or solid masses are identified in this region. Right thyroid hypoechoic nodule is noted measuring 9 mm x 7 mm x 6 mm.", "output": "1. Mild subcutaneous soft tissue thickening in the region of palpable abnormality with no discrete mass identified.2. Right thyroid hypoechoic subcentimeter nodule."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old male with cirrhosis screening for HCC LIVER:The liver has cirrhotic morphology, with coarse echogenicity. Liver measures 15.7 cm in length. No new worrisome masses are noted. The portal vein is hepatopetal in flow and is patent. Flow within the portal vein is measured at 19.7 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is visualized with two subcentimeter stones and very minimal sludge. Sonographic Murphy's sign was negative. The gallbladder wall measures 0.2 cm, this is normal thickness. No evidence of acute cholecystitis. There is one area along the superior wall of the gallbladder that may represent adenomyomatosis vs. stone. The common bile duct measures 0.3 cm which is normal caliber.PANCREAS: No significant abnormality noted.SPLEEN: The spleen measures 11.1 cm in length. No significant abnormality noted.KIDNEYS: The right kidney measures 12.9 cm in length. There are several subcentimeter nonobstructing stones in the right kidney. No worrisome masses or hydronephrosis is seen in the right kidney. The left kidney measures 13.1 cm in length. A nonobstructing stone is seen within the left kidney measuring 0.8 cm x 0.5 cm. No new worrisome masses or hydronephrosis is seen on the left kidney.", "output": "1. The liver has cirrhotic morphology, no worrisome masses are noted.2. Several subcentimeter nonobstructing stones are visualized within the kidneys bilaterally.3. Several small subcentimeter stones are seen within the gallbladder, but no evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 69 yo female with history of right upper quadrant pain and gallstones; please evaluate for any abnormalities. LIVER: The liver measures 15.6 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 0.21 m/s.BILIARY TRACT: Cholelithiasis including nonmobile shadowing stones without associated gallbladder wall thickening or pericholecystic fluid. The sonographic Murphy's sign is negative (confirmed with technologist). 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 8.2 cm in length. RIGHT KIDNEY: Kidney measures 11.0 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 11.4 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Cholelithiasis without sonographic evidence of acute cholecystitis or biliary ductal dilatation.2.Increased hepatic echogenicity raising the possibility of parenchymal dysfunction/fatty infiltration. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old with right breast cystic mass returns for short-term follow-up ultrasound study. Focused ultrasound is performed for the right breast, the cystic mass t right breast 12:00 position, appears much smaller in this current study measuring 5 x 3 mm (previously 11 x 6 mm). The lesion appears to be a ruptured cyst.", "output": "No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Patient with known bilateral biopsy-proven fibroadenomas presents for routine follow-up A targeted bilateral breast ultrasound was performed for the palpable area of concern. Right breast known fibroadenoma at 10:00 position measures 27 x 14 x 27 mm, previously measured 25 x 16 x 29 mm, mostly unchanged. Left breast known fibroadenoma at 10:00 position measures 29 x 21 x 31 mm, mostly unchanged from prior study when it measured 33 x 25 x 31 mm.", "output": "Stable bilateral known palpable biopsy-proven fibroadenomas.No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "85-year-old male with bacteremia. Evaluate for biliary obstruction. LIVER: Liver appears coarsely echogenic. No focal mass or fluid collection. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: There is very mild dilatation of the intrahepatic biliary tract. Common duct is within normal limits for age and not significantly changed from prior CT. The gallbladder is well-visualized, and there is a small, 3 to 4 mm polyp. No wall thickening pericholecystic fluid or gallstones.PANCREAS: Limited without gross abnormality.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Very mild prominence of the intrahepatic very tract without obstructing calculus or mass identified. Small gallbladder polyp without acute gallbladder abnormality."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female with abnormal liver function. LIVER: Liver is normal in size and moderately echogenic, likely due to fatty infiltration. No gross, focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder is absent. The visualized biliary tract is normal in caliber.PANCREAS: Limited by bowel gas. The head and body are normal. The tail was not well seen.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Splenic size is normal.Right pleural effusionConsolidation right lung base with question of mild diaphragmatic thickening.", "output": "Echogenic liver likely due to fatty infiltration.Right pleural effusion with right lung consolidation."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate liver and evaluate for ascites. Hypoalbuminemia, edema, shortness of breath LIVER: Liver measures 18.5 cm with diffuse coarse echotexture without any focal lesions. No hepatic cirrhotic morphology noted. Normal flow directionality and patency of the portal vein noted. No biliary ductal dilatation. BILIARY TRACT: Gallbladder Is partially distended, incompletely evaluated without any gallstones within it. Common duct is nondilated measures up to 2 mm. No pericholecystic fluid.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: Spleen measures 11.8 cm with normal echo texture.RIGHT KIDNEY: Right kidney measures 12.1 cm and left kidney measures 11.4 cm. Simple cyst identified in both kidneys, cyst in the right kidney measures 1.1 x 1 x 1 cm, and cyst in the left kidney measures 0.9 x 1.3 x 1.3 cm.OTHER: No significant abnormalities noted.", "output": "Mild coarse echotexture of the liver without any focal lesion.Partially distended gallbladder, limited evaluation without evidence of gallstones."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Edinburgh is a 78-year-old female with a personal history of right breast mastectomy for IDC/DCIS in 2011 and hormonal therapy. She now presents with a palpable mass in the left axilla. Upon physical exam at the patient's area of concern, no discrete mass is appreciated.Targeted ultrasound of the left axilla was performed, demonstrating a benign left axillary lymph node measuring 1.1 x 1.0 x 1.5 cm. Normal hilar vascular flow was identified. No additional suspicious lesions were identified.", "output": "Normal left axillary lymph node. No sonographic evidence for malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually, due next in Feb 2017. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Patient submitted outside mammograms for review. 6 mm round circumscribed mass is identified in the left breast upper-outer quadrant mid depth which appears minimally increased from prior studies dating back to 2013. Outside Hospital ultrasound has not been submitted. Repeat left breast ultrasound was recommended. A targeted left upper-outer quadrant ultrasound was performed. A round hypoechoic lesion with minimal through transmission measuring 5 x 5 x 5 mm identified at 3:00 position most likely corresponding to the mammographic abnormality. No suspicious solid mass noted.", "output": "Simple cyst identified in the left breast 3:00 position most likely corresponding to the mammographic abnormality in question. Patient prefers the cyst to be aspirated over a 6 month follow-up. Patient will be scheduled for a left breast cyst aspiration and a postprocedure mammogram. Findings were conveyed to Donna Christian at the time of dictation.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old male with advanced heart failure possible transplant. LIVER:Liver echotexture normal to slightly increased. Mild hepatomegaly. No focal hepatic abnormality. Hepatic contour appears within normal limits. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein. Waveform is pulsatile consistent with congestive heart failure. GALLBLADDER, BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: Inadequately visualized due to bowel gas.SPLEEN: No significant abnormality noted.KIDNEYS: The right kidney measures 12 cm in length. Echotexture is mildly increased consistent with parenchymal disease. Very small right renal cyst. No hydronephrosis, shadowing calculus or solid mass.Left kidney measures approximately 10.8 cm in length although is less well-visualized than the right due to limited scanning field related to cutaneous pads. Echotexture appears increased. There is a 2 cm simple-appearing left renal cyst. No hydronephrosis, obvious shadowing calculus or mass.ABDOMINAL AORTA: Inadequately visualized due to bowel gas.INFERIOR VENA CAVA: Distal abdominal inferior vena cava is normal and patent.OTHER: Right pleural effusion. Urinary bladder decompressed with Foley catheter.", "output": "1. Mild hepatomegaly with borderline increased echogenicity2. Echogenic kidneys with cysts.3. Right pleural effusion.4. Limited visualization of pancreas and aorta.."}
{"instruction": "Generate impression based on findings.", "input": "62 years old, Female, Reason: pt with known secondary hyperparathyroidism and thyroid nodule, pls identify any thyroid nodules and possible parathyroid adenomas History: secondary hyperparathyroidism, thyroid nodule RIGHT LOBE MEASUREMENTS: 7.8 x 3.7 x 2.9 cmLEFT LOBE MEASUREMENTS: 5.3 x 2.6 x 2.1 cmISTHMUS MEASUREMENTS: 1.3 cmRIGHT LOBE: In the right lobe of the thyroid there is a very large heterogeneous appearing nodule measuring 3.9 x 2.5 x 3.4 cm which is amenable to biopsy. Biopsy will be performed. Additional subcentimeter benign-appearing colloid cysts are also present.LEFT LOBE: Multiple subcentimeter colloid nodules on the left which are favored to have a benign etiology.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: There is an extra thyroidal hypoechoic focus inferior to the left thyroid lobe likely representing the known parathyroid hyperplasia or parathyroid adenoma.", "output": "1.Large heterogeneous right thyroid nodule amenable to biopsy, which will be performed today.2.Hypoechoic focus inferior to the left thyroid lobe likely secondary to known parathyroid hyperplasia or parathyroid adenoma3.Multiple bilateral subcentimeter benign-appearing colloid cysts."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female with history of benign left breast biopsy in 2015. Additional history of benign right breast biopsy in 1992. No current breast complaints. Family history of breast cancer (mother, maternal grandmother, three paternal aunts). 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 heterogeneously dense, which may obscure small masses(BiRads Density Category C), unchanged in pattern and distribution. There are asymmetries in the right outer breast on the cc view and in the left breast posteriorly on the MLO view. These asymmetries persist with spot compression Ultrasound was subsequently performed bilaterally.ULTRASOUND", "output": "1. Indeterminate mass in the 9:00 position of the left breast, for which ultrasound guided biopsy is recommended. 2. Otherwise benign examination as described above with numerous subcentimeter cysts in both breasts. These findings were discussed with the patient at the time of examination. Additionally, participation in research protocol MRI was also discussed and the patient was amenable to participation. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old female with abdominal pain. Question of gallstones. LIVER: The liver measures 17.4 in length. 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 or gallbladder wall thickening. Sonographic Murphy's sign is negative. 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 10.8 cm in length. No evidence of hydronephrosis. Renal cortical echogenicity is increased.OTHER: The left kidney measures 10.1 cm in length. No evidence of hydronephrosis. Renal cortical echogenicity is increased.The spleen measures 7.4 cm in length.There is mild to moderate ascites, most predominantly within the lower quadrants.Left pleural effusion.", "output": "1. No cholelithiasis or sonographic evidence of acute cholecystitis.2. Mild to moderate lower abdominal predominant ascites.3. Medical renal disease.4. Left pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "Female 68 years old Reason: eval CKD History: renal insufficiency - hx of CKD RIGHT KIDNEY: Right kidney measures 9.6 cm. There is diffusely increased echogenicity of the renal cortex. No hydronephrosis or shadowing calculus. Anechoic cyst measures 1.3 x 1.5 x 1.3 cm.LEFT KIDNEY: Left kidney measures 9.5 cm. There is diffuse increased echogenicity of the renal cortex. No hydronephrosis or shadowing calculus. Incompletely evaluated hypoechoic focus, likely representing a small cyst measures 1.1 x 1.1 cm.URINARY BLADDER: The patient had just urinated. Urinary bladder is collapsed.OTHER: No significant abnormalities noted.", "output": "Bilateral increased echogenicity of the renal cortex compatible with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old male with thyroid nodule. Patient has mass involving thoracic spine. RIGHT LOBE MEASUREMENTS: Right lobe measures 6 x 3.5 x 2.9 cmLEFT LOBE MEASUREMENTS: Left lobe measures 4.9 x 1.9 x 1.9 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Right lobe contains a large hypoechoic mass. This demonstrates significant and discontinuous rim calcification and internal echoes although it is difficult to determine how much of that is artifact and how much represent solid material.LEFT LOBE: Small without massISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Large densely rim calcified right thyroid mass. Due to the calcification is difficult to determine whether it is predominantly fluid or solid internally."}
{"instruction": "Generate impression based on findings.", "input": "History of thyroid cancer status post thyroidectomy. 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. The previously described lymph node is not evident on the current examination.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: Round hypoechoic structure deep to the left thyroid bed is presumed to be the esophagus (image 08:17:12), as seen on prior exams. Attention to this region on subsequent exams is recommended to confirm this.", "output": "No suspicious lymphadenopathy or evidence of recurrence."}
{"instruction": "Generate impression based on findings.", "input": "Male 65 years old Reason: 65 y/o male with hepatitis c, with reported history of liver mass, eval for liver mass or biliary obstruction History: belly pain melena LIVER: The background liver parenchyma is heterogeneous and echogenic suggestive of diffuse parenchymal disease. Multiple hepatic masses are visualized. Within the right hepatic lobe there is a mildly hypoechoic and heterogeneous liver mass, which appears encapsulated measuring 11.0 x 8.6 x 10.2 cm. There is a second heterogeneous liver mass in the right hepatic lobe adjacent to the first, larger mass. This second mass measures 5.1 x 4.9 x 5.7 cm. An anechoic, minimally complex, cystic-appearing lesion is present in the far right lobe of the liver measuring 2.1 x 4.1 x 1.6 cm. Main portal vein is patent with normal directional flow and a peak velocity of 18.3 cm/s.BILIARY TRACT: Common bile duct measures 6 mm. The gallbladder is not visualized, possibly obscured by liver masses. No intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: Pancreas is not well-visualized secondary to overlying bowel gas.SPLEEN: Spleen measures 9.7 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 11.9 cm in length. Anechoic mid right renal cyst measures 1.8 x 1.6 x 1.8 cm. Anechoic left superior renal cyst cyst measures 2.6 x 2.8 x 2.9 cm. The left kidney measures 11.4 cm. OTHER: No significant abnormalities noted.", "output": "Multiple large solid hepatic masses. Findings most likely represent hepatocellular carcinoma. Benign hepatic masses are considered much less likely. Dedicated hepatic MRI is recommended for further evaluation. Findings discussed with Dr. Dia in ER at 1610 on 10/5/2016."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate ascites and for urinary tract obstruction History: abdominal pain, aki RIGHT KIDNEY: Normal in echogenicity measuring 11.2 cm in length. No hydronephrosis or nephrolithiasis.LEFT KIDNEY: Normal in echogenicity measuring 11.5 cm in length. No hydronephrosis or nephrolithiasis.OTHER: Small right pleural effusion. Abdominal and pelvis ascites with numerous septations in the lower abdomen indicative of loculated fluid. The bladder is decompressed limiting evaluation.", "output": "1. Abdominal and pelvic ascites with loculation.2. Small right pleural effusion. 3. No hydronephrosis or urinary tract obstruction. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate liver parenchyma and vasculature, blockage seen on CT chest History: Abdominal pain and bloating LIVER: The liver measures 14.2 cm in length. Mildly increased hepatic echogenicity. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.26 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 9.5 cm in length. RIGHT KIDNEY: Native kidney not visualized.LEFT KIDNEY: Native kidney not visualized.OTHER: No significant abnormalities noted.", "output": "Increased hepatic echogenicity suggesting fatty infiltration/dysfunction. Portal vein appears grossly patent. Additional dedicated cross-sectional imaging could be considered as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Female 36 years old Reason: Appendicitis History: RLQ pain 10/10 cant stand.Patient pregnant with triplets. Per technologist note, pain in right lower quadrant since 6:00 PM on 1/9/2016. Appendix was not visualized. Several small lymph nodes are seen. No evidence of ascites.", "output": "Nonvisualization appendix by ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "Male; 48 years old. Reason: 48M PMHx lymphoma as a child w/ radiation S/P AVR/MVR for AS/MS, with transaminitis and elevated bilirubin. Eval for biliary etiologies, possible fatty liver or hepatic congestion? History: none LIVER: The liver measures 16.8 cm in length. The liver surface is smooth and the parenchyma is normal in echotexture. There is no worrisome mass and no ascites. The main portal vein is patent and demonstrates a normal direction of flow with a paucity of 20 cm/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is normal in appearance without wall thickening or cholelithiasis. The common duct measures 2 mm. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas are normal in appearance. The tail of the pancreas is obscured by overlying bowel gas.SPLEEN: The spleen measures 10 cm in length.RIGHT KIDNEY: The right kidney measures 12.0 cm in length. The renal cortex is normal in echogenicity. There is no renal stone, hydronephrosis or worrisome renal mass.LEFT KIDNEY: The left kidney measures 11.3 cm in length. The renal cortex is normal in echogenicity. There is no renal stone, hydronephrosis or worrisome renal massOTHER: No significant abnormalities noted.", "output": "Normal ultrasound of the right upper quadrant. No cholelithiasis or evidence of hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old male patient status post kidney transplant with high creatinine. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No perirenal fluid collection is identified.KIDNEY: The transplant kidney measures 11 cm in length.COLLECTING SYSTEM/URETER: No evidence of hydronephrosis.URINARY BLADDER: The urinary bladder is decompressed.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vesselsThe right internal iliac artery and vein are patent.The transplant renal artery anastomosis demonstrates peak systolic velocity 1.2 m/s with RI 0.86. Intrarenal resistive indices range from 0.65-0.83. There is redemonstration of an arteriovenous fistula within the lower pole. OTHER: No significant abnormality noted", "output": "1. No hydronephrosis.2. Redemonstration of a lower pole AV fistula; consultation with interventional radiology for embolization may be considered. "}
{"instruction": "Generate impression based on findings.", "input": "Male 79 years old Reason: Evaluate for obstruction History: post-op AKI RIGHT KIDNEY: Measures 10.0 cm in length. The renal parenchyma echogenicity is mildly increased without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 11.6 cm in length. The renal parenchyma echogenicity is mildly increased without hydronephrosis, nephrolithiasis, or solid mass.URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: Echogenic liver parenchyma and shadowing gallstones.", "output": "1. Mild increased renal echogenicity bilaterally consistent with medical renal disease. 2. No nephrolithiasis, hydronephrosis, or suspicious mass lesion. "}
{"instruction": "Generate impression based on findings.", "input": "Male 60 years old Reason: 60 yo M w/ AML with neutropenic fever and sepsis w unclear source, CT abd on admit w/ cholelithiasis and ?acute cholecystitis but no abd pain, now has abd pain; pls eval for e/o acute cholecystitis History: see above LIVER: Partially visualized liver is normal in appearance. Main portal vein is patent with normal directional flow.BILIARY TRACT: Shadowing gallstone is present in the gallbladder. Gallbladder wall is within normal limits measuring 2 mm. No pericholecystic fluid. Negative sonographic Murphy's sign. Common bile duct is normal measuring 3 mm. No intra or extrahepatic biliary ductal dilatation.OTHER: No perihepatic ascites", "output": "Cholelithiasis without evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "History of hepatitis B. Evaluate for HCC. LIVER: The liver is slightly coarse in echotexture. No focal suspicious lesion. It is normal in size measuring 16 cm in craniocaudal dimension. No biliary ductal dilatation. The portal vein is patent with normal hepatopedal blood flow at 21 cm/s.GALLBLADDER, BILIARY TRACT: No biliary ductal dilatation with the common duct measuring 5 mm. Status post cholecystectomy.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas.RIGHT KIDNEY: The right kidney is in the pelvis measuring 10.3 cm in length without hydronephrosis, shadowing nephrolithiasis or focal suspicious lesion. Normal echotexture.OTHER: The spleen is normal in size measuring 7.1 cm in length. The left kidney measures 12.4 cm in length without hydronephrosis, shadowing nephrolithiasis or suspicious lesion. Normal echotexture.", "output": "Coarse hepatic parenchyma without focal hepatic lesion or specific evidence of cirrhosis."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old female patient with septic shock, firm abdomen, acute kidney injury. Assess right upper quadrant, liver, gallbladder. LIVER:The liver measures 24.7 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/s.GALLBLADDER, BILIARY TRACT: There is sludge within the gallbladder, 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 visualized proximal pancreas is normal in echogenicity. The remaining pancreas is obscured by overlying bowel gas.SPLEEN: The spleen is not visualized.KIDNEYS: The right kidney measures 10.3 cm and the left kidney measures 7.6 cm in length. Renal cortical echogenicity is increased. No evidence of hydronephrosis.ABDOMINAL AORTA: The proximal and mid-abdominal aorta are normal in caliber. The distal abdomina aorta is obscured by overlying bowel gas.INFERIOR VENA CAVA: The IVC is patent. OTHER: The bladder is decompressed with a Foley catheter.", "output": "1. Hepatomegaly.2. Biliary sludge. 3. Echogenic kidneys consistent with medical renal disease/parenchymal dysfunction. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old female with left thyroid nodule. Evaluate for growth. RIGHT LOBE MEASUREMENTS: 4.6 cm x 1.4 cm x 1.6 cmLEFT LOBE MEASUREMENTS: 5.4 cm x 1.7 cm x 1.6 cmISTHMUS MEASUREMENTS: 3 mm in thicknessRIGHT LOBE: Heterogeneous echotexture which limits evaluation for discrete nodules, however there appears to be a heterogeneous nodule at the lower pole measuring 1.0-cm x 1.0 cm x 0.5 cm. There is some internal vascularity with no definite microcalcifications.LEFT LOBE: Heterogeneous echotexture. In the midpole there is a mixed solid cystic nodule measuring 1.1-cm x 0.7-cm x 0.8-cm with internal cystic degeneration and containing colloid. There is some internal vascularity with no definite microcalcifications. Additional mixed solid cystic nodule at the lower pole measures 2.3 cm x 1.3 cm x 1.2 cm with internal echogenic foci with comet tail artifact consistent with colloid as well as additional echogenic foci likely microcalcifications. There is some internal vascularity as well. These do not appear to be significantly changed. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right neck level 3 lymph node measures 1.0 cm x 0.7 cm x 0.3 cm. Left level 3 lymph node measures 0.3 cm x 0.4 cm x 0.3 cm.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous thyroid gland. Bilateral thyroid nodules with dominant nodule in the left lower pole does not appear to be significantly changed when compared to outside hospital thyroid ultrasound dated 5/27/2014. "}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: No significant abnormalities noted. 16.6 cm in lengthGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.2 cm in lengthOTHER: Left kidney 10.9 cm in length. Benign left renal cyst. Spleen 7.6 cm in length. No ascites.", "output": "Negative right upper quadrant limited ultrasound. Specifically, no evidence for hepatobiliary abnormality. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "45 years old, Female, Reason: assess for causes of RUQ pain radiating to back History: NAFLD LIVER: The liver is enlarged measuring 22.5 cm in length. Increased liver parenchymal echotexture suggestive of fatty infiltration. 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: Patient has history of cholecystectomy. 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 9.2 cm in length. RIGHT KIDNEY: Kidney measures 12.8 cm in length. Normal echotexture. Nohydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 11.5 cm in length. Normal echotexture. Nohydronephrosis or shadowing calculus.OTHER: No significant abnormalities noted.", "output": "1.Hepatomegaly and increased hepatic parenchymal echogenicity consistent with fatty infiltration of the liver."}
{"instruction": "Generate impression based on findings.", "input": "Male 18 years old Reason: hypertension in young male History: hypertension RIGHT KIDNEY: The right kidney measures 10.5 cm. There is no hydronephrosis or shadowing renal stones.LEFT KIDNEY: The left kidney measures 10.6 cm. There is no hydronephrosis or shadowing renal stones.OTHER: The bladder was empty and was not imaged. The liver was noted to be diffusely echogenic suggestive of fatty infiltration.", "output": "1. Unremarkable appearance of the kidneys.2. The liver was noted to be echogenic which is most likely due to fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "Pyuria RIGHT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 9.2 cm in lengthLEFT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 9.4 cm in length.OTHER: Bladder nondistended with mild trabeculation. Severely enlarged and irregularly contoured prostate", "output": "Normal renal parenchymal echogenicity without mass, stone, or hydronephrosis. Bladder nondistended with mild trabeculation. Severely enlarged and irregularly contoured prostate."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female who is intubated for evaluation of liver and gallbladder. LIVER: The liver is normal in echogenicity and measures 13.8 cm in length. The main portal vein is patent with peak systolic velocity measuring 13.5 cm/s.BILIARY TRACT: The gallbladder is not visualized. No intra or extrahepatic biliary ductal dilatation with the common bile duct measuring 2 mm in diameter.PANCREAS: No significant abnormalities noted.SPLEEN: Spleen is normal in echotexture and measures 8 cm in length.RIGHT KIDNEY: Right kidney measures 10.1 cm in length and the left kidney measures 10 cm in length. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Limited examination given patient intubation. Gallbladder is not visualized. No intra or extrahepatic biliary duct dilatation."}
{"instruction": "Generate impression based on findings.", "input": "54 years old, Male, Reason: evaluate for cholelithiasis History: abd pain, pancreatitis LIVER: The liver is enlarged measuring 19.5 cm in length. Increased echogenicity of hepatic parenchyma is consistent with fatty infiltration. 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. The sonographic Murphy's sign is negative. Mild intrahepatic biliary duct dilatation. The proximal Common bile duct is dilated measuring 0.8 cm. the distal common bile duct measures up to 1 cm in diameter. No obstructing stone or mass is identified on this exam.PANCREAS: The pancreas is not well visualized in this exam. Visualized portions of the pancreas appear mildly hypoechoic and edematous consistent with pancreatitis. The pancreatic duct is not definitely identified on this exam.SPLEEN: No significant abnormalities noted. The spleen measures 11.0 cm in length. RIGHT KIDNEY: Kidney measures 11.8 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 13.0 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Mild Intra-and extrahepatic biliary ductal dilatation without obstructing stone or mass identified on this exam, please correlate with bilirubin levels.2.Normal gallbladder without evidence of cholelithiasis or cholecystitis.3.Hepatomegaly with fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "Left breast simple cyst and a clustered cyst at 12:00 position for which six-month follow-up left breast ultrasound is recommended. Family history of breast cancer in her mother diagnosed at age 50. Targeted left breast ultrasound was performed at 12:00 position. Redemonstrated is a clustered cyst at 12:00 position that measures 5 x 6 mm, mostly unchanged from prior study. No suspicious solid mass noted.", "output": "Stable clustered cyst in the left breast 6:00 position. Annual bilateral diagnostic mammogram is recommended in 6 months.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Male 40 years old History: h/o recurrent thyroid cancer in the past, Thyroglobulin level had increased in the prior 6 months, so we are repeating a 6 month follow up ultrasound RIGHT LOBE: Status post thyroidectomy. There is an unchanged hypoechoic nodule within the superior aspect of the right thyroid bed measuring approximately 0.5 x 0.4 x 0.5 cm, previously 0.6 x 0.5 x 0.6 cm.LEFT LOBE: Patient status post thyroidectomy. No residual or recurrent thyroid tissue is present at the left thyroidectomy bed.ISTHMUS: Post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No significant interval change in hypoechoic right superior thyroidectomy bed nodule over multiple prior exams."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female presents with transaminase. Evaluate hepatic vasculature. LIVER:The liver measures 14.8 cm. There is increased, coarse, and heterogeneous echotexture. No masses, ascites, or intrahepatic biliary dilation.GALLBLADDER, BILIARY TRACT: The gallbladder does not appear distended. The gallbladder wall measures 0.2 cm. The common bile duct measures 0.4 cm. There is an approximately 1.3 x 0.9 cm echogenic focus most likely representing a stone within the gall bladder. No pericholecystic fluid. Negative sonographic Murphy's sign.PANCREAS: Evaluation of the pancreas limited by overlying bowel gas.SPLEEN: The spleen measures 7.1 cm. No significant abnormalities are noted.KIDNEYS: The right kidney measures 10.0 cm. The cortex has increased echogenicity. No shadowing calculi or hydronephrosis. The left kidney measures 9.1 cm. The cortex has increased echogenicity. No shadowing calculi or hydronephrosis. ABDOMINAL AORTA: Patent without aneurysm.PORTAL VENOUS: The portal vein is patent with normal hepatopedal flow. The peak velocity is measured at 17.0 cm/s. The right portal vein is patent. The left portal vein is patent.HEPATIC ARTERIES: The hepatic arteries are patent.INFERIOR VENA CAVA: Patent without thrombus.OTHER: There is a small right-sided pleural effusion.", "output": "1. Increased, coarse, and heterogeneous echotexture of the liver consistent with chronic liver disease/parenchymal dysfunction. No masses or ascites.2. Echogenic kidneys consistent with medical renal disease/parenchymal dysfunction.3. Cholelithiasis without signs of acute inflammation.4. Small right-sided pleural effusion.5. Patent hepatic vasculature."}
{"instruction": "Generate impression based on findings.", "input": "83-year-old male with acute kidney insufficiency. RIGHT KIDNEY: The right kidney measures 9.9 cm in length with diffuse cortical parenchymal loss and increased echogenicity. There is moderate to marked hydronephrosis and at least proximal to mid hydroureter. Linear echogenic focus seen within the pelvis is suggestive of a stent. No gross mass identified.LEFT KIDNEY: The left kidney measures 9.7 cm in length with diffuse cortical parenchymal loss and increased echogenicity. There is moderate hydronephrosis and at least proximal hydroureter. No gross solid mass identified. There is likely simple cortical cyst.URINARY BLADDER: There is a Foley catheter present although there remains a moderate amount of fluid within the bladder. Bladder appears trabeculated and small foci of gas are seen non dependently likely due to Foley catheter.OTHER: No significant abnormalities noted.", "output": "1. Bilateral hydronephrosis with apparent stent identified within the right renal pelvis, but not within the urinary bladder.2. Echogenic kidneys with parenchymal loss.3. Moderately filled urinary bladder with Foley catheter in place."}
{"instruction": "Generate impression based on findings.", "input": "63 year old female with right upper quadrant pain. Evaluate for biliary or hepatic pathology. LIVER: Coarse echogenicity of the liver measuring 19.4 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate directional flow.GALLBLADDER, BILIARY TRACT: Sludge and small echogenic foci likely stones within the gallbladder. Gallbladder wall thickening of the 4 mm nonspecific in the setting of ascites. No pericholecystic fluid. Sonographic Murphy's sign is negative. No intra-or extrahepatic delayed ductal dilatation.PANCREAS: Visualized portions of the pancreas are normal in echogenicity. No pancreatic ductal dilatation.RIGHT KIDNEY: Not well assessed with diffusely increased echogenicity. Cyst at the upper pole measures 3.8 cm x 3.3 cm x 3.0 cm.OTHER: Left kidney not well seen, however is increased in echogenicity. Normal echogenicity of the spleen measuring 11.47 m in length.", "output": "1. Sludge and likely small stones within the gallbladder with gallbladder wall thickening which is nonspecific in the setting of ascites. Sonographic Murphy's sign is negative.2. Diffusely increased echogenicity of the kidneys which are difficult to visualize suggestive of parenchymal dysfunction. Right renal cyst not significantly changed. 3. Enlarged and coarse echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. "}
{"instruction": "Generate impression based on findings.", "input": "Female 51 years old Reason: biliary stone? History: abd pain LIVER: Liver is echogenic suggesting fatty infiltration. BILIARY TRACT: Sludge is present in the gallbladder. No shadowing stone. Gallbladder wall is normal. Common bile duct measures 5 mm, within normal limits. No shadowing stone. Negative Murphy's sign.OTHER: No ascites", "output": "1.Gallbladder sludge is present without evidence of cholecystitis.2.Fatty infiltration of liver."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Primary HPT History: Primary HPT RIGHT LOBE MEASUREMENTS: 5.3 x 1.8 x 1.2 cmLEFT LOBE MEASUREMENTS: 5.9 x 1.4 x 1.3 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Hypoechoic nodule in the right lower pole measures 0.6 x 0.4 x 0.5 cm.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No extrathyroidal tissue which would correspond with a parathyroid adenoma.LYMPH NODES: Right level 1B node measures 1.4 x 0.7 x 0.5 cm. Left level 1B node measures 1.5 x 0.9 x 0.5 cm.OTHER: No significant abnormality noted.", "output": "1.No ultrasound evidence of a parathyroid adenoma.2.Subcentimeter indeterminate thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "Renal cystic lesion seen on MR RIGHT KIDNEY: Multiple benign-appearing cysts without worrisome mass, stone, or hydronephrosis. Right kidney 10.9 cm in lengthLEFT KIDNEY: Multiple appearing cysts without worrisome mass, stone, or hydronephrosis. Left kidney 11.1 cm in lengthOTHER: Bladder nondistended", "output": "Multiple bilateral renal cysts without worrisome mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Left scrotal lump RIGHT TESTIS: 4.5 x 2.3 x 2.8 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristicsLEFT TESTIS: 4.6 x 2.2 x 2.6 cm. No worrisome intratesticular mass. 0.1 x 0.1 x 0.2 focal coarse calcification within the left testicle; favor benign etiology.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Moderate size left varicocele.", "output": "No worrisome intratesticular mass. Tiny focal coarse calcification within the left testicle; favor benign etiology. Moderate-sized left varicocele."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old Male. Proteinuria. Ultrasound guidance and technical assistance was provided for a right kidney biopsy. The procedure was successfully completed. Two cores were obtained.", "output": "Successful ultrasound guided biopsy of the right kidney."}
{"instruction": "Generate impression based on findings.", "input": "History of renal stones status post lithotripsy, per patient RIGHT KIDNEY: 11.2 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: Collapsed.OTHER: No significant abnormality noted.", "output": "No renal stones evident. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female with history of thyroid cancer. Evaluate for recurrence. RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyPOSTOPERATIVE BED: Again noted is a heterogeneous focus in the left thyroid bed which measures 1.0 x 0.5 x 0.5 cm, unchanged. No evidence of recurrence or residual disease.LYMPH NODES: No cervical lymphadenopathy.OTHER: No significant abnormality noted.", "output": "1.Status post thyroidectomy. 2.Stable small nodule in the left thyroid bed."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female called back from screening mammography for further evaluation of cluster of calcifications in the upper outer right breast. DIAGNOSTIC RIGHT BREAST MAMMOGRAM: Right ML, 2 right breast magnified, and 2 right breast 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. There is cluster of calcifications in the right upper outer quadrant which layer anteriorly and posteriorly. Centrally the calcifications are not layering however is stable from prior study. Additionally a small cluster of calcifications in the upper outer quadrant quadrant at the posterior depth is noted overlying the stable intramammary lymph nodes. Scattered calcifications elsewhere are also present. All of these calcifications are mostly unchanged compared to the 2012 examination.Additionally, there is focal lesion at the 12:00 position which disperses into normal breast parenchyma on spot compression.RIGHT BREAST ULTRASOUND: A targeted right breast ultrasound was performed. There are multiple calcifications as well as small cysts with the largest measuring up to 6 x 3 mm from the 9 to 10:00 position; findings consistent with fibrocystic changes. Additionally, there are at least 2 benign-appearing lymph nodes at the 11:00 position, 4 cm from the nipple measuring up to 10 x 5 mm. No sonographic evidence of a solid or cystic mass at the 12:00 position.", "output": "Findings consistent with fibrocystic changes in the right upper outer quadrant. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually given history of calcifications. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Cail is a 46 year old woman who returns for further evaluation of a new mass in the right breast identified on screening mammogram dated 7/7/2016. CC and ML views of the right breast plus two compression CC views and a single compression ML view 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. There is a circumscribed oval mass within the right lateral breast, anterior depth, which persists on spot compression views. ULTRASOUND", "output": "Subcentimeter round mass in the right breast 8:00 position 2 cm from the nipple, with internal vascularity noted on color Doppler interrogation, for which the differential diagnosis includes intraductal papilloma, fibroadenoma and malignancy. Ultrasound-guided biopsy is recommended. These findings and recommendation were discussed with Ms. Cail, who agrees with the plan. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Ultrasound guidance for biopsy. Proteinuria and renal insufficiency Ultrasound guidance was provided for Dr. Stakus to perform a biopsy of the right kidney.", "output": "Sound guidance provided for kidney biopsy."}
{"instruction": "Generate impression based on findings.", "input": "History of ulcerative colitis and unexplained leukopenia. Evaluate for splenomegaly. 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. 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 11.6 cm in length. The left kidney is 11.6 cm in length, with a 6 mm nonobstructing stone noted in the midpole. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 12.4 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.", "output": "1. Spleen size at the upper limits of normal. 2. 6 mm nonobstructing left renal stone."}
{"instruction": "Generate impression based on findings.", "input": "23-year-old female with flank pain. RIGHT KIDNEY: The right kidney measures 10.3 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Left kidney measures 11.6 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.OTHER: Shadowing gallstones within the gallbladder without wall thickening or pericholecystic fluid.Liver parenchyma appears moderately echogenic which may be due to fatty infiltration.", "output": "No evidence for urolithiasis or hydronephrosis.Fatty liver.Gallstones.Report to Dr. Sharon Mangum Fax 773 834 0162"}
{"instruction": "Generate impression based on findings.", "input": "Female 55 years old Reason: history of thyroid nodules History: none RIGHT LOBE MEASUREMENTS: Right lobe measures 6.1 x 2.4 x 2.3 cm.LEFT LOBE MEASUREMENTS: 5.2 x 2.5 x 2.5 cm.ISTHMUS MEASUREMENTS: 0.6 cm.RIGHT LOBE: Right heterogeneously echogenic nodule measures 2.8 x 1.7 x 1.7 cm. Heterogeneous background thyroid.LEFT LOBE: Left solid thyroid nodule with some mixed echogenicity measures 1.9 x 1.7 x 2.5 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing left level 3 lymph node.OTHER: No significant abnormality noted.", "output": "Right heterogeneously echogenic thyroid nodule and left solid thyroid nodule are amenable to biopsy if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with right upper quadrant pain LIVER: 15 cm in length. No focal hepatic lesions.BILIARY TRACT: Gallbladder is partially collapsed with normal wall thickness. No evidence of cholelithiasis.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.KIDNEY: No significant abnormalities noted. OTHER: Peripherally calcified lesion adjacent to the right hepatic lobe measures 5.9 x 4.7 x 4.3 cm, not significantly changed since 2006 most compatible with prior infection or hematoma.Previously identified right adrenal lesion not clearly visualized on current examination, possibly due to adjacent bowel gas.", "output": "1.No acute abnormalities to account for the patient's right upper quadrant pain. No evidence of cholelithiasis or acute cholecystitis. 2.Other findings as described above. "}
{"instruction": "Generate impression based on findings.", "input": "27-year-old female with 1 cm smooth mobile breast mass at 6:00 position about 4 cm from areola palpated by referring clinician presenting for targeted right breast ultrasound. No personal or family history of breast cancer. On physical examination, no palpable masses were identified.A targeted right ultrasound was performed for the palpable area of concern. In the right breast at 6:00 to 9:00 position, including 6:00 position 4 cm from the nipple corresponding to the provided history of palpable abnormality, there is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy. Consider clinical correlation given the provided history of palpable lesion. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "82-year-old female with liver lesions likely consistent with cysts. Evaluate liver lesions seen on CT for evidence of malignancy. Also evaluate for signs of chronic liver disease. LIVER: Normal echogenicity of the liver. Multiple cysts are noted in the right hepatic lobe, the largest of which is located along the inferior aspect of the right hepatic lobe measuring 3.6 cm x 3.1 cm x 4.1 cm containing internal septations and some debris with suggestion of peripheral nodularity. Two additional smaller cysts are noted containing thin internal septations, one of which measures 2.5 cm x 1.8 cm x 2.1 cm, and the second cyst measures 1.7 cm x 1.8 cm x 1.4 cm. Main portal vein is patent with appropriate directional flow; peak velocity measures 17.1 cm/sec.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. Common duct measures up to 1.0 cm 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 increased in echogenicity suggestive of fatty atrophy.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 10.7 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the spleen measuring 9.8 cm in length.Normal echogenicity of the left kidney measuring 10.2 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "Dominant complex cyst at the inferior aspect of the right hepatic lobe with suggestion of peripheral nodularity. Recommend MRI for further evaluation. Additional smaller minimally complex cysts are likely benign."}
{"instruction": "Generate impression based on findings.", "input": "Male 64 years old Reason: r/o recurrence History: h/o thyroid cancer. US in 4/16 showed possible new abnormal node. This is a 6 month follow up study RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy. 3 mm cystic focus in the left superior thyroid bed is unchanged.LYMPH NODES: Benign-appearing level 5 lymph node is unchanged.OTHER: No significant abnormality noted.", "output": "No significant change from previous study."}
{"instruction": "Generate impression based on findings.", "input": "Hypercalcemia RIGHT LOBE MEASUREMENTS: 3.6 x 1.5 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.1 x 1 x 1.5 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Diffusely heterogeneous gland without discrete nodule.LEFT LOBE: Diffusely heterogeneous gland without discrete noduleISTHMUS: Diffusely heterogeneous gland without discrete nodulePARATHYROID GLANDS: 3.7 x 1.7 x 1.4 cm hypoechoic extrathyroidal focus projecting posterior and inferior to the left thyroid gland. The inferior margin of this lesion extends down to the supraclavicular thoracic inlet region.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Hypoechoic extrathyroidal focus projecting posterior and inferior to the left thyroid gland consistent with suspected parathyroid adenoma. The inferior margin of this lesion extends down to the supraclavicular thoracic inlet region.Diffusely heterogeneous gland without discrete nodule; raises the possibility of chronic thyroiditis."}
{"instruction": "Generate impression based on findings.", "input": "53 year old female who was recalled from screening mammogram for areas of asymmetry in the posterior depth of bilateral upper breast. Family history of breast cancer in her mother diagnosed at age 37. 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 heterogeneously dense, which may obscure small masses(BiRads Density Category C), unchanged in pattern and distribution. Oval asymmetry in the left posterior superior breast disperses into normal breast tissue.Asymmetry in the right superior posterior breast partially persist on the MLO spot compression view and hence targeted ultrasound was performed.Ultrasound: Targeted right superior posterior breast ultrasound was performed. No suspicious cystic or solid mass noted.", "output": "No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram with tomo synthesis given her dense breast 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": "Please evaluate the right breast, upper lateral area for abscess/signs of soft tissue infection. Patient is admitted for abscess, unclear source. She has area of mild induration and redness in the right upper lateral area approximately 10:00 position from the areola. On physical examination, a superficial skin ulcer (patient has a habit of picking herself) in the right breast medially approximately 4:00 position, 5 cm from the nipple. A 3 cm mobile palpable lump is identified in the right breast 10:00 position, 8 cm from the nipple. Right breast appears red and warm.A targeted right ultrasound was performed for the patient\u2019s area of concern at 10:00 position. Ultrasound demonstrates skin thickening and edema. At 10:00 position there are 2 adjacent oval to round hypoechoic to anechoic areas with few areas of through transmission, measuring 1.6 x 1.3 x 1.6 cm and 1.6 x 1.1 x 1.1 cm. Adjacent to these 2 hypoechoic areas is an area of increased echogenicity. Patient denies history of trauma and is not on any blood thinners.", "output": "2 adjacent hypoechoic areas with adjacent hyperechogenicity in the right breast 10:00 position corresponding to the palpable abnormality most likely represents area of hematoma/fat necrosis versus abscess. Also noted is right breast skin thickening and edema consistent with cellulitis.Surgical consultation to be performed if clinically indicated. Findings and recommendations were discussed with Dr. Ram Krishnamoorthi at pager 4111.After patient completes her course of antibiotics if things resolve, follow-up ultrasound can be performed.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "HCV cirrhosis screening for HCC LIVER: Mildly irregular contour with coarse liver echotexture consistent with cirrhosis, unchanged. No mass lesion. Liver length 14.5 cm. Portal vein patent with flow toward the liver on color Doppler imaging.GALLBLADDER, BILIARY TRACT: Stable cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No hydronephrosis. The right kidney measures 10.6 cm in length. Upper pole nonobstructing stone unchanged. Left kidney measures 11.8 cm in length. Septated presumed left renal cyst unchanged. OTHER: No ascites.", "output": "Stable mildly cirrhotic morphology without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Palpable scrotal nodule RIGHT TESTIS: 5.2 x 1.7 x 3 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristicsLEFT TESTIS: 5 x 2.1 x 2.6 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristicsRIGHT EPIDIDYMIS: 0.5 x 0.4 x 0.4 cm right epididymal cyst.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: 2.1 x 0.9 cm hypoechoic lesion within the subcutaneous tissues of the scrotum corresponding to the palpable nodule. This lesion demonstrates no significant vascularity", "output": "No intratesticular mass. Bilaterally symmetric Doppler flow characteristics. Benign right epididymal cyst.Hypoechoic lesion within the subcutaneous tissues of the scrotum corresponding to the clinically palpable nodule. Although this may represent a lymph node, this lesion is best considered indeterminate by ultrasound criteria"}
{"instruction": "Generate impression based on findings.", "input": "Elevated transaminitis alkaline phosphatase and decreased albumin. LIVER: The liver is normal in morphology, size and echogenicity measuring 18.5 cm in craniocaudal dimension. No focal lesion or intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 27 cm/s. Small amount of perihepatic fluid. BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 2 mm. Partially contracted gallbladder without gallstones, significant wall thickening, pericholecystic fluid or focal tenderness.PANCREAS: The visualized portions of the pancreatic head and body are unremarkable. The remainder is obscured by overlying bowel gas shadowing.SPLEEN: Splenomegaly, measuring 17.8 cm in length without focal abnormality. Small amount of perisplenic fluid.RIGHT KIDNEY: The right kidney measures 12.7 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 13.2 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. A prominent cortical column is noted. Color Doppler demonstrates hilar blood flow.Small right pleural effusion.", "output": "No biliary ductal dilatation or gallbladder pathology. The liver is normal in size without a focal lesion.Splenomegaly and trace abdominopelvic ascites is nonspecific."}
{"instruction": "Generate impression based on findings.", "input": "Elevated serum bilirubin LIVER: Again noted is a large mass replacing most of the right lobe of the liver. The mass is very heterogeneous. Main portal vein is compressed by the mass but patent. There is small amount of perihepatic fluid. Common bile duct is not dilated. There is no intrahepatic biliary dilatation. Gallbladder was not definitely identified due to heterogeneous liver and large masses. Small amount of right-sided pleural effusion.BILIARY TRACT: No biliary dilatation. Gallbladder cannot be well differentiated from the surrounding large mass.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Large heterogeneous liver mass. No definite biliary dilatation."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female presents with transaminitis. There is a clinical concern for hepatitis. Of note, this exam is limited due to body habitus and inability to optimally position the patient.LIVER:The liver measures 18.5 cm. The parenchyma is echogenic. The main portal vein is patent with normal hepatopedal flow. As above, the sensitivity of detecting focal lesions is limited in this study.GALLBLADDER, BILIARY TRACT: The gallbladder is inadequately visualized study. The gallbladder wall measures 3.2 mm. Common bile duct measures 2.1 mm.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: The spleen was not visualized on this study.KIDNEYS: Right kidney measures 11.6 cm. Left kidney was not visualized on this study due to inability to optimally position the patient. Right kidney parenchyma mildly echogenic. No shadowing calculi, hydronephrosis, or focal mass on the right. OTHER: No significant abnormality noted.", "output": "1. Increased echogenic parenchyma of the liver consistent with chronic liver disease/parenchymal dysfunction. Sensitivity in detecting focal masses on the study is limited.2. Limited study as above due to body habitus, inability to optimally position the position, and increased echogenicity of liver parenchyma."}
{"instruction": "Generate impression based on findings.", "input": "Reason: r/o recurrence History: h/o thyroid cancer. 2 year follow up RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: No evidence of disease recurrence. There is a multilobulated nodule which may represent a lipoma in the right neck measuring 5.3 x 2.7 x 9.6 cm. It appears roughly stable although it's difficult to give a comparative size measurement given size (larger than the field of view of the ultrasound probe); that this is a clinical concern, suggest correlation with cross-sectional imaging such as MRI or CT.LEFT LOBE: No evidence of disease recurrence.ISTHMUS: No evidence of disease recurrence.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Again noted are benign-appearing cervical lymph nodes.OTHER: Probable right neck lipoma.", "output": "Stable examination without evidence of disease recurrence or regional lymphadenopathy. Presumed lipoma in the right neck which could be confirmed using CT or MRI."}
{"instruction": "Generate impression based on findings.", "input": "Elevated calcium kidney stones RIGHT LOBE MEASUREMENTS: 1.3 x 2.1 x 5.3 cmLEFT LOBE MEASUREMENTS: 5.3 x 0.8 x 1.9 cmISTHMUS MEASUREMENTS: 0.2 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": "Unremarkable thyroid gland without nodules or regional adenopathy. No evidence for parathyroid adenoma."}
{"instruction": "Generate impression based on findings.", "input": "Congestive heart failure with ascites LIVER: Unremarkable parenchymal echogenicity without mass. Liver length 15.7 cmGALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No ductal dilatation.PANCREAS: 1.9 x 1.9 x 1.8 cm cystic lesion arising from the pancreatic body.RIGHT KIDNEY: Echogenic parenchyma again noted without mass, stone, or hydronephrosis. Right kidney 8.3 cm in lengthOTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. Left kidney 8 cm in length. Spleen 8.1 cm in length. Mild ascites.", "output": "Unremarkable hepatic parenchyma without mass or ductal dilatation. Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without obstruction. Mild ascites.Pancreatic body cyst."}
{"instruction": "Generate impression based on findings.", "input": "Female 65 years old; Reason: HCV, Cirrhosis, eval for HCC History: HCV, Cirrhosis LIVER: The liver measures 15.3 cm in length. There is coarse increased echogenicity of the liver parenchyma. The liver has a nodular appearance. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 10.5 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder surgically absent. The common bile duct measures 1.0 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 11.5 cm and no significant abnormalities are noted. Small calcifications are redemonstrated within the spleen.RIGHT KIDNEY: The right kidney measures 12.8 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen. A renal cyst is at the superior pole seen measuring 6.3 cm x 4.7 cm x 4.9 cm. This is increased in size from prior ultrasound.LEFT KIDNEY: The left kidney measures 11.9 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: Redemonstration of a recannulization of the umbilical vein is seen from prior ultrasound. No ascites is seen.", "output": "1. The liver has cirrhotic morphology as seen on prior exam. No focal hepatic masses or ascites. Recannulization of the umbilical vein is redemonstrated compatible with portal hypertension. The portal vein is patent with decreased velocity flow.2. Right renal cyst is revisualized slightly larger than prior."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old man with history of hydronephrosis and decreased urinary output. RIGHT KIDNEY: The right kidney measures 12.2 cm in length and shows diffusely increased echotexture. There is mild pelvicalyceal dilatation. No focal mass lesion. No shadowing calculi.LEFT KIDNEY: The left kidney measures 13.1 cm in length and shows diffusely increased echotexture. No mass, stone or hydronephrosis.URINARY BLADDER: The urinary bladder is nondistended. A Foley catheter balloon is seen.OTHER: There is no free or loculated fluid.", "output": "1.Mild right-sided pelvicalyceal dilatation. Normal appearing left collecting system.2.Increased echogenicity of the renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female with generalized abdominal pain, right upper quadrant pain and elevated white count. Sickle cell. LIVER: Liver is again noted to be enlarged, measuring 21 cm in length. There is no focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal veinGALLBLADDER, BILIARY TRACT: Patient has had a cholecystectomy. Visualized portions of the intra and extra hepatic biliary tract are normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Very small spleen.", "output": "Hepatomegaly as previously noted. No abnormalities to explain patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old female patient with history of thyroid cancer. Two year follow-up study. Evaluate for adenopathy, recurrence. RIGHT LOBE: Status post thyroidectomy without recurrent or residual parenchymal tissue identified.LEFT LOBE: Status post thyroidectomy without recurrent or residual parenchymal tissue identified.ISTHMUS: Status post thyroidectomy without recurrent or residual parenchymal tissue identified.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology lymph nodes are noted.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy without specific evidence of disease recurrence or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old history of hydrocele on the testicular ultrasound 6/2015 now with intraoperative finding of no hydrocele concerning for mass RIGHT TESTIS: Right testis is small in size and measures 2.9 x 1.2 x 2.2 cm. It appears uniformly hypoechoic with mild peripheral vascularity concerning for torsion. The testes also appears to have significant mass effect over the due to the adjacent large organizing hematoma which is mentioned in detail belowLEFT TESTIS: Left testis measures 3.6 x 1.3 x 2 cm. Hypoechoic with normal vascularity.RIGHT EPIDIDYMIS: Not well visualized due to the large organizing hematomaLEFT EPIDIDYMIS: Not well visualizedOTHER: Within the right scrotal sac previously described hydrocele is not visualized instead a large mixed echogenic complex mass is noted that measures 3.4 x 2.9 x 3.8 cm causing significant mass effect over the right testis pushing it medially and inferiorly. This most likely represents a chronic/organizing hematoma.Few pockets of fluid are noted superiorly along the inguinal canal", "output": "1. Large complex mass involving the right scrotal sac measuring up to 3.8 cm with significant mass effect over the right testis most likely representing a chronic/organizing hematoma. The right testes appears smaller in size with altered echotexture and decreased vascularity concerning for torsion.2. Heterogenous appearance of the left testis probably related to the chronic hematoma."}
{"instruction": "Generate impression based on findings.", "input": "Female 61 years old Reason: ?stones History: pain LIVER: Liver measures 15 cm. Normal echogenicity. No focal liver lesions.BILIARY TRACT: No evidence of cholelithiasis. No evidence of intra or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.RIGHT KIDNEY: Echogenic right kidney. There is a 2.4 cm simple appearing cyst within the right kidney. No evidence of hydronephrosis. OTHER: There are at least 2 large 6 thick-walled cystic lesions, one in the left lower quadrant and second one on the right side inferior to the right kidney. The cystic lesion in the left lower quadrant is larger and measures 8.5 x 3 cm. The etiology of these cystic lesions is unclear. Cystic lesion on the right side measures 2.6 x 2.3 cm.", "output": "Multiple intra-abdominal cystic lesions. Metastatic disease cannot be excluded. CT of abdomen pelvis is recommended for further evaluation of these lesions.Dr. Sadduddin was notified and acknowledged about the above findings at the time of the dictation. "}
{"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. Scattered simple cysts were identified bilaterally. There is no solid or cystic mass identified.", "output": "Bilateral simple cysts. No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Mild hepatomegaly. 2 subcentimeter well-circumscribed echogenic right lobe foci; favor benign etiology such as hemangiomas.. Unremarkable echogenicity. Liver length 18.6 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.8 cm in lengthOTHER: Left kidney 13.2 cm in length. Spleen 10.9 cm in length. No ascites.", "output": "Mild hepatomegaly. 2 subcentimeter well-circumscribed echogenic right lobe foci; favor benign hemangiomas. Unremarkable gallbladder without evidence for acute inflammation. No ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Hrovat is a 58 year old female with a personal history of left breast lumpectomy in 2009 for ILC/LCIS along with right breast reduction in 2010 treated with radiation, chemotherapy, and hormonal therapy. She presents today after physical exam changes on same-day physician appointment. Targeted grayscale and color ultrasound of the left breast.In the left breast 2:00 position, approximately 2 cm from the nipple, there is a superficially located avascular hypoechoic lesion with posterior shadowing identified, measuring approximately 1.0 x 0.6 x 0.9 cm. Sonographic findings are compatible with benign fat necrosis. Just inferolateral to this lesion, in the left breast, is an additional superficially located avascular hypoechoic lesion and internal calcifications measuring approximately 1.2 x 0.3 x 1.4 cm. Sonographic findings are compatible with benign fat necrosis.", "output": "Benign fat necrosis of the left breast. No sonographic evidence of malignancy. Patient should continue to follow up with her surgeon as clinically warranted. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually, due next in June 2017. All results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male with history of hepatitis C. LIVER: Mildly increased echogenicity of the liver parenchyma, without focal mass or other significant abnormality. The liver measures approximately 16 cm in length.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right kidney measures 9.6 cm.OTHER: Status post splenectomy. Left kidney measures 10 cm.", "output": "No focal masses or findings of portal hypertension."}
{"instruction": "Generate impression based on findings.", "input": "Thyromegaly RIGHT LOBE MEASUREMENTS: 5.2 x 4.9 x 1.3 cmLEFT LOBE MEASUREMENTS: 5.6 x 1.8 x 1.2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: 2 subcentimeter spongiform nodules. An upper pole nodule measures 0.7 x 0.6 x 0.6 cm; a lower pole nodule measures 0.7 x 0.7 x 0.4 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Normal sized thyroid gland. Benign-appearing subcentimeter left spongiform thyroid nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "54 year old female with right upper quadrant pain. Evaluate for liver mass, cholelithiasis. LIVER: Normal echogenicity of the liver measuring 14.4 cm in length. Multiple cysts are again seen, the largest in the right lobe lobe measures 3.0 cm x 2.6 cm x 2.9 cm not significantly changed. No suspicious hepatic lesions. Portal vein is patent with appropriate directional flow; peak velocity at 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Normal echogenicity gallbladder. No gallbladder wall thickening. No pericholecystic fluid. Sonographic Murphy's sign is negative. Common bile duct measures 4 mm in caliber with no intra-or extrahepatic biliary ductal dilatation.PANCREAS: Normal echogenicity of the visualized pancreas. No pancreatic ductal dilatation.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 10.1 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the spleen measuring up to 9.0 cm in length. An adjacent isoechoic round lesion measures 1.8 cm x 1.6 cm x 1.8 cm likely a splenule.Normal echogenicity of the left kidney measuring 10.8 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "Liver cysts not significantly changed. No evidence of cholelithiasis or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male patient with right upper quadrant pain extending into the epigastrium. LIVER: The liver measures 15.6 cm in length. 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 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 11.8 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.8 cm in length. No evidence of hydronephrosis.The spleen measures 10.8 cm in length.", "output": "No specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old male with elevated LFTs. Evaluate for hepatic process Examination is limited given overlying bandages, per technologist. LIVER: Liver is normal in echogenicity and measures 19.9 cm in length. Main portal vein is patent with peak systolic velocity of 0.2 m/s.GALLBLADDER, BILIARY TRACT: Gallbladder wall measures 0.3 cm and the common bile duct measures 0.2 cm in diameter.PANCREAS: Not visualized.KIDNEY: Kidneys are normal in echogenicity with the right kidney measuring 11.4 cm and left kidney measuring 9.7 cm in length.OTHER: No significant abnormalities noted.", "output": "Given limited examination, no sonographic evidence of hepatic abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Right perinephric hematoma. Chronic renal disease. Abdominal pain RIGHT KIDNEY: Echogenic parenchyma again noted. No hydronephrosis. Stable multiple renal cysts. Right kidney 13.3 cm in length. Right perinephric hematoma again noted largely unchanged measuring approximately 8.5 x 5.1 cm. No obvious evidence for active bleeding at this timeLEFT KIDNEY: Echogenic parenchyma again noted. No hydronephrosis. 11.7 cm in length.OTHER: No significant abnormalities noted.", "output": "No significant change in right perinephric hematoma without obvious evidence for active bleeding. Echogenic renal parenchyma unchanged consistent with medical renal disease/parenchymal dysfunction without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "10-year-old male presents with CVA tenderness, concern for pyelonephritis. KIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 14.6 cm Left: 12.9 cm   Mean for age: 9 cm  Range for age: 7.5 - 11 cmADDITIONAL OBSERVATIONS: Right ureteral jet is observed.", "output": "Asymmetric enlargement of the right kidney without abnormal echogenicity of the renal parenchyma. No evidence of hydronephrosis. Findings may reflect pyelonephritis in the appropriate clinical setting.*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.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": "Ms. Mazza is a 33-year-old female presenting with a physician detected mass in the left upper outer breast. Patient denies any overlying skin changes or nipple discharge.Of note, the patient's physician declined obtaining a baseline mammogram for this patient. Of note, the patient's physician declined obtaining a baseline mammogram for this patient.Upon physical exam at the palpable area of concern, no discrete mass is appreciated.A targeted left breast ultrasound was performed for the palpable area of concern. In the left breast 2:00 location, approximately 4 cm nipple, no cystic or solid mass is 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": "56-year-old female patient with AKI. Evaluate transplant kidney. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No perinephric fluid collection is identified.KIDNEY: The transplant kidney measures 11.9 cm in length. Renal cortical echogenicity is within normal limits.COLLECTING SYSTEM/URETER: There is mild pelvocaliectasis.URINARY BLADDER: The bladder is mostly decompressed.OTHER: No significant abnormality noted", "output": "Mild pelvocaliectasis of the transplant kidney."}
{"instruction": "Generate impression based on findings.", "input": "Call back from screening mammogram for a new mass in the left breast. 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. An irregularly shaped mass is again identified at far medial left breast. The mass persists with spot compression. No calcifications are associated with this mass.Focused ultrasound was performed for left medial breast. There is an irregularly shaped hypoechoic mass at 9 o'clock position, 12 cm from nipple, in the left breast. Marked blood flow is observed within this mass. There is a tubular shaped hypoechoic lesion extending medially from the mass toward the sternum. Overall size of this lesion is 35 x 10 x 12 mm.", "output": "Highly suspicious mass in the left far medial 9 o'clock position. Ultrasound guided biopsy is recommended. Results and recommendations were discussed with the patient.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Subclinical hyperthyroidism with a history of possible toxic nodular goiter. RIGHT LOBE MEASUREMENTS: 5.1 x 1.8 x 1.9 cm.LEFT LOBE MEASUREMENTS: 5.3 x 2.2 x 1.9 cm.ISTHMUS MEASUREMENTS: 4 mm.RIGHT LOBE: Heterogeneous and nodular echotexture with subcentimeter hypoechoic nodule in the posterior mid gland.LEFT LOBE: Heterogeneous and nodular echotexture with subcentimeter hypoechoic nodule in the posterior mid gland.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Heterogeneous echotexture with two subcentimeter nodules. "}
{"instruction": "Generate impression based on findings.", "input": "Male 64 years old Reason: Evaluate for hydronephrosis History: Elevated creatinine RIGHT KIDNEY: Echogenic kidney. Right kidney measures 11 cm. no focal lesions or hydronephrosis except for subcentimeter simple cysts.LEFT KIDNEY: Echogenic kidney. Left kidney measures 11 .2 cm. Again noted is upper pole complex cystic lesion measuring 6 x 4.4 cm. This is not significantly changed in size and appearance compared to previous study. No hydronephrosis.URINARY BLADDER: Mild bladder wall thickening.OTHER: Cholelithiasis.", "output": "Left upper pole complex cystic lesion. CT or MRI with renal mass protocol is recommended for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for thyroiditis or thyroid nodule History: tender gland, dysphagia with solid foods RIGHT LOBE MEASUREMENTS: 4.9 x 1.4 cm in the longitudinal dimension, 1.6 cm in the transverse dimension. Volume 5.3 ml. LEFT LOBE MEASUREMENTS: 5 x 1 cm in the longitudinal dimension, 2 cm in the transverse dimension. Volume 5.08 ml.ISTHMUS MEASUREMENTS: 0.3 cm in the AP dimension.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: Hypoechoic lesion in the right inferior auricular region measures 1.2 x 0.5 cm and corresponds to location of patient's tenderness. This likely represents a lymph node although no discrete fatty hilum is identified.OTHER: No significant abnormality noted.", "output": "Lesion deep to palpation in the right neck corresponds with a 1.2 x 0.5 cm hypoechoic lesion. Although could represent a lymph node it does not demonstrate typical characteristics of one and other etiologies cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": "67 years, Female, Reason: rule out recurrence of thyroid cancer History: none. RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: Status post thyroidectomy. No residual or recurrent tissue identified.LEFT LOBE: Status post thyroidectomy. No residual or recurrent tissue identified.ISTHMUS: Status post thyroidectomyPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A benign appearing left level 3 node measures 0.5 x 0.3 x 0.8 cm, previously 1.0 x 0.7 x 0.4 cm.OTHER: No significant abnormality noted.", "output": "No evidence of local recurrence or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 15.1 cm in lengthLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 16 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": "55-year-old female evaluation of mass on the left lateral buttock. Over the patient's palpable area of concern, there is a round complex solid/cystic lesion within the soft tissue. This measures 2.3 cm x 1.4 cm x 2.0 cm. Diffuse edema is present near the lesion.", "output": "Indeterminate complex solid/cystic lesion is seen within the soft tissue over the patient's area of concern in the left lateral buttock. Soft tissue edema is present near the lesion."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female patient with cirrhosis. Assess patency of blood vessels. HCC screening. LIMITED ABDOMENLIVER: The liver measures 15.6 cm in length, is nodular in contour, and demonstrates coarsened heterogeneous echogenicity. No focal hepatic lesion is identified.BILIARY TRACT: There are no gallstones, pericholecystic fluid, or gallbladder wall thickening. There is no intra or extrahepatic biliary ductal dilatation. The common duct measures 6 mm in diameter.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen measures 16.6 cm in length. RIGHT KIDNEY: The right kidney measures 10.7 cm in length. No evidence of hydronephrosis.OTHER: The left kidney measures 11.1 cm in length. No evidence of hydronephrosis.", "output": "1. Cirrhotic morphology of the liver with complete reversal of the portal venous system. 2. Splenomegaly and numerous peripancreatic/perisplenic collateral vessels."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal bloating, evaluate for ascites. Limited images of the abdomen demonstrate mild-moderate ascites in all 4 quadrants.", "output": "Mild-moderate ascites."}
{"instruction": "Generate impression based on findings.", "input": "87-year-old female with history of renal failure RIGHT KIDNEY: Measures 11.4 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 9.9 cm in length. 1.5 cm left renal cyst without septation or nodular 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. "}
{"instruction": "Generate impression based on findings.", "input": "74-year-old female with thyroid mass and neck adenopathy and priorCT. RIGHT LOBE MEASUREMENTS: 4.1 x 1.8 x 1.6 cmLEFT LOBE MEASUREMENTS: 1.8 x 1.8 x 5.1 cmISTHMUS MEASUREMENTS: 0.2-cmRIGHT LOBE: Heterogeneous in echotexture. Cystic nodule with comet tail artifactconsistent with colloid measuring 0.5 x 0.5 x 0.5 cm. Very small, hypoechoic nodulespresent as well.LEFT LOBE: Heterogeneous in echo architecture. Spongiform appearing lower pole nodulemeasuring 0.8 x 0.7 x 1 cm likely with comet tail artifact consistent with colloid nodule.Posterior solid nodule with internal dense rim calcification measuring 1.4 x 1.3 x 2.3cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Abnormal lymph nodes identified in the left neck including a round cystic --appearing level 3 node measuring 0.5 x 0.5 x 0.7 cm a round solid 0. 5 x 0.5 x 0.8 cmlevel 3 node and a predominantly cystic level floor/supraclavicular cystic node measuring0.9 x 0.9 x 0.9 cm. OTHER: No significant abnormality noted.", "output": "Solid left thyroid nodule with smaller nodules most suggestive of colloidnodules.Necrotic -- appearing left neck lymph nodes.US GUIDED FNA; 3/6/2015 12:46 PMCLINICAL INFORMATION AND PRE-OPERATIVE DIAGNOSIS: Thyroid mass, neck adenopathyPOST-OPERATIVE DIAGNOSIS : SameCOMPARISON: Same-day ultrasound, CT neck from 2/19/15OPERATORS: Doctors paushter; The attending physician, Dr. paushter, performed theprocedure. TECHNIQUE: Following a discussion of the procedure with the patient, including its risks,benefits, alternatives and steps to prevent infection, an informed written consent wasobtained and documented in the patient's chart. The time-out form was completed toconfirm patient identity and side/type of procedure.Localizing US demonstrated large solid left thyroid mass and necrotic -- appearing leftsupraclavicular lymph node. The skin over the target area was cleansed with chlorhexidine. Transducer was sterilelysheathed. Local anesthesia was obtained using 1% lidocaine, superficially and at depth. Using aseptic technique, and continuous ultrasound guidance, the thyroid lesion wassampled using 25 gauge needles. Two fine needle aspirations were performed. The leftsupraclavicular lymph node was sampled using 25-gauge needles. Four fine needleaspirations were performed.Cytology was present to confirm specimen adequacy. Specimen was handed to cytology. The patient tolerated the procedure well without immediate complications. Routine postprocedure instructions were communicated to the patient.COMPLICATIONS: NoneESTIMATED BLOOD LOSS: Less than 5 cc. An adhesive bandage was placed on the patient?sskin."}
{"instruction": "Generate impression based on findings.", "input": "Male 58 years old Reason: OHT evaluation History: OHT evaluation LIVER:Liver parenchyma is within normal limits. No focal hepatic mass. Main portal vein is patent with normal directional flow.GALLBLADDER, BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. Gallbladder is normal. No gallstones.PANCREAS: The visualized portions of the pancreas are normal in appearance.SPLEEN: No significant abnormality noted. Spleen measures 11.6 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 11.6 cm. Left kidney measures 11.5 cm. ABDOMINAL AORTA: No significant abnormality within the aorta. No aneurysms identified. Normal vascular flow in the aorta.INFERIOR VENA CAVA: No significant abnormality noted.BLADDER: No significant abnormality noted.", "output": "Normal sonographic evaluation of the abdominal viscera."}
{"instruction": "Generate impression based on findings.", "input": "68 year-old male with HCV. LIVER: Coarse echogenicity of the liver measuring 19.3 cm in length. Benign-appearing cyst in the right lobe of the liver measures 8 mm x 4 mm x 5 mm.GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No pericholecystic fluid. No gallbladder wall thickening. Prominence of the common bile duct proximally measuring 10 mm in caliber which tapers distally to 5 mm. No evidence of choledocholithiasis. PANCREAS: The visualized portions of the pancreas are normal in echogenicity. No pancreatic ductal dilatation.RIGHT KIDNEY: Measures 11.0 cm in length. No hydronephrosis. Benign-appearing cyst in the midpole measures 1.1 cm x 1.1 cm x 1.0 cm.OTHER: Left kidney measures 11.8 cm in length. No hydronephrosis.Normal echogenicity of the spleen measuring 10.7 cm in length.", "output": "1. Hepatomegaly with coarse echotexture suggestive of parenchymal dysfunction/fatty infiltration.2. Prominence of the common bile duct which tapers distally. No evidence of choledocholithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for evidence of obstruction or renal disease History: Acute kidney injury. LIVER:The liver demonstrates increased echogenicity and mild cirrhotic morphology with no focal hepatic mass or biliary ductal dilatation. The liver measures 15.8 cm in length. GALLBLADDER, BILIARY TRACT: No pericholecystic fluid. Possible sludge is noted in the gallbladder. The gallbladder wall measures 3 mm in thickness.PANCREAS: Limited evaluation due to overlying bowel gas. No significant abnormalities.SPLEEN: The spleen is enlarged and measures 13.4 cm in length.KIDNEYS: The right kidney measures 11.7 cm in length and demonstrates normal echogenicity with no evidence of hydronephrosis. The left kidney measures 11.5 cm in length and demonstrates normal echogenicity with no evidence of hydronephrosis. ABDOMINAL AORTA: The proximal abdominal aorta measures 2.3 x 2.1 cm on is normal in appearance.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Right pleural effusion and trace ascites are noted.", "output": "1.Echogenic liver with mild cirrhotic morphology with no focal hepatic mass or biliary ductal dilatation. Patent hepatic vasculature and TIPS.2.Normal sonographic evaluation of the kidneys with no evidence of hydronephrosis or shadowing calculi.3.Mild ascites and splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "87-year-old male with renal failure, likely CKD. Assess for hydronephrosis. RIGHT KIDNEY: Measures 11.6 cm in length. There are multiple predominately simple appearing cysts, the largest of which is located at the superior pole measures 2.5 cm x 2.1 cm x 2.1 cm. No hydronephrosis or shadowing calculi are noted.LEFT KIDNEY: Measures 11.0 cm in length. There are multiple predominately simple appearing cysts, the largest of which is located at the inferior pole measuring 3.5 cm x 2.4 cm x 2.8 cm. No hydronephrosis or shadowing calculi are noted.OTHER: No significant abnormalities noted.", "output": "Bilateral predominately simple appearing renal cysts, a couple of which have thin septations. If a more complete evaluation of these cysts is warranted, a dedicated CT renal protocol can be obtained for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "66 year old female with coagulopathy, elevated LFTs. History of aortic dissection and surgery with acute renal and hepatic failure. Evaluate hepatic blood flow. Limited exam as patient has midline bandage, unable to visualize left liver and pancreas.LIMITED ABDOMENLIVER: Increased echogenicity of the liver measuring 19.7 cm in length. No focal hepatic lesion.BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Pancreas is not well assessed.SPLEEN: Normal echogenicity of the spleen measuring 10.2 cm in length. RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 9.0 cm in length. No hydronephrosis or shadowing calculi.OTHER: Normal echogenicity of the left kidney measuring 10.4 cm in length. No hydronephrosis or shadowing calculi.", "output": "1. Patent hepatic vasculature.2. Increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. 3. Small amount of upper abdominal ascites."}
{"instruction": "Generate impression based on findings.", "input": "Reason: calcifications of the thyroid also right level 2A lymph node. Evaluate for extent of adenopathy. History: eval thyroid for nodules also right level 2A node and extent of adenopathy. RIGHT LOBE MEASUREMENTS: Measures 4.5 x 2.1 x 2.3 cm.LEFT LOBE MEASUREMENTS: Measures 4.0 x 1.1 x 1.4 cm.ISTHMUS MEASUREMENTS: Measures up to 0.2 cm in thickness.RIGHT LOBE: Multiple nodules. Dominant nodule in the mid pole measures 2.9 x 1.9 x 2.4 cm, is mixed solid and cystic, has mild internal vascularity, and has an area in the inferior portion with punctate reflectors with associated comet tail artifact which is favored to reflect colloid rather than calcifications. Smaller upper pole mixed solid and cystic nodule measuring approximately 1.2 x 1.1 cm.LEFT LOBE: Nodule in the superior pole measures 1.9 x 0.9 x 1.3 cm, is mixed cystic and predominantly solid, is predominantly isoechoic, demonstrates mild internal vascularity, and lacks definite microcalcifications. Overall, this nodule is of low suspicion for neoplasm. Nodule in the inferior pole measures 0.5 x 0.5 x 0.6 cm, is primarily solid, hypoechoic, demonstrates internal vascularity, and contains punctate calcifications.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Several bilateral level 2 cervical lymph nodes are identified, favor benign morphology. Example right level 2 lymph node measures 1.3 x 0.5 x 0.7 cm. Example left level 2 lymph node measures 1.5 x 0.5 x 1.0 cm.OTHER: No significant abnormality noted.", "output": "1.Multiple thyroid nodules as described above. At least one suspicious subcentimeter nodule in the left inferior pole would be amenable to fine-needle aspiration.2.Bilateral level 2 cervical lymph nodes, favor benign morphology. However, given history of FDG avidity of cervical lymph nodes, continued follow-up is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal swelling. Evaluate for cirrhotic morphology. LIVER: Non-cirrhotic liver morphology. 18 cm in length. 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 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 10.6 cm in length. The left kidney is 11.4 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.4 cm in length, without focal lesions evident.OTHER: Minimal perihepatic free fluid identified.", "output": "1. Increased hepatic echogenicity compatible with parenchymal dysfunction and/or steatosis, without biliary ductal dilation.2. Minimal perihepatic free fluid."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs, abdominal pain LIVER: Liver measures 18.3 cm with mild increased echogenicity consistent with hepatic steatosis. No focal lesions noted. No intra or extrahepatic biliary ductal dilatation noted. Portal vein demonstrates normal flow directionality and patency.GALLBLADDER, BILIARY TRACT: Gallbladder is well distended with normal gallbladder wall thickness. No pericholecystic fluid. Common hepatic duct measures up to 5 mm.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Right kidney measures 10.3 cm the left kidney measures 9.9 cm. Increased echogenicity noted bilaterally consistent with chronic medical renal disease. No focal lesions or hydronephrosis. Spleen measures 10.8 cm without any focal lesion.OTHER: No ascitesRight pleural effusion", "output": "Echogenic kidneys consistent with chronic medical renal diseaseMild hepatic steatosis noted.Right pleural effusion"}
{"instruction": "Generate impression based on findings.", "input": "Mass seen at base of penis. RIGHT TESTIS: 3.7 x 3 x 2.5 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristics.LEFT TESTIS: 3.2 x 2.4 x 2.8 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristics.RIGHT EPIDIDYMIS: Benign-appearing subcentimeter epididymal cystLEFT EPIDIDYMIS: Benign-appearing subcentimeter epididymal cyst.OTHER: Abnormal soft tissue mass measuring 2.8 x 4.8 x 3 cm at the base of the penis adjacent to the urethra; this lesion demonstrates internal vascularity.", "output": "Abnormal soft tissue mass adjacent to the urethra within the base the uterus with internal vascularity; a neoplastic etiology cannot be excluded. No intratesticular mass. "}
{"instruction": "Generate impression based on findings.", "input": "Renal stones RIGHT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 9.1 cm in lengthLEFT KIDNEY: Normal parenchymal echogenicity without mass or hydronephrosis. Punctate nonobstructing left renal stone again noted. Left kidney 8.9 cm in length.OTHER: Bladder nondistended", "output": "Stable punctate nonobstructing left renal stone. No right renal stone. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male with abnormal LFTs, evaluate for cirrhosis, hepatocellular carcinoma. LIVER: Measures 16.8 cm in length. Unremarkable morphology with increased hepatic echogenicity. No discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Cholelithiasis without 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": "1. Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease, without discrete focal lesion. 2. Cholelithiasis without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Bilateral renal masses RIGHT KIDNEY: Right midpole hypoechoic lesion unchanged measuring 2.1 x 1.7 x 1.8 cm. Other subcentimeter lesions also stable. No stone or hydronephrosis. Right kidney 12.6 in meters in length.LEFT KIDNEY: Left renal lesions seen on the recent CT are not visible on today's ultrasound. No hydronephrosis. Left kidney 12.2 cm in length.OTHER: Bladder nondistended", "output": "Stable right midpole hypercholic renal lesion. Other right subcentimeter lesions also stable. Left renal lesions seen on the recent CT cannot be visualized on today's ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "Male 36 years old Reason: eval for liver disease History: persistently elevated LFTs w/o clear etiology despite work-up LIVER: Diffusely increased hepatic attenuation most compatible with fatty infiltration. No focal hepatic mass. No nodularity to the contour of the liver to suggest cirrhosis. Main portal vein is patent with normal directional flow and a peak velocity of 17 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Common bile duct measures 2 mm. No evidence of acute inflammation of the gallbladder. No gallstones.PANCREAS: The visualized portions of the pancreas are normal in appearance.SPLEEN: Spleen is normal in appearance measuring 11.5 cm.KIDNEYS: Normal cortical medullary differentiation bilaterally. No hydronephrosis, shadowing calculi, or mass. Anechoic cyst in the superior pole the right kidney measures 2.0 x 1.9 x 1.5 cm, similar to what was seen on prior CT. Right kidney measures 12.9 cm. Left kidney measures 12.0 cm.OTHER: No ascites", "output": "Diffusely increased hepatic attenuation most compatible with fatty infiltration. No focal hepatic mass or sonographic evidence of cirrhosis."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old male patient with history of gallbladder polyp. LIVER: The liver measures 16.8 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: A polyp noted near the gallbladder neck measures up to 9 mm, previously 5 mm in the largest dimension. Common tail artifact within the gallbladder wall is suggestive of adenomyomatosis. 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 11.1 cm in length. No evidence of hydronephrosis. A subcentimeter anechoic lesion within the right mid pole likely represents a cyst.OTHER: The left kidney measures 10.9 cm in length. No evidence of hydronephrosis. A 1.6 x 1.8 cm hypoechoic lesion within the left midpole does not meet criteria for a simple cyst.The spleen measures 11 cm in length.", "output": "1. Interval increase in size of a gallbladder polyp measuring up to 9 mm.2. Indeterminant hypoechoic left midpole renal lesion; consider pre- and post-contrast imaging as clinically indicated. Findings communicated via telephone to V. Buie at 1044 hrs on 11/6/2015."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate left facial mass; r/o parotid mass History: left facial swelling At the site of the patient's reported palpable abnormality in the superficial soft tissues of the left preauricular area, there is an ovoid mass measuring 2.7 x 1.4 x 2.4 cm which is heterogeneous but predominantly hypoechoic and lacks internal vascularity. The mass demonstrates an apparent \"tail\" extending to the skin surface.", "output": "Avascular mass within the superficial left preauricular region, favor benign etiology such as a sebaceous cyst."}
{"instruction": "Generate impression based on findings.", "input": "76 years old, Female, Reason: r/o adenopathy, recurrence History: h/o thyroid cancer MEASUREMENTS: Patient status post thyroidectomy.RIGHT LOBE AREA: Previously noted anechoic focus measuring up to 5 mm in the right thyroid surgical bed is again noted and unchanged in size and appearance.LEFT LOBE AREA: No evidence of local recurrence.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign appearing level 2 lymph node measuring 0.6 x 0.3 x 0.5 cm.OTHER: No significant abnormality noted.", "output": "Anechoic 5-mm focus in the right thyroid surgical bed is unchanged in appearance since 2013 exam. Follow-up ultrasound examination is recommended to ensure stability. No definite evidence of local recurrence or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: RUQ pain, epigastric pain. Examination mildly limited by constraints positioning patient. LIVER: The liver measures 12.0 cm in length. The liver parenchymal echotexture is normal. Several cystic structures within the liver some with mildly thickened internal septations. The largest cystic lesions is in the right lobe measuring up to 3.0 cm, slightly increased in size from 2010 CT. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.27 m/s.BILIARY TRACT: Single shadowing gallstone without associated gallbladder wall thickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 6 mm in diameter.PANCREAS: Not well visualized. SPLEEN: No significant abnormalities noted. The spleen measures 6.8 cm in length. RIGHT KIDNEY: Kidney measures 9.8 cm in length. Increased parenchymal echogenicity. No hydronephrosis, shadowing calculus, or mass. Cyst measuring up to 1.3 cm. LEFT KIDNEY: Kidney measures 9.2 cm in length. Increased parenchymal echogenicity. No hydronephrosis, shadowing calculus, or mass.OTHER: No significant abnormalities noted.", "output": "1.Mildly limited exam. 2.Cholelithiasis without evidence of acute cholecystitis or biliary ductal dilation. 3.Echogenic kidneys suggestive of medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Papillary thyroid carcinoma, evaluate lateral neck lymph nodes RIGHT LOBE MEASUREMENTS: 4.8 x 1.7 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.6 x 1.5 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: 0.6 x 0.4 x 0.6 cm right upper lobe thyroid nodule with numerous echogenic foci which could represent microcalcifications was previously FNA, consistent with papillary carcinomaLEFT LOBE: 0.3 x 0.3 x 0.3 cm cystic lesion in the midpole of the left lobe is unchanged.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Level 3 right neck lymph node measures 2.5 x 0.7 x 0.3 cm, unchanged from prior examination OTHER: No significant abnormality noted.", "output": "Known papillary carcinoma in the right thyroid gland is unchanged.Level 3 right neck lymph node is unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain with leukocytosis. LIVER: Mildly heterogeneous liver echotexture without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 16.6 cmBILIARY TRACT: Cholelithiasis and gallbladder sludge associated with gallbladder wall thickening and pericholecystic fluid. Positive Murphy's sign. No ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 7 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 11 cm in lengthOTHER: Left kidney 11.9 cm in length. No ascites.", "output": "Cholelithiasis and gallbladder sludge associated with gallbladder wall thickening and pericholecystic fluid. Positive Murphy's sign. Findings worrisome for acute cholecystitis. No ductal dilatation. Mildly heterogeneous liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 58 years old; Reason: eval hyperthyroidism History: somnolescent RIGHT LOBE MEASUREMENTS: 5.7 x 3.4 x 3.4 cm.LEFT LOBE MEASUREMENTS: 4.1 x 2.5 x 1.4 cm.ISTHMUS MEASUREMENT: 0.5 cm.RIGHT LOBE: There are 2 nodules on the right. The larger one measures approximately 3.5 x 3.2 x 4.1 cm and is mixed cystic-solid and very heterogenous at the inferior aspect of the thyroid. Small echogenic foci may represent calcifications. No internal vascularity. The other is a predominately solid nodule measuring approximately 1.7 x 1.0 x 1.7 cm without microcalcifications or hypervascularity. LEFT LOBE: There are subcentimeter round anechoic lesions on the left measuring approximately 0.6 x 0.7 x 0.7 cm consistent with simple cysts.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted. OTHER: No significant abnormality noted.", "output": "1.Suspicious nodule in the right lobe (papillary thyroid ca) amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old female post thyroidectomy for thyroid cancer. Evaluate for recurrence. Hypothyroid. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massesLEFT LOBE: On today's study and the medial aspect of the left bed there is an ovoid hypoechoic region measuring approximately 0.3 cm in maximum diameter. This may represent a small lymph node but should be followed by ultrasound.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Small, hypoechoic region left thyroid bed. See above."}
{"instruction": "Generate impression based on findings.", "input": "80 year-old male with complex cystic left renal mass. RIGHT KIDNEY: The right kidney measures 10.6 cm in length. Echotexture is within normal limits. There is no hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 10.9 cm in length. There is again noted a complex cystic mass arising from the upper pole, measuring approximately 2.5 by 3 x 3 cm lateral change. This demonstrates lobulation, or least one thin septation and contains minimal eccentric calcification by prior CT. No hydronephrosis or shadowing calculus.OTHER: No significant abnormalities noted.", "output": "Stable complex cyst upper pole left kidney."}
{"instruction": "Generate impression based on findings.", "input": "Chronic renal disease with worsening renal function RIGHT KIDNEY: Unremarkable echogenicity without mass, stone, or hydronephrosis. 10.7 cm in length.LEFT KIDNEY: Unremarkable echogenicity without mass, stone, or hydronephrosis. 11.3 cm in length.OTHER: Bladder nondistended", "output": "Negative renal ultrasound without evidence for mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old male with history of cirrhosis. Evaluate for lesions. LIVER: Liver measures 22.4 cm in length. There is markedly increased echogenicity consistent with fatty infiltration which diminishes the sensitivity for the detection of focal lesions. No obvious superimposed focal lesions are identified.BILIARY TRACT: Status post cholecystectomy. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.SPLEEN: Measures 12.3 cm. Unremarkable in echogenicity.KIDNEY: 3.1 cm right renal cyst without septation or nodular component. No hydronephrosis. OTHER: No significant abnormalities noted.", "output": "Markedly increased hepatic echogenicity consistent with fatty infiltration, which diminishes the sensitivity for the detection of subtle lesions. Dedicated CT or MRI of the liver is recommended for future evaluation given this limitation."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female with recurrent abdominal pain after meals, history of gallstones. Evaluate for biliary obstruction. LIVER: Normal echogenicity of the liver measuring 17.4 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate hepatopetal; peak velocity measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: Multiple shadowing stones within the gallbladder. No pericholecystic fluid. No gallbladder wall thickening. Sonographic Murphy's sign is negative. Common duct measures 4 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: Measures 12.4 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 10.9 cm in length. No hydronephrosis or shadowing calculi are noted.Normal echogenicity of the spleen measuring 9.8 cm in length.", "output": "Cholelithiasis without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant and right CVA tenderness LIVER: Mildly heterogeneous liver without mass. Liver length 16.3 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 7.9 cm in length RIGHT KIDNEY: No significant abnormalities noted. 10.9 cm in length OTHER: Left kidney 11.7 cm in length. No ascites", "output": "Mildly heterogeneous liver echotexture raises the possibility of parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "63 years old, Female, Reason: right upper quadrant pain with radiation to back, eval for gallstones History: see above LIVER: The liver measures 13 cm in length. Increased echogenicity of the liver is consistent with fatty infiltration. 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. 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 7.5 cm in length. RIGHT KIDNEY: Kidney measures 10 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 9.5 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis.2.Increased echogenicity of the liver is consistent with fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "Male 26 years old Reason: epigastric abdominal pain; family history of gallstones History: epigastric abdominal pain; nausea LIVER: Liver is normal in appearance measuring 15.3 cm. No hepatic mass. Main portal vein is patent with a peak velocity of 33.7 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Common bile duct measures up to 3 mm. No gallstones are present within the gallbladder. Gallbladder wall is upper limits of normal measuring 3 mm in thickness, likely secondary to underdistention.PANCREAS: Pancreas obscured by overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 12.1 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Left kidney measures 12.2 cm in length. Right kidney measures 10.7 cm in length. OTHER: No significant abnormalities noted.", "output": "No evidence of cholelithiasis or cholecystitis as clinically questioned. No specific findings to account for the patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with acute kidney injury RIGHT KIDNEY: Measures 10.1 cm in length. Increased renal echogenicity without hydronephrosis or nephrolithiasis. 1.3 cm right renal cyst without septation or suspicious nodular component.LEFT KIDNEY: Limited examination of the left kidney, as the patient refused to continue the test due to pain after a single image was obtained. Measures 9.4 cm in length. Increased echogenicity without hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Limited evaluation of the left kidney as described above. Increased renal echogenicity consistent with medical renal disease. No evidence of hydronephrosis or nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "History of unlikely benign right breast mass at 8:00 position from outside hospital, patient presents for a follow-up examination. A targeted right ultrasound was performed. Stable parallel oriented lobulated benign morphology mass in the right breast 8:00 position measures 10 x 7 x 11 mm, mostly unchanged from prior study when it measured 11 x 6 x 11 mm. No suspicious masses noted.", "output": "No sonographic evidence for malignancy. Stable benign morphology mass in the right breast 8:00 position most consistent with a fibroadenoma. Patient is scheduled for surgical follow-up today.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old female presents with right upper quadrant pain. Evaluate for cholelithiasis. LIVER:Measures 17.4 cm. Course, heterogenous echogenicity of the liver parenchyma. No focal masses, ascites, intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder was not able to be definitely visualized on this study.PANCREAS: Evaluation the pancreas limited due to overlying bowel gas.SPLEEN: Measures 10.0 cm without sonographic abnormalities.KIDNEYS: The right kidney measures 10.6 cm. Left kidney measures 10.7 cm. The cortices have normal echogenicity. No shadowing calculi, hydronephrosis, or focal masses. OTHER: There is a small fluid collection between the inferior vena cava and the liver with some internal echoes which could represent a decompressed gallbladder or a loop of bowel which is incompletely visualized on this study.", "output": "1. Course, heterogenous echogenic texture of the liver parenchyma is with chronic liver disease/parenchyma dysfunction.2. Gallbladder was not fully visualized on this study. There is a small fluid collection between the inferior vena cava and the liver which could represent a decompressed gallbladder although this could also represent a loop of bowel."}
{"instruction": "Generate impression based on findings.", "input": "73 year-old male with renal insufficiency. RIGHT KIDNEY: The right kidney measures 9.1 cm in length without hydronephrosis or shadowing calculus. Note is made of a 9 mm simple appearing interpolar cyst. Color Doppler demonstrates hilar blood flow. The renal cortex is moderately echogenic.LEFT KIDNEY: The left kidney measures 9.0 cm without hydronephrosis or shadowing calculus. Note is made of a 1 cm near anechoic lesion likely benign cyst. Color Doppler demonstrates hilar blood flow. The renal cortex is moderately echogenic.URINARY BLADDER: Minimally distended bladder with a presumed Foley, correlate clinically with appropriate positioning.", "output": "1. No hydronephrosis.2. A compatible medical renal disease.3. Presumed Foley is poorly visualized; correlate clinically with appropriate functioning."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Mildly heterogeneous echogenic liver parenchyma without worrisome mass. Stable hepatic cyst. Liver length 19 cm.GALLBLADDER, BILIARY TRACT: Gallbladder stones and sludge without acute inflammation or duct dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.7 cm in lengthOTHER: Left kidney 12.4 cm in length. Spleen 7.9 cm in length. Trace ascites. Dilated bowel loops again noted", "output": "Mild hepatomegaly with mildly heterogeneous echogenic liver parenchyma suggestive for fatty infiltration/parenchymal dysfunction without worrisome mass or ductal dilatation. Cholelithiasis without acute inflammation. Trace ascites. Dilated bowel loops again noted."}
{"instruction": "Generate impression based on findings.", "input": "Transaminitis. Evaluate for cholelithiasis. LIVER: Non-cirrhotic liver morphology. 19 cm in length. Heterogeneous parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No intrahepatic biliary ductal dilation. Common bile duct prominence is within normal limits given cholecystectomy. No biliary stones identified.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 11.5 cm in length, with simple appearing cysts. The left kidney is 9.7 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.9 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.", "output": "Heterogeneous hepatic echogenicity, compatible with chronic liver disease. No biliary ductal dilation."}
{"instruction": "Generate impression based on findings.", "input": "Male, 74 years old. Acute rise in creatinine, oliguria. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 10.2 cm in length, with increased cortical echogenicity and mild cortical thinning. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 12.2 cm in length with increased cortical echogenicity and mild cortical thinning. No shadowing stones or hydronephrosis.OTHER: The bladder is decompressed.", "output": "Mildly increased renal cortical echogenicity compatible with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old male with smoking history. Screening exam Abdominal aortic measurements:Proximal aorta: 2.6 x 2.2 cm.Mid aorta: 1.4 x 1.8 cm.Distal aorta: 1.2 x 1.3 cm.Right common iliac artery: 0.9 x 0.9 x 1.0 cm.left common iliac artery: 0.9 x 1.0 x 1.1 cm.", "output": "Normal caliber of the aorta with no evidence of aneurysm."}
{"instruction": "Generate impression based on findings.", "input": "Patient presents with a left breast lump for 5 months, patient is lactating for 16 months. Recent mammogram dated 11/17/2015 was within normal limits. On physical examination, no discrete palpable mass noted in the left upper inner quadrant approximately 9 to 10:00 position. A rib is palpated in that area. A targeted left ultrasound was performed for the patient\u2019s area of concern. There is no solid or cystic mass identified. Normal glandular tissue noted.", "output": "No sonographic evidence for malignancy corresponding to patient's palpable area of concern in the left upper inner breast.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "75 years old, Female, Reason: 75yo F with metabolic acidosis, eval for obstruction RIGHT KIDNEY: Kidney measures 9.4 cm in length. Increased echogenicity of the kidney is consistent with medical renal disease. No evidence of hydronephrosis or shadowing calculus. Right renal cyst measures 1.0 x 1.0 x 0.6 cm.LEFT KIDNEY: Kidney measures 8.0 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. No hydronephrosis, shadowing calculus or mass.BLADDER: Bladder is incompletely distended around a Foley catheter and appears unremarkable. OTHER: Mild to moderate amount of ascites is present within the pelvis.", "output": "1.No evidence of hydronephrosis or shadowing calculus.2.Increased echogenicity of the kidneys bilaterally is consistent with medical renal disease.3.Mild to moderate amount of ascites is present within the pelvis."}
{"instruction": "Generate impression based on findings.", "input": "Lesion over the lower manubrium/upper sternal junction MANUBRIUM/UPPER STERNAL JUNCTION: There is a 1.9 cm x 1.1 cm x 1.8 cm hypoechoic lesion within the soft tissue along the sternal notch corresponding to palpable lump. This lesion is nonvascular. There is a small area of increased hyperechogenicity which may reasonable the fatty hilum of a lymph node.", "output": "1. Nonvascular hypoechoic lesion is visualized along the sternal notch. This is indeterminate on ultrasound however is amenable to ultrasound-guided biopsy if necessary."}
{"instruction": "Generate impression based on findings.", "input": "Left-sided testicular pain. History of delayed distended on the left. RIGHT TESTIS: 4.3 x 1.6 x 2.8 cm. Normal parenchymal echotexture and vascularity.LEFT TESTIS: 3.0 x 1.3 x 2.0 cm. Normal parenchymal echotexture and vascularity.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Left-sided varicocele.DOPPLER", "output": "1. Asymmetric testicular size, without torsion, altered vascularity, or associated mass.2. Left varicocele."}
{"instruction": "Generate impression based on findings.", "input": "Reason: thyroid nodule on ct scan RIGHT LOBE MEASUREMENTS: 4.6 x 2.5 x 2.6 cm.LEFT LOBE MEASUREMENTS: 4.8 x 2.0 x 2.1 cm.ISTHMUS MEASUREMENTS: 0.4 cm in thickness.RIGHT LOBE: Inferior pole nodule measures 2.3 x 1.5 x 2.2 cm, is spongiform in appearance, contains mild internal vascularity, lacks internal calcifications, and is of very low suspicion for low suspicion for malignancy.LEFT LOBE: Inferior pole nodule measures 1.1 x 0.9 x 1.0 cm, is predominantly isoechoic in appearance, contains mild peripheral vascularity, lacks internal calcifications, has an hypoechoic halo, and is of intermediate suspicion for neoplasm. Second more inferior inferior pole nodule measures 0.9 x 0.7 x 1.2 cm, is partially cystic and partially solid in appearance, contains mild internal vascularity, lacks internal calcifications, and is of very low suspicion for neoplasm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Single benign morphology left level 2 cervical lymph node noted.OTHER: No significant abnormality noted.", "output": "Multiple thyroid nodules as described above. 1.1 cm nodule in the inferior pole of the left lobe is of intermediate suspicion for neoplasm and would be amenable to FNA biopsy as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old male with chronic viral hepatitis C, confusion and ascites on physical exam. Exam is somewhat limited by the patient's inability to cooperate.LIVER:Liver is small, echogenic and nodular in contour consistent with cirrhosis. No gross, focal hepatic abnormality although the patient was unable to fully cooperate. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder contains a stone in the region of the neck, minimally mobile, but without significant gallbladder distention or wall thickening. The visualized biliary tract is normal in caliber.PANCREAS: Limited due to bowel gas.SPLEEN: Enlarged, measuring 18.3 cm in length.KIDNEYS: The right kidney measures approximately 12.3 cm in length. Kidney appears mildly echogenic as noted on the prior exam consistent with parenchymal disease. In the extreme lower pole of the right kidney, there is a small cystic area that may have a focus of calcification. This is unchanged from the prior exam.The left kidney demonstrates significant parenchymal loss and associated caliectasis, particularly in the lower pole. There are likely small cortical cysts as well. Renal length is difficult to assess. No obvious dilatation of the upper pole collecting system or renal pelvis. Patient has a history of significant, obstructive left nephrolithiasis and this is likely chronic. Previously noted calcification in the extreme lower pole not visualized on today's exam.ABDOMINAL AORTA: Normal in caliber without aneurysm.INFERIOR VENA CAVA: Visualized inferior vena cava is patent by color Doppler.OTHER: No ascites. Bladder decompressed with Foley catheter in place. Right pleural effusion.", "output": "Cirrhotic appearing liver with patent main portal vein.. There is associated splenomegaly.Renal parenchymal disease with renal cysts as well as chronic caliectasis involving the lower pole of the left kidney.Gallstone in the gallbladder neck without wall thickening or pericholecystic fluid.Right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female with thrombocytopenia. LIVER: Measures 20.1 cm in length. Increased hepatic echogenicity without discrete focal lesion, though with this degree of increased echogenicity or subtle lesion could be missed. 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": "Hepatomegaly with markedly increased echogenicity consistent with hepatic steatosis. No discrete focal lesion, though with this degree of fatty infiltration a subtle lesion could be missed."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 42 year old male with hepatitis C cirrhosis History: variceal bleed LIVER: Coarse, heterogeneous hepatic echotexture along with nodular peripheral contour, consistent with cirrhosis. The liver measures 18.8 cm in length, indicating mild hepatomegaly. The portal vein is patent with normal hepatopedal portal venous blood flow, maximum flow rate 23.6 cm/s.GALLBLADDER, BILIARY TRACT: Echogenic debris in the gallbladder without evidence of inflammation or cholecystitis. The gallbladder wall measures 0.3 cm. The proximal common bile duct measures 0.4 cm. No biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 12.6 cm in length. No hydronephrosis, mass, or stones.LEFT KIDNEY: The left kidney measures 13.2 cm in length. No hydronephrosis, mass, or stones.OTHER: Trace ascites. Splenomegaly, with spleen length measuring 22.3 cm.", "output": "1. Cirrhotic liver, mild hepatosplenomegaly, and trace ascites without focal mass or biliary ductal dilatation.2. Small debris in the gallbladder without evidence of inflammation or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Left-sided papillary thyroid carcinoma. Assess for suspicious lymph nodes. RIGHT LOBE MEASUREMENTS: 5.3 x 1.9 x 1.7 cmLEFT LOBE MEASUREMENTS: 6.2 x 1.6 x 1.7 cmISTHMUS MEASUREMENTS: 2 mm in AP dimensionRIGHT LOBE: A heterogeneous nodule in the lower pole measures 1.5 x 0.8 x 1.1 cmLEFT LOBE: A heterogeneous nodule in the upper pole with microcalcifications measures 0.9 x 0.8 x 1.0 cm, compatible with the patient's known history of papillary carcinoma.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not identifiedLYMPH NODES: A left lateral neck level 3 lymph node measuring 3 mm in short axis contains punctate echogenic foci which may represent microcalcifications, though this is nonspecific in appearance.OTHER: No significant abnormality noted.", "output": "1. Heterogeneous left thyroid lobe nodule identified, compatible with the patient's known history of papillary carcinoma.2. Subcentimeter left level 3 lymph node with punctate echogenic foci possibly representing microcalcifications, however this is nonspecific in appearance."}
{"instruction": "Generate impression based on findings.", "input": "Reason: renal insufficiencyy RIGHT KIDNEY: The right kidney measures 10.0 cm in length. Tiny subcentimeter hyperechoic focus in the inferior pole of the kidney represents a nonobstructive renal calculus. No hydronephrosis or masses.LEFT KIDNEY: The left kidney measures 9.7 cm in length. Left midpole anechoic peripelvic cyst measures 0.9 x 0.8 x 0.8 cm. Additional exophytic hypoechoic lesion arising from the superior pole of the left kidney appears to demonstrate demonstrate a solid component and measures 1.3 x 1.0 cm in the long axis. No hydronephrosis or shadowing renal stones.OTHER: The bladder is decompressed, precluding its evaluation.", "output": "Exophytic left renal cyst of questionable complexity can be followed up with renal protocol MRI or CT scan or with follow-up ultrasound as clinically indicated. "}
{"instruction": "Generate impression based on findings.", "input": "Dysphagia RIGHT LOBE MEASUREMENTS: 5.3 x 1.6 x 1.4 cm. Normal in size with normal background echotexture and vascularity.LEFT LOBE MEASUREMENTS: 4.8 x 1.4 x 1.0 cm. Normal in size with normal background echotexture and vascularity.ISTHMUS MEASUREMENTS: 4 mm in AP dimension.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: 4 mm cystic nodule is noted, without suspicious features.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "4 mm cystic nodule identified. No thyromegaly to suggest etiology of dysphagia."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for perinephric abscess History: UTI, fever BLADDER  Wall Thickness: Normal  Contents: Bladder is distended with small amount of debris within the bladder. 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: 0 Left: 0  Length*** Right: 9 cm Left: 8.2 cm   Mean for age: 8 cm  Range for age: 6.8 - 9 cmADDITIONAL OBSERVATIONS: None.", "output": "Small amount of debris within the bladder. Otherwise normal examination with no evidence of perinephric abscesses.*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": "Female 26 years old; Reason: eval cholecystitis, ductal blockage History: RUQ abdominal pain, gallstones on CT The exam was slightly limited due to patient's body habitus.The gallbladder wall measures 3.9 mm. Two echogenic shadowing foci are seen within the gallbladder with a small amount of sludge. The patient did have a positive sonographic Murphy's sign. No pericholecystic fluid is seen. The common bile duct measures 3.8 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": "Cholelithiasis with equivocal sonographic evidence for acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Female; 36 years old. Reason: Outside Request: abdominal pain x 1 day LIVER: The liver measures 12.5 cm in length. The liver surface is smooth. The parenchyma is normal in echogenicity and architecture. No focal hepatic mass 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 bile duct measures 4 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: Head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 8.5 cm in length.RIGHT KIDNEY: The right kidney measures 9.7 cm in length. The renal parenchyma is normal in echogenicity. There is no hydronephrosis or shadowing renal stone. LEFT KIDNEY: The left kidney measures 8.9 cm in length. The renal mass normal echogenicity. There is no hydronephrosis or shadowing renal stone.", "output": "Normal ultrasound of the right upper quadrant. "}
{"instruction": "Generate impression based on findings.", "input": "24-year-old with physician palpated nodularity of both breasts. Patient reports no significant change in nodularity with self breast examinations. Family history of breast cancer in her mother diagnosed at 44 years of age. A bilateral breast ultrasound was performed for the patient\u2019s area of concern. There is no solid or cystic mass identified. Normal glandular tissue was seen bilaterally.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Female 63 years old; Reason: history of papillary thyroid carcinoma, had surveillance ultrasound the week of influenza A diagnosis after completing Tamiflu with lymph nodes identified, mobile on exam, please evaluate for interval change History: none The patient is status post total thyroidectomy.RIGHT THYROIDECTOMY BED: No lesions within the thyroidectomy bed are visualized and suspicious for recurrence.LEFT THYROIDECTOMY BED: No lesions within the thyroidectomy bed are visualized and suspicious for recurrence.LYMPH NODES: No suspicious regional adenopathy noted. A right level 2/3 lymph node is visualized measuring 1.0 cm x 1.0 cm x 0.5 cm. This has a fatty hilum.", "output": "No lesions suspicious for recurrence are seen within the thyroidectomy bed. No suspicious regional adenopathy is identified."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female patient with history of lung cancer (diagnosed at the age of 48) and painful region in her right breast. Per patient, the painful area in the medial right breast has been present for several years, but has worsened in intensity since her surgery for lung cancer in Oct 2014. The patient's clinical team did not want a mammogram for today's examination. Limited examination without concomitant mammogram. Upon physical exam at the patient's area of concern, no discrete mass is appreciated. A targeted right breast ultrasound was performed for the patient\u2019s area of concern at the 3:00 position within the right breast. There is no suspicious solid or cystic mass identified. Normal glandular tissue is seen.", "output": "No sonographic evidence for malignancy in the patient's area of concern with ultrasound showing normal glandular tissue. The patient should follow up with her primary care team as clinically warranted, presuming these results are concordant with the physical exam findings. Of note, this examination is incomplete without an accompanying bilateral mammogram and should be obtained when patient's health allows for it.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Proteinuria and chronic kidney disease RIGHT KIDNEY: Mildly echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Possible benign subcentimeter angiomyolipoma upper pole. Right kidney 10.8 cm in lengthLEFT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. Left kidney 11.9 cm in length.OTHER: Bladder nondistended", "output": "Mildly echogenic parenchyma suggestive for medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Female; 27 years old. Reason: gallstones, gallbladder wall dilation History: transaminitis, elevated bili LIVER: The liver measures 15.3 cm in length. The contour is smooth and the parenchyma demonstrates a coarsened echotexture.The main portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.2 m/sec. No worrisome hepatic lesion is identified.BILIARY TRACT: Small layering stones are seen within the gallbladder. No gallbladder wall thickening or pericholecystic fluid. No sonographic Murphy sign elicited. The common bile duct is normal and measures 5 mm in diameter. There is no intrahepatic delayed ductal dilatation. No biliary ductal stone is identified.PANCREAS: Head of the pancreas is unremarkable. The body and tail are obscured by overlying bowel gas.SPLEEN: The spleen measures 9.9 cm in length.RIGHT KIDNEY: The right kidney measures 11.6 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis, renal stone, or worrisome mass identified.OTHER: The left kidney measures 10.8 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis, renal stone, or worrisome mass identified.", "output": "1.Small layering gallstones without sonographic evidence of cholecystitis.2.Coarsened echotexture of hepatic parenchyma."}
{"instruction": "Generate impression based on findings.", "input": "History of HCV, screening for hepatocellular carcinoma. LIVER: The liver measures 14.2 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 0.19 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 5 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 9.8 cm in length. RIGHT KIDNEY: Kidney measures 10.1 cm in length. Normal cortical echotexture. No hydronephrosis. Unchanged cortical cyst measuring up to 1.0 cm.LEFT KIDNEY: Kidney measures 10.9 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Echogenic hepatic parenchyma suggesting chronic liver disease without focal hepatic lesion. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old male with history a right upper quadrant abdominal pain. Nausea after eating. LIVER: The liver parenchyma is within normal limits, and the liver measures 15.6 cm in length. No intrahepatic biliary dilatation.BILIARY TRACT: No biliary dilatation, gallbladder wall thickening or pericholecystic fluid. Small gallstones are seen in the gallbladder neck, however they do not appear impacted since the gallbladder is not excessively distended.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted, and the spleen measures 11.5 cm.RIGHT KIDNEY: No significant abnormalities noted, and the right kidney measures 11 cm. OTHER: No significant abnormalities noted, and the left kidney measures 11 cm.", "output": "Cholelithiasis, without findings of cholecystitis or other significant abnormality."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female patient with abdominal pain, occasional bloating. Evaluate right upper quadrant. LIVER: The liver measures 13.1 cm in length. Hepatic parenchymal 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. 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 10.2 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. OTHER: The left kidney measures 11 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis.The spleen measures 9.3 cm in length.", "output": "1. Hepatic steatosis.2. Increased renal cortical echogenicity which can be seen with medical renal disease. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 51 years old. AKI. RIGHT KIDNEY: The right kidney measures 8.6 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.3 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The bladder is incompletely distended.", "output": "Increased renal cortical echogenicity, compatible with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "70 year old female patient with multiple nodules. RIGHT LOBE MEASUREMENTS: 3.9 x 1.0 x 1.3 cm.LEFT LOBE MEASUREMENTS: 3.5 x 1.3 x 1.1 cm.ISTHMUS MEASUREMENTS: 1 mm in thicknessRIGHT LOBE: There is a round, solid nodule with minimal internal vascularity and no shadowing calcifications within the right lower pole measuring 0.7 x 0.6 x 0.7 cm. LEFT LOBE: There is a hypoechoic solid nodule measuring 1.0 x 1.3 x 1.7 cm which is either inferior to the left thyroid lobe or exophytic in etiology. An additional heterogeneous solid nodular focus is noted inferior to the thyroid lobe measuring 0.8 x 1.0 x 0.6 cm. A 0.6 x 0.4 x 0.4 cm anechoic structure is also seen inferior and posterior to the left thyroid lobe. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: See above.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral thyroid nodules, some of which may be extrathyroidal or parathyroid in origin on the left; correlate with history of parathyroid adenoma/calcium levels. "}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are digital mammographic images (2/29/16, 3/9/16), ultrasound images of left breast (3/9/2016) performed at Envision Diagnostic Center. DIGITAL MAMMOGRAPHIC IMAGES (2/29/16, 3/9/16):The breast parenchyma is heterogeneously dense (BiRADS Density Category C). There is a cluster of calcifications at upper inner quadrant in the right breast.Scattered benign appearing calcifications are seen in the left breast. There is a focal asymmetry at upper outer quadrant in the left breast.ULTRASOUND IMAGES OF LEFT BREAST (3/9/2016):Ultrasound images of left upper outer quadrant (12:00-3:00) are obtained. There are several simple cysts with normal breast tissue in this area.", "output": "A cluster of calcifications at upper inner quadrant in the right breast, for which stereotactic core biopsy is recommended. No mammographic or sonographic evidence for malignancy in the left breast.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old male patient with history of thyroid cancer. 6 month follow up study. RIGHT LOBE: Status post thyroidectomy. A hypoechoic nodule within the superior aspect of the right thyroid bed measures approximately 0.6 x 0.5 x 0.6 cm, previously 0.5 x 0.5 x 0.6 cm. This nodule is similar in size and appearance dating back to thyroid ultrasounds from 3/14/2012.LEFT LOBE: Status post thyroidectomy without residual parenchymal tissue identified.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No significant interval change in a hypoechoic right superior thyroid bed nodule dating back to 3/14/2012."}
{"instruction": "Generate impression based on findings.", "input": "Distended gallbladder seen on CT LIVER: Mildly heterogeneous and echogenic liver echotexture without mass. Liver length 13.1 cm.GALLBLADDER, BILIARY TRACT: Gallbladder collapsed without ductal dilatation.PANCREAS: Pancreatic calcifications again noted.RIGHT KIDNEY: No significant abnormalities noted. 10.3 cm in lengthOTHER: Left kidney 11.1 cm in length. Spleen 7 cm in length. No ascites", "output": "Gallbladder now collapsed without evidence for acute inflammation or ductal dilatation. Mildly heterogeneous and echogenic liver echotexture suggestive for parenchymal dysfunction without mass. No ascites. Pancreatic calcifications again noted consistent with chronic pancreatitis."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: Coarse echogenic liver echotexture without mass. Liver length 21.9 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 13.2 cm in lengthOTHER: Left kidney 12.4 cm in length. Spleen 9.6 cm in length. No ascites", "output": "Coarse echogenic liver echotexture consistent with fatty infiltration/parenchymal dysfunction. Moderate hepatomegaly. No mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Male 66 years old; Reason: r/o recurrence History: h/o thyroid cancer in the past. 2 year follow up study RIGHT LOBE MEASUREMENTS: The right thyroid lobe is surgically absent.LEFT LOBE MEASUREMENTS: The left thyroid lobe is surgically absent.ISTHMUS MEASUREMENT: The isthmus is surgically absent.RIGHT LOBE: No residue or recurrence noted in the thyroid bed.LEFT LOBE: No residue or recurrence noted in the thyroid bed.ISTHMUS: Surgically absent as above.LYMPH NODES: Prominent bilateral lymph nodes appear appear benign.OTHER: No significant abnormality noted.", "output": "1.Status post thyroidectomy without evidence of residue recurrence in the thyroid bed."}
{"instruction": "Generate impression based on findings.", "input": "Hypermetabolic focus seen on PET; history vaginal carcinoma RIGHT LOBE MEASUREMENTS: 1.6 x 1.9 x 5.6 cmLEFT LOBE MEASUREMENTS: 1.7 x 1.9 x 4.3 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Diffusely heterogeneous gland with reticular background associated with increased vascularity. No discrete massLEFT LOBE: Diffusely heterogeneous gland with reticular background associated with increased vascularity. No discrete massISTHMUS: Diffusely heterogeneous gland with reticular background associated with increased vascularity. No discrete massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous thyroid gland with reticular background associated with increased vascularity. Findings suggestive for acute on chronic thyroiditis. No discrete mass. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Male, 90 years old. Abdominal bloating; no hx of constipation. Hx of renal cyst. No ascites is identified.Cholelithiasis. Gallbladder wall thickness is normal.Increased renal cortical echogenicity. Multiple renal cysts are noted bilaterally, appearing grossly similar to the prior study dated 12/29/2014.", "output": "1.No ascites.2.Increased renal cortical echogenicity, suggestive of medical renal disease or parenchymal dysfunction.3.Cholelithiasis without evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "HCV LIVER: Coarse echogenic liver parenchyma again noted without mass. Liver length 17.2 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.1 cm in lengthOTHER: Left kidney 10 cm in length. Spleen 9.7 cm in length. No ascites.", "output": "Stable coarse echogenic liver parenchyma again noted consistent with chronic liver disease without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "19-year-old male with known left gynecomastia presents for follow-up exam With physical examination, there is a thickening of tissue behind the nipple in the left breast. Focused ultrasound shows the same amount of breast tissue behind the nipple as seen on the previous study, consistent with gynecomastia. No solid or cystic lesions are seen in the left breast. For comparison ultrasound for the right retroareolar region is performed. In the right retroareolar region, there is small amount of normal breast tissue, consistent with gynecomastia.", "output": "Ultrasound findings are consistent with gynecomastia, left greater than right. No sonographic evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female with abdominal pain, evaluate for biliary tree obstruction, liver pathology. LIVER: Measures 16.5 cm in length. 1.0 cm circumscribed hyperechoic focus in the left hepatic lobe consistent with a hemangioma.GALLBLADDER, BILIARY TRACT: A large nonmobile gallstone is present in the gallbladder neck. The gallbladder is filled with sludge and mildly distended. There is gallbladder wall thickening and trace abdominal ascites. There is no biliary ductal dilation.PANCREAS: No significant abnormalities noted.KIDNEY: The right kidney measures 11.6 cm without hydronephrosis. The left kidney is not clearly visualized due to patient body habitus and bowel gas.OTHER: No significant abnormalities noted.", "output": "1. Findings consistent with acute cholecystitis. 2. Nonvisualization of the left kidney due to patient body habitus and bowel gas. "}
{"instruction": "Generate impression based on findings.", "input": "Chronic renal disease RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 10.2 cm in length.LEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 10.1 cm in length.OTHER: 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": "Female 31 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. 2 passes were made. 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": "Elevated LFTs LIVER: No significant abnormalities noted. Liver length 15.1 cmGALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.8 cm in lengthOTHER: Left kidney 10.2 cm in length. Spleen 11.6 cm in length. No ascites.", "output": "Negative right upper quadrant ultrasound. Specifically, no evidence for hepatobiliary abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules RIGHT LOBE MEASUREMENTS: 5.3 x 1.8 x 2.2 cmLEFT LOBE MEASUREMENTS: 4.4 x 2.1 x 1.6 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: No significant change in multiple mixed cystic, solid, and spongiform nodules. Representative upper pole nodule measures 0.9 x 0.6 x 0.9 cm. Representative inferior nodule measures 1 x 0.8 x 0.9 cm.LEFT LOBE: No significant change in multiple mixed cystic, solid, and spongiform nodules. Representative upper pole nodule measures 0.7 x 0.4 x 0.7 cm.ISTHMUS: No change in multiple mixed cystic, solid, and spongiform nodules.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable multiple bilateral mixed cystic, solid, and spongiform nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female. Right breast cancer status post 3 cycles of chemotherapy. Reevaluate size of tumor. A targeted right breast ultrasound was performed for the patient's known breast cancer at the 9 to 10 o'clock position, 1 to 4 cm from the nipple. The larger, more anterior component of a heterogeneously hypoechoic mass containing a biopsy clip measures 2.7 x 2.4 x 3.0 cm, previously 3 x 2.8 x 3.4 cm. Posterolaterally, the smaller component of the mass at the 10 o'clock position measures 1.7 x 1.1 x 2.1 cm, previously 1.7 x 1.7 x 1.9 cm, slighty decreased in size. An enlarged right axillary lymph node containing a biopsy clip measures 2.2 x 2.3 x 0.9 cm, previously 3.3 x 2.8 x 0.9 cm.", "output": "Slightly decreased size of the patient's known right breast cancer and decrease of the biopsied axillary lymph node. If further imaging is needed, a follow up MRI is suggested. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old woman with right breast cancer status post adjuvant chemotherapy presents for follow-up. MAMMOGRAM: Three standard 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), unchanged in pattern and distribution. Density associated with the previously biopsied irregular mass in the right lateral breast has significantly decreased and margins are not well delineated, making it difficult to measure. Associated pleomorphic calcifications and position of the marking clip are unchanged.ULTRASOUND:Targeted ultrasound was performed for the mammographic and clinical area of concern.In the right lateral breast on 9:00 position, 8 cm from nipple, biopsy marker clip and with associated hypoechoic area measuring 9 x 9 x 10 mm seen, consistent with the biopsy-proven cancer. Internal vascularity is not present.", "output": "Significant interval decrease in size of biopsy-proven right lateral breast malignancy measuring up to 9 x 9 x 10 mm, previously measured 19 x 20 x 24 mm on ultrasound 8/24/2015.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female with elevated liver function tests. Abdominal pain. LIVER: Measures 15.5 cm in length. Mildly increased hepatic echogenicity. Hyperechoic lesion in the right hepatic dome measures 0.9 x 1.1 x 0.6 cm, most consistent with a small hemangioma. No additional lesions are identified.BILIARY TRACT: No cholelithiasis or biliary ductal dilation. PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "1. Mildly increased hepatic echogenicity may represent hepatic steatosis or parenchymal disease. 2. Otherwise, no acute abnormalities to account for the patient's abdominal pain. "}
{"instruction": "Generate impression based on findings.", "input": "86-year-old male with hematuria RIGHT KIDNEY: Measures 10.1 cm in length. Increased renal echogenicity. 4.1 x 5.1 x 4.7 cm right inferior pole renal cyst without septation or solid component, not significantly changed. No hydronephrosis.LEFT KIDNEY: Measures 10.2 cm in length. Increased renal echogenicity without hydronephrosis.URINARY BLADDER: Incompletely distended.OTHER: No significant abnormalities noted.", "output": "Increased echogenicity consistent with medical renal disease, without significant change since 2012. "}
{"instruction": "Generate impression based on findings.", "input": "72-year-old male with increased LFTs on chemotherapy. Evaluate for obstruction or mass. LIVER: Normal echogenicity of the liver measuring 13.9 cm in length. No focal hepatic lesions. Patent portal vein with appropriate directional flow.BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. Common bile duct measures 4 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are normal in echogenicity with no evidence of pancreatic ductal dilatation.SPLEEN: Normal echogenicity of the spleen measuring 7.8 cm in length.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 12.2 cm in length. Renal cyst at the midpole measures 1.0 cm x 0.8 cm x 1.4 cm. No hydronephrosis or shadowing calculi are noted. OTHER: Normal echogenicity of the left kidney measuring 11.9 cm in length. Upper pole cyst measures 2.7 cm x 2.9 cm x 2.8 cm. No hydronephrosis or shadowing calculi are noted.", "output": "Unremarkable examination. Stable bilateral renal cysts. "}
{"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 suspicious solid or cystic mass identified. A few bilateral several millimeter sized cysts are seen. A normal intramammary lymph node is noted in the left breast near one o'clock.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Increasing LFTs LIVER: Echogenic coarse liver echotexture without mass. Liver length 18.5 cmGALLBLADDER, BILIARY TRACT: Gallbladder sludge with diffuse gallbladder wall thickening. Trace pericholecystic fluidPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma again noted without hydronephrosis. 6.5 cm in lengthOTHER: Echogenic left renal parenchyma. Kidney 7.3 cm in length. Spleen 11 cm in length. Mild ascites.", "output": "Echogenic coarse liver echotexture consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Mild ascites. Gallbladder sludge with diffuse gallbladder wall thickening without obvious acute inflammation. Echogenic renal parenchyma again noted consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male with hepatitis C. Evaluate for mass. LIVER: Hepatomegaly with liver measuring 22 cm in length. The parenchyma is heterogeneously echogenic. No focal mass. No obvious cirrhotic morphology. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Normal gallbladder and biliary tract.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Small cyst. OTHER: Dromedary hump left kidney with small cyst.", "output": "Coarsely echogenic, enlarged liver."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Please evaluate for gallstones History: Pancreatitis with AST/ALT elevation BILIARY TRACT: There is a single nonmobile 3 mm echogenic focus within the gallbladder wall at the fundus which may represent an adherent stone or a small polyp. No additional gallstones are identified. No definite gallbladder wall thickening. Trace pericholecystic fluid along the posterior wall of the gallbladder as seen on recent CT which is nonspecific but may be related to pancreatitis. Patient also reported tenderness over the gallbladder, however, this is nonspecific in the setting of pancreatitis. The common bile duct is mildly dilated measuring up to 8 mm. No shadowing ductal stones are identified. No intrahepatic biliary ductal dilatation is seen.OTHER: No significant abnormalities noted.", "output": "Possible cholelithiasis versus small gallbladder polyp. Mild extrahepatic biliary ductal dilatation, but no sonographic evidence of choledocholithiasis. MRCP may be considered for additional evaluation as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "29 year old female with thyrotoxicosis. Evaluate for nodule, vascularity. RIGHT LOBE MEASUREMENTS: 6.4 cm x 1.1 cm x 2.4 cmLEFT LOBE MEASUREMENTS: 6.5 cm x 1.4 cm x 2.4 cmISTHMUS MEASUREMENTS: 5 mm in thicknessRIGHT LOBE: Heterogeneous in echotexture with slight increased vascularity. No discrete nodules are identified. LEFT LOBE: Heterogeneous in echotexture with slight increased vascularity. Predominantly solid nodule with hypoechoic halo at the mid to lower pole measures 5 mm x 4 mm x 4 mm. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Heterogeneous and enlarged thyroid gland suggestive of thyroiditis. 2. Subcentimeter solid left thyroid nodule. Continued surveillance is recommended."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male patient with history of thyroid cancer. Evaluate for abnormal nodules, notes. Status post surgery and I-131. RIGHT LOBE MEASUREMENTS: Status post total thyroidectomy.LEFT LOBE MEASUREMENTS: Status post total thyroidectomy.ISTHMUS MEASUREMENTS: Status post total thyroidectomy.RIGHT LOBE: There is a heterogeneous soft tissue in the right thyroid bed that measures 0.7 x 0.7 x 1.0 cm.LEFT LOBE: No residual tissue or evidence of recurrence.ISTHMUS: No residual tissue or evidence of recurrence.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No suspicious appearing lymph nodes.OTHER: No significant abnormality noted.", "output": "No change in heterogeneous soft tissue in the right thyroid bed thought to represent scarring."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female 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: 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 evidence of recurrent or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Reason: cholecystitis History: critically ill, persistent reflux of bile LIVER: The liver measures 18.3 cm in length, enlarged. Diffusely heterogeneous hepatic parenchyma. The portal vein is patent with normal directional hepatopetal portal venous blood flow, peak velocity 25.8 cm/s with a pulsatile waveform. No focal mass.GALLBLADDER, BILIARY TRACT: The gallbladder is collapsed with shadowing stones. No evidence of pericholecystic fluid or inflammation. The gallbladder wall measures 0.2 cm. The common bile duct measures 0.4 cm. Negative sonographic Murphy's sign. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 11.3 cm. Echogenic renal parenchyma. No shadowing stones or hydronephrosis. Small 1.0 x 0.9 x 1.0 cm lower pole cyst. No injury isLEFT KIDNEY: The left kidney measures 11.3 cm. Echogenic renal parenchyma. No shadowing stones or hydronephrosis.OTHER: Status post splenectomy with multiple rounded hypoechoic lesions in the left upper quadrant, representing accessory splenules. No ascites. Left pleural effusion.", "output": "1. Heterogeneous hepatic parenchyma with a pulsatile portal venous waveform, consistent with hepatic venous congestion.2. Cholelithiasis without evidence of acute cholecystitis.3. Echogenic renal parenchyma, consistent with medical renal disease.4. Left pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female with area of asymmetry on screening mammogram in the right axillary region. Three standard views of the right breast with spot compression 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. Again seen is a 7 mm oval asymmetry in the right axillary region which persists with spot compression.ULTRASOUND", "output": "Findings compatible with a sebaceous cyst in the right axilla in the area of mammographic concern. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually.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": "47 year old male with acute kidney injury, anuria. Evaluate for decrease kidney perfusion or hydronephrosis. RIGHT KIDNEY: No significant abnormalities noted. No evidence of hydronephrosis. The right kidney measures 11.1 cm in length.LEFT KIDNEY: The left kidney is not well visualized which may be related to the patient's body habitus.OTHER: No significant abnormalities noted.", "output": "Unremarkable ultrasound examination of the right kidney. No evidence of hydronephrosis, as clinically questioned. Limited evaluation of the left kidney, which may be related to the patient's body habitus."}
{"instruction": "Generate impression based on findings.", "input": "Male 76 years old; Reason: evaluate for hepatic dysfunction History: as above LIVER: The liver measures 16.6 cm in length. There is coarse increased echogenicity of the liver parenchyma. There is a nodular appearance to the liver and moderate ascites is seen. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 19.8 cm/s. Pleural effusion is seen on the right.GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.2 mm. Several small shadowing stones are seen along with minimal layering sludge. No pericholecystic fluid. Negative sonographic Murphy sign. The common bile duct measures 2.9 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 12.0 cm and no significant abnormalities are noted.Pleural effusion is seen on the left.RIGHT KIDNEY: The right kidney measures 10.8 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.8 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. The liver has a coarse nodular appearance which is compatible with cirrhotic morphology. Moderate ascites is present. There are no worrisome masses seen within the liver.2. Cholelithiasis without evidence of acute cholecystitis.3. Bilateral pleural effusions are seen."}
{"instruction": "Generate impression based on findings.", "input": "Ms.MINOO ZARNEGAR, 67 years old, submitted outside study for review. Images performed at St. Alexius Medical Center submitted for review: Right breast and right axillary ultrasound 1/7/2016.Images submitted for comparison:PET/CT scan 1/20/2016. THE RIGHT BREAST BREAST ULTRASOUND 1/7/2016 : Static ultrasound images are submitted for interpretation. At the 8:00 position, approximately 7 cm from the nipple there is a 1.3 x 0.6 x 1.9 cm mixed echogenicity, part solid part cystic mass with a slightly thickened echogenic rim, which extends to and partially involves the overlying skin. Two static images were also submitted from the axilla, where no abnormal lymph nodes are evident.PER OUTSIDE PATHOLOGY:A. right breast punch biopsy at the site of palpable abnormality, presumably also performed at the site of sonographic abnormality. - Invasive lobular carcinoma, pleomorphic type. Grade 2. ER and PR positive, HER-2 negative.", "output": "Mixed cystic and solid mass in the right breast, presumably corresponding to a punch biopsy revealing invasive lobular carcinoma.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "End-stage renal disease. Increased BUN/Creatinine. RIGHT KIDNEY: Right kidney measures 9.2 cm. There is increased cortical echogenicity. No suspicious lesion, hydronephrosis or renal calculus is identified.LEFT KIDNEY: Left kidney measures 10.8 cm. There is increased cortical echogenicity. No suspicious lesion, hydronephrosis or renal calculus is identified.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Increased echogenicity of the kidneys, probably medical renal disease. No hydronephrosis or renal calculi identified."}
{"instruction": "Generate impression based on findings.", "input": "Male; 61 years old. Reason: Evaluate for HCC History: HCV, cirrhosis LIVER: The liver measures 15.2 cm in length. The parenchyma is mildly coarse in echotexture and heterogeneous. No focal hepatic lesion is identified.The portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.2 m/sec.BILIARY TRACT: Cholelithiasis is again seen, there is no gallbladder wall thickening or pericholecystic fluid. The common duct measures up to 1.5 cm in diameter which is slightly increased compared to the prior ultrasound. There is no intrahepatic biliary ductal dilatation seen.PANCREAS: Again seen is a 2.0 x 2.0 x 1.2 cm peripancreatic lymph node (image time stamped 1:19:14 p.m.) this previously measured 1.7 x 1.4 x 1.1 cm. The head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 10.0 cm in length.KIDNEYS: The left kidney measures 10.0 cm in length, the right kidney measures 9.2 cm in length. The cortex is normal in echogenicity bilaterally. There is no hydronephrosis or shadowing stone.", "output": "1.Mildly coarse liver parenchyma without focal lesion identified.2.Prominent peripancreatic lymph node may be benign and reactive in etiology in the setting of cirrhosis however would be better characterized on ERCP/MRCP if clinically warranted.3.Cholelithiasis without evidence of acute cholecystitis.4.Slight increase in extrahepatic biliary ductal dilatation. This would be further evaluated with ERCP/MRCP if clinically warranted. No intrahepatic biliary ductal dilatation delineated."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 47-year-old female with Li Fraumeni syndrome. Evaluate for hepatic hemangioma, gallstones. LIVER: The liver measures 21.1 cm in length. Mildly increased parenchymal echogenicity is suggestive of fatty infiltration/parenchymal dysfunction. There is redemonstration of a predominantly hypoechoic mass within the right lobe of the liver measuring 5.6 x 4.6 x 5.5 cm, not significant changed from prior ultrasound allowing for differences in technique. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.21 m/s.BILIARY TRACT: Cholelithiasis. No gallbladder wall thickening or pericholecystic fluid is visualized. 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 within the visualized portions of the pancreas.SPLEEN: The spleen measures 10.4 cm in length. RIGHT KIDNEY: Kidney measures 13.7 cm in length. Normal cortical echotexture. No hydronephrosis, shadowing calculus, or mass. Renal cyst. LEFT KIDNEY: Kidney measures 12.5 cm in length. Normal cortical echotexture. No hydronephrosis, shadowing calculus, or mass.OTHER: No significant abnormalities noted.", "output": "1.Cholelithiasis.2.Hepatomegaly and hepatic steatosis.3.Hepatic mass as characterized on prior MRI as compatible with a hemangioma, similar in size to 6/3/2016 ultrasound allowing for differences in technique."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old male patient with history of Graves' disease, presents for planning prior to radioactive iodine treatment. Patient unable to return for early imaging, no 4 hour images acquired. The 24-hour uptake is 64% (normal range 10-30% at 24-hours).", "output": "Markedly increased uptake compatible with Graves' disease."}
{"instruction": "Generate impression based on findings.", "input": "Follow-up thyroid nodule. RIGHT LOBE MEASUREMENTS: 6.0 x 1.5 x 1.3 cmLEFT LOBE MEASUREMENTS: 3.8 x 1.5 x 1.4 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: The right thyroid lobe is normal in morphology and echogenicity. In the interpolar lesion there is a well-defined 6 x 5 x 8 mm isoechoic nodule with peripheral rim calcification and mild internal vascularity. Previously the nodule measured 6 x 6 x 7 mm.LEFT LOBE: The left thyroid lobe is normal in morphology and echogenicity without a discrete nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Prominent right level 3 lymph node demonstrates normal oval shape and a fatty hilum on longitudinal view, unchanged.OTHER: No significant abnormality noted.", "output": "Stable 8 mm right thyroid interpolar region nodule with peripheral rim calcification and mild internal vascularity. This was previously sampled by FNA in 2014."}
{"instruction": "Generate impression based on findings.", "input": "Female, 56 years old. Hx of kidney cancer s/p right partial nephrectomy, evaluate for metastatic disease. RIGHT KIDNEY: Status post right partial nephrectomy. The right kidney measures 10.9 cm in length, with normal echotexture. No focal lesions or hydronephrosis. No perinephric collections.LEFT KIDNEY: The left kidney measures 12.9 cm in length, with normal echotexture. No focal lesions or hydronephrosis. No perinephric collections.OTHER: The bladder is decompressed. Increased hepatic echogenicity is noted.", "output": "1.Status post right partial nephrectomy without evidence of local disease recurrence.2.Increased liver echogenicity, compatible with fatty infiltration."}
{"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": "History renal cell carcinoma with solitary kidney RIGHT KIDNEY: Mildly echogenic renal parenchyma without mass, stone, or hydronephrosis. 12.7 cm in length.LEFT KIDNEY: Status post nephrectomyOTHER: Bladder collapsed", "output": "Mildly echogenic right renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or obstruction. Status post left nephrectomy."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old female with right upper quadrant pain. LIVER: Upper normal to mildly enlarged. Liver is highly echogenic presumably due to severe fatty infiltration with focal sparing at the level of the gallbladder. This limits penetration and evaluation of deep liver. No focal abnormality identified. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: Limited due to bowel gas. Pancreatic head and body are normal. The tail was not well seen.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Left kidney without hydronephrosis. Splenic size normal.", "output": "Normal gallbladder and biliary tract.Highly echogenic, fatty liver."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Mildly heterogeneous and echogenic liver echotexture without mass. Liver length 15.3 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.4 cm in lengthOTHER: Left kidney 11.5 cm in length. Spleen 12 cm in length. No ascites.", "output": "Mildly heterogeneous and echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female status post renal transplant presents after trauma to transplant area. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: Very large complex anechoic area consistent measuring approximately 16.1 x 9.9 x 13.9 cm, although these measurements are imprecise given the large complex nature of the collection. No signs of active bleeding. KIDNEY: Measures approximately 11.6 cm. There is increased echogenicity. No hydronephrosis, shadowing calculi.COLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: The bladder is nondistended.OTHER: No significant abnormality noted", "output": "1. Very large, complex fluid collection is consistent with a hematoma. No active signs of bleeding. No hydronephrosis.2. Increased echogenicity of renal transplant consistent with medical renal disease/parenchymal dysfunction. No hydronephrosis"}
{"instruction": "Generate impression based on findings.", "input": "Ms. Allen submitted outside examinations:-Bilateral screening mammogram: 12/23/2009-Bilateral breast ultrasound: 12/23/2009-Ultrasound-guided biopsy of right breast: 2/12/2010All examinations were performed at Mercy Hospital. Submitted outside studies were compared to the current mammogram dated 4/7/2016. The breast parenchyma is heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. Multiple circumscribed masses identified in both breasts (right upper outer and left upper outer quadrants) are stable when compared to prior examinations and compatible with cysts (as seen on prior ultrasound examinations). In addition, a cluster of calcifications in the left upper outer breast are faintly seen on prior ML view from 2009. There is no significant change between these studies.", "output": "Multiple benign cysts of both breasts. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually, due next in April 2017. BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "50 year-old female with hyperparathyroidism. Evaluate for parathyroid adenoma. RIGHT LOBE MEASUREMENTS: 4.7 x 1.5 x 1.1 cmLEFT LOBE MEASUREMENTS: 4.9 x 1.6 x 1.1 cmISTHMUS MEASUREMENTS: 0.5-cmRIGHT LOBE: Ovoid 0.3 x 0.5 x 0.8 solid nodule. Heterogeneous echotexture.LEFT LOBE: No significant abnormality noted. Heterogeneous echotexture.ISTHMUS: Heterogeneous echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Heterogeneous thyroid with at least one discrete small right-sided solid nodule.No extrathyroidal mass."}
{"instruction": "Generate impression based on findings.", "input": "Male; 59 years old. Reason: cholecystitis History: elevated lft LIMITED ABDOMENLIVER: The liver measures 12.9 cm in length. The liver surface is nodular, the parenchyma is diffusely increased in echo density and coarsened in echotexture. No focal hepatic lesion is identified. There is a mild amount of ascites.BILIARY TRACT: Small shadowing stones are seen within the gallbladder neck. There is no gallbladder wall thickening or pericholecystic fluid. The common duct measures 0.4 cm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: Pancreas is not well-visualized due to overlying bowel gas.SPLEEN: The spleen measures 11.2 cm in length. KIDNEYS: The right kidney measures 10.4 cm in length, the left measures 1.2 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing renal stone.OTHER: No significant abnormalities noted.", "output": "1.Cirrhotic liver morphology with a mild amount of ascites and right pleural effusion.2.Reversal of flow in the main portal vein.3.Cholelithiasis without evidence acute cholecystitis or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain LIVER:No significant abnormality noted. Liver length 16.5 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation. No intrahepatic ductal dilatation. Mild dilatation of the extrahepatic duct with maximal diameter of 1 cm. Distal aspect of the common bile duct is obscured by gasPANCREAS: Pancreatic tail mass again noted.SPLEEN: 10.5 cm in lengthKIDNEYS: Echogenic kidneys without worrisome mass, stone, or hydronephrosis. Left renal cyst. Right kidney 6.3 cm in length. Left kidney 8.5 cm in length.ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Bilateral pleural effusions.", "output": "Cholelithiasis without acute inflammation. Mild dilatation of the extra hepatic duct; distal common bile duct obscured by gas. No intrahepatic duct dilatation.Pancreatic tail mass again noted.Echogenic kidneys consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female patient with papillary thyroid cancer. Evaluate for thyroid nodules, central, and lateral lymph nodes. RIGHT LOBE MEASUREMENTS: 3.7 x 1.3 x 1.8 cm.LEFT LOBE MEASUREMENTS: 4.3 x 1.3 x 1.3 cm.ISTHMUS MEASUREMENTS: 3 mm in thickness.RIGHT LOBE: The right thyroid lobe is homogeneous in echogenicity without focal thyroid lesion.LEFT LOBE: There are two solid, hypoechoic nodules within or possibly external to the inferior aspect of the left thyroid lobe. These measures 0.9 x 0.7 x 0.9 cm and 0.6 x 0.7 x 1.1 cm.ISTHMUS: There is a 1.1 x 0.9 x 0.9 cm heterogeneous, hypoechoic solid nodule with internal echogenic foci within the left aspect of the isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology lymph nodes are noted within the bilateral neck.OTHER: No significant abnormality noted.", "output": "1. Two left lower pole possibly exophytic solid nodules and solid isthmus nodule.2. No regional lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Mr. Rutherford is a 49-year-old female with a history of recurrent left breast abscesses. She presents today with a four-day history of left breast swelling/pain/tenderness with an associated open wound. Upon physical exam of the left central breast, there is marked skin thickening, erythema, and redness of the overlying skin. Just medial to the left nipple-areola complex is a 1 cm open wound with draining pus/blood.Targeted left breast ultrasound was performed for the patient's area of concern. In the left retroareolar area, there is a large irregular hypoechoic area measuring 3.7 x 0.8 x 0.8 cm with marked associated vascularity. This appears very similar in appearance to prior ultrasound exam performed in April 2015, and is compatible with a chronic recurrent abscess.", "output": "Chronic recurrent abscess in the left retroareolar region. Patient is to follow-up with Joly Jose immediately after this appointment. All results and recommendations were relayed to the patient and Joly. BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Female 20 months old Reason: Evaluate for abscess History: acute onset tender mass below nipple Round, circumscribed, hypoechoic, solid-appearing mass in the left breast at the level of the nipple measuring 1.3 cm in diameter, consistent with abscess.", "output": "Hypoechoic mass in the left breast consistent with abscess. "}
{"instruction": "Generate impression based on findings.", "input": "Left renal cyst seen on outside CT RIGHT KIDNEY: 11.2 cm in length. Visualization is limited by overlying bowel gas. No hydronephrosis is present.LEFT KIDNEY: 12.5 cm in length. A 1.3 x 1.3 x 1.3 cm benign-appearing cyst is noted in the inferior pole, with layering milk of calcium. This appears grossly similar in size to the prior CT. No suspicious lesions are evident. No hydronephrosis.OTHER: No significant abnormality noted.", "output": "1.3 cm simple cyst in the left kidney, without suspicious features."}
{"instruction": "Generate impression based on findings.", "input": "73 years Female with history of thyroid nodule. RIGHT LOBE MEASUREMENTS: 4.4 x 1.3 x 1.5 cmLEFT LOBE MEASUREMENTS: 5.4 x 2.2 x 1.6 cmISTHMUS MEASUREMENTS: 0.2 cm in thickness. RIGHT LOBE: Normal echotexture. There is an oval-shaped, hypoechoic nodule with well-defined borders in the inferior aspect of the right lobe which measures 0.5 x 0.3 x 0.3 cm.LEFT LOBE: Normal echotexture. There is a dominant nodule within the mid pole of the left lobe which measures 1.8 x 1.5 x 1.7 cm. The nodule is mixed solid and cystic, is round/oval in shape, has smooth borders, and demonstrates internal vascularity.ISTHMUS: Normal echotexture without discrete nodules. PARATHYROID GLANDS: No significant abnormalities.LYMPH NODES: No significant abnormalities. OTHER: No significant abnormalities.", "output": "Dominant left midpole mixed solid/cystic nodule measuring up to 1.8 cm which would be amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: primary hyperparathyroidism kidney stones? History: hypercalcemia RIGHT KIDNEY: The right kidney measures 12.7 cm in length. There is no hydronephrosis. No shadowing calculi or masses are seen. The renal parenchymal echogenicity is unremarkable.LEFT KIDNEY: The left kidney measures 11.5 cm in length. There is no hydronephrosis. No shadowing calculi or masses are seen. The renal parenchymal echogenicity is unremarkable.OTHER: Bilateral ureteral jets visualized.", "output": "Unremarkable ultrasound examination of the kidneys without evidence of renal calculi or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Male 62 years old Reason: assess for liver lesions History: Hx of HCV LIVER: Mildly hyperechoic hepatic mass with a hypoechoic rim, measuring 3.5 x 3.7 x 4.1 cm is highly concerning for malignancy. Background liver appears coarse and nodular compatible with cirrhosis. Two other hyperechoic foci in the liver are nonspecific. Main portal vein is patent with normal directional flow and a peak velocity of 14.3 cm/s.BILIARY TRACT: Stones and sludge are present within the gallbladder. Cholesterol deposits are also present within the gallbladder wall. No evidence of acute blood or inflammation. No intra or extrahepatic biliary ductal dilatation.PANCREAS: The visualized portions of the pancreas are normal in appearance.SPLEEN: Spleen is normal in appearance measuring 9.1 cm.KIDNEYS: There is a partially visualized horseshoe kidney. No hydronephrosis or shadowing stone is identified.OTHER: No significant abnormalities noted.", "output": "1.Hyperechoic hepatic mass with a hypoechoic rim is highly concerning for malignancy. Recommend dedicated hepatic CT or MRI to further characterize.2.Cirrhotic liver morphology.3.Incidental note of a horseshoe kidney."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid carcinoma status post thyroidectomy RIGHT LOBE: Status post thyroidectomy without mass. Previously noted hypoechoic focus within the right thyroid bed not identified on the current examination.LEFT LOBE: Status post thyroidectomy. Stable stable hypoechoic left thyroid bed focus measuring 0.3 x 0.2 x 0.5 cm.ISTHMUS: Status post thyroidectomy without massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing reactive mildly prominent left level 1 lymph nodes; favor benign reactive etiologyOTHER: No significant abnormality noted.", "output": "Previously noted subcentimeter right thyroid bed hypoechoic focus not appreciated on current examination. Stable subcentimeter left thyroid bed hypoechoic focus. Benign-appearing reactive mildly enlarged left level 1 lymph nodes; favor benign reactive etiology. No worrisome regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Female 42 years old; Reason: Right Isthmus PTC 1.3cm. Assess lymph nodes. History: Right Isthmus PTC 1.3cm. Assess lymph nodes. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 1.5 x 1.5 x 5.1 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 1.3 x 1.4 x 5.3 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.5 cm.RIGHT LOBE: There is a nodule in the mid right lobe measuring 0.5 cm x 0.4 cm x 0.4 cm. This nodule is isoechoic to the thyroid with a hypoechoic periphery. No microcalcifications are seen.LEFT LOBE: The left lobe is slightly heterogeneous. In the main/inferior portion there is a subcentimeter hypoechoic nodule. No internal microcalcifications are seen.ISTHMUS: Irregular hypoechoic nodule with internal microcalcifications is seen within the isthmus representing previously identified papillary thyroid cancer. This measures 1.2 cm x 0.7 cm x 1.3 cm and is taller than wide.LYMPH NODES: No suspicious adenopathy noted.", "output": "1.Lesion representing previously biopsied papillary thyroid cancer is redemonstrated within the isthmus.2. No suspicious regional adenopathy is seen.3.Subcentimeter nodule in the mid/right lobe measuring 0.5 cm x 0.4 cm x 0.4 cm as well as a small subcentimeter nodule seen in the left lobe."}
{"instruction": "Generate impression based on findings.", "input": "Mononucleosis. Elevated liver function tests. LIVER: Non-cirrhotic liver morphology. 21 cm in length. 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 12.6 cm in length. The left kidney is 13.3 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 14.3 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites.", "output": "Spleen at the upper limits of normal in size. No specific sonographic abnormality otherwise identified."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Iannitelli is a 44 year old female with personal history of left lumpectomy in 2008 for invasive ductal carcinoma with nodal involvement, status post radiation and chemotherapy. She presents today for six-month follow-up of a probably benign finding in the right breast 9:00 position. On physical examination, no discrete mass is palpated at the area of interest in the right breast. A targeted right breast ultrasound was performed at the area of concern on the prior ultrasound and also at the patient's palpable concern from 6:00 to 11:00 location in the right breast. -Multiple simple cysts are noted in the outer right breast at the site of patient's palpable concern. The largest cyst measures up to 9 x 4 x 8 mm in the right breast at 10:00 location, 2 cm from the nipple. -Previously identified clustered cyst in the right breast 9:00 location, 2 cm from the nipple has slightly decreased in size and now measures 6 x 3 x 5 mm (previously measures 8 x 4 x 6 mm).", "output": "Slightly decrease in size of clustered cyst in the right breast 9:00 location. No sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 6 months in order to confirm stability of these findings. All 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": "Female; 49 years old. Reason: Large Thyroid mass that extends from the right lobe to the left. History: Large Thyroid mass that extends from the right lobe to the left. RIGHT LOBE MEASUREMENTS: 7.5 x 2.2 x 2.5 cmLEFT LOBE MEASUREMENTS: 7.5 x 2.1 x 1.8 cm ISTHMUS MEASUREMENTS: 3.5 cmRIGHT LOBE: The right lobe is completely replaced by nodules. No dominant nodule is identified. LEFT LOBE: Left lobe is completely replaced by solid nodules with minimal flow on color Doppler. No dominant nodule is identified.ISTHMUS: The Isthmus is completely replaced by solid nodules with minimal flow on color Doppler. No dominant nodule is identified.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No worrisome lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Multinodular goiter."}
{"instruction": "Generate impression based on findings.", "input": "History of pancreatic cancer status post ERCP presenting with fever. LIVER: The liver is heterogeneously coarse and echogenic limiting evaluation for a focal lesion. No intrahepatic biliary ductal dilatation. Several punctate probable calcifications. Attenuated portal vein with intact hepatopedal portal venous blood flow at ~20 cm/second. Mild perihepatic ascites.BILIARY TRACT: Partially distended gallbladder with sludge wall thickening and mild pericholecystic fluid. Evaluation for focal tenderness is limited by patient's altered mental state. No extrahepatic biliary ductal dilatation.PANCREAS: The pancreas is obscured by overlying bowel gas.SPLEEN: The spleen is normal in size measuring 11 cm without a focal abnormality.RIGHT KIDNEY: The right kidney measures 10.5 cm. It is mildly echogenic without hydronephrosis or shadowing nephrolithiasis. OTHER: The left kidney measures 11.3 cm. It is mildly echogenic without hydronephrosis or shadowing nephrolithiasis.", "output": "1. Partially distended gallbladder with sludge wall thickening and mild pericholecystic fluid. Evaluation for focal tenderness is limited by patient's altered mental status. Findings raise the possibly of acute cholecystitis.2. Heterogeneously coarse and echogenic liver parenchyma suggests parenchymal dysfunction/infiltrative disease, however limits evaluation for a focal lesion. Attenuated portal vein with intact hepatopedal portal venous blood flow. No biliary ductal dilatation. If further evaluation is clinically warranted a CT and/or MR should be considered.3. Echogenic kidneys suggesting medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Radical hysterectomy for cervical cancer in November 2015. Left-sided flank pain. RIGHT KIDNEY: 11.6 cm in length. Mildly increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 11.0 cm in length. Mild hydronephrosis is present. Mildly increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones.BLADDER: No significant abnormality noted. OTHER: A dilated distal left ureter is not identified.", "output": "Mild left hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with chronic hepatitis C. LIVER: Measures 17.2 cm in length. Increased hepatic echogenicity without discrete focal lesion.BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis.PANCREAS: No significant abnormalities noted.SPLEEN: Measures 14.9 cm without focal lesion.KIDNEY: Increased renal echogenicity without hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Increased hepatic echogenicity consistent with chronic liver disease, without focal hepatic lesion.2.Increased renal echogenicity consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Reason: left cervical lymphadenopathy, asymptomatic, eval LN vs mass History: as above There are several prominent hypoechoic lymph nodes in the left preauricular region underlying the patient's palpable nodule. While the lymph nodes do not meet size criteria for enlargement, the lack visible fatty hila.", "output": "While the lymph nodes do not meet size criteria for enlargement, they lack definite benign features. These may be amenable to biopsy if clinically indicated or alternatively could be followed with follow-up ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Kaplan is a 25-year-old female with history of palpable area of the left breast 1:00 position 3 cm from the nipple. Family history of maternal grandmother and ovarian cancer in paternal great aunt. On physical examination, no palpable mass is identified. A targeted left ultrasound was performed for the patient\u2019s 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: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Cotten is a 72-year-old female presenting for follow-up ultrasound for cluster of cysts in the right breast. No personal or family history of breast cancer. Physical examination of the right breast demonstrated no palpable abnormality.A targeted right ultrasound was performed for the sonographic area of concern. In the right breast 1:00 position 1 cm from the nipple is an anechoic area with internal septation measuring 1.2 cm x 0.5 cm x 0.9 cm previously 1.2 cm x 0.5 cm x 1.5 cm. No internal vascularity is evident. Findings are most compatible with cluster of cysts. There is no solid mass identified.", "output": "Findings most compatible with a benign cluster of cysts. No sonographic evidence for malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 6 months. At that time, if everything remains stable, patient can resume annual screening mammography. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (6 Months)."}
{"instruction": "Generate impression based on findings.", "input": "71 year old man with right goiter. RIGHT LOBE MEASUREMENTS: 4.0 x 2.7 x 1.0 cm.LEFT LOBE MEASUREMENTS: 5.1 x 2.4 x 1.9 cm.ISTHMUS MEASUREMENTS: 0.2 cm in AP dimension.RIGHT LOBE: The right lobe of the gland is displaced posteriorly by a predominantly simple cystic structure measuring 9.4 x 7.8 x 4.6 cm in size. This cystic structure contains minimal posterior septation and mural nodularity.LEFT LOBE: The left lobe of the gland is atrophic and slightly heterogeneous in echotexture with ill-defined solid nodule measuring 3.0 x 2.3 x 1.6 cm.ISTHMUS: Atrophic and slightly heterogeneous echotexture. PARATHYROID GLANDS: No enlarged parathyroid gland identified.LYMPH NODES: No regional lymphadenopathy. OTHER: No significant abnormality noted.", "output": "A large predominantly simple cystic structure with minimal posterior septation and mural nodularity displaces the right thyroid lobe posteriorly. The left lobe of the gland is atrophic with slightly heterogeneous echotexture and contains an ill-defined solid nodule."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for hepatocellular carcinoma. History of cirrhosis. LIVER: The liver is coarse in echogenicity, shrunken and nodular consistent with cirrhosis and fibrosis. No focal suspicious lesion is identified. Note is made of a right hepatic lobe cyst, confirmed on recent MRI.There is normally oriented low amplitude main portal venous blood flow at 0.1 m/s. The right and left portal vein is not visualized.BILIARY TRACT: Nonspecific mild gallbladder wall thickening in the setting of cirrhosis. The gallbladder is full of stones and contracted.The common bile duct measures up to 8 mm, unchanged.PANCREAS: Limited evaluation of the pancreatic head and neck is unremarkable.SPLEEN: Splenomegaly measuring 18.3 cm in length without a focal lesion.RIGHT KIDNEY: The right kidney measures 10.8 cm in length without hydronephrosis, shadowing nephrolithiasis or suspicious lesion evident. OTHER: Patent periumbilical collateral vessel is noted. The left kidney measures 11 cm in length without hydronephrosis, shadowing nephrolithiasis or suspicious lesion. A 1.2 cm cyst is noted and was seen on the prior MRI.", "output": "Stable examination with cirrhosis without suspicious liver lesion. Diminished normally oriented portal venous blood flow appearing similar to the prior study."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old male with history of liver transplant and right flank pain. Evaluate for capsular hematoma. LIVER: Perihepatic bland fluid is seen, may represent ascites although this is nonspecific. There is no internal vascularity or mixed echogenicity of the fluid.BILIARY TRACT: No significant abnormalities noted.OTHER: Skin thickening is noted over the incision site, correlate with physical exam to exclude cellulitis.", "output": "Bland perihepatic fluid is noted, may represent ascites. No hepatic capsular hematoma is seen."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old female with palpable lump in right breast for one week. Family history of breast cancer in grandmother and maternal aunt. A targeted right breast ultrasound was performed for the palpable area of concern. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy. Follow-up with primary care physician and return for screening mammography beginning at age 40. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Male 39 years old Reason: right testicular pain, evaluate for abnormality History: acute right testicular pain with active hand, foot and mouth illness RIGHT TESTIS: Right testicle measures 5.1 x 2.4 x 3.3 cm. Diffusely increased vascular flow within the right testicle. Background echogenicity of the testicle is mildly heterogeneous. Small hydrocele. No focal testicular mass. LEFT TESTIS: Left testicle measures 5.4 x 2.7 x 3.2 cm. Background echogenicity of the testicle is relatively homogeneous. No focal testicular mass. Small hydrocele.RIGHT EPIDIDYMIS: Right epididymis measures 0.2 x 1.0 x 1.0 cm. Increased vascular flow of the right epididymis suggests epididymitis.LEFT EPIDIDYMIS: Left epididymis measures 3.2 x 0.8 1.5 cm, and is normal in appearance.OTHER: No significant abnormalities noted.", "output": "Findings consistent with acute epididymo-orchitis"}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for whole breast ultrasound for dense breast screening. Personal history of multiple bilateral benign breast biopsies (left breast stereotactic biopsy in 2009 for fibrocystic changes, bilateral cyst aspiration in 2005, right excisional biopsy in 2000 for fibrocystic changes, right stereotactic biopsy in 2000 for fibrotic breast tissue). Strong family history of breast cancer in mother, maternal great aunt, and maternal great cousin. 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. Given the patient's strong family history, a consultation with the cancer high risk clinic/genetic counselor is advised.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for possible sources of infection LIVER: The liver measures 18.9 cm in length. The liver parenchymal echotexture is normal. In the right hepatic lobe, there is a cyst measuring 3.3 x 2.3 cm which appears to contain thin internal septations and is similar in size to 2007 CT. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.35 m/s.BILIARY TRACT: The gallbladder is surgically absent. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 2.5 mm in diameter.PANCREAS: The pancreas is largely obscured.SPLEEN: The spleen is enlarged and measures 16.0 cm in length. RIGHT KIDNEY: Kidney measures 11.8 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 12.3 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.No forthcoming cause of infection identified as clinically questioned.2.Splenomegaly.3.Hepatic cyst appearing similar to 2007 CT."}
{"instruction": "Generate impression based on findings.", "input": " There remains a T1 isointense, T2 hyperintense minimally expansile intramedullary lesion within the cervical cord extending from the lower level of C2 to C4. The lesion is largest within the midportion measuring 9 x 6 mm in the AP and transverse dimensions (series 11, image 18), compared to 7 x 5 previously, suggesting that the lesion may be minimally larger. The lesion is unchanged in the craniocaudal dimension where it measures 22 mm (series 6, image 7). There has been interval recurrence of the associated enhancement which had seemingly resolved on the prior exam. On the axial images, the enhancement is not as discrete as it was on the first examination, but on the sagittal images, the enhancement is at least as conspicuous as on the first study. No other areas of enhancement are noted within the spinal cord. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. There is developmental narrowing of the cervical spine and possible thickening of the posterior longitudinal ligament through much of the cervical spine.C2-C3: Shallow disc protrusion without spinal canal stenosis or neuroforaminal narrowing. C3-C4: Posterior disc-osteophyte complex with mild to moderate spinal canal stenosis. Mild bilateral facet hypertrophy and neuroforaminal narrowing.C4-C5: Posterior disc bulge with mild spinal canal stenosis and a superimposed left paracentral disc protrusion. Mild to moderate left neuroforaminal narrowing.C5-C6: Mild developmental spinal canal narrowing and mild right neuroforaminal narrowing due to uncovertebral hypertrophy.C6-C7: Left paracentral disc protrusion with mild left neuroforaminal narrowing. Two oval left thyroid T2 hyperintense lesions are noted, the largest measures 8 x 14 mm. If clinically warranted, further evaluation with ultrasound may be considered along with correlation with laboratory values.", "output": "1. There has been interval return of enhancement of the intramedullary lesion extending from C4 to C6. There may also be a subtle increase in the size of the signal abnormality within the cord. The recurrence of these findings may reflect changes in steroid dosing. The differential diagnosis continues to include demyelination, inflammation including granulomatous disease, potentially lymphoma, and less likely primary cord tumor.2. Unchanged, developmentally narrowed cervical spinal canal with mild to moderate multilevel cervical spondylosis. "}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female with biopsy proven cancer in the right breast and a questionable right axillary lymph node on outside hospital ultrasound, presents for repeat right axillary ultrasound. A right axillary ultrasound was performed. A lymph node low in the right axilla (designated 2 on the final image) measures 1.2 x 0.4 x 0.8 cm and has a partial fatty hilum and normal vascularity however there is focal cortical thickening up to 7 mm. An adjacent benign lymph node measures 1.8 x 0.6 x 0.4 cm with a fatty hilum and thin cortex.", "output": "Focal eccentric cortical thickening of a low right axillary lymph node. Ultrasound-guided core needle biopsy may be performed if clinically indicated.BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with complex renal cyst. Evaluate for stability or change in appearance. RIGHT KIDNEY: The right kidney measures 10.1 cm in length. Cortex is mildly echogenic consistent with parenchymal disease. There is a very small simple cyst in the lower pole. No hydronephrosis, shadowing calculus or solid mass.LEFT KIDNEY: The left kidney measures 11.1 cm in length. Cortex is mildly echogenic consistent with parenchymal disease. Arising from lower pole is a complex cystic mass with some rim calcification measuring 1.9 x 2.7 x 2.5 cm. These measurements may not be directly comparable to those from CT, and size stability over 5 years is consistent with benignity. No hydronephrosis, shadowing calculus or other mass. OTHER: Bladder is decompressed.INDEX LESION MEASUREMENTS (Current exam date/time: 2/19/2016 13:15:00)LEFT LOWER POLE LEFT RENAL MASS: 2.7 x 1.9 cm (Image 10496, Series 2).2.5 cm (Image 12032, Series 2).", "output": "Complex cystic left renal mass with measurements as given above"}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for obstruction. Rising creatinine RIGHT KIDNEY: The right kidney measures 8.1 cm. The right kidney is increased echogenicity. A right lower pole anechoic lesion measures 1.0 x 1.2 x 1.2 cm, compatible with simple cyst. There is no hydronephrosis or renal calculus.LEFT KIDNEY: The left kidney measures 7.7 cm. There is no hydronephrosis, renal calculus or suspicious lesion.URINARY BLADDER: The prostate measures 5.3 x 4.6 x 4.2 cm, mildly enlarged. The bladder is incompletely distended.OTHER: No significant abnormalities noted.", "output": "Nonspecific echogenic bilateral kidneys, compatible with renal parenchymal dysfunction. No hydronephrosis, renal calculi or suspicious lesion identified. "}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain. Sickle cell disease. Status post cholecystectomy. LIVER: 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 11.0 cm in length. The left kidney is 10.6 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: Spleen is not visualized, likely representing stigmata of sickle cell disease.OTHER: No significant abnormalities noted. No ascites.", "output": "No sonographic findings to account for the patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "Probable nodule in the left lower back. There is an ovoid hypoechoic cystic lesion in the superficial subcutaneous tissue of the left lateral back measuring 0.6 x 0.3 x 0.4 cm. The lesion does not demonstrate internal vascularity or internal echoes.", "output": "Cystic lesion in the left back may represent a dermoid cyst, sebaceous cyst, or resolving hematoma."}
{"instruction": "Generate impression based on findings.", "input": "61 years old, Female, Reason: concern for ascites History: increase in abdominal size/cirrhosis Large amount of perihepatic ascites is present. There is a significant amount of free fluid within the left upper quadrant, right and left lower quadrants, as well as the pelvis. Incidental note is made of a cirrhotic liver as seen on prior examinations.", "output": "Four quadrant ascites."}
{"instruction": "Generate impression based on findings.", "input": "41 year old female with hyperparathyroidism. Please evaluate for thyroid nodules. RIGHT LOBE MEASUREMENTS: 4.7 x 1.9 x 1.2 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.7 x 1.1 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: Note is made of a hypoechoic oval well-circumscribed nodule along the inferior pole of the right lobe of the thyroid gland, measuring 6 x 8 x 6 mm. There is associated internal vascularity. No microcalcification is evident.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal morphology left level 2 and level 4 cervical lymph nodes.OTHER: No significant abnormality noted.", "output": "8 mm nodule along the inferior pole of the right lobe of the thyroid gland, which is suspicious for a parathyroid adenoma candidate. Please refer to concomitant nuclear medicine exam from same day for additional findings."}
{"instruction": "Generate impression based on findings.", "input": "Worsening acute kidney injury. RIGHT KIDNEY: The right kidney measures 13.7 cm. The cortex is echogenic. No hydronephrosis or renal calculus identified.LEFT KIDNEY: The left kidney measures 13.0 cm. The cortex is echogenic. No hydronephrosis or renal calculus identified.URINARY BLADDER: Bladder distended and contains debris.OTHER: No significant abnormalities noted.", "output": "1.Echogenic kidneys, compatible with medical renal disease. No renal calculus or hydronephrosis identified.2.Debris noted within the bladder."}
{"instruction": "Generate impression based on findings.", "input": "Female 25 years old; Reason: 25F with thrombocytopenia and hx lupus, evaluate spleen History: thrombocytopenia LIVER: The liver measures 12.7 cm in length. There is normal echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen.SPLEEN: The spleen measures 8.21 cm and is without abnormalities.OTHER: No significant abnormality noted.", "output": "1. Normal ultrasound of the spleen without splenomegaly or other findings to explain patient's thrombocytopenia."}
{"instruction": "Generate impression based on findings.", "input": "Female 38 years old Reason: recurrent medullary carcinoma History: fatigue Skin was marked for the following lesions. No dye injection was deemed unnecessary. 2 or more conglomerate lesions in the right thyroid bed were marked.Station 2 lymph nodes was marked in the right submandibular area.Lesion in the left thyroid bed was marked. This is the lesion that was biopsied previously.Lesion previously described in the left supraclavicular area was marked.", "output": "4 sites marked."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old female with epigastric pain, evaluate for gallstones LIVER: Normal hepatic echogenicity. Subcentimeter simple cyst. The main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: No gallstones or biliary dilation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Measures 11.2 cm. No hydronephrosis or mass.OTHER: Spleen measures 10.5 cm. Left kidney measures 10.8 cm. No hydronephrosis or mass.", "output": "Normal right upper quadrant ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodule seen on MR exam as well as right cheek mass RIGHT LOBE MEASUREMENTS: 5.2 x 1.9 x 2.5 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.4 x 1.6 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Large mixed cystic and solid thyroid nodule measuring approximately 2.5 x 1.4 x 4.3 cm. Multiple colloid concretions within this nodule.LEFT LOBE: Spongiform benign-appearing nodule within the lower pole measuring 2 x 1 x 1 cm. Superior pole nodule measuring 0.7 x 0.6 x 0.8 cm; this superior nodule demonstrates rim calcification.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Ultrasonographic examination of the subcutaneous tissues of the right cheek demonstrates normal vasculature without evidence for abnormal mass or vascular malformation.", "output": "Right thyroid nodule with characteristics suggestive for benign colloid nodule. Benign-appearing spongiform inferior left thyroid nodule. Subcentimeter superior pole left thyroid nodule with rim calcification.No evidence for abnormal mass or vascular malformation involving right cheek."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Mildly coarse liver echotexture without mass. Liver length 19.6 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 10 cm in length OTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. 9 cm in length. Bilateral pleural effusions. Trace ascites", "output": "Coarse echogenic liver parenchyma with hepatomegaly consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Cholelithiasis without acute inflammation. Trace ascites.Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "History right renal cysts RIGHT KIDNEY: 3 x 3.7 x 3.5 cm solid exophytic mass arising from the upper pole of the right kidney. Additional subcentimeter right renal cysts. Echogenic renal parenchyma without hydronephrosis. Right kidney 8.7 cm in length.LEFT KIDNEY: Multiple cysts. Echogenic renal parenchyma. Nonobstructing subcentimeter renal stone. No hydronephrosis. Right kidney 10.7 cm in length.OTHER: Bladder nondistended", "output": "Solid exophytic mass arising from the upper pole of the right kidney. This lesion does not fill the criteria for a benign lesion and a malignancy must be considered.Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without obstruction.Nonobstructing subcentimeter left renal stone."}
{"instruction": "Generate impression based on findings.", "input": "Male, 85 years old. AKI, hx of BPH RIGHT KIDNEY: The right kidney measures 13.6 cm in length, with increased cortical echogenicity and cortical atrophy. Multiple cystic lesions are again noted. A septated cyst or two adjacent cysts in the lower pole measure 11.0 x 6.4 x 7.4 cm, unchanged. No shadowing stones are hydronephrosis.LEFT KIDNEY: The left kidney measures 13.3 cm in length, with increased cortical echogenicity and cortical atrophy. Multiple cystic lesions are noted, including a 5.5 x 4.0 x 4.2 cm midpole cyst, unchanged. No shadowing stones or hydronephrosis.OTHER: The bladder is incompletely distended. The prostate is enlarged.", "output": "1.Enlarged prostate without hydronephrosis or significant bladder distention.2.Renal atrophy and increased renal cortical echogenicity, compatible with medical renal disease. Bilateral renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Alston is a 69 year old female status post bilateral mastectomy in August 2014. She now presents with a palpable lump in the left lateral reconstructed breast. The physician palpated area of concern in the left lateral breast is marked. Upon physical exam, there is a palpable superficial mobile mass present.A targeted left ultrasound was performed for the palpable area of concern. There is an ovoid hyperechoic solid mass measuring 2.1 x 0.6 x 2.8 cm. This mass is not associated with any vascularity. It is superficially located. There is no suspicious solid or cystic mass identified.", "output": "Sonographic findings compatible with fat necrosis in the left lateral reconstructed breast. No sonographic evidence for malignancy. Patient may continue to follow-up with surgery as clinically warranted. All results and recommendations were relayed to the patient and Sarah Petraitis at the time of dictation.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine. Congenital solitary left kidney. RIGHT KIDNEY: Not present.LEFT KIDNEY: 11.4 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: Collapsed.OTHER: No significant abnormality noted.", "output": "Solitary left kidney with echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Reason: history of papillary thyroid carcinoma, please evaluate for recurrence RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Hypoechoic nodule in the superior aspect of the thyroid bed measures 0.2 x 0.4 x 0.4 cm, unchanged.LEFT LOBE: There are 3 hypoechoic nodules in the inferior aspect of the left thyroid bed.Nodule 1: 0.3 x 0.4 x 0.3 cm, unchanged.Nodule 2: 0.5 x 0.4 x 0.3 cm, unchanged.Nodule 3: 0.5 x 0.4 x 0.4 cm, unchanged.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small benign-appearing lymph nodes. A left level 2 node measures 0.7 x 0.2 x 0.8 cm. A right level 2 node measures 0.9 x 0.4 x 1.3 cm.OTHER: No significant abnormality noted.", "output": "Stable small bilateral hypoechoic foci in the thyroid bed. No regional lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "57 year old female who was recalled from screening mammogram for new right upper outer quadrant mass. 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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A 5 mm spiculated mass persists on spot compression views in the right upper outer quadrant.Ultrasound: Targeted right upper quadrant ultrasound was performed. Right breast 10 o'clock position 4 cm from the nipple, there is a suspicious taller than wide hypoechoic mass measuring 5 x 4 mm, which most likely responsible mammographic abnormality.", "output": "Suspicious spiculated 5-mm mass in the right breast 10 o'clock position on mammogram and ultrasound, needs further evaluation with ultrasound guided biopsy.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "81-year-old female with chronic viral hepatitis and cirrhosis with small nodular density gallbladder on recent CT. LIVER: Liver is coarsely echogenic but normal in size. No obvious focal hepatic mass. GALLBLADDER, BILIARY TRACT: The gallbladder is adequately visualized although with some limitation due to body habitus. No shadowing gallstones are seen, and the gallbladder wall thickness is normal. The small soft tissue focus identified on prior CT is not seen on ultrasound exam. The biliary tract is normal in caliber. PANCREAS: The head and body are normal. The tail was not well seen due to bowel gas.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Splenic size is normal.", "output": "Gallbladder wall abnormality not identified on today's exam.Echogenic liver."}
{"instruction": "Generate impression based on findings.", "input": "Female, 50 years old. Reason: thyromegaly History: thyromegaly x5 months RIGHT LOBE MEASUREMENTS: 1.9 x 2.1 x 6.5 cmLEFT LOBE MEASUREMENTS: 2.9 x 2.3 x 6.8 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Mildly heterogeneous echotexture. A right lower pole nodule measures 0.8 x 0.6 x 0.6 cm, cystic and solid/spongiform, well marginated, without significant increased vascularity. An additional right lower pole nodule measures 1.0 x 0.4 x 0.9 cm, well marginated, cystic and solid with punctate echogenic foci.LEFT LOBE: Mildly heterogeneous echotexture. An ill-defined area of heterogeneity in the left lower pole measures 4.4 x 1.8 x 2.6 cm, with mild internal vascularity and punctate echogenic foci with suggestion of ringdown artifact.ISTHMUS: Mildly heterogeneous echotexture. A nodule at the junction of the isthmus and left lobe measures 0.8 x 0.7 x 0.8 cm, well marginated, solid and heterogeneous, noncalcified, with peripheral vascularity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Enlarged, heterogeneous thyroid, with cystic and solid nodules as detailed above. A dominant nodule in the left lower pole measures up to 4 cm, punctate echogenic foci with associated ringdown artifact suggested, seen in setting of inspissated colloid. However, if there is continued clinical concern, benignity of this nodule may be confirmed with dedicated fine needle aspiration. Additional small nodules measure up to 1 cm. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: HCV, elevated APRI @ 2.99 eval for lesions. History: HCV, probable cirrhosis LIVER: The liver measures 11.6 cm in length. Coarse, echogenic hepatic parenchyma. The portal vein is patent with normal directional hepatopedal portal venous flow, peak velocity 23 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. The common hepatic duct measures 0.3 cm. No biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 9.7 cm in length. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.2 cm in length. No shadowing stones or hydronephrosis.OTHER: No ascites.", "output": "1. Coarse, echogenic liver, consistent with hepatic parenchymal dysfunction or chronic liver disease. No focal mass is identified."}
{"instruction": "Generate impression based on findings.", "input": "Ms. ROSAMOND GEARY is a 69 years old female with a personal history of benign needle biopsy in the right breast. Patient complains of a area of pain in retroareolar region of left breast. She has a family history of breast cancer in her mother. MAMMOGRAM:Three standard views of the left breast as well as three 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. A triangular marker was placed over the region of pain in the retroareolar region, slightly medial. No suspicious masses or calcifications are identified in the region of painULTRASOUND:On physical examination, no discrete palpable mass noted. Patient complains of pain off-and-on in the left breast 10 to 11:00 position.A targeted left ultrasound was performed for the painful area of concern. There is no solid or cystic mass identified.", "output": "No mammographic or sonographic abnormality corresponding to area of pain in the left breast No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually, due in June 2016. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.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": "Gas pain LIVER: Non-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. Biliary sludge noted. Otherwise unremarkable appearance of the gallbladderPANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney is 10.8 cm in length. The left kidney is 11.2 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 5.9 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid identified.", "output": "1. Mildly coarsened liver echogenicity, compatible with parenchymal dysfunction.2. Biliary sludge."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis LIVER: Mild cirrhotic morphology with coarse echogenic liver echotexture again noted without worrisome mass. Right hepatic cyst again noted and unchanged. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 16.4 cmBILIARY TRACT: Mild gallbladder wall thickening/edema with negative Murphy's.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 10.2 cm in lengthRIGHT KIDNEY: Right renal cyst. Right kidney 9.9 cm in length. OTHER: Left kidney 10.4 cm in length. Left renal cyst. No ascites", "output": "Stable mild cirrhotic morphology without worrisome mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female evaluation of mass on the left lateral buttock. Over the patient's palpable area of concern, there is a round complex solid/cystic lesion within the soft tissue. This measures 2.3 cm x 1.4 cm x 2.0 cm. Diffuse edema is present near the lesion.", "output": "Indeterminate complex solid/cystic lesion is seen within the soft tissue over the patient's area of concern in the left lateral buttock. Soft tissue edema is present near the lesion."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal 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 shadowing gallstones are noted, without gallbladder wall thickening or pericholecystic fluid.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 11.1 cm in length. The left kidney is 11.5 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 12.9 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No free fluid identified.", "output": "Cholelithiasis, without evidence of cholecystitis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old male presents with hyperbilirubinemia. Evaluate for biliary pathology. LIVER:The liver measures 18.7 cm in length. The parenchyma appears coarse and echogenic. No intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow. Mild ascites.GALLBLADDER, BILIARY TRACT: There are multiple subcentimeter echogenic foci in the gall bladder, the largest measuring approximately 0.6 x 0.4 x 0.7 cm, that are nondependent and are consistent with gallbladder polyps. Negative Murphy sign. The gallbladder wall measures 0.4 cm. There is no pericholecystic fluid. The common bile duct measures 5.6 mm.PANCREAS: Evaluation the pancreas is limited by overlying bowel gas, however the visualized portions appear normal.SPLEEN: The spleen measures 16.7 cm.KIDNEYS: The right kidney measures 11.2 cm and the left kidney measures 11.7 cm. The kidneys appear atrophic. No shadowing calculi, mass, or hydronephrosis. OTHER: No significant abnormality noted.", "output": "1. Coarse and echogenic liver consistent with chronic liver disease/parenchymal dysfunction. There is mild ascites, but no mass.2. Atrophic and echogenic kidneys consistent with chronic renal disease/parenchymal dysfunction.3. Gallbladder polyps without signs of acute cholecystitis or ductal dilatation.4. Hepatosplenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "71 year old female presents for preoperative exam prior to heart transplant. LIVER: The liver parenchyma is within normal limits. No intrahepatic biliary dilatation.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. The common bile duct measures up to 0.9 cm, which may be related to the patient's age and postoperative status. No intrahepatic biliary dilatation or significant abnormality otherwise.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. Spleen measures 9.1 cm in length.KIDNEYS: The right kidney measures 9 cm. There is a mildly complex cyst in the right kidney upper pole which measures 2.8 x 2.1 x 2.7 cm, and has an internal septation and subtle nodularity of the wall. This may be followed on subsequent exams. The left kidney is within normal limits, and measures 9.2 cm.ABDOMINAL AORTA: The proximal aorta measures 2.5 cm, mid aorta measures 1.9 cm, and the distal aorta measures 1.8 cm in diameter.INFERIOR VENA CAVA: The inferior vena cava is within normal limits.OTHER: No significant abnormality noted.", "output": "Mildly complex cyst in the right kidney upper pole, which may be followed on subsequent exams.No additional significant abnormality."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old female patient with history of intra and extrahepatic ductal dilatation. 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 0.4 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 8 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 11.9 cm in length and demonstrates increased cortical echogenicity. There is mild right hydronephrosis.OTHER: The left kidney measures 12.3 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis.The spleen measures 13.2 cm in length.", "output": "1. Hepatic steatosis.2. No intra or extra-hepatic biliary ductal dilatation.3. Mild right hydronephrosis.4. Increased renal cortical echogenicity suggestive of medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "15 year old female patient with history of right breast lump x 1.5 months and right axillary pain. A targeted right breast ultrasound was performed of the right axilla and palpable right breast mass. In the area of the palpable abnormality a hypoechoic oval lobulated mass was seen in the 12:30 position of the right breast 2 cm from the nipple that measures 1.8 x 0.7 x 1.6 cm and demonstrates increased vascularity.No abnormalities were identified in the area of patient's pain in the medial axilla. Separate from the area of patient's pain in the right axilla were two prominent nonspecific lymph nodes, measuring up to 1.7 cm in maximal dimension.", "output": "1.Findings compatible with a fibroadenoma in the right breast. Recommend surgical consultation.2.No significant abnormalities in the right axilla in the area of patient's pain.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old female with increased creatinine. Technical assistance provided for ultrasound-guided renal biopsy by the nephrology service. Three passes were performed.", "output": "Technical assistance provided for renal biopsy."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old female. Call back from screening for a focal asymmetry in the left outer breast. MAMMOGRAM: A standard 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 composed of scattered fibroglandular density, unchanged in pattern and distribution. The previously noted focal asymmetry in the left upper outer breast became less conspicuous on the spot compression views. LEFT BREAST ULTRASOUND: Targeted ultrasound of the left upper outer quadrant showed a 5 x 3 x 3 mm cyst at 2:00 o'clock, 6 to 10 cm from the nipple. An additional smaller cyst is seen at 1 o'clock.", "output": "Small benign cysts in the left breast. No mammographic or sonographic evidence of malignancy. The 2:00 cyst explains the asymmetry for which the patient was recalled. As long as the patient's physical examination remains normal, patient may return to annual bilateral screening mammogram. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Refractory abdominal 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. A 4 mm non-shadowing non-mobile echogenic focus in the gallbladder may represent a gallbladder polyp or adherent stone. Otherwise unremarkable appearance of the gallbladder. 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 9.9 cm in length. The left kidney is 9.8 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 9.8 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.", "output": "4 mm echogenic focus in the gallbladder may represent a gallbladder polyp or adherent stone. Ultrasound follow-up in 6-12 months is recommended to assess stability."}
{"instruction": "Generate impression based on findings.", "input": "20 year-old female with a history of thyroid cancer post thyroidectomy and radioactive iodine. Enlarged submandibular lymph nodes identified on prior study. There is a heterogeneous right submandibular lymph node measuring 1.1 x 2.7 by 2.5 cm with punctate internal echogenic foci. Several of these areas demonstrate comet tail artifact. This is decreased in size when compared to the prior exam.There is a heterogeneous left submandibular lymph node measuring 0.9 x 1.7 x 2.2 cm without significant change. There are several punctate internal echogenic foci, at least a few of which may also demonstrate comet tail artifact.OTHER: No significant abnormality noted.", "output": "No change or slight decrease in submandibular lymph nodes."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 55 y/o F with prior RUQ pain. RUQ ultrasound requested to rule out gallstones or other etiology LIVER: Mildly increased hepatic parenchymal echogenicity and mild hepatomegaly. No intrahepatic or extrahepatic biliary ductal dilatation. The liver measures 16.7 cm in length. Normal portal venous hepatopedal blood flow, 39.1 cm/s.GALLBLADDER, BILIARY TRACT: No stones or sludge. No pericholecystic fluid. The gallbladder wall measures 0.3 centimeters in thickness. The common hepatic duct measures 0.4 cm.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 11.5 cm in length. The left kidney measures 12.9 cm in length. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Mild hepatomegaly and echogenic liver, which may reflect parenchymal dysfunction or hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male with history of severe hepatic steatosis. LIVER: The liver measures 19.5 cm in length. The parenchyma is severely coarse and echogenic which limits evaluation of discrete liver lesions. The portal vein is patent demonstrating brisk hepatopetal flow with a velocity of 0.5 m/s.BILIARY TRACT: The gallbladder is absent. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 5 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 11.0 cm in length. RIGHT KIDNEY: Kidney measures 12.8 cm in length. Increased parenchymal echogenicity is suggestive of medical renal disease/parenchymal dysfunction. Previously visualized right renal calculus is not visualized on this exam. LEFT KIDNEY: Kidney measures 12.4 cm in length. Increased parenchymal echogenicity is suggestive of medical renal disease/parenchymal dysfunction. No hydronephrosis, shadowing calculus or mass.OTHER: Bilateral pleural effusions.", "output": "1.Enlarged, echogenic liver suggestive of severe hepatic steatosis, similar to prior. 2.Echogenic kidneys suggestive of medical renal disease/parenchymal dysfunction. 3.Bilateral pleural effusions. "}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female with acute renal insufficiency. RIGHT KIDNEY: Right kidney measures 9.8 cm in length. Echotexture appears within normal limits. There is a 2.7 cm simple cyst arising from the upper pole. No hydronephrosis or shadowing calculus.LEFT KIDNEY: Left kidney measures 9 cm in length. Echotexture appears within normal limits. Likely small cyst in the lower pole. No hydronephrosis or shadowing calculus.OTHER: Right pleural effusion.Bladder decompressed with Foley catheter.", "output": "No hydronephrosis. Echotexture within normal limits."}
{"instruction": "Generate impression based on findings.", "input": "Reason: abnormal liver function tests LIVER: The liver measures 15.0 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 0.21 m/s.BILIARY TRACT: Sludge is present within the gallbladder without associated significant gallbladder wall thickening. 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 9.1 cm in length. RIGHT KIDNEY: Kidney measures 9.9 cm in length. Increased cortical echogenicity. No hydronephrosis. Renal sinus cyst.LEFT KIDNEY: Kidney measures 12.0 cm in length. Increased cortical echogenicity. No hydronephrosis. OTHER: Mild ascites.", "output": "1.Increased hepatic echogenicity suggestive of parenchymal dysfunction/fatty infiltration. 2.Gallbladder sludge without evidence of cholecystitis.3.Mild ascites, new from April 2016 CT.4.Echogenic kidneys suggestive of medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Male 69 years old; Reason: LFT elevation of unknown etiology History: transaminase elevation LIVER: The liver measures 14.8 cm in length. There is increased and coarse echogenicity of the liver parenchyma which appears similar to the prior study. No focal hepatic lesions or ascites. No intrahepatic ductal dilation is seen. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.7 mm. No stones are seen, however gallbladder sludge is noted and the gallbladder is distended. No pericholecystic fluid or wall thickening. The common bile duct measures 9.1 mm in diameter and appears unchanged in comparison to the prior study PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.7 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 8.9 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.1 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: There is a trace right sided pleural effusion.", "output": "1. Coarse echotexture of liver appears similar to the prior study consistent with chronic liver disease / parenchyma disfunction. No focal masses, lesions, or ascites.2. Gallbladder sludge without ductal dilation or acute inflammation.3. Echogenic kidneys without hydronephrosis suggestive of chronic medical kidney disease/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with cystectomy, right upper quadrant pain. LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. Common bile duct appears normal in caliber. No choledocholithiasis is identified.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: The patient noted tenderness to palpation over his surgical scars during the examination.", "output": "Postoperative changes of cholecystectomy. No specific sonographic findings to account for the patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhotic liver LIVER: Cirrhotic liver without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent portal vein but with reversal of flow. Liver length 15 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: Not visualized due to overlying gasRIGHT KIDNEY: No significant abnormalities noted. 10.4 cm in lengthOTHER: Left kidney 9.3 cm in length. Spleen absent. Moderate ascites.", "output": "Cirrhotic liver without mass or ductal dilatation. Limited Doppler interrogation of the main portal vein demonstrates reversal of portal venous flow. Associated with moderate ascites. Cholelithiasis without acute inflammation."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old male with history of chronic hepatitis C. LIVER: The liver demonstrates heterogeneous hyperechoic echotexture, similar to prior. The liver measures 16.3 cm. No appreciable masses.BILIARY TRACT: Small amount of pneumobilia. No significant biliary dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. Spleen measures 13 cm.RIGHT KIDNEY: No significant abnormalities noted. Right kidney measures 8.7 cm.OTHER: No significant abnormalities noted. Left kidney measures 8.9 cm. Small amount of abdominal ascites.", "output": "Findings compatible with hepatic steatosis and small amount of ascites."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old male with sickle cell anemia, transaminitis and hyperbilirubinemia. LIVER: Slightly increased hepatic echogenicity. GALLBLADDER, BILIARY TRACT: Collapsed gallbladder with cholelithiasis. Unremarkable appearance of the common bile duct.PANCREAS: No significant abnormalities noted.KIDNEY: No significant abnormalities noted.SPLEEN: Splenomegaly. The spleen measures 16.9 cm in length.", "output": "1. Cholelithiasis without specific evidence of acute cholelithiasis. 2. Slightly increased hepatic echogenicity which may represent diffuse parenchymal disease or hepatic steatosis. 3. Splenomegaly. "}
{"instruction": "Generate impression based on findings.", "input": "50-year-old male with acute on chronic kidney injury and rising creatinine RIGHT KIDNEY: The right kidney measures 10.4 cm in length. There is increased echogenicity within the cortex. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 9.9 cm in length. There is increased echogenicity within the renal cortex. No hydronephrosis, stones, or worrisome masses are seen.BLADDER: The bladder is visualized and no significant abnormalities are seen. Bilateral ureteral jets are visualized.", "output": "Bilaterally increased echogenicity within the renal cortex compatible with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Gross hematuria RIGHT KIDNEY: No significant abnormalities noted. 11.9 cm in lengthLEFT KIDNEY: No significant abnormalities noted. 11.4 cm in lengthOTHER: Bladder nondistended", "output": "Negative renal ultrasound. Specifically, no evidence for worrisome mass, acute inflammation, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "55 years old, Male, Reason: r/o cholecystitis History: sepsis of unclear source with elevated bilirubin LIVER: The liver measures 16.6 cm in length. Echogenicity of the liver is within normal limits. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.4 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The sonographic Murphy's sign is negative. Mild intrahepatic biliary ductal dilatation which is nonspecific but may be further evaluated with MRCP if clinically warranted. The common bile duct measures 3 mm in diameter. Focus of adenomyomatosis or cholesterolosis is noted in the anterior portion of the gallbladder.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 11.8 cm in length. RIGHT KIDNEY: Kidney measures 11.0 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 9.8 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Gallbladder sludge without evidence of cholecystitis.2.Mild intrahepatic ductal dilatation which can be further evaluate MRCP if further evaluation is clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "elevated creatinine status post cystectomy, assess for obstruction RIGHT KIDNEY: Measures 9.0 cm. Echogenic renal parenchyma. No hydronephrosis or mass.LEFT KIDNEY: Measures 7.5 cm. Echogenic renal parenchyma. No hydronephrosis or mass.OTHER: The bladder is not visualized. Gallstones.", "output": "Atrophic kidneys and medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Male; 63 years old. Reason: evaluate for ascites History: ascites Cirrhotic liver morphology. The bladder is decompressed by a Foley catheter.There is mild ascites in the abdomen and pelvis.", "output": "Mild ascites."}
{"instruction": "Generate impression based on findings.", "input": "52 year old female patient requiring LVAD work up screening. LIVER:The liver measures 14.9 cm in length. No focal hepatic lesion is identified. The main portal vein is patent with hepatopetal flow measuring 0.2 m/s.GALLBLADDER, BILIARY TRACT: No gallstones, pericholecystic fluid, or gallbladder wall thickening is seen. There is no intra or extrahepatic biliary ductal dilatation. The common duct measures 2 mm in diameter.PANCREAS: The visualized head and body of the pancreas is normal in echogenicity. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 9 cm in length.KIDNEYS: The right kidney measures 10.1 cm in length. The left kidney measures 9.5 cm in length. No evidence of hydronephrosis. ABDOMINAL AORTA: The aorta is normal in caliber measuring 2.2 x 1.7 cm proximally, 1.5 x 1.3 cm in the midportion, and 1.2 x 1.1 cm distally. The right common iliac artery measures 0.8 x 0.6 cm. The left common iliac artery measures 0.7 x 0.7 cm.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No acute sonographic abnormality noted within the abdomen."}
{"instruction": "Generate impression based on findings.", "input": "67 year-old female with right upper quadrant pain. LIVER: Liver is normal in size and is moderately echogenic. This is not specific but could be due to fatty infiltration. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: The gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Fatty liver. Normal gallbladder and biliary tract."}
{"instruction": "Generate impression based on findings.", "input": "79-year-old female with multinodular goiter. Compare with prior exam. RIGHT LOBE MEASUREMENTS: 2.6 x 2.2 x 5.2 cmLEFT LOBE MEASUREMENTS: 2.4 x 1.7 x 5.7 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Right lobe is diffusely heterogeneous in echotexture. There is a dominant solid nodule with cystic components which is heterogeneous although largely echogenic in the superior pole. This measures 1.8 x 2.1 x 2.4 cm, unchanged in the prior exam.LEFT LOBE: Diffusely heterogeneous in echotexture. There is a dominant nodule which is probably solid with cystic components, heterogeneous in echotexture. This measures 1.9 x 2.2 x 2.4 cm perhaps minimally increased from prior exam.ISTHMUS: There is a predominantly solid nodule with cystic components with a predominant spongiform appearance measuring 0.8 x 1 x 1.3 cm without change.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Thyroid nodules as noted above. Of the measured nodules, one on the left may have increased slightly in size and the other 2 are stable."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with history of multinodular goiter. RIGHT LOBE MEASUREMENTS: 4 x 1.6 x 1.2 cmLEFT LOBE MEASUREMENTS: 3.6 x 1 x 1 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Mildly heterogeneous in echotexture. Predominant solid nodule in the upper pole measuring 0.8 x 1.1 x 0.8 cm mildly heterogeneous with echogenic areas in likely very small cystic component.Probably solid nodule in the lower pole measuring 0.4 x 0.5 x 0.7 cm again mildly heterogeneous with internal increased echogenicity and likely small cystic areas.LEFT LOBE: Mildly heterogeneous in echotexture. 0.4 x 0.5 x 0.6 cm spongiform-appearing nodule in the midportion. Other small cystic areas identified with comet tail artifacts consistent with colloid.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 nodules. Left nodule has appearance of a colloid nodule. Right nodules likely benign although indeterminate."}
{"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 suspicious or solid mass identified. A simple cyst is noted in the right outer breast.This exam was double read by Dr. Abe.", "output": "No sonographic evidence for malignancy.Today's mammogram will be separately dictated. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Male, 66 years old. Abdominal distension No free fluid is seen in the four quadrants of the abdomen.The liver is diffusely echogenic.", "output": "1.No ascites.2.Increased hepatic echogenicity, compatible with fatty infiltration or parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney failure RIGHT KIDNEY: Left kidney measures 10.3 cm. Cortex is echogenic. No hydronephrosis or mass.LEFT KIDNEY: Right kidney measures 10.9 cm. Cortex is echogenic No hydronephrosis or mass.OTHER: Foley catheter in a collapsed bladder. Large volume pelvic ascites.", "output": "No sonographic findings of nephrolithiasis or hydronephrosis.AscitesI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old female with history of clear cell sarcoma status post resection. Status post left lumpectomy for fibroadenoma in December 2010. Patient presents with palpable mass in the left breast. The area of the palpable abnormality was marked by the surgeon. A targeted left breast ultrasound was performed for the palpable area of concern. At the 12:00 position, 1 cm from the nipple, there is a circumscribed, wider than tall hypoechoic mass. This mass is difficult to measure due to large size, but measures at least 3.9 cm in greatest dimension.", "output": "A 3.9 cm mass in the left breast, corresponding to the area of palpable abnormality is probably a fibroadenoma, with other etiologies such as metastasis less likely. If needed clinically, it would be amenable to ultrasound guided biopsy. The patient has been seen by Dr. Jaskowiak today. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Post Liver Transplant. Please evaluate all vessels for patency. LIMITED ABDOMENLIVER: The liver is normal in echogenicity and echotexture. The liver measures 17.2 cm in length.BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: Pancreas is not well-visualized due to overlying bowel gas.SPLEEN: The spleen displays normal echotexture. RIGHT KIDNEY: The right kidney is normal in echogenicity and demonstrates no hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Patent portal venous and hepatic arterial systems."}
{"instruction": "Generate impression based on findings.", "input": "48 year old male with a history of right lower quadrant pain and tenderness in the inguinal region. Reports congenital absence of left testis. RIGHT TESTIS: The right testis is normal in morphology, echogenicity, and size, measuring 2.6 x 4.9 x 2.3 cm. Spectral Doppler demonstrates arterial blood flow.LEFT TESTIS: NoneRIGHT EPIDIDYMIS: Normal morphology, echogenicity, and size without evidence of hyperemia.LEFT EPIDIDYMIS: NoneOTHER: Evaluation of the right inguinal region demonstrates no discrete abnormality.", "output": "Normal right testis. Absent left testis."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid cancer status post thyroidectomy 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: Interval appearance of 0.9 x 0.6 x 0.9 hypoechoic focus posterior to the right carotid artery at level 4. No change in hypoechoic lymph node left level 4 again measuring 0.9 x 0.5 x 0.4 cm.OTHER: 1.1 x 0.9 x 4 cm hypoechoic focus within level 5 on the left corresponding to known neurofibroma.", "output": "Interval appearance of hypoechoic focus posterior to the right carotid artery at level 4. Nodal recurrence cannot be excluded; would recommend ultrasound-guided FNA biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate left renal cyst/mass RIGHT KIDNEY: The right kidney measures 12.4 cm in length. Normal renal parenchymal echogenicity. No hydronephrosis or shadowing stones. No focal masses.LEFT KIDNEY: The left kidney measures 12.2 cm in length. Normal renal parenchymal echogenicity. No hydronephrosis or shadowing stones. No focal masses. Numerous simple left renal cysts which are simple, some of which are septated.Left lower pole cyst: 2.0 x 1.6 x 1.4 cm, previously 2.1 x 1.9 x 1.8 cm.Left mid pole cyst: 1.3 x 1.3 x 1.2 cm, previously 1.3 x 1.0 x 1.2 cm.OTHER: Coarse, echogenic hepatic parenchyma.", "output": "1. Stable appearance and size of simple left renal cysts with septation. No focal mass.2. Echogenic hepatic parenchyma, consistent with hepatic steatosis or parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "21-year-old female with history of right quadrant pain. Concern for biliary dilatation or acute ischemia of the liver. Status post cholecystectomy. LIVER: The liver measures approximately 18 cm in length. Gallbladder is surgically absent. No significant intrahepatic biliary dilatation.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy.PANCREAS: Limited evaluation of the pancreas reveals no significant abnormality. RIGHT KIDNEY: The right kidney measures 10.5 cm in length, without hydronephrosis or hydroureter.OTHER: Left kidney measures 10.4 cm in length, without hydronephrosis or hydroureter. The spleen is autoinfarcted, with internal calcifications. Equivocal node in the hepatic hilum, may represent hepatic parenchyma, nonspecific.", "output": "Status post cholecystectomy, with autoinfarcted spleen. No additional significant abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Male 69 years old; Reason: US-guided FNA of new right sided node History: h/o thyroid cancer (adn Schwanomma). now with new right sided node On the prior ultrasound a hyperechoic focus was seen on the right concerning for a lymph node recurrence at level 4. This measured 0.9 cm x 0.6 cm x 0.9 cm. The patient presented today for fine needle aspiration of this lesion. However on today's study, this lesion was not identified in trans or longitudinally. No residual lymph node is seen on the right at level 4.", "output": "Right level 4 lymph node seen on prior ultrasound was not visualized on this study. Accordingly, no biopsy was performed. However, would recommend continued surveillance follow-up ultrasound in 6 months with special attention to this region."}
{"instruction": "Generate impression based on findings.", "input": "Male 53 years old Reason: rule out hydronephrosis History: right ureteral stricture RIGHT KIDNEY: The right kidney measures 11.0 cm. There is mild right hydronephrosis and proximal hydroureter.LEFT KIDNEY: The left kidney measures 11.8 cm. There is minimal left hydronephrosis, not significantly changed compared to prior study.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "1. Mild right hydronephrosis and proximal hydroureter. 2. Minimal left hydronephrosis is not significantly changed compared to prior study."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess for cholecystitis vs. Perinephric abscess History: fever, gram negative bacteremia on antibiotics. LIVER: The liver measures 17.5 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 0.26 m/s.BILIARY TRACT: Cholelithiasis without associated gallbladder wall thickening or pericholecystic fluid. Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 2.6 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 8.8 cm in length. RIGHT KIDNEY: Kidney measures 11.6 cm in length. Increased cortical echogenicity. No hydronephrosis. Heterogeneous complex cystic lesion in the right midpole pole measures 1.7 x 1.6 x 1.8 cm, previously 2.4 x 1.8 x 1.9 cm. The previously seen complex lesion in the right upper pole is not well seen on today's examination.LEFT KIDNEY: Kidney measures 11.0 cm in length. Increased cortical echogenicity. No hydronephrosis. In the left lower pole, there is a thinly septated cyst measuring up to 1.2 cm, not significant changed.ABDOMINAL AORTA: Proximal aorta measures 2.4 x 2.2 cm. The middle aorta measures 1.9 x 2.1 cm. Distal aorta measures 2.3 x 2.1 cm. Atherosclerotic disease. Focal areas of ectasia better appreciated on recent CT.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Foley catheter within the bladder.", "output": "1.Cholelithiasis without sonographic evidence of cholecystitis.2.Complex right renal midpole lesion appears similar to 12/9/2016 exam. Previously seen right upper pole lesion not well visualized on today's examination. Repeat dedicated multiphasic cross-sectional imaging should be considered for additional evaluation. No perinephric fluid collections identified.3.Echogenic kidneys suggestive of medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Male 47 years old; Reason: Assess for hepatic damage/source of abnormal LFTs History: AST/ALT and billirubin elevation, tremors LIVER: The liver measures 19.4 cm in length. There is 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 23.2 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.1 mm. No stones are seen but a small amount of sludge is seen within the gallbladder. No pericholecystic fluid. The common bile duct measures 3.2 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.3 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 12.0 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.7 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. The liver has increased echogenicity which is compatible with fatty liver/hepatocellular dysfunction. No worrisome masses are seen.2. No sonographic evidence of cholelithiasis or acute cholecystitis. No intra or extrahepatic ductal dilation is seen."}
{"instruction": "Generate impression based on findings.", "input": "Patient w/ new onset ascites, evaluate for hepatic origin, cirrhosis, portal hypertension LIVER: Liver length measures 12.0 cm. Common bile duct measures 0.4 cm. Normal portal venous blood flow.GALLBLADDER, BILIARY TRACT: Gallbladder wall measures 0.2 cm. No significant abnormalities noted.PANCREAS: Not visualized.SPLEEN: Spleen length measures 7.0 cm.KIDNEYS: Right kidney length measures 9.5 cm, left kidney length measures 10.0 cm. Mildly echogenic renal parenchyma, consistent with medical renal disease. No hydronephrosis or hydroureter.ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Mild volume ascites.", "output": "1. Mild volume ascites. 2. Mildly echogenic renal parenchyma, consistent with medical renal disease. "}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury. Ultrasound guidance was provided to the clinical service for performance of a renal biopsy. 3 passes with an 18-gauge core biopsy device were made of the left iliac fossa transplant graft. Postbiopsy images show no evidence of hematoma or other complication.", "output": "Ultrasound guidance was provided to the clinical service for performance of a renal biopsy."}
{"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 mass identified. Bilateral cysts, right greater than left, are present.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Bloom is a 25 year old female with a personal history of bilateral breast cysts. Patient reports that her physician felt diffuse lumpiness of her breasts on physical exam particularly in the right upper outer quadrant, thought to possibly be from fibrocystic disease. Patient states that her boyfriend also felt a palpable area in the right lower outer breast. Family history of breast cancer in her maternal great grandmother. Targeted ultrasound of the right upper outer breast showed dense breast tissue. No solid mass or cysts. Focused ultrasound of the area of palpable abnormality in the right lower outer breast was then done, which showed a few benign appearing lymph nodes.", "output": "Patient's area of palpable concern in the right lateral breast showed dense breast tissue and a few benign appearing lymph nodes. No sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually when the patient turns 40. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Female 60 years old Reason: microscopic hematuria for many years, h/o renal cysts 2011 History: microscopic hematuria RIGHT KIDNEY: The right kidney measures 11.0 cm. There is no hydronephrosis or shadowing stones. No convincing renal cyst identified on today's study.LEFT KIDNEY: The left kidney measures 11.4 cm. There is no hydronephrosis or shadowing stones. No convincing renal cyst identified on today's study.URINARY BLADDER: Bladder is poorly distended.OTHER: No significant abnormalities noted.", "output": "Unremarkable appearance of the kidneys. No specific cause for hematuria is identified."}
{"instruction": "Generate impression based on findings.", "input": "60 year old female who was recalled from screening mammogram for left breast calcifications. No family history of breast cancer. MAMMOGRAM: An ML view and two spot magnification 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 developing cluster of calcifications in the upper outer left breast, which appear pleomorphic on spot magnifications views. There is questionable asymmetry associated with these calcifications. ULTRASOUND: A targeted left ultrasound was performed for the mammographic area of concern. Within the upper outer quadrant of the left breast, there is no solid or cystic mass.", "output": "Cluster of pleomorphic calcifications within the upper outer left breast. Stereotactic guided left breast biopsy is recommended. Result and recommendations were discussed with the patient, and all of her questions were answered.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old female patient with bilateral saline implants with history of prior implant revision. Patient presented with a palpable abnormality in the left breast. Patient submitted outside study for review. Submitted for review are diagnostic mammogram and ultrasound (4/14/15), biopsy ultrasound (5/4/15), and postbiopsy mammogram (5/4/15) performed at Presence St. Mary's Hospital Indiana. For comparison,standard mammogram (11/30/2011) is available. DIAGNOSTIC MAMMOGRAM AND ULTRASOUND", "output": "Palpable abnormality in the left breast 6:00 position with ultrasound demonstrating 2 cm hypoechoic area. Concordant pathology reports from biopsy of this area at outside hospital demonstrated fibrocystic disease without atypia or malignancy, with areas of fibrosis and pseudoangiomatosis hyperplasia. Correlation with physical examination is recommended to ensure concordance between the biopsy result and physical exam. As long as the patient's physical examination remains benign, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "80-year-old female with lower abdominal pain, dark urine. RIGHT KIDNEY: Measures 10.6 cm in length. Mildly increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 10.4 cm in length. Mildly increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.", "output": "1. Mildly increased renal echogenicity consistent with medical renal disease. 2. No nephrolithiasis, hydronephrosis, or suspicious mass. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 48 years old. Hypertension RIGHT KIDNEY: The right kidney measures 10.9 cm in length, with normal cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.6 cm in length, with normal cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The bladder is incompletely distended.", "output": "Normal renal ultrasound. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: No significant abnormalities noted. Liver length 18.3 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.2 cm in lengthOTHER: Left kidney 10.2 cm in length. Spleen 8.2 cm in length. No ascites.", "output": "Cholelithiasis without acute inflammation or ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Hypothyroidism RIGHT LOBE MEASUREMENTS: 5.5 x 1.8 x 1.7 cmLEFT LOBE MEASUREMENTS: 10.8 x 6.7 x 5.4 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Diffusely heterogeneous gland. 1.9 x 1.2 x 1.5 cm predominant solid mid pole nodule.LEFT LOBE: Heterogeneous enlarged left thyroid gland with dominant mixed cystic solid nodule measuring 7.1 x 3.0 x 6.6 cmISTHMUS: Spongiform left isthmic nodule measuring 2.0 x 1.4 x 1.2 cmPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Heterogeneous enlarged thyroid gland with dominant mixed cystic and solid nodule. Predominantly solid mid pole right thyroid nodule. Both of these nodules are amenable to ultrasound-guided biopsy. Spongiform left isthmic nodule; favor benign etiology. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "50 year-old male with history of metastatic renal cell carcinoma, new onset left testicular swelling and pain. RIGHT TESTIS: Normal in echogenicity and vascularity.LEFT TESTIS: Normal in echogenicity and vascularity.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: Small left epididymal cyst and hydrocele, otherwise unremarkable.OTHER: No significant abnormalities noted.", "output": "No testicular mass, torsion, or acute inflammatory process. "}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male with history of Budd-Chiari syndrome presents for an ascites check. OTHER: Moderate ascites is in all 4 quadrants of the abdomen.", "output": "1. Moderate diffuse ascites as above."}
{"instruction": "Generate impression based on findings.", "input": "86-year-old male with urinary frequency, history of BPH. Pre and postvoid some images of the bladder were obtained. Prior to voiding, the bladder volume was 159.3 mL. After voiding, the bladder volume was 35.3 mL. There is mild bladder wall thickening which may be secondary to chronic BPH.", "output": "Small post void residual volume as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "Male 60 years old; Reason: pt s/p robotic whipple with biliary leak s/p IR Right biliary system PTC - concern for obstruction of left biliary system - please eval for ductal dilation History: rising Alk phos LIVER: The liver measures 16.1 cm in length. The left lobe of the liver is not well-visualized. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 14.8 cm/s. GALLBLADDER/BILIARY TRACT: The patient is status post Whipple procedure. The common bile duct measures 3.1 mm.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen is poorly visualized in this study.RIGHT KIDNEY: The right kidney is poorly visualized in this study.LEFT KIDNEY: The left kidney measures 13.9 cm in length. The cortex appears to have normal echogenicity but is not well-visualized. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No obvious loculated fluid collection is seen.", "output": "This study is technically limited due to patient's discomfort however no obvious intrahepatic ductal dilation or loculated fluid collections are seen."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old male patient with hepatitis C. Evaluate for cirrhosis. LIVER: The liver measures 15.4 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 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 10.8 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 12.6 cm in length. No evidence of hydronephrosis. There is a 1.5 x 1.3 cm left midpole renal cyst.The spleen measures 9.5 cm in length.", "output": "1. No focal hepatic lesion identified.2. Cholelithiasis without sonographic evidence of acute cholecystitis.3. Left renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Quintero is a 26 year old female presenting with a tender palpable mass in the left breast. She has no family history of breast cancer. Upon physical exam at the patient's area of concern, a tender nodular area is identified.A targeted left breast ultrasound was performed for the palpable area of concern. In the left breast 12:00 location, approximately 5 cm from the nipple, no suspicious cystic or solid mass is 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: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Reason: rule out gallstones History: pancreatitis LIVER: The liver measures 17.1 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 0.24 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: Not well visualized.SPLEEN: No significant abnormalities noted. The spleen measures 10 cm in length. RIGHT KIDNEY: Kidney measures 10.2 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or massLEFT KIDNEY: Kidney measures 11.4 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or massOTHER: No significant abnormalities noted.", "output": "No evidence of acute cholecystitis or biliary ductal dilatation. Pancreas not well visualized."}
{"instruction": "Generate impression based on findings.", "input": "42 year-old history of phyllodes tumor in the left breast presents with painful areas in each breast. LEFT: On physical exam, there is erythema and visible skin changes in the left breast upper inner quadrant likely related to excision of phyllodes tumor. There is pain on palpation of the marked area in the left upper outer quadrant near the axillary tail. No discrete mass is palpated. A targeted left grayscale and color Doppler ultrasound was performed for the patient\u2019s area of concern, and in the left breast 1:00 position near the axillary tail. Dense fibroglandular tissue is seen. No solid or cystic mass.RIGHT: On physical exam, there is pain on palpation of the marked area in the right upper-outer quadrant near the axillary tail. No discrete mass is palpated. A targeted right gray scale and color Doppler ultrasound was performed for the patient\u2019s area of concern, and in the right breast 11:00 position near the axillary tail. Dense fibroglandular tissue is present. A few small cysts are seen, for example in the 11:00 position near the axillary tail measuring 3 x 4 mm. No solid or cystic mass.", "output": "No suspicious findings in either breast upper-outer quadrant in the areas of concern. Small cysts in the right breast. No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old with known left breast cancer who is receiving neoadjuvant chemotherapy presents for ultrasound study to evaluate the response. Focused ultrasound of the left breast tumor is performed. Again visualized is an irregularly shaped hypoechoic mass with increased vascularity measuring 19 x 15 x 14 mm (previously 47 x 26 x 43 mm) at 2:00 position, 8 cm from the nipple.", "output": "Decrease in size of the known cancer in the left breast. BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old male patient with right upper quadrant abdominal pain. Evaluate for biliary etiology. LIVER: The liver measures 16.0 cm in length. No focal hepatic lesion is identified. Hepatic parenchymal echogenicity is increased. 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 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 10.1 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.3 cm in length. No evidence of hydronephrosis.The spleen measures 11.7 cm in length.", "output": "1. Increased hepatic parenchymal echogenicity which can be seen with hepatic parenchymal dysfunction.2. No cholelithiasis or sonographic evidence of acute cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female presents with right upper quadrant pain. Of note, she is status post cholecystectomy. LIVER:The liver measures 14.1 cm. The parenchyma has normal echogenicity. No focal mass, ascites, or intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is surgically absent. The common bile duct measures 0.8 cm.PANCREAS: Evaluation appears limited by overlying bowel gas.SPLEEN: The spleen measures 9.7 cm. No sonographic abnormalities.KIDNEYS: Right kidney measures 10.6 cm. The left kidney measures 10.5 cm. The cortices have normal echogenicity. No shadowing calculi, no focal mass, or hydronephrosis. ABDOMINAL AORTA: Patent with normal dimensions.INFERIOR VENA CAVA: Patent with normal dimensions.OTHER: No significant abnormality noted.", "output": "1. Normal abdominal ultrasound without findings to explain patient's abdominal pain.2. Surgical changes of a cholecystectomy."}
{"instruction": "Generate impression based on findings.", "input": "Female; 78 years old. Reason: 78 yo f w/ elevated lfts, concern for fatty liver vs. biliary disease History: elevated lfts LIVER: The liver is enlarged and measures 19.3 cm in length. The liver contour is smooth, the parenchyma is normal in echogenicity. No worrisome mass is identified.BILIARY TRACT: Punctate shadowing stones are seen within the gallbladder. There is no gall bladder wall thickening or pericholecystic fluid. There is mild intrahepatic biliary ductal dilatation. The common hepatic duct measures 4 mm in diameter, the common bile duct measures 10 mm in diameter. No shadowing stones are seen within the duct.PANCREAS: The head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 9.3 cm in length.KIDNEYS: The right kidney measures 10.9 centimeters in length and contains a 6 x 7 x 5 mm simple cyst. The left kidney measures 11.5 cm in length. Bilaterally there is no hydronephrosis or shadowing renal stone, the renal cortex is normal in echogenicity. OTHER: No significant abnormalities noted.", "output": "1.Hepatomegaly.2.Mild intra-and extrahepatic biliary ductal dilatation. No stones are seen within the ducts. This finding may be age-related rather than secondary to an obstructive process."}
{"instruction": "Generate impression based on findings.", "input": "Female; 59 years old. Reason: Please eval ruq for signs of abscess and liver abnormalities in a pt with gb cancer History: gallbaldder ca, fevers LIVER: The liver measures 16.3 cm in length. The liver is echogenic with a coarsened echotexture. Multifocal, confluent hypoechoic masses are seen in both lobes of the liver and occupy the majority of the right lobe. There is mild ascites.The main portal vein is patent with hepatopetal flow and a peak velocity of 0.56 m/sec.BILIARY TRACT: Status post cholecystectomy. Mild bilobar intrahepatic biliary ductal dilatation. A stent is seen within the common duct which measures 6 mm in diameter.PANCREAS: The head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 7.9 cm in length.RIGHT KIDNEY: The right kidney measures 9.4 cm in length. The cortex normal in echogenicity There is no hydronephrosis, shadowing renal stone, or worrisome mass identified. OTHER: The left kidney measures 11.1 cm in length. The cortex is normal in echogenicity. There is no hydronephrosis, shadowing renal stone, or worrisome mass identified.", "output": "1.Bilobar multifocal confluent liver lesions are favored to represent neoplasm/malignancy. There is no definitive evidence of abscess. Correlation with cross-sectional imaging is recommended for further evaluation.2.Mild bilobar intrahepatic biliary ductal dilatation.3.Mild ascites."}
{"instruction": "Generate impression based on findings.", "input": "Male, 76 years old. Renal failure RIGHT KIDNEY: The right kidney measures 9.8 cm in length, with normal cortical echotexture. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.9 cm in length, with normal cortical echotexture. No shadowing stones or hydronephrosis.OTHER: The bladder is decompressed, with Foley catheter in place.", "output": "No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "High creatinine RIGHT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. 10.8 cm in length.LEFT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. 9.9 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": "Renal transplant with elevated creatinine. Right iliac fossa renal transplant is identified. Ultrasound guidance was provided to the clinical service for performance of an inferior pole biopsy. Three needle passes were made. No immediate post procedure complications identified.", "output": "Ultrasound guidance was provided to the clinical service for the performance of a renal biopsy."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old male with autoimmune pancreatitis presents for follow-up. LIVER:Measures 16.2 cm. Increased, coarse echogenicity. No ascites, focal mass, or intrahepatic biliary dilation. The main portal vein is patent with hepatopedal flow measured at 27.1 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is absent.PANCREAS: The pancreas is absent.SPLEEN: The spleen is absent.KIDNEYS: Right kidney measures 10.4 cm. Left kidney measures 11.9 cm. Unremarkable echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "1. Increased, coarse echogenicity of the liver consistent with chronic liver disease/parenchymal dysfunction. No mass or ascites.2. Patent portal vein with hepatopedal flow.3. Surgical changes of a splenectomy, pancreatectomy, and a cholecystectomy."}
{"instruction": "Generate impression based on findings.", "input": "Female 37 years old Reason: 37 y.o. with PTC. History: PTC Mass previously seen in the inferior left thyroid bed was identified and the skin was marked for surgical planning.Mass previously seen in the inferior right thyroid bed was identified and the skin was marked for surgical planning.Additional mass on the right between the carotid and jugular was identified and the skin was marked.Search for additional lymph nodes was made in the left neck and small nonpathologic size nodes are seen. No additional areas were marked.Dye injection was deemed unnecessary", "output": "3 sites marked for surgical planning."}
{"instruction": "Generate impression based on findings.", "input": "Female 35 years old Reason: Patient with elevated LFTs, eval portal vein and hepatic vasculature to rule out thrombosis History: As above LIMITED ABDOMENLIVER: Again noted coarse echotexture of the liver.Other findings are also stable from recent ultrasound.OTHER: No significant abnormalities noted.", "output": "Coarse echotexture of the liver. Patent hepatic vasculature."}
{"instruction": "Generate impression based on findings.", "input": "2-year-old male patient with concern for abscess near the perineum. There is skin thickening and edema, compatible with a cellulitis type pattern. There is a 7 mm nonloculated fluid collection.", "output": "Findings compatible with cellulitis and 7 mm nonloculated fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain after eating LIVER: Measures 12.7 cm in length. Mildly echogenic hepatic parenchyma. No focal hepatic lesions. The portal vein is patent.GALLBLADDER, BILIARY TRACT: Multiple foci of comet tail artifact are noted in the gallbladder fundus consistent with adenomyomatosis. No cholelithiasis. No biliary dilation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Measures 11.0 cm. No hydronephrosis or mass.OTHER: Spleen measures 14 cm in length. Left kidney measures 12.5 cm in length.", "output": "1.Adenomyomatosis.2.Echogenic liver parenchyma suggests fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old female with abdominal/right upper quadrant pain. Acute pancreatitis. LIVER: Highly echogenic which may be due to fatty infiltration or other parenchymal disease.GALLBLADDER, BILIARY TRACT: Limited views the gallbladder demonstrate no gross shadowing gallstones, wall thickening or pericholecystic fluid. The visualized biliary tract is normal in caliber.PANCREAS: Not visualized due to bowel gas and body habitus.RIGHT KIDNEY: No gross hydronephrosis.OTHER: Left abdomen could not be evaluated.", "output": "Limited examination without gross gallbladder abnormality. Echogenic liver."}
{"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": "65-year-old man status post liver transplant evaluate for recurrence cirrhosis. LIMITED ABDOMENLIVER: The liver measures 18.7 cm. This is enlarged however stable from prior ultrasound. There is coarse increased echogenicity within the liver. Additionally there is a nodular appearance of liver which was not notable on prior ultrasound from 2015. This is concerning for cirrhotic morphology. There is no intrahepatic ductal dilation. No worrisome mass are noted within the liver.BILIARY TRACT: The common duct measures 0.5 cm.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen measures 14 cm in length, this is slightly enlarged. No significant abnormalities are noted. RIGHT KIDNEY: The right kidney measures 10.3 cm. This cyst is present in the right kidney measures 2.1 cm x 2.0 cm not present on prior exam. No worrisome mass, hydronephrosis, or stones are present.LEFT KIDNEY: The left kidney measures 11.3 cm in length. The cortex is of normal echogenicity. There is no mass, hydronephrosis or stones present.", "output": "1. There is new cirrhotic morphology present on this exam, not seen on prior ultrasound in 2015. No worrisome masses or intrahepatic ductal dilation are seen within the liver.2. Hepatomegaly is stable from prior ultrasound.3. Portal venous system, hepatic arteries, hepatic veins, and IVC are all patent with appropriate flow.4. New 2 x 2 cyst is located in the right kidney."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with abnormal renal function, abnormal liver function and congestive heart failure. The exam is limited by patient's inability to cooperate and changed position.LIVER:Liver is moderately echogenic which is nonspecific but may be related to fatty infiltration. This has changed when compared to limited views from prior exam. Overall hepatic size is within normal limits. Main portal vein is patent with appropriate flow direction. Tracing is pulsatile which may be seen with congestive heart failure.GALLBLADDER, BILIARY TRACT: Gallbladder appears normal without cholelithiasis, wall thickening or pericholecystic fluid. Visualized biliary tract is normal in caliber.PANCREAS: The body is normal. The head and tail are poorly visualized due to bowel gas.SPLEEN: Not visualized due to patient position.KIDNEYS: The right kidney measures approximately 10.7 cm in length. The left kidney is poorly visualized due to patient positioning, measuring approximately 11.3 cm in length. Mildly echogenic kidneys unchanged from prior exam. No hydronephrosis, shadowing calculus or mass. ABDOMINAL AORTA: Proximal and mid aorta normal in caliber. Distal aorta not demonstrated due to bowel gas.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Small amount of perihepatic fluid.", "output": "Echogenic liver possibly due to fatty infiltration.Normal gallbladder and biliary tract.Mildly echogenic kidneys without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Oliguria RIGHT KIDNEY: 10.5 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 9.8 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: Markedly distended.OTHER: No significant abnormality noted.", "output": "Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease. Marked bladder distention."}
{"instruction": "Generate impression based on findings.", "input": "Male 75 years old; Reason: r/o adenopathy, recurrence History: h/o thyroid cancer. 2.5 year follow up study RIGHT LOBE, LEFT LOBE, ISTHMUS MEASUREMENTS: The thyroid has been surgically removed.RIGHT LOBE, LEFT LOBE, ISTHMUS: The thyroid has been surgically removed. No evidence of recurrence.LYMPH NODES: No adenopathy.", "output": "1.Surgical changes of a thyroidectomy without evidence of recurrence or adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Weakness Prominent partial fusion is noted at the C2 and C3 vertebrae. There is mild grade 1 subluxation in the C3-C4 level with minimal retrolisthesis at C6-C7. Prominent endplate degenerative irregularities are also present at C6-C7 and to a lesser degree at C5-C6. There is no acute appearing compression deformity.The axial images show prominent disk/spur complex at the C3-C4 level resulting in mild central canal and moderate left-sided foraminal stenosis. Mild stenotic findings are present at C4-C5 and C5-C6 although there is moderate right sided foraminal stenosis. C6-C7 shows mild central canal and bilateral foraminal stenosis. C7-T1 has milder degenerative findings without significant stenosis. Incidental note is made of prominent enlargement with heterogeneous attenuation of the thyroid gland including dystrophic calcification with deviation of the trachea to the right side of midline. This may be further evaluated with ultrasound performed clinically.", "output": "Moderate degenerative changes with partial fusion C2-C3 and no acute fracture.Prominent enlargement of heterogeneous appearing thyroid possibly goiter. This would be better evaluated with ultrasound if warranted clinically."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant tenderness. Food intolerance. LIVER: Non-cirrhotic liver morphology. Heterogeneous liver echotexture. 15.7 cm in length. Multiple hepatic 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: 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 11.5 cm in length, with a 7.6 cm benign-appearing cyst.. The left kidney is 9.6 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 9.8 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites identified.", "output": "Normal sonographic appearance of the gallbladder, per clinical query. No specific findings to account for the patient's symptoms.Heterogeneous hepatic echotexture, may reflect underlying hepatic steatosis/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old male with history of elevated LFTs. Evaluate for biliary obstruction. LIVER: No intrahepatic or extrahepatic biliary dilatation. The portal vein is tortuous, as seen on prior CT.GALLBLADDER, BILIARY TRACT: Cholelithiasis, without evidence of cholecystitis.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Cholelithiasis, and portal vein tortuosity as above."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 11.1 cm in lengthLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 11.5 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": "Reason: s/p thyroidectomy, neck pain and dysphagia. Partial thyroidectomy in 1979 for a symptomatically large goiter. She reports benign pathology. She had a completion thyroidectomy in 12/2013, pathology report with colloid nodular disease. RIGHT LOBE: Homogenous, hypoechoic soft tissue in the right thyroid bed extending into the isthmus measures 1.9 x 2.9 x 0.9 cm and represents recurrent or residual thyroid tissue. No suspicious nodules or lesions in the thyroid bed.LEFT LOBE: Homogenous, hypoechoic soft tissue in the left thyroid bed measures 0.8 x 0.8 x 1.0 cm and represents recurrent or residual thyroid tissue. No suspicious nodules or lesions in the thyroid bed.ISTHMUS: Residual isthmic thyroid tissue as noted above without suspicious nodules or lesions.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted. No cervical lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Findings consistent with residual or recurrent thyroid tissue in the thyroidectomy bed. No suspicious nodules or masses."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female with thyrotoxicosis and hyperparathyroidism. Evaluate for thyroid nodule or parathyroid adenoma. RIGHT LOBE MEASUREMENTS: At least 2 x 2.6 x 8.3 cm. Extends substernally.LEFT LOBE MEASUREMENTS: At least 2.3 x 2.6 x 5.6 cm. Extends substernally.ISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Echotexture is diffusely heterogeneous with some very small, hypoechoic nodules, many of which are complex cystic. In the inferior right lobe is a solid nodule with cystic component and wall calcification as well as septation with thick calcification measuring 0.7 x 0.9 cm.LEFT LOBE: Echotexture is diffusely heterogeneous with very small hypoechoic nodules, many of which are complex cysticISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No definite enlarged parathyroid identified. However, the size of the gland and caudal extent may make extrathyroidal mass less evident.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Thyromegaly with very small, likely cystic or complex cystic nodules. Larger complex cystic nodule with calcification on the right.No definite parathyroid mass although substernal extent of thyroid is limiting."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old female patient with thrombocytosis. Assess spleen size. The liver measures 17.8 cm in length.The spleen measures 11.7 cm in length and contains multiple echogenic foci compatible with calcifications. The splenic vein and artery are patent.", "output": "1. Spleen size within normal limits.2. Splenic calcifications compatible with prior granulomatous disease."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old male with pancreatitis, concern for gallstones. LIVER: Measures 13.2 cm in length. Unremarkable hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: No cholelithiasis. The gallbladder is partially collapsed without 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. There is no peripancreatic fluid, collection, or ductal dilation.SPLEEN: Unremarkable in size and echogenicity. KIDNEY: Mildly increased renal echogenicity. No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "1.No evidence of cholelithiasis or cholecystitis.2.Mildly increased renal echogenicity may represent medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "43 years old, Male, Reason: RUQ pain History: RUQ pain LIVER: The liver measures 23 cm in length. The liver parenchymal echotexture is borderline. 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. Per ultrasound technologist, 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: Partially obscured by bowel gas but visualized portions unremarkable.SPLEEN: No significant abnormalities noted. The spleen measures 16 cm in length. RIGHT KIDNEY: Kidney measures 13 cm in length. Normal echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 14 cm in length. Normal echotexture. No hydronephrosis.", "output": "1.No cholelithiasis or acute cholecystitis, no biliary duct dilatation.2.Apparent increased size of organs may be within normal limits."}
{"instruction": "Generate impression based on findings.", "input": "38 year old male with rising LFTs and abdominal pain, evaluate for hepatic pathology/cholecystitis. LIVER: The liver is enlarged measuring 18.8 cm in length. The liver parenchyma is again markedly heterogenous. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.4 m/s.BILIARY TRACT: Gallbladder sludge, thickened gallbladder wall, nonspecific in setting of ascites. No additional signs of acute cholecystitis. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3 mm in diameterPANCREAS: Nonvisualization of pancreas secondary to overlying bowel gas.SPLEEN: The spleen is markedly heterogenous, new from the prior examination.RIGHT KIDNEY: Kidney measures 8.0 cm in length. Increased parenchymal echogenicity is suggestive of medical renal disease/parenchymal dysfunction. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Not visualized. OTHER: Incompletely imaged pleural effusions and complex ascites. Right iliac fossa transplant kidney with mild caliectasis appearing similar to to 5/22/2015 vascular ultrasound.", "output": "1.New marked heterogeneity of the spleen which could be related to infarctions and/or hematoma. In the appropriate clinical setting, contrast-enhanced CT recommended for further evaluation.2.Hepatomegaly and marked heterogeneity of the liver which may be related to underlying steatosis/parenchymal dysfunction but underlying mass cannot be excluded. In the appropriate clinical setting, could be further evaluated with dedicated cross-sectional imaging.3.Mild caliectasis of the transplant kidney appearing grossly similar to recent vascular ultrasound.4.Gallbladder sludge. Gallbladder wall thickening which is nonspecific in the setting of ascites.5.Pleural effusions.Findings discussed with MARTIN, ELIZABETH at 4:24 p.m. on 6/12/2015."}
{"instruction": "Generate impression based on findings.", "input": "96-year-old female with sepsis. There is a clinical concern for cholecystitis. LIVER:Measures 19.1 cm. Prominent triads suggestive of parenchymal edema which can be seen in the setting of hepatitis or any infiltrative process. No focal mass. No intrahepatic biliary dilation.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. The wall measures 0.9 cm. There is some pericholecystic fluid. No stones or sludge. Common bile duct measures 0.3 cm. Sonographic Murphy's sign was equivocal as patient is unresponsive.PANCREAS: Evaluation of the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 10.8 cm. No sonographic abnormalities.KIDNEYS: Right kidney measures 9.4 cm. Left kidney measures 9.5 cm. The kidneys are echogenic. No hydronephrosis, shadowing calculi, or focal mass.OTHER: There is a large right sided pleural effusion.", "output": "1. Prominent triads suggestive of parenchymal edema which can be seen in the setting of hepatitis or any infiltrative process.2. Gallbladder wall thickening and some pericholecystic fluid without cholelithiasis or ductal dilatation. Sonographic Murphy's sign equivocal as above. An acute inflammatory process cannot be excluded.3. Large right-sided pleural effusion.4. Echogenic kidneys consistent with medical renal disease/parenchymal dysfunction. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine RIGHT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. Right kidney 13.2 cm in length.LEFT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. Left kidney 13.5 cm in length.OTHER: Bladder nondistended. Mild ascites. Moderate right pleural effusion.", "output": "Normal renal ultrasound. Unremarkable renal parenchymal echogenicity without mass, stone, or obstruction. Mild ascites. Moderate right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules. Asymptomatic. RIGHT LOBE MEASUREMENTS: 1.6 x 1.4 x 3.8 cm, similar to prior.LEFT LOBE MEASUREMENTS: 1.9 x 1.1 x 3.5 cm, similar to prior.ISTHMUS MEASUREMENTS: 2 mm in AP dimension, similar to prior.RIGHT LOBE: The right thyroid lobe is heterogeneous, without discrete nodules.LEFT LOBE: The previously seen circumscribed solid nodule with peripheral vascularity is unchanged at 8 x 6 x 11 mm, without suspicious features.ISTHMUS: The previously seen circumscribed solid nodule with internal echogenic foci is unchanged at 10 x 6 x 9 mm.PARATHYROID GLANDS: Not identified.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Unchanged thyroid nodules compared to 11/13/2013. The isthmus nodule may be amenable to percutaneous biopsy, if clinically warranted and not already performed."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old male with lymphoma, anemia, thrombocytopenia. Right-sided back pain and dropping hemoglobin. Limited abdominal ultrasound demonstrates no evidence of hematoma or dependent blood product to suggest retroperitoneal bleed. The partially visualized spleen is enlarged consistent with the patient's history of lymphoma.", "output": "1. No evidence of retroperitoneal hematoma. If there is continued high clinical suspicion, CT is recommended for further evaluation.2. Hepatosplenomegaly. "}
{"instruction": "Generate impression based on findings.", "input": "Enlarged thyroid gland. RIGHT LOBE MEASUREMENTS: 5.7 x 1.8 x 1.4 cm. Normal in size with normal background echotexture and vascularity.LEFT LOBE MEASUREMENTS: 5.0 x 1.4 x 1.6 cm. Normal in size with normal background echotexture and vascularity.ISTHMUS MEASUREMENTS: 4 mm in AP dimension, within normal limits.RIGHT LOBE: A 5 mm spongiform nodule is noted in the inferior pole.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "5 mm thyroid nodule without suspicious features. Normal background thyroid gland."}
{"instruction": "Generate impression based on findings.", "input": "30 year-old female with right upper quadrant pain LIVER: Upper normal in size. No focal hepatic abnormality.GALLBLADDER, BILIARY TRACT: Gallbladder contains a small common deep tendon and shadowing gallstone without wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Echogenicity appears within normal limits.OTHER: Complex splenic cyst without change", "output": "Gallstone without complication. No interval change."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female with acute kidney injury (AKI) and no clear etiology. RIGHT KIDNEY: The right kidney measures 10.5 cm in length. Hyperechoic parenchymal echogenicity. No hydronephrosis, shadowing calculi, or suspicious masses. There are scattered anechoic cortical cysts, which measure up to 2.1 x 2.1 x 2.3 cm. No significant interval change is noted.LEFT KIDNEY: The left kidney measures 10.9 cm in length. Hyperechoic renal parenchyma is again noted. There is a stable parapelvic cyst of the left lower renal pole measuring 2 x 2.3 x 1.8 cm. No hydronephrosis, shadowing calculi, or suspicious masses. No significant interval change is identified.URINARY BLADDER: The urinary bladder is collapsed and not visualized.OTHER: No significant abnormalities noted.", "output": "1. Echogenic renal parenchyma compatible with medical renal disease.2. No hydronephrosis.3. Stable bilateral renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old male patient with previous liver abscesses, as well as concern for cholangitis. Assess liver fluid collections. LIVER: The liver measures 20.4 cm in length and is diffusely heterogeneous in echogenicity with multiple more focal hypoechoic areas which likely correspond to multiple lesions seen on recent CT. No discrete drainable fluid collection is identified. No flow is detected within the main portal vein which appears occluded. A stent is noted in the liver. GALLBLADDER, BILIARY TRACT: The gallbladder is contracted and filled with echogenic material. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 3 mm in diameter.PANCREAS: The pancreas is not visualized on this examination.RIGHT KIDNEY: The right kidney measures 13.4 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. OTHER: The left kidney measures 13.2 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis.The spleen measures 10.3 cm in length.Bilateral pleural effusions are noted.", "output": "1. Diffusely heterogeneous hepatic parenchyma with focal areas of hypoechogenicity which appear to correlate with multiple lesions seen on recent CT. No discrete drainable collection is identified.2. Occluded main portal vein.3. Contracted, debris-filled gallbladder without definite sonographic evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female with lump of 1.5 cm diameter on the right posterior calf. Grayscale and color limited ultrasound of the right posterior lower extremity at the patient's described palpable abnormality demonstrates no mass, fluid collection, or other specific findings to account for the patient's symptoms.", "output": "No sonographic abnormalities to account for the patient's palpable complaint."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B LIVER: Coarse echogenic liver echotexture without mass. Liver length 16.4 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. 9.3 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 11.5 cm in lengthOTHER: Left kidney 13 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture consistent with fatty infiltration without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male with renal transplant and elevated white count and creatinine. RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: Expanded kidney measures approximately 11.7 cm in length. Echotexture appears normal. There are multiple cortical cysts as well parapelvic cysts present, the largest measuring up to 4 cm in maximum diameter. Some of these are minimally complex with thin septation.COLLECTING SYSTEM/URETER: When compared to the prior study, there has been almost complete resolution of previously noted hydronephrosis after placement of Foley catheter.URINARY BLADDER: Decompressed. Foley catheter visualized.OTHER: No significant abnormality noted", "output": "Almost complete resolution of hydronephrosis when compared to recent exam.Multiple renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female patient with thyroid nodule on neck CT. Further characterize with ultrasound. RIGHT LOBE MEASUREMENTS: 5.2 x 2.1 x 2.4 cm.LEFT LOBE MEASUREMENTS: 5.1 x 2.2 x 1.7 cm.ISTHMUS MEASUREMENTS: 3 mm in thickness.RIGHT LOBE: There is a heterogeneous, slightly hypoechoic solid nodule within the right inferior pole measuring 1.8 x 1.3 x 1.8 cm. No calcifications are identified.LEFT LOBE: There is a 0.8 x 0.7 x 1.0 cm spongiform nodule within the inferior pole.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A benign morphology lymph node is noted in the left neck.OTHER: No significant abnormality noted.", "output": "Dominant solid right thyroid nodule, which is amenable to biopsy if clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "54 year-old woman with right breast cancer on chemotherapy. A targeted right ultrasound was performed for the multiple, palpable masses in the right breast and right axilla. At the two o'clock position 4 cm from the nipple, there is a 15 x 13 x 11 mm hypoechoic mass with irregular margins and increased vascularity, previously 15 x 14 x 11 mm.At the 10 o'clock position 5 cm from the nipple there is a 24 x 20 x 9 mm hypoechoic mass with irregular margins and mildly increased vascularity, previously 24 x 18 x 9 mm.An enlarged right axillary lymph node with increased cortical flow is seen and measures 18 x 13 x 6 mm, previously 23 mm in largest dimension.", "output": "1. Unchanged appearance and size of the right breast masses at the 2 o'clock and 10 o'clock position.2. Minimal decrease in size of right axillary lymph node.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Male 65 years old; Reason: assess for AAA. Also follow up lesion seen on 2008 CT scan dome of liver History: \"buzzing in abdomen\" and pulsatile aorta on exam LIVER: The liver measures 14.8 cm in length. There is increased echogenicity of the liver parenchyma. Several anechoic cyst are seen throughout the liver. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 19.9 cm/s. At the dome of the liver there is a hyperechogenic lesion measuring 3.5 cm x 1.9 cm x 2.7 cm this corresponds to the liver dome lesion seen on the prior CT in 2008. On the CT this is measured 3.2 cm x 2.8 cm.GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.2 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 3.4 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9.4 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. The renal cyst is seen at the inferior pole measuring 2.6 cm x 2.8 cm x 2.2 cm.LEFT KIDNEY: The left kidney measures 12.5 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: The bladder is visualized without any significant abnormalities.DOPPLERS:ABDOMINAL AORTA:Proximal: 2.4 cm in AP dimensionMid: 2.0 cm in AP dimensionDistal: 2.1 cm in AP dimensionAt the mid abdominal aorta flow is patent and appropriately directional with peak systolic velocity of 73.3 cm/s.ILIAC ARTERIES: Right common iliac artery measures 1.3 cm, the left iliac artery measures 1.1 cm.", "output": "1. There is increased echogenicity of the liver compatible with fatty infiltration/hepatocellular dysfunction. There are several subcentimeter cysts seen within the liver.2. Hyperechogenic focus in the dome of the liver may represent a hemangioma, but appears stable in size from prior CT. This could be further evaluated with MRI.3. The abdominal aorta is nondilated."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Benign renal cyst. 7.6 cm in length.LEFT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Benign-appearing renal cyst. 10 cm in lengthOTHER: Bladder nondistended. Moderate ascites.", "output": "Echogenic parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old female with right upper quadrant pain. LIVER: Moderately echogenic presumably due to fatty infiltration as seen on the prior exam. No focal hepatic abnormality. Liver is not enlarged.BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: Limited in visualization.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Presumed fatty liver without change. Normal gallbladder and biliary tract."}
{"instruction": "Generate impression based on findings.", "input": "Bilateral renal cysts RIGHT KIDNEY: Atrophic echogenic renal parenchyma again noted. Stable numerous minimally complex renal cysts. No worrisome mass. No hydronephrosis. Right kidney 11.7 cm in lengthLEFT KIDNEY: Atrophic echogenic renal parenchyma again noted. Stable numerous minimally complex renal cysts. No worrisome mass. No hydronephrosis. Left kidney 14.3 cm in length.OTHER: No significant abnormalities noted.", "output": "Stable examination. No change in atrophic echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass or obstruction. Stable bilateral numerous minimally complex cysts."}
{"instruction": "Generate impression based on findings.", "input": "Male 31 years old; History: Epigastric and RUQ pain. Evaluate for hepatobiliary pathology. LIVER: The liver measures 18.5 cm in length. There is increased echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 3 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 8.6 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.0 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 9.8 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.", "output": "1. Mild hepatomegaly and increased hepatic echogenicity consistent with fatty liver/parenchymal dysfunction. No masses or ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Bacteremia and diffuse pain LIVER: Coarse echogenic liver parenchyma without mass. Liver length 19.2 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 11.6 cm in lengthOTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. 9.8 cm in length. Spleen 12.7 cm in length. No ascites. Right pleural effusion.", "output": "Coarse echogenic liver parenchyma suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Cholelithiasis without acute inflammation. No ascites.Echogenic renal parenchyma raises the possibility of medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Female 59 years old Reason: HCC screening History: hep B, cognitive impairment LIVER: Coarse liver echogenicity similar to the prior exam. Liver measures 11.5 cm. No focal hepatic masses. Normal vascular flow in the portal vein with peak velocity of 16.9 cm/s.BILIARY TRACT: Gallbladder wall is upper limits of normal at 0.29 cm which may be seen in setting of liver disease. Common hepatic duct measures 0.3 cm. Common duct measures 3.7 mm.PANCREAS: Pancreas is normal in appearance. Pancreatic tail is obscured by bowel gas.SPLEEN: Spleen measures 7.1 cm in length and is normal and homogeneous echogenicity.RIGHT KIDNEY: Right kidney measures 9.5 cm in length. Mild to moderate hydronephrosis is similar to the prior exam. No shadowing calculi.LEFT KIDNEY: Left kidney measures 9.04 cm in length and demonstrates normal echogenicity. No mass or shadowing calculi. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Fatty infiltration of the liver similar to the prior exam. No suspicious hepatic masses.2.Mild to moderate right hydronephrosis, similar to the prior exam."}
{"instruction": "Generate impression based on findings.", "input": "80-year-old female with nausea and vomiting. Evaluate for cholecystitis. LIVER: The liver is normal in morphology, echogenicity and size, measuring 14.1 cm in craniocaudal dimension. No suspicious focal hepatic lesion or intrahepatic biliary ductal dilatation. There is normal hepatopetal portal venous blood flow at 24 cm/sec.GALLBLADDER, BILIARY TRACT: No biliary ductal dilatation with the common bile duct measuring 3 mm at the pancreatic head. A normally distended gallbladder is seen without cholelithiasis, wall thickening, pericholecystic fluid, or focal tenderness.PANCREAS: The visualized portions of the pancreatic body and head are normal.RIGHT KIDNEY: The right kidney measures 9.1 cm with mildly increased cortical echogenicity. No shadowing nephrolithiasis. There is a 2.3-cm simple appearing cyst.OTHER: The spleen is normal in size, measuring 7.9 cm. The left kidney measures 9.1 cm with increased cortical echogenicity. No shadowing nephrolithiasis. There is a 2.7 cm simple appearing cyst.", "output": "No cholelithiasis or evidence of acute gallbladder inflammation. Echogenic kidneys with bilateral simple appearing cysts."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Unremarkable echogenicity for age. No worrisome mass, stone, or hydronephrosis. Minimally complex cysts. Right kidney 12.6 cm in lengthLEFT KIDNEY: Unremarkable echogenicity for age. No worrisome mass, stone, or hydronephrosis. Minimally complex cysts. Left kidney 11.3 cm in lengthOTHER: Enlarged prostate. Bladder nondistended.", "output": "No evidence for worrisome renal mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male with hepatitis C and known gallstones. Evaluate for hepatocellular carcinoma. LIVER: The liver is mildly and coarsely echogenic but normal in size. There is no focal hepatic abnormality identified.BILIARY TRACT: Gallbladder contains multiple, dependent shadowing gallstones without wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: Inadequately visualized due to bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "1. Coarsely echogenic liver without mass.2. Gallstones without complication."}
{"instruction": "Generate impression based on findings.", "input": "45 year old presents for a short term follow up ultrasound for an enlarged lymph node in the left axilla. Focused ultrasound of left axilla revealed that the enlarged lymph node seen on the prior study has become normal sized. There are several normal size lymph nodes in the left axilla.", "output": "No sonographic evidence of malignancy. Normal lymph nodes in left axilla. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Male 47 years old Reason: eval right flank and lateral right abdomen for fluid collection History: right lateral abdominal pain No discrete fluid collection seen in the right lower quadrant or right flank.The bladder is mildly distended.There is no free intraperitoneal fluid seen.Edematous soft tissues.", "output": "Edematous soft tissues with no abdominal wall fluid collections or ascites."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old male with right upper quadrant pain. LIVER: Liver is normal in size and echotexture. No focal hepatic abnormality is identified. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Unfortunate, gallbladder is contracted in a postprandial state. On this limited study there are no definite shadowing gallstones and there is no pericholecystic fluid.PANCREAS: Not imagedRIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Examination gallbladder limited by postprandial state. No gross abnormality."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female with prior thyroidectomy for thyroid cancer. 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 change. No evidence for recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "27-year-old male with acute myeloid leukemia and acute kidney injury. RIGHT KIDNEY: The right kidney measures 10.7 cm in length. Echo texture within normal limits. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 11.5 cm in length.Echo texture within normal limits. No hydronephrosis, shadowing calculus or mass. OTHER: Bladder poorly distended.", "output": "Normal kidneys."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old female with a thyroid nodule. RIGHT LOBE MEASUREMENTS: 4.5 x 1.2 x 1.0 cm.LEFT LOBE MEASUREMENTS: 4.8 x 0.9 x 1.3 cmISTHMUS MEASUREMENTS: 1 mm RIGHT LOBE: 7 x 6 x 6 mm lower pole hypoechoic well-defined solid nodule with punctate echogenic foci which may represent microcalcifications.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": "Indeterminate 7-mm right thyroid lobe hypoechoic nodule with indeterminate echogenic foci. This nodule is amenable to fine needle aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Male 59 years old Reason: Patient w/ recent PD cath removal, notes abd distension, fluid, concern for passive hepatic congestion vs dwelling dialysate History: abd distension LIVER: Increased liver echogenicity with a mildly coarse appearance which can be secondary to fatty infiltration or diffuse hepatic dysfunction. No focal mass. Liver measures 16.1 cm. Main portal vein is patent with normal directional flow and a normal waveform. Peak velocity at the portal vein is 35 cm/s. No specific evidence of cirrhosis.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. The gallbladder appears contracted with shadowing stones. The gallbladder wall is slightly thickened measuring 4 mm, however this is likely secondary to contraction. Common bile duct measures 5 mm. Negative Murphy's sign.PANCREAS: Visualized portions of the pancreas are normal in appearance.SPLEEN: Spleen is slightly enlarged measuring 14.9 cm. Small splenule is present.KIDNEYS: Kidneys are atrophic and echogenic. No hydronephrosis or mass is identified. OTHER: Large volume ascites with multiple septations, some of which may be loculated.", "output": "1.Large volume ascites with septations, suggesting it may be loculated.2.Nonspecific mildly increased echogenicity of the liver may be secondary to fatty infiltration or diffuse hepatic dysfunction. Portal vein is patent with normal directional flow."}
{"instruction": "Generate impression based on findings.", "input": "Transplant kidney. Hematuria. TRANSPLANT KIDNEY: 12.9 cm in length. Slightly increased renal parenchymal echogenicity. No hydronephrosis. No focal lesions or stones identified.BLADDER: No significant abnormality noted.OTHER: No significant abnormalities noted.", "output": "Increased renal echogenicity without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for whole breast ultrasound for dense breast screening. Family history of breast cancer in mother and sister. 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.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "33 years old, Female, Reason: hx of PTC History: for routine surveilillance RIGHT LOBE MEASUREMENTS: Patient status post thyroidectomyLEFT LOBE MEASUREMENTS: Patient status post thyroidectomyISTHMUS MEASUREMENTS: Patient status post thyroidectomyRIGHT LOBE: No definite evidence of recurrence.LEFT LOBE: Small subcentimeter hypoechoic areas in the left thyroid bed without vascular flow likely represent postsurgical changes. Continued follow-up is recommended for confirmation of stability. No definite evidence of recurrence.ISTHMUS: No definite evidence of recurrence.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Bilateral subcentimeter benign-appearing level 3 lymph nodes.OTHER: No significant abnormality noted.", "output": "1.No evidence of recurrent disease or lymphadenopathy.2.Subcentimeter hypoechoic areas in the left thyroid bed are favored to represent postsurgical changes. Continued follow-up is recommended for confirmation of stability. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: abnormal nodes? History: thyroid cancer RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Status post thyroidectomy. No suspicious nodules identified within the thyroidectomy bed.LEFT LOBE: Status post thyroidectomy. No suspicious nodules identified within the thyroidectomy bed.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Single right level 2 cervical lymph node measuring 0.5 x 1.8 x 2.4 cm which demonstrates benign morphologic features.OTHER: No significant abnormality noted.", "output": "No evidence of residual or recurrent disease within the thyroidectomy bed. Single benign-appearing right cervical lymph node."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 62 year-old female with elevated alkaline phosphatase. RUQ ultrasound requested to further evaluate. LIVER: The liver measures 16.1 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 10.4 cm in length. RIGHT KIDNEY: Kidney measures 9.8 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 7.6 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Mildly increased parenchymal echogenicity is suggestive of fatty infiltration/parenchymal dysfunction. 2.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis.3.Atrophy left kidney. "}
{"instruction": "Generate impression based on findings.", "input": "34 year-old female with history of nephrolithiasis. RIGHT KIDNEY: The right kidney measures 9.3 cm in length and shows normal echotexture. Minimal to mild right hydronephrosis. There are a few nonobstructing shadowing renal calculi.LEFT KIDNEY: The left kidney measures 10.4 cm in length and shows normal echotexture. There are a few nonobstructing shadowing renal calculi. No mass or hydronephrosis.URINARY BLADDER: The urinary bladder is normal in appearance.OTHER: There is no free or loculated fluid.", "output": "1.Large impacted stone is seen in the gallbladder neck. 2.Nonobstructing renal calculi are seen bilaterally.3.Minimal to mild right hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with history of complex renal cyst for follow-up. RIGHT KIDNEY: Right kidney measures approximately 10.6 cm in length. Renal cortex is highly echogenic consistent with parenchymal disease. Simple and mildly complex cysts are identified, little changed from the prior exam. The largest which has a single fine septation measures approximately 1.8 x 2.1 x 2.5 cm without change. No hydronephrosis or shadowing calculus.LEFT KIDNEY: The left kidney measures slightly over 10 cm in length. The parenchyma is highly echogenic consistent with parenchymal disease.Simple and mildly complex cysts are again identified, little changed from the prior exam. Mid pole cyst measures 1.3 cm in greatest diameter without change. No solid mass or obvious nephrolithiasis. There is again noted mild dilatation of renal pelvis and lower pole collecting system, decreased compared to prior exam. Echogenic, peripheral focus in the midportion of the right kidney appears stable as well, most consistent with a focal calcification.OTHER: No gross bladder abnormality.", "output": "Stable, mildly complex renal cysts that by appearance do not require follow-up.Stable, mild dilatation of the left renal collecting system."}
{"instruction": "Generate impression based on findings.", "input": "Reason: AKI in setting of DKA/dehydration Limited exam due to poor patient cooperation and delirium RENAL TRANSPLANT: The transplanted kidney measures 12.6 cm in length. Unremarkable echotexture and echogenicity. No hydronephrosis.LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality noted. No perinephric fluid.COLLECTING SYSTEM/URETER: Poorly visualized, however no evidence of hydronephrosis.URINARY BLADDER: Poorly visualized.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels normal color Doppler flow is visualized, however accurate evaluation of the peak velocities and relative indices is limited by patient movement. The inflow and outflow vessels are patent.Right iliac artery peak velocity is 82.5 cm/s, relative index 0.75.Renal artery mid segmental peak systolic velocity is 41.1 cm/s, relative index 0.58Renal artery inferior segmental peak velocity is 53.8 cm/s, relative index 0.63.Renal artery at the anastomosis peak systolic velocity is 62.6 cm/s, relative index 0.79 cm", "output": "Limited vascular examination due to patient movement, however the inflow and outflow vessels are patent. No perinephric fluid collections or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "History of radiation as a child RIGHT LOBE MEASUREMENTS: 4.2 x 1.4 x 1.7 cm.LEFT LOBE MEASUREMENTS: 4.8 x 1.8 x 2.4 cm.ISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: 0.4 x 0.6 x 0.3 hypoechoic nodule.LEFT LOBE: Multiple spongiform nodules. The largest measures 1.7 x 1.5 x 1.9 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple left spongiform nodules; favor benign etiology. Subcentimeter right hypoechoic nodule. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Male; 49 years old. Reason: Patient with elevated creatinine, likely long standing CKD, rule out obstruction History: As above RIGHT KIDNEY: The right kidney measures 14.1 cm in length. The renal parenchyma is echogenic. There is no shadowing renal stone or hydronephrosis.LEFT KIDNEY: The left kidney measures 14.0 cm in length. The renal parenchyma is echogenic. In the lower pole there is a focal, hypoechoic tubular structure without vascularity. There is no hydronephrosis or shadowing renal stoneBLADDER: The bladder is nondistended. Bilateral ureteral jets are identified.", "output": "1.Bilateral echogenic kidneys compatible with medical renal disease.2.Focal, hypoechoic tubular structure in the lower pole of left kidney likely represents a small dilated calix. No hydronephrosis bilaterally."}
{"instruction": "Generate impression based on findings.", "input": "60 year old female who was recalled from screening mammogram for new focal asymmetry in the right upper 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), unchanged in pattern and distribution. 13 mm focal asymmetry in the right breast 12:00 position persists on spot compression views. No associated calcifications noted. On spot compression views the asymmetry demonstrates irregular margins.Ultrasound: Ultrasound demonstrates hypoechoic mass at 12:00 position, with apical blood flow measuring 6 x 6 x 5 mm. A possible hyperechoic septation is noted within the mass. Differential includes a complicated cyst however given that no definite posterior acoustic enhancement is noted, presence of apical blood flow, and suspicious morphology on mammogram, ultrasound-guided core biopsy is recommended.", "output": "Screening detected mass right breast 12:00 position with sonographic correlate, ultrasound-guided core biopsy is recommended for further evaluation.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant and epigastric pain LIVER: No significant abnormalities noted. Liver length 12.5 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation. Possible benign adenomyomatosisPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.5 cm in length OTHER: Left kidney 9.7 cm in length. Spleen 10.3 cm in length. No ascites.", "output": "Cholelithiasis without acute inflammation or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "48 -Year-old female with prior hemi-thyroidectomy. Follow-up right nodule. RIGHT LOBE MEASUREMENTS: 4.4 x 1.7 x 1.7 cmLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: No significant abnormality noted.RIGHT LOBE: There is again noted an almost isoechoic but mildly heterogeneous and predominantly solid nodule in the mid right lobe, measuring 1 x 1 x 1 cm without change. This has an incomplete hypoechoic rim. There may be a small isoechoic nodule in the far inferior right lobe, difficult to compare the prior exam.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": "Dominant right lobe mass is stable. There is small mass in the far inferior right lobe and follow up in 6 months recommended. No mass in the left bed."}
{"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.This exam was double read by Dr. Abe.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for residual thyroid tissue History: Status post thyroidectomy for questionable pre-malignant lesions RIGHT LOBE: Status post thyroidectomy without new suspicious lesions in the thyroidectomy bed.LEFT LOBE: Status post thyroidectomy without new suspicious lesions in the thyroidectomy bed.ISTHMUS: Status post thyroidectomy without new suspicious lesions in the thyroidectomy bed.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted. Benign-appearing right level 2 cervical lymph node measures 2.1 x 0.6 x 0.9 cm. No cervical lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy without evidence of recurrence."}
{"instruction": "Generate impression based on findings.", "input": "Female, 19 years old. Pain over graft site, UTI RIGHT KIDNEY: The right kidney measures 6.7 cm in length, with markedly increased cortical echogenicity. No hydronephrosis.LEFT KIDNEY: The left kidney is not well visualized.TRANSPLANT KIDNEY: The right iliac fossa transplant kidney measures 13.77 m in length, with increased cortical echogenicity. Hydronephrosis is progressed from prior, particularly in the upper pole calyx/collecting system appears more dilated. No perinephric fluid collection is identified.OTHER: The bladder is incompletely distended.", "output": "1.Increased hydronephrosis predominantly involving the upper portion of the transplant kidney collecting system.2.Increased parenchymal echogenicity of the transplant kidney, similar to prior.3.Atrophic native kidneys."}
{"instruction": "Generate impression based on findings.", "input": "Male; 81 years old. Reason: aki History: aki RIGHT KIDNEY: The right kidney measures 9.7 cm in length. The parenchyma is normal echogenicity. There is a 1.3 x 0.7 x 1.1 cm simple appearing cyst. There is no hydronephrosis or shadowing renal stone.LEFT KIDNEY: The left kidney is poorly visualized, it measures 10.8 cm in length. The parenchyma is normal in echogenicity. There is no hydronephrosis or shadowing renal stone.URINARY BLADDER: The bladder is decompressed by Foley catheter.OTHER: The prostate measures 6.5 x 5.8 x 3.8 cm.", "output": "1.No hydronephrosis.2.1.3-cm simple appearing right renal cyst.3.Enlarged prostate with measurements as above."}
{"instruction": "Generate impression based on findings.", "input": "Ventriculomegaly, seizure. There is moderate prominence of the lateral ventricles bilaterally. Cortical sulci are also prominent and there is relative lucency in the periventricular white matter. There is no gross hemorrhage or mass. Subtle scalp swelling is incidentally noted in the frontal region.", "output": "Immature appearance with prominent ventricles and sulci especially in the frontal region and decreased attenuation white matter with no hemorrhage."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Coarse echogenic liver echotexture again noted without mass. Liver length 15.2 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: Gallbladder absent. No ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 8.7 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.1 cm in lengthOTHER: Left kidney 11.2 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture again noted consistent with fatty infiltration/parenchymal dysfunction without mass or duct dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old male with concern for soft tissue infection of the neck. No significant subcutaneous fluid. No abscess identified.", "output": "1. No abscess identified."}
{"instruction": "Generate impression based on findings.", "input": "Female 72 years old Reason: 72 y/o with hemolytic anemia, eval for splenomegaly History: abdominal pain LIVER: Increased echotexture of the liver suggestive of chronic liver disease. Liver is enlarged measuring 18.7 cm. No focal liver lesions.BILIARY TRACT: Gallbladder is distended with sludge. No evidence of gallbladder wall thickening or pericholecystic fluid. No evidence of intra or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: Spleen measures 10 cm.RIGHT KIDNEY: No evidence of hydronephrosis bilaterally. OTHER: No significant abnormalities noted.", "output": "Enlarged liver with increased echotexture suggestive of fatty liver.Distended gallbladder with moderate amount of sludge."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old male with hepatocellular carcinoma and mass in the hepatic dome. LIVER: High in the dome there is a hypoechoic mass measuring approximately 2.6 x 3.3 x 2.4 cm. Biopsy of this mass was requested. However the mass is immediately adjacent to the heart and lung. It was felt that this could not be approached safely and therefore biopsy was not performed.OTHER: No significant abnormalities noted.", "output": "Unable to biopsy hepatic mass due to safety concerns."}
{"instruction": "Generate impression based on findings.", "input": "Male 27 years old; Reason: 27 year-old male with 5/2016 cholecystectomy, with intraoperative findings of fatty liver. RUQ u/s requested to further evaluate the liver. History: as above LIVER: The liver measures 15.4 cm in length. There is 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. GALLBLADDER/BILIARY TRACT: The gallbladder is absent. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 1.4 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 8.8 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 9.2 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.", "output": "1. Increased echogenicity of the liver suggestive of chronic liver disease/fatty infiltration. No masses."}
{"instruction": "Generate impression based on findings.", "input": "Squamous cell carcinoma of the lung with possible left cervical adenopathy PARATHYROID GLANDS: 0.8 x 0.4 cm hypoechoic focus projecting posterior to the mid right thyroid gland. It is unclear whether not this represents a benign intrathyroid nodule or is extrathyroidal.LYMPH NODES: Abnormal appearing enlarged left level 4 lymph node measuring 1.6 x 2.4 x 1.9 cm.OTHER: No significant abnormality noted.", "output": "Abnormal appearing enlarged left level 4 cervical lymph node. Worrisome for metastatic adenopathy. This lymph node is amenable to US guided percutaneous biopsy.Hypoechoic focus projecting posterior to the mid right thyroid gland. While this may represent a benign appearing intrathyroidal nodule, a parathyroid adenoma cannot be excluded. Would recommend correlation with calcium and PTH."}
{"instruction": "Generate impression based on findings.", "input": "Reason: LLE cellulitis - assess for drainable fluid collection. Within the left lower extremity anteriorly along the lateral aspect at the area of palpable abnormality there is a hypoechoic somewhat heterogeneous irregular collection measuring 7 mm x 7 mm x 6 mm which may represent a possible small abscess.", "output": "Possible small abscess as described above not be amenable to drainage."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old female patient with history of multiple thyroid nodules. Evaluate for interval change. RIGHT LOBE MEASUREMENTS: 1.9 x 1.6 x 4.8 cm, previously 1.2 x 2.0 x 4.7 cm.LEFT LOBE MEASUREMENTS: 1.6 x 1.0 x 4.2 cm, previously 1.0 x 1.6 x 4.7 cm.ISTHMUS MEASUREMENTS: 3 mm in thickness.RIGHT LOBE: A hypoechoic nodule within the upper pole measures 0.9 x 1.0 x 1.3 cm, previously 0.8 x 0.9 x 1.5 cm.LEFT LOBE: No new suspicious nodules are identified.ISTHMUS: A solid hypoechoic midline nodule measures 0.6 x 0.4 x 0.5 cm, previously 0.4 x 0.3 x 0.5 cm, and is similar in morphology compared to the prior study with internal calcification. An additional solid nodule within the left aspect of the isthmus measures 0.6 x 0.3 x 0.7 cm, previously 0.8 x 0.4 x 0.8 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A right level two lymph node measures 1.6 x 0.5 x 2.3 cm, previously 1.2 x 0.5 x 2.2 cm.OTHER: No significant abnormality noted.", "output": "1. Stable right thyroid nodule.2. Two isthmic nodules, one of which contains calcifications, also stable. "}
{"instruction": "Generate impression based on findings.", "input": "Right breast mass, possible fibroadenoma with prior benign biopsy result. Recent mastitis treated effectively, currently asymptomatic. A targeted right ultrasound was performed for the area marked by the clinical service. At the right 9 o'clock position, there is a mixed echogenicity lesion measuring 1.6 x 1.5 cm. This has peripheral blood flow.", "output": "1.6-cm mixed echogenicity lesion near the site of clinical concern. This could represent a recurrent galactocele or less likely an area of fat necrosis. Surgical consultation is recommended and the patient will be seeing Dr. Jaskowiak today.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "36 year old female at 22 weeks gestation presents for right breast ultrasound. Patient states she had warm, erythematous, and extremely tender right breast two weeks ago, which has somewhat resolved with warm compresses. Physician palpated right breast nodule. On physical examination, there is diffuse nodular pattern of glandular tissue appreciated, compatible with the patients gravid state. No discrete palpable mass is identified.A targeted right ultrasound was performed for the patient\u2019s area of concern. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy. If the patients physical examination remains normal, she should return for annual screening mammograms, beginning at age 40. Result and recommendations were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are digital mammographic images of left breast (3/9/15), ultrasound images of left breast and left axilla (3/9/15), images from ultrasound guided biopsy of left breast and post procedural left mammographic images (3/10/15) performed at Diagnostic Imaging Specialist of Chicago. DIGITAL MAMMOGRAPHIC IMAGES OF LEFT BREAST (3/9/15):Four spot views of left breast are submitted. No standard views of left breast or no mammographic images of right breast are submitted.The breast parenchyma is heterogeneously dense. Saline implant is present.There are segmentally distributed fine linear calcifications, measuring 49 x 28 mm on CC view, in the left breast at upper outer quadrant.ULTRASOUND IMAGES OF LEFT BREAST AND LEFT AXILLA (3/9/15):There is an irregularly shaped mass, measuring 26 x 13 mm, with marked blood flow at 1 o'clock position, 1 cm from nipple, in the left breast. Two separate oval and round masses, measuring 10 mm and 4 mm, are present adjacent to the main mass. These masses are located within the area of segmental calcifications on mammogram. A lymph node with abnormally thickened cortex is visualized in the left axilla.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF LEFT BREAST AND POST PROCEDURAL LEFT MAMMOGRAPHIC IMAGES (3/10/15):Ultrasound guided biopsy for left 1 o'clock mass and left axillary lymph node (FNA) is performed with appropriate needle placement. Post-procedural mammographic images show that a marker clip placed within the area of calcifications in the left upper outer quadrant.Although the pathology results are not available, the left breast mass and calcifications are highly suggestive of malignancy.", "output": "Highly suspicious lesion in the left breast on mammogram and ultrasound, with suspicious left axillary lymph node.MRI is recommended for assessment of the lesion.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old female with no family history of breast cancer. During routine physical exam, primary care physician noted palpable lesion in the left breast. On physical exam, within the left breast at 2:30, 1cm from the nipple, there is a small firm mass. A targeted left ultrasound was performed for the palpable area of concern. Within the left breast at 2:30, 1 cm from the nipple, the palpable mass corresponds to multiple simple cysts, the largest measuring 1.1 x 0.8 x 1.0 cm. Additional subcentimeter simple and complicated cysts containing internal debris are present.", "output": "No sonographic evidence for malignancy. Palpable lesion corresponds to benign cysts.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "22-year-old female with a left breast palpable mass for past 2 weeks. It is nontender. No family history of breast cancer. A targeted left ultrasound was performed for the palpable area of concern. On physical examination, a pea sized mobile nontender lump is palpated behind the left nipple. A simple cyst is identified behind the left nipple measuring 1.1 x 0.9 x 1 cm without peripheral blood flow. No suspicious solid mass noted.", "output": "Palpable abnormality behind the left nipple corresponds to a simple cyst.No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old male with history of hepatitis B. Evaluate for apicitis or carcinoma. Follow-up gallbladder polyps. LIVER: The previously identified hemangioma in the left lobe of the liver is poorly visualized, measuring approximately 2.8 x 2.8 x 2.7 cm, not significantly changed from prior exams. This was demonstrated to be a hemangioma on prior CT but remains quite atypical by ultrasound. The superficial, presumed hemangioma previously identified is not well seen on today's study. There is a very small, 1 cm hemangioma in the inferior right lobe of the liver. This correlates with prior CT. No new masses are identified with certainty. Liver parenchyma is mildly echogenic.BILIARY TRACT: Again identified are two non-mobile, non--- shadowing hyperechoic foci in the gallbladder consistent with gallstones. These measure approximately 5 mm in greatest diameter and appears stable. No shadowing gallstones. No wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: Pancreatic head is normal. The body and tail are less well-visualized due to bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Mildly echogenic liver with stable mass is previously identified as hemangiomas by CT. There is a subcapsular lesion identified on prior exams which is not well seen on today's study. No new hepatic masses.Stable gallbladder polyps."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old male with right vocal cord small cell carcinoma. Evaluate for thyroid mass/neuroendocrine tumor. Thyroid incompletely imaged due to substernal extent.RIGHT LOBE MEASUREMENTS: 4.7 x 3 x 6.8 cmLEFT LOBE MEASUREMENTS: 5.3 x 4.1 x 8.5 cmISTHMUS MEASUREMENTS: 1.3 cmRIGHT LOBE: Enlarged and diffusely heterogeneous in echotexture. There is a 1 x 0.7 x 1.1 cm nodule which is predominantly isoechoic with the remainder of the thyroid and with an incomplete hypoechoic rim.LEFT LOBE: Enlarged and diffusely heterogeneous in echotexture. Complex cystic nodule in the mid left lobe measuring 0.6 x 1.4 x 1.4 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: At level 3-4 on the right there is a 1 x 1.8 x 1.3 cm lymph node which is more rounded than typical and without definite hilum. Second nondescript and smaller node at level 3 on the right.OTHER: Extensive, incompletely occlusive thrombus in the right internal jugular vein associated with catheter.", "output": "Goiter with substernal extension. Solid right nodule, complex cystic left nodule. Right nodule would be amenable to biopsy if desired.At least one abnormal-appearing right cervical lymph node at level 3-4.Extensive thrombus right internal jugular vein.These results were discussed with Maureen Crowley, pager 5508 at 11:30 AM."}
{"instruction": "Generate impression based on findings.", "input": "Increasing LFTs LIVER: Mildly heterogeneous and coarse liver echotexture. Liver length 15.5 cm. Bilobar well circumscribed hyperechoic lesions within the right and left lobe of the liver. Lesion within the right lobe of liver measures 1 x 1 cm. The left lobe lesion measures 1.4 x 1.1 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.2 cm in length OTHER: Left kidney 9.4 cm in length. Spleen 9.8 cm in length. No ascites.", "output": "Mildly heterogeneous and coarse liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without ductal dilatation. Bilobar well-circumscribed hyperechoic liver foci; given the patient's age, would favor benign etiology such as hemangiomas. However, would recommend continued special attention to these lesions on future surveillance scans. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Transaminitis LIVER: Non-cirrhotic liver morphology. Mildly coarsened hepatic echogenicity, compatible with parenchymal dysfunction. 13 mm homogeneously hyperechoic lesion in the posterior right lobe likely represents a hemangioma. No suspicious hepatic lesions noted. 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 11.2 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9.4 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid identified.", "output": "Mildly coarsened hepatic echogenicity, compatible with parenchymal dysfunction. No specific findings otherwise to account for the patient's presentation."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old male with transaminitis and HIV. Assess for cirrhosis and biliary obstruction. LIVER:Mild ascites. Normal echogenicity. No intrahepatic biliary dilation, focal mass.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with anechoic lumen. Echogenic material partially fills the lumen, consistent with cholelithiasis. Gallbladder wall measures 1.8 mm. Common hepatic duct measures 0.3 cm. No pericholecystic fluid. Negative sonographic Murphy's sign.PANCREAS: Evaluation the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 12.0 cm without sonographic abnormalities.KIDNEYS: Left kidney measures 12.1 cm. Right kidney measures 11.3 cm. Normal echogenicity. No hydronephrosis, shadowing calculi, or focal mass. OTHER: No significant abnormality noted.", "output": "1. Cholelithiasis and gallbladder wall thickening. Of note, in the context of ascites gallbladder wall thickening is nonspecific.2. Mild ascites."}
{"instruction": "Generate impression based on findings.", "input": "Nephrolithiasis. RIGHT KIDNEY: 13.2 cm in length. Unremarkable renal parenchymal echogenicity. A 4.6 cm minimally complex cyst is again seen in the midpole, unchanged. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 12.9 cm in length. Unremarkable renal parenchymal echogenicity. Two 1-2 cm stones are noted in the upper pole, unchanged. A 2 cm benign-appearing cyst is noted in the upper pole. No suspicious lesions are evident. No hydronephrosis.BLADDER: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Unchanged left nephrolithiasis, without hydronephrosis"}
{"instruction": "Generate impression based on findings.", "input": "Male 38 years old Reason: lupus nephritis History: proteinuria Ultrasound guidance was performed for kidney biopsy.", "output": "Ultrasound guidance was performed for kidney biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Female; 64 years old. Reason: evaluate for cirrhosis and ascites History: history of heavy alcohol use and abdominal distention LIVER: The liver measures 11.9 cm in length. The liver capsule is smooth. The parenchyma is heterogeneous in echotexture. No focal hepatic mass is identified. There is no ascites.The main portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.3 m/sec.BILIARY TRACT: The gallbladder is normal in appearance. There is no bladder wall thickening or pericholecystic fluid. The common duct measures 4 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head of the pancreas is unremarkable. The body and tail are obscured by overlying bowel gas.SPLEEN: The spleen measures 6.4 cm in length.KIDNEYS: The right kidney measures 9.7 cm in length. The left kidney measures 9.2 cm in length. The kidneys have a lobulated contour bilaterally likely secondary to scarring as seen on the prior CT. The renal parenchyma is normal in echogenicity bilaterally. There is no hydronephrosis or shadowing stone.OTHER: No significant abnormalities noted.", "output": "1.Heterogeneous liver parenchyma is nonspecific but likely represents chronic parenchymal dysfunction.2.No focal hepatic lesion.3.No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Right renal mass RIGHT KIDNEY: Interval decrease in size of mid pole mass now measuring 1.3 x 1.4 cm; this is in comparison to 2.5 x 2.4 cm on 1/28/2013. Benign subcentimeter renal cysts. No stone or hydronephrosis. Right kidney 11.2 cm in lengthLEFT KIDNEY: Subcentimeter cysts. No worrisome mass, stone, or hydronephrosis. 10.7 cm in length.OTHER: Bladder nondistended. Large prostate gland again noted. Right pleural effusion.", "output": "Interval decrease in size of right mid pole renal mass."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old male with cystic fibrosis and right upper quadrant pain. LIVER: Normal in size and echotexture. No focal abnormality. Limited spectral and color Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder appears unremarkable without cholelithiasis, wall thickening or pericholecystic fluid, although a small portion of the fundus is poorly visualized due to adjacent bowel gas. The biliary tract is normal in caliber.PANCREAS: Inadequately visualized due to bowel gasRIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "No evidence for cholelithiasis."}
{"instruction": "Generate impression based on findings.", "input": "27-year-old with a palpable left breast lump for 3 weeks which is gradually decreased in size since past 2 weeks. The patient does not feel a lump. No family history of breast cancer A targeted left ultrasound was performed for the patient\u2019s area of concern at 8:00 position of the left breast. On physical examination, no discrete palpable mass noted. Ultrasound demonstrates normal glandular tissue. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy corresponding to patient's area of concern in the left breast 8:00 position.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Islet cell transplant 2 years ago LIVER: Mildly coarse liver texture again noted without mass. Liver length 11.5 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. 7.2 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 8.9 cm in lengthOTHER: Left kidney 9.4 cm in length. No ascites.", "output": "Stable examination. Mildly coarse liver echotexture again noted without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney failure evaluate for acute etiology RIGHT KIDNEY: Right kidney measures 8.6 cm with increased echogenicity consistent with chronic medical renal disease. No hydronephrosis noted. 1.2 cm simple cyst identified in the mid pole of right kidney.LEFT KIDNEY: Left kidney measures 9.1 cm with increased echogenicity compatible with chronic medical renal disease. 4 cm left renal cyst with through transmission consistent with a simple cyst. No hydronephrosis.OTHER: Partially distended bladder, incompletely evaluated.Left pleural effusion.", "output": "Bilateral echogenic kidneys consistent with chronic medical renal disease. Bilateral simple cysts.Left pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter RIGHT LOBE MEASUREMENTS: 6.8 x 1.9 x 1.5 cmLEFT LOBE MEASUREMENTS: 6.6 x 2.9 x 2.2 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Stable diffusely heterogeneous gland. Stable right thyroid nodules. Reference midpole nodule measures 1.8 x 1.1 x 1.5 cm. Reference lower pole nodule measures 0.9 x 0.7 x 1 cmLEFT LOBE: Stable diffusely heterogeneous gland. Stable left thyroid nodules. Reference upper pole nodule measures 2.0 x 1.9 x 1.7 cm. Lower pole reference nodule measures 1.2 x 0.7 x 0.9 cmISTHMUS: Diffusely heterogeneous gland. Stable isthmic nodule measuring 1.4 x 1.2 x 0.7 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable bilateral thyroid nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "History left thyroid nodule RIGHT LOBE MEASUREMENTS: 1.2 x 4.1 x 1.2 cm.LEFT LOBE MEASUREMENTS: 1.2 x 3.5 x 1.1 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: 0.5 x 2 x 0.2 cm hypoechoic nodule with central increased echogenicity within the upper pole 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": "Subcentimeter hypoechoic nodule with central increased echogenicity within the upper pole left thyroid gland. No regional adenopathy. The subcentimeter nodule will be biopsied later today."}
{"instruction": "Generate impression based on findings.", "input": "Male 62 years old; Reason: r/o gall stones History: post prandial abdominal pain LIVER: The liver measures 18.7 cm in length. There is slightly increased coarse 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 16.7 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is contracted and the wall measures 2.1 mm. No stones are seen. No pericholecystic fluid. Negative sonographic Murphy sign. The common bile duct measures 3.3 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9.6 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.9 cm in length. The cortex has mild atrophy but appears normally echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 12.2 cm in length. The cortex has mild atrophy but appears normally echogenicity. No hydronephrosis, stones, or worrisome masses are seen.URINARY BLADDER: The bladder is partially visualized without any significant abnormalities noted.", "output": "1. The gallbladder appears contracted however no evidence of cholelithiasis or acute cholecystitis are seen2. There is hepatomegaly with increased coarse liver echogenicity compatible with fatty infiltration/hepatocellular dysfunction. No worrisome masses are seen.3. Bilaterally the kidneys have mild cortical atrophy."}
{"instruction": "Generate impression based on findings.", "input": "Thyrotoxicosis, with multinodular goiter. Evaluate for change in size of nodules. RIGHT LOBE MEASUREMENTS: 3.6 x 1.6 x 1.3 cm, previously 4.3 x 1.4 x 1.8 cmLEFT LOBE MEASUREMENTS: 3.4 x 1.9 x 2.1 cm, previously 4.2 x 2.0 x 2.4 cmISTHMUS MEASUREMENTS: 4 mm, unchangedRIGHT LOBE: Multiple nodules, some of which are calcified within the right lobe. An inferior right thyroid nodule measures 1.2 x 0.8 x 0.9 cm, previously 1.0 x 0.6 x 0.7 cm. A right superior thyroid nodule containing calcification measures 0.8 x 0.7 cm, probably unchanged (though unable to measure AP dimension due to shadowing).LEFT LOBE: Multiple heterogeneous thyroid nodules are again identified. There is a mixed solid/cystic nodule within the superior left thyroid lobe measuring 2.0 x 1.4 x 1.7 cm, with no internal calcification, probably unchanged. A mixed solid/cystic nodule, without calcification, within the inferior left thyroid lobe measures 1.7 x 1.5 x 1.8 cm, previously 1.5 x 1.2 x 1.6 cm.ISTHMUS: Inferior medial solid appearing nodule within the left isthmus measures 2.2 x 1.2 x 2.2 cm, previously 2.1 x 1.3 x 1.7 cm, with increased vascularity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple bilateral thyroid nodules with increased size of a solid nodule within the left isthmus with increased vascularity.Mixed cystic/solid nodule within the left lobe are stable to slightly increased in size.Right thyroid nodules, one of which contains calcification, are not significantly changed.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Reason: enlarged thyroid RIGHT LOBE MEASUREMENTS: 5.4 x 1.8 x 1.4 cmLEFT LOBE MEASUREMENTS: 5.1 x 1.8 x 1.4 cmISTHMUS MEASUREMENTS: 0.18 cmRIGHT LOBE: Two abutting hypoechoic nodules in the right superior thyroid lobe measure in total 1.4 x 0.8 x 1.0 cm. Hypoechoic, spongiform nodule in the inferior right thyroid lobe measures 0.9 x 0.4 x 0.4 cm. There is no internal vascularity.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": "Two nodules in the right thyroid lobe. The more inferior nodule is of very low suspicion and the more superior nodule is benign appearing."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with hard thyroid on exam. RIGHT LOBE MEASUREMENTS: 4.9 x 1.7 x 1.6 cmLEFT LOBE MEASUREMENTS: 5.2 x 1.4 x 1.3 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Predominantly solid right lower pole nodule with areas of increased echogenicity measures 1.6 x 0.9 x 1.2 cm.LEFT LOBE: Left upper pole predominantly solid nodule with scattered small echogenic foci measures 1.0 x 0.6 x 1.0 cm. More inferiorly, a smaller nodule in the mid polar left thyroid has mixed solid and cystic components.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral predominately solid thyroid nodules as described above are amenable to biopsy."}
{"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 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": "63-year-old male with history of chronic kidney disease and 1 cm lesion seen on prior ultrasound. RIGHT KIDNEY: Measures 12.1 cm in length. No nephrolithiasis, hydronephrosis, or suspicious lesions.LEFT KIDNEY: Measures 11.4 cm in length. No nephrolithiasis or hydronephrosis. Redemonstration of a 1 cm echogenic focus in the superior pole, which may represent interposed adjacent mesenteric fat or possibly a small angiomyolipoma, unchanged since the prior study and without definite correlate lesion on prior CT scan.OTHER: No significant abnormalities noted.", "output": "No interval change in 1 cm echogenic focus in the left kidney, which may represent interposed adjacent mesenteric fat or possibly a small angiomyolipoma. "}
{"instruction": "Generate impression based on findings.", "input": "42-year-old male patient with NASH cirrhosis. Evaluate for malignancy, portal hypertension. LIVER: The liver measures 23.5 cm in length. 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. Sonographic Murphy's sign is negative. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 2 mm in diameter.PANCREAS: The pancreas is not well visualized on this examination. RIGHT KIDNEY: The right kidney measures 13.7 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 14.6 cm in length. No evidence of hydronephrosis.The spleen measures 18.8 cm in length.", "output": "1. Hepatosplenomegaly without focal hepatic lesion.2. Patent portal vein."}
{"instruction": "Generate impression based on findings.", "input": "Reason: r/o obstruction History: none, but increased Cr RIGHT KIDNEY: Right kidney measures 10.1 cm. There is a simple appearing cyst in the right upper pole measuring 1.4 x 1.6 x 1.4 cm, previously 1.4 x 1.6 x 1.4 cm. No hydronephrosis or or shadowing stones. Normal parenchymal echogenicity.LEFT KIDNEY: Left kidney measures 9.5 cm. Hypoechoic lesion in the left lower pole measures 0.8 x 0.7 x 0.7 cm and likely represents a cyst. No hydronephrosis or shadowing stones. Normal parenchymal echogenicity.OTHER: No significant abnormalities noted.", "output": "No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Female 59 years old; Reason: Abnormal LFT History: viral enterogastritis LIVER: The liver measures 18.8 cm in length. There is mildly 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 measuring 22.7 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.7 mm. No stones are seen with minimal dependent sludge. No pericholecystic fluid. The common bile duct measures 2.6 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 12.0 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.8 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.5 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "Mild hepatomegaly. There is a slightly increased liver echogenicity which is compatible with fatty infiltration/hepatocellular dysfunction. No worrisome masses are seen."}
{"instruction": "Generate impression based on findings.", "input": "Reason: baseline examination as part of heart transplant evaluation LIVER:The liver measures 15 cm in length. Coarse, echogenic hepatic parenchyma. The hepatic veins appear dilated. The portal vein is patent with normal hepatopedal directional portal venous flow, peak velocity 16.8 cm/s and mildly pulsatile. No focal mass.GALLBLADDER, BILIARY TRACT: No significant abnormality noted. The gallbladder wall measures 0.2 cm and the common bile duct measures 0.3 cm. No biliary ductal dilatation. The gallbladder is unremarkable without evidence of shadowing stones or sludge.PANCREAS: Obscured by bowel gas.SPLEEN: The spleen measures 10.6 cm in length.KIDNEYS: The right kidney measures 9.1 cm in length. The left kidney measures 9.7 cm in length. Echogenic renal parenchyma bilaterally. Small nonobstructive renal stone in the mid right kidney measures a maximum of 0.7 cm. Minimally complex cyst in the mid to lower pole of the left kidney measures 1.7 x 0.9 cm. No hydronephrosis.ABDOMINAL AORTA: The proximal aorta measures 1.9 x 2.1 cm, mid aorta 1.7 x 1.8 cm, distal aorta 1.4 x 1.5 cm, of normal size without ectasia or aneurysm. The right iliac artery measures 1.0 x 0.9 cm and the left iliac artery measures 0.9 x 0.9 cm.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No ascites.", "output": "1. Coarse, echogenic liver along with dilated hepatic veins and pulsatile portal venous flow are consistent with congestive hepatopathy likely related to CHF.2. Subcentimeter nonobstructive right renal stone.3. Echogenic renal parenchyma, consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Papillary thyroid carcinoma status post thyroidectomy RIGHT LOBE: Status post thyroidectomy. Stable 0.6 x 0.7 x 0.3 cm thyroidectomy bed hypoechoic focus.LEFT 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. Stable subcentimeter right thyroidectomy bed hypoechoic focus"}
{"instruction": "Generate impression based on findings.", "input": "42 year old female with a personal history of high likely benign mass in the left breast. A targeted left ultrasound was performed for the mammographic area of concern. 3:00 position and an oval circumscribed hypoechoic mass measuring 8 x 5 x 11 mm, compatible with benign mass is unchanged.", "output": "High likely benign mass in the left breast, most likely fibroadenoma or possibly papilloma. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "41 year-old male with hepatitis B. HCC screening. LIVER: Diffuse increased echogenicity of the liver measuring 16.0 cm in length. No focal hepatic lesion. Portal vein is patent with appropriate directional flow.GALLBLADDER, BILIARY TRACT: Linear echogenic strands within the gallbladder are again seen and appear similar to prior study. No pericholecystic fluid. No gallbladder wall thickening. Common bile duct measures 4 mm in caliber. No intra or extrahepatic biliary ductal dilatation.PANCREAS: The visualized portions of the pancreas are normal in echogenicity. No pancreatic ductal dilatation.RIGHT KIDNEY: The right kidney measures 12.3 cm in length. No hydronephrosis.OTHER: Left kidney measures 11.9 cm in length. No hydronephrosis. Normal echogenicity of the spleen measuring 12.5 cm in length.", "output": "1. Increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesion. 2. Linear echogenic strands within the gallbladder may represent septations or adherent sludge, however given stability compared to prior exam, findings favor internal gallbladder septations. "}
{"instruction": "Generate impression based on findings.", "input": "Male 39 years old Reason: Localized pain and abdominal wall mass/lesion in left abdomen. Assess for abdominal wall mass, lipoma History: abdominal pain The palpable lump corresponds to an echogenic area measuring 2.7 x 3.9 x 1.2 cm. It has similar texture to adjacent muscle. No flow on color Doppler imaging. No cystic components.", "output": "Nonspecific echogenic lesion. While this could represent a lipoma as clinically questioned, ultrasound is nonspecific."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Almendras is a 44-year-old female presenting with a palpable right breast lesion x7 years; fluctuates with menstrual cycle. Family history of breast cancer in maternal aunt and great aunt. Upon physical exam, nodular breast tissue is identified.A targeted right breast ultrasound was performed for the patient\u2019s area of concern. Normal fibroglandular tissue is identified in the right upper outer quadrant. There is no solid or cystic mass identified.", "output": "Normal fibroglandular tissue in the right upper outer quadrant. No sonographic evidence for malignancy. Patient can resume annual screening mammography, due next in May 2017. All results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Male; 59 years old. Reason: GB or liver or biliary tract abn History: ruq pain LIVER: The liver measures 13 cm in length. Cirrhotic liver morphology with nodular contour and coarsened echotexture. No worrisome hepatic lesions are identified.The main portal vein is patent with hepatic pedal flow and a peak velocity of 0.15 m/sec.There is mild ascites.BILIARY TRACT: The gallbladder is nondistended. The gallbladder wall measures 3 mm in thickness, normal. There is no cholecystic fluid. The patient was not tender when scanning over the gallbladder. The common duct measures 3 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreas is not well visualized to overlying bowel gas.SPLEEN: The spleen measures 12 cm in length.RIGHT KIDNEY: The right kidney measures 9.5 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing stone. No worrisome mass is identified. OTHER: The left kidney measures 9.8 cm in length. The renal cortex is normal in echogenicity. There is no hydronephrosis or shadowing stone. No worrisome mass is identified.", "output": "1.No cholelithiasis, biliary dilatation, or evidence of acute cholecystitis.2.Cirrhotic liver morphology with mild ascites."}
{"instruction": "Generate impression based on findings.", "input": "62 year old female status post left mastectomy in 2006 for invasive ductal carcinoma with DCIS presents for follow-up. Patient received hormonal therapy. Patient has had a right mastopexy in 2006. No current breast complaints. History of breast cancer in maternal cousin diagnosed at age 56 and paternal cousin diagnosed at age 55. Mammogram shows a circumscribed 3 mm oval subdermal asymmetry in the inferior aspect of the right breast. This has been stable since at least 2011. A targeted right ultrasound was performed for the mammographic area of concern. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy. There is no sonographic correlate to the stable mammographic asymmetry. The asymmetry is benign based on morphology and stability. The lack of sonographic correlate suggests that it is probably a focal superficial island of glandular tissue. Please see accompanying mammography report. The results were discussed with the patient at the completion of the exam.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old female status post left lumpectomy 2007 for invasive ductal carcinoma DCIS status post radiation, chemotherapy and hormonal therapy presents to evaluate left breast thickening for one week. A targeted left ultrasound was performed for the patient\u2019s area of concern. Area of thickening and pain noted in the left upper inner quadrant 10 to 11 o'clock position which is marked by Donna Christian. No lump was palpated on physical examination. Ultrasound demonstrates normal glandular tissue. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy, corresponding to area of left breast thickening and pain.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Male; 21 years old. Reason: evaluate for loculated fluid collection associated with pilonidal cyst/abscess History: ongoing induration, foul smelling drainage s/p incision on 01/31/2014 In the region of the patient's incision there is a sinus tract extending to skin surface. It is approximately 6 mm in depth and extends approximately 1 cm craniocaudal. There is no drainable fluid collection and no increased vascularity in this region.", "output": "A sinus tract is seen at the site of the patient's incision. No drainable fluid collection was identified."}
{"instruction": "Generate impression based on findings.", "input": "2 year old female patient with right hydronephrosis. Follow up scan. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. 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: 0 Left: 0  Length*** Right: 6.2 cm Left: 6.8 cm   Mean for age: 7 cm  Range for age: 6 - 8 cmADDITIONAL OBSERVATIONS: None", "output": "No hydronephrosis bilaterally.*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": "48 year old female with right upper quadrant pain. Evaluate for cholecystitis, cholelithiasis LIVER: Slight coarse echotexture of the liver measuring 17.0 cm in length. No focal hepatic lesions. Portal vein is patient with appropriate directional flow; peak velocity measures 0.3 m/s. GALLBLADDER, BILIARY TRACT: Normal echogenicity of the gallbladder. No shadowing calculi are noted. No pericholecystic fluid. No gallbladder wall thickening. Sonographic Murphy's sign is negative. No intra or extrahepatic biliary ductal dilatation. PANCREAS: Visualized portions of the pancreas are normal in echogenicity. No pancreatic ductal dilatation.RIGHT KIDNEY: Normal echogenicity measuring 11.2 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the spleen measuring 8.0 cm in length.Left kidney measures 11.5 cm in length. Upper pole of the left kidney is not visualized however the remaining visualized kidney appears normal in echogenicity. No hydronephrosis or shadowing calculi are noted.", "output": "Coarse echotexture of the liver suggestive of parenchymal dysfunction/fatty infiltration. No evidence of cholelithiasis or cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "36-year-old pregnant female patient with history of left breast fibroadenoma status post surgery January 2014. Pathology results from surgery are unknown at this time. Patient reports no palpable abnormality at this time. Targeted grayscale and Color Doppler ultrasound of the left breast was performed for the patient\u2019s area of concern, with special attention to the 3:00-5:00 position 5 cm from the nipple. Benign fibroglandular tissue and fat lobules are present. No discrete solid or cystic mass is identified.", "output": "No discrete solid or cystic mass. No sonographic evidence for malignancy. Recommend obtaining surgical pathology report from left breast surgery performed in January 2014 at the outside hospital (to confirm removal of fibroadenoma) and clinical follow-up. The last time the 3:00 mass was shown sonographically was in 2013 (before her surgery). BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Male; 61 years old. Reason: macroadenoma of pituitary; low TSH History: macroadenoma of pituitary RIGHT LOBE MEASUREMENTS: 7.2 x 3.0 x 3.1 cmLEFT LOBE MEASUREMENTS: 7.4 x 1.2 x 2.4 cmISTHMUS MEASUREMENTS: 0.9 cmRIGHT LOBE: Right lobe is enlarged, extending below the level of clavicle. The intrathoracic portion is not well visualized. Multiple nodules are seen in the inferior right thyroid lobe. A mid thyroid nodule measures 1.5 x 1.2 x 1.2 cm it is predominantly isoechoic with small hypoechoic areas. This nodule extends intra-thoracically, the intrathoracic portion is not well visualized.LEFT LOBE: The left lobe is enlarged, extending below the level of the clavicle. Intrathoracic portion is not well visualized. No discrete nodule is seen.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No worrisome lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Enlarged thyroid with multiple right lobe nodules."}
{"instruction": "Generate impression based on findings.", "input": "Female 57 years old Reason: Eval anterior abdominal soft tissue mass (just above umbilicus); R/o lipoma vs cyst vs abscess vs malignancy History: Anterior soft tissue mass (just above umbilicus) Ultrasound demonstrates an irregular contoured fluid collection with mural nodules. Mural nodules or hypovascular on color Doppler imaging. Overall dimension is measured as 4.7 x 3.3 x 4.4 cm. There is no evidence of peristalsis. No definite connection to the peritoneal cavity.", "output": "Irregular shape fluid collection with mural soft tissue nodularity is nonspecific. Neoplasm cannot be excluded. Infected fluid collection cannot be excluded. Although less likely something related to abdominal wall herniation containing infarcted omentum or fluid in the hernia sac cannot be excluded. If clinically warranted further evaluation to be obtained with CT."}
{"instruction": "Generate impression based on findings.", "input": "50 year-old female with right upper quadrant pain. LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: The gallbladder contains likely two small non-dependent and non-shadowing echogenic foci measuring 4 -- 5 mm in diameter arising from the wall. The gallbladder is otherwise normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Small gallbladder polyps. No other abnormality identified."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male with history of liver fibrosis. Evaluate for HCC. LIVER: Normal liver size, measuring 16.2 cm in craniocaudal dimension. The liver is nodular and coarse in echotexture consistent with fibrosis. No focal hepatic lesion is identified. No intrahepatic biliary ductal dilatation. Pulsatile hepatopetal portal venous blood flow at 40 cm/sec. Dilated hepatic veins suggests increased right-sided heart pressure.GALLBLADDER, BILIARY TRACT: Normally distended gallbladder without wall thickening, pericholecystic fluid, or focal tenderness. No extrahepatic biliary ductal dilatation with the common duct measuring 5 mm.PANCREAS: Partially visualized pancreas is unremarkable.RIGHT KIDNEY: The right kidney is normal in size, measuring 11.2 cm in length. The hydronephrosis, shadowing calculus or discrete lesion evident.OTHER: The left kidney is normal in size measuring lump a 9 cm without hydronephrosis, shadowing calculus or discrete lesion evident. Mild splenomegaly, measuring 15.6 cm. Moderate bilateral pleural effusions.", "output": "Cirrhotic liver morphology without focal lesion or biliary ductal dilatation. Splenomegaly. Moderate bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old female patient with new onset liver panel abnormalities. LIVER: The liver measures 13.8 cm in length. No focal hepatic lesion is identified. Hepatic parenchymal echogenicity is increased. 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 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 9.4 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 8.9 cm in length. No evidence of hydronephrosis.The spleen measures 7.7 cm in length.", "output": "Increased hepatic echogenicity which can be seen in the setting of hepatic steatosis/hepatic parenchymal dysfunction. No mass"}
{"instruction": "Generate impression based on findings.", "input": "Female 51 years old Reason: pre- total pancreatectomy with auto islets, please doppler portal vein and asses for patency and portal hypertension LIVER: Liver is enlarged, coarse, and echogenic. No focal hepatic mass. Main portal vein is patent with hepatopetal flow and a peak velocity of 19.0 cm/s. Right and left portal veins are also patent. BILIARY TRACT: No intra-axial hepatic biliary ductal dilatation. Patient is status post cholecystectomy. Common bile duct measures up to 13 mm, which can be seen in the setting of prior cholecystectomy.PANCREAS: Portions of the 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 10.8 cmKIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 9.9 cm area. Left kidney measures 9.6 cm. OTHER: No significant abnormalities noted.", "output": "1.Main, right, and left portal veins are patent with hepatopetal flow.2.Course and echogenic liver most consistent with fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "51 years old, Male, Reason: cyst? right tibial mass, enlarging and tender to palpation, no erythema/warmth, contingous with scar of 20 year old acl recontruction History: cyst? right tibial mass, enlarging and tender to palpation, no erythema/warmth, contiguos with scar of 20 year old acl reconstruction Right lower extremity: In the right tibial area there is a cystic-appearing mass measuring 4.0 x 1.1 x 2.2 cm. Mass is nonvascular and is favored to represent a complex cyst.", "output": "1.Nonvascular cystic appearing mass in the right tibial area."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female post thyroidectomy for thyroid cancer. Follow-up. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massLEFT LOBE: In the medial left thyroid bed/isthmus there is again noted an ovoid, well-demarcated hypoechoic nodule measuring 0.3 x 0.6 x 7 cm, unchanged. On today's study, there is evidence for central hilum suggesting lymph node. Also within the left bed there is again noted hyperechoic region measuring 0.6 x 0.6 x 0.6 cm without significant change, likely representing scarring.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. Presumed left bed/isthmus lymph node."}
{"instruction": "Generate impression based on findings.", "input": "Pericholecystic fluid noted on recent CT LIVER: No significant abnormalities noted.BILIARY TRACT: Diffuse gallbladder wall thickening with pericholecystic fluid associated with cholelithiasis. Negative Murphy's sign. No ductal dilatation.OTHER: No significant abnormalities noted.", "output": "Diffuse gallbladder wall thickening with pericholecystic fluid associated with cholelithiasis. Although there was a negative Murphy's sign, the patient was sleeping; acute and/or chronic inflammation is suspected. No ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female with nausea and vomiting, abdominal pain LIVER: Measures 17.6 cm in length. Coarse liver without discrete focal lesion.BILIARY TRACT: Status post cholecystectomy. No biliary ductal dilation.PANCREAS: Portions of the pancreas are not clearly seen due to body habitus and bowel gas. The imaged portions of the pancreas are unremarkable.SPLEEN: No significant abnormalities noted.KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Coarse liver. Status post cholecystectomy. Otherwise, no specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old female with history of thyroid cancer status post thyroidectomy. Evaluate for masses and lymphadenopathy RIGHT LOBE MEASUREMENTS: Status post thyroidectomy LEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: No discrete nodules or masses in the thyroidectomy bed.LEFT LOBE: No discrete nodules or masses in the thyroidectomy bed.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Several small benign appearing lymph nodes in the neck. No pathologic lymphadenopathy.OTHER: No significant abnormality noted.", "output": "No evidence of disease recurrence or pathologic lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "78 year old female with right upper quadrant pain. Evaluate for gallstones. LIVER: The liver measures 16.7 cm in length. The liver contour is smooth, the parenchyma is normal in echogenicity. No mass is identified.BILIARY TRACT: Small stones are seen within the gallbladder. There is no gall bladder wall thickening or pericholecystic fluid. There is persistent, mild intrahepatic biliary ductal dilatation. The common hepatic duct measures 0.3 cm in diameter, the common bile duct measures 1.1 in diameter. No convincing evidence of choledocholithiasis.PANCREAS: Limited evaluation of the pancreas reveals no significant abnormality.SPLEEN: The spleen measures 9.3 cm in length.KIDNEYS: The right kidney measures 9.1 centimeters in length. The left kidney measures 10.1 cm in length. Bilaterally there is no hydronephrosis or shadowing renal stone, the renal cortex is normal in echogenicity. OTHER: No significant abnormalities noted.", "output": "Mild biliary dilatation, similar to prior. No stones are seen within the ducts. As was noted previously, this finding may be age-related rather than secondary to an obstructive process."}
{"instruction": "Generate impression based on findings.", "input": "Male 60 years old; Reason: assess for liver abnormalities, hepatic congestion. History: increasing liver enzymes LIVER: The liver measures 16.6 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 28.9 cm/s. There is a small amount of ascites and right pleural effusion.GALLBLADDER/BILIARY TRACT: No stones are seen in the gallbladder, only minimal sludge. The gallbladder is incompletely visualized due to LVAD. No pericholecystic fluid. The common bile duct measures 3.6 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.4 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.5 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.2 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. The liver has coarse increased echogenicity which is compatible with fatty infiltration/hepatocellular dysfunction. A small amount of ascites is present as is a right pleural effusion.2. Bilaterally the kidneys have increased echogenicity which is compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "60 year-old female with a history of thyroid cancer. Status post total thyroidectomy. Evaluate for evidence of tumor recurrence and the previously seen lesion. THYROID: The patient is status post thyroidectomy. RIGHT THYROIDECTOMY BED: Status post thyroidectomy with no evidence of residual or recurrent disease. LEFT THYROIDECTOMY BED: Stable small medial hypoechoic focus in the anterior left thyroid bed measuring 2 x 1 x 5 mm, compared to 2 x 4 x 5 mm previously, unchanged and suggestive of scarring.ISTHMUS BED: Status post thyroidectomy with no evidence of residual or recurrent disease. LYMPH NODES: Bilateral morphologically unremarkable and normal-sized lymph nodes are identified.PARATHYROID GLANDS: No significant abnormality noted.OTHER: At level IV on the right there is an hypoechoic structure which appears to correspond to the previously described right level IV lymph node. On today's examination it appears tubular with internal blood flow on Color Doppler and in contiguity to the adjacent vasculature, most consistent with a vessel. No additional suspicious foci are identified in this region.", "output": "1. The previously described right level IV lymph node has either resolved or corresponds to a vessel as described above. No evidence of tumor recurrence or suspicious lymphadenopathy. 2. Left thyroidectomy bed focus suggestive of a scar."}
{"instruction": "Generate impression based on findings.", "input": "Male 50 years old abdominal pain LIVER: The liver is coarse and hyperechoic consistent with fatty infiltration. No focal mass. Main portal vein is patent with normal directional flow and a peak velocity of 19.6 cm/s. No definite sonographic evidence of cirrhosis.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Gallbladder is normal in appearance. No gallstones. Common bile duct is not well-visualized.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: Spleen is normal measuring 9.6 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 13.4 cm. Left kidney measures 13.2 cm. OTHER: No ascites.", "output": "Coarsened hyperechoic liver is consistent with fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old male presents with epigastric pain. There is clinical concern for cholelithiasis and cholecystitis. LIVER:Measures 17.2 cm. Mildly increased echogenicity. No focal mass, ascites, intrahepatic biliary dilation portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. Wall measures 0.2 cm. Common bile duct measures 0.2 cm. Echogenic dependent material within the lumen of the gallbladder consistent with gallbladder sludge. No stones or pericholecystic fluid. Negative sonographic Murphy's sign.PANCREAS: Evaluation of the gallbladder is limited due to overlying bowel gas.SPLEEN: Measures 9.4 cm without sonographic abnormalities.KIDNEYS: Right kidney is 12.3 cm. Left kidney is 12.8 cm. Normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "1. Increased hepatic echogenicity consistent with fatty infiltration and chronic liver disease/parenchymal dysfunction. No mass or ascites.2. Gallbladder sludge without evidence of cholelithiasis or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal LFTs and acute renal failure LIVER:Coarse echogenic liver echotexture again noted without mass. Liver length 18.3 cmGALLBLADDER, BILIARY TRACT: Stable sludge and stones without acute inflammation or ductal dilatationPANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. 9.7 cm in lengthKIDNEYS: No significant abnormality noted. Specifically, no evidence for worrisome mass, stone, or hydronephrosis. Right kidney 11.1 cm in length; left kidney 12.7 cm in length.ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No ascites; left pleural effusion", "output": "Coarse echogenic liver parenchyma again noted consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Stable gallbladder sludge and stones without acute inflammation. No ascites. Unremarkable kidneys without evidence for mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury. Transplant kidney. History of obstruction. RENAL TRANSPLANT LOCATION: Left iliac fossa.PERITRANSPLANT TISSUES: There is a complex 12 cm collection with internal septation adjacent to the transplant kidney upper pole extending cephalad.KIDNEY: 10.6 cm in length. Increased renal parenchymal echogenicity. COLLECTING SYSTEM/URETER: Mild hydronephrosis.URINARY BLADDER: Not well visualized.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels of the transplant kidney. The velocities and resistive indices of the transplant renal artery are within normal limits. There is focal abnormal flow at the upper pole of the kidney, suggestive of a small AV fistula, of questionable clinical significance. The left iliac artery and vein are patent.OTHER: Prominent loop of colon noted adjacent to the kidney.", "output": "1. Mild hydronephrosis which appears unrelated to the fluid collection.. 2. Patent transplant renal artery with normal flow dynamics.3. 12 cm complex collection adjacent to the transplant kidney. This is incompletely evaluated by ultrasound and CT may be considered as clinically warranted.4. Focal abnormal flow at the upper pole of the kidney, suggestive of a small AV fistula, of questionable clinical significance."}
{"instruction": "Generate impression based on findings.", "input": "38 year-old female right upper quadrant pain. LIVER: Increased echogenicity of the liver measuring 21.6 cm in length. No focal hepatic lesion. Main portal vein is patent with appropriate directional flow, peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Gallbladder unremarkable. No gallbladder wall thickening. No pericholecystic fluid. Sonographic Murphy's sign negative. Common duct measures 3 mm in caliber. No intra or extrahepatic biliary ductal dilatation.PANCREAS: Distal pancreatic tail is obscured by overlying bowel gas. The visualized pancreas is unremarkable.RIGHT KIDNEY: Normal echogenicity measuring 12.1 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the spleen measuring 10.6 cm in length. Normal echogenicity of the left kidney measuring 11.4 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "Hepatomegaly with increased parenchymal echogenicity suggestive of hepatic steatosis/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "94-year-old female with tachycardia. Evaluate for goiter. RIGHT LOBE MEASUREMENTS: 5.1-cm x 1.8-cm x 1.9-cmLEFT LOBE MEASUREMENTS: 5.7-cm x 2.3 cm x 1.8 cm.ISTHMUS MEASUREMENTS: Occupied by a complex cystic nodule. See below. RIGHT LOBE: Multiple spongiform and complex cystic nodules are present most containing echogenic foci with comet tail artifact consistent with colloid nodules. The largest of these nodules is located in the lower pole measuring 5 mm x 4 mm x 3 mm with no internal vascularity or definite microcalcifications. LEFT LOBE: As in the right thyroid lobe there are multiple spongiform and complex cystic nodules are present most containing echogenic foci with comet tail artifact consistent with colloid nodules. The largest of these nodules is located in the lower pole measuring 1.7 cm x 1.4 cm x 1.5 cm with no internal vascularity or definite microcalcifications. ISTHMUS: Complex predominantly cystic nodule in the isthmus measuring 2.5 cm x 1.4 cm x 3.1 cm with no internal vascularity or definite microcalcifications. PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multinodular goiter with features consistent with colloid nodules. "}
{"instruction": "Generate impression based on findings.", "input": "48 years old, Male, Reason: S/p DDRT. now with progressive oliguria History: oliguria TECHNIQUE: Grey scale sonography of the renal transplant; Color/spectral doppler of the renal transplant inflow and outflow vasculature.", "output": "Elevated velocity at the anastomosis measuring up to 2.9 meters per second. This would meet the Doppler criteria for narrowing however, intrarenal resistive indices are normal. This may represent postsurgical edema and a full sonography is suggested.Findings discussed with Dr. Bryan at the time of dictation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Chronic kidney disease. RIGHT KIDNEY: The right kidney measures 10.2 cm in length without hydronephrosis, shadowing nephrolithiasis or suspicious lesion.LEFT KIDNEY: The left kidney measures 11.7 cm in length without hydronephrosis, shadowing nephrolithiasis or suspicious lesion.OTHER: The urinary bladder is contracted limiting evaluation.", "output": "No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 14 y/o M with mixed phenotype ALL; concerns for cholecystitis; liver toxicity; VOD; please comment on presence of ascites History: RUQ and RLQ abdominal tenderness and guarding LIMITED ABDOMENLIVER: The liver is mildly echogenic with a slightly coarsened echotexture, measuring 16.2 cm in length. No focal liver masses are identified. There is no significant intrahepatic biliary ductal dilatation. BILIARY TRACT: The gallbladder is nondistended and filled with debris, as seen previously. Mild echogenicity in the gallbladder fossa may reflect focal fat deposition. The gallbladder wall is upper limits of normal in thickness, measuring 3 mm. No definite pericholecystic fluid is identified. The common bile duct is 4 mm in diameter, within normal limits.PANCREAS: The pancreatic head is visualized and appears normal. The distal pancreas is obscured.SPLEEN: No significant abnormalities noted. KIDNEYS: The right kidney is normal in size and echogenicity without hydronephrosis or nephrolithiasis. The left kidney is also normal in appearance, without hydronephrosis or nephrolithiasis. OTHER: No free fluid.", "output": "1.Echogenic and coarsened texture of the liver, compatible with an infiltrative process, as can be seen in hepatic steatosis among other etiologies.2.Mild gallbladder distention and gallbladder debris/sludge without definite evidence of acute cholecystitis. No biliary ductal dilatation.3.No free fluid."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female post thyroidectomy for thyroid cancer. Follow-up nodules. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: In the right thyroid bed there is again noted a predominantly hypoechoic nodule with a more echogenic periphery again suggestive of lymph node. This essentially unchanged in the prior study. Remeasuring this nodule due to bilobed appearance and measures 0.3 x 0.5 x 1 cm, not significantly changed from a retrospective measurement of 0.3 x 0.5 x 1 cm.LEFT LOBE: In the left thyroid bed there is again noted a hypoechoic nodule with an echogenic center consistent with lymph node measuring 0.3 x 0.4 x 0.5 cm without significant change. There is a second similar-appearing area measuring 0.5 x 0.6 x 0.5 cm which again appear stable.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 is noted above with presumed lymph nodes in the bilateral thyroid beds."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female with sepsis in abdominal gallbladder wall and CT. LIVER: Attenuation of liver is somewhat limited by patient's ability to cooperate. No gross, focal abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder wall is thickened and somewhat hypoechoic. However no gallstones are identified. No focal pericholecystic fluid. Gallbladder wall thickening may be nonspecific in the face of ascites is identified in prior CT, and hypoalbuminemia may contribute to this appearance. The biliary tract is normal in caliber.PANCREAS: Not adequately visualized.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Borderline splenomegaly", "output": "Gallbladder wall thickening without obvious gallstones."}
{"instruction": "Generate impression based on findings.", "input": "63 year old with history of right mastectomy for breast cancer. Patient has declined routine mammogram and left breast ultrasound is requested. On physical exam, there is no palpable abnormality of the left breast.A whole left breast ultrasound was performed. In the left breast 7:00 position 3 cm from nipple, there is a small cluster of cysts measuring approximately 3 x 3 x 4 mm. There is no suspicious solid mass identified.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with renal transplant and acute kidney insufficiency. RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: 10.3 cm in length. Very mild dilatation of the renal collecting system when compared to the prior exam. Parenchyma appears unremarkable.COLLECTING SYSTEM/URETER: Very mild dilatation of the renal collecting system when compared to the prior exam.URINARY BLADDER: DecompressedOTHER: No significant abnormality noted", "output": "Mild dilatation of the renal collecting system when compared to prior exam."}
{"instruction": "Generate impression based on findings.", "input": "HIV with abdominal pain LIVER: No significant abnormalities noted. Liver length 18 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.7 cm in length.OTHER: Left kidney 11.7 cm in length. Spleen 11 cm in length. No ascites.", "output": "Negative for acute, inflammatory, or neoplastic process. No hepatobiliary abnormality noted."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for obstruction History: increased urine output, worsening creatinine. RIGHT KIDNEY: 11.2 cm in length, however with ill-defined borders similar to prior study. Several anechoic simple cysts measuring up to 2.3 cm. Markedly echogenic parenchyma, consistent with medical renal disease. No hydronephrosis hydroureter.LEFT KIDNEY: 11.6 cm in length, however with ill-defined borders similar to prior study. Several anechoic simple cysts measuring up to 1.5 cm. Markedly echogenic parenchyma, consistent with medical renal disease. No hydronephrosis hydroureter.OTHER: Anechoic fluid-filled bladder.", "output": "Small echogenic kidneys consistent with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old male with acute kidney injury. Evaluate for obstruction. RIGHT KIDNEY: The right kidney measures approximately 10.7 cm in length. Echotexture echotexture is perhaps minimally increased. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Left kidney measures approximately 10.1 cm in length. Echotexture is perhaps minimally increased. No hydronephrosis, shadowing calculus or mass.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Mildly echogenic kidneys without significant change when compared to prior ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "Male 51 years old Reason: Significant protrusion over left lower back - please eval soft tissue. Grayscale and color Doppler ultrasound in the region of the lung show no clear mass. No cystic areas. No areas of hypervascularity.", "output": "No findings to explain mass. Possibility of lipoma could be evaluated with CT if clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury. Prostate cancer. RIGHT KIDNEY: 11.5 cm in length. Decreased renal cortical thickness compared to that seen in 2012. Subcentimeter cysts noted. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 11.9 cm in length. Decreased renal cortical thickness compared to that seen in 2012. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old female presents for evaluation of the parathyroid gland. RIGHT LOBE MEASUREMENTS: 5.7 x 1.5 x 1.5 cm.LEFT LOBE MEASUREMENTS: 5.6 x 7.7 x 1.2 cm.ISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: Homogenous parenchyma without abnormality.LEFT LOBE: Homogenous parenchyma. There are 2 similar-appearing nodules, the larger of which is approximately 0.7 x 0.5 x 0.5 cm, round, well-defined with posterior acoustic enhancement.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: There is an approximately 1.0 x 0.4 x 0.3 cm parathyroid adenoma candidate that is posterior and lateral to the right thyroid bed. LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Possible right inferior parathyroid adenoma as described above.2. Multinodular thyroid as described above. Favor benign nodules."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Li is a 22-year-old female presenting with bilateral palpable masses for the past 2 months. Per patient, the right breast lesion has demonstrated increased growth over the past 2 months. Upon physical exam of the right superior breast, there is a superficially located large mobile mass appreciated. Upon physical exam of the left upper outer breast, there is an additional large mobile mass appreciated.A targeted right breast ultrasound was performed for the palpable area of concern. In the right breast 12:00 location, approximately 3 cm from the nipple, there is a lobulated predominantly hypoechoic mass identified measuring 3.5 x 2.1 x 3.3 cm. There is moderate associated vascularity.A targeted left breast ultrasound was performed for the palpable area of concern. In the left breast 1:00 location, approximately 3 cm from the nipple, there is a lobulated hypoechoic mass identified measuring 1.3 x 0.9 x 1.2 cm. There is mild associated vascularity.", "output": "Bilateral palpable masses, one which has demonstrated interval growth over the past 2 months. Given bilaterality and palpability of lesions, a consultation with a breast surgeon is recommended for further evaluation.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old female with history of bilateral mastectomy with flap reconstruction for right breast cancer. Patient presents with pain in the right axilla and fullness. A right breast ultrasound was performed of the right axilla. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy. The patient will be seen in surgery clinic today to ensure these negative results are concordant with physical exam. BIRADS: 1 - Negative.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old male with sickle cell anemia, jaundice, hyperbilirubinemia. LIVER: Measures 19.0 in length, mildly enlarged. Unremarkable hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Cholelithiasis and gallbladder sludge without gallbladder wall thickening or sonographic Murphy sign. 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: 1.6 cm complex right mid-polar cyst with internal echogenic material is unchanged since the prior study. 2.4 x 1.4 x 1.0 cm left renal cyst also unchanged. No hydronephrosis. OTHER: No significant abnormalities noted.", "output": "1.Cholelithiasis and gallbladder sludge without evidence of acute cholecystitis or biliary ductal dilation.2.Bilateral renal cysts as described above without significant interval change since the prior study."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Coarsened hepatic echotexture without focal mass. The portal vein is patent.GALLBLADDER, BILIARY TRACT: The gallbladder is sonographically normal in appearance. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Measures 13.1 cm. Superior pole cyst measures 5 cm. No hydronephrosis.OTHER: The left kidney measures 13.47 m in length. No hydronephrosis or mass. Spleen measures 10.4 cm in length.", "output": "Coarsened hepatic echotexture without focal mass."}
{"instruction": "Generate impression based on findings.", "input": "history of obesity presents for evaluation of hepatic steatosis. LIVER:Measures 11.6 cm. Mildly increased and coarse echogenicity. No intrahepatic biliary dilation, ascites, or focal mass. The portal vein is patent.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. The wall measures 0.2 cm. No stones, sludge, or pericholecystic fluid. The common bile duct measures 0.3 cm.PANCREAS: Evaluation the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 11.6 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 11.4 cm. Left kidney measures 11.1 cm. Normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "Mildly increased and coarse echogenicity of liver may reflect mild fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "Male, 74 years old. Creatinine elevation RIGHT KIDNEY: The right kidney measures 8.9 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.5 cm in length, with mildly increased cortical echogenicity. A mid to upper pole exophytic simple cyst measures 1.8 x 1.8 x 1.8 cm area of shadowing stones or hydronephrosis.OTHER: Prevoid bladder volume is approximately 207 mL. Post void bladder volume is approximately 95 mL.", "output": "1.Increased renal cortical echogenicity, compatible with medical renal disease. No hydronephrosis.2.Post void residual: 95 mL."}
{"instruction": "Generate impression based on findings.", "input": "Female 23 years old with an enlarged thyroid gland RIGHT LOBE MEASUREMENTS: 7.7 x 4.9 x 4 cmLEFT LOBE MEASUREMENTS: 6.1 x 1.7 x 2 cmISTHMUS MEASUREMENT: 1 cmRIGHT LOBE: Dominant lower pole cystic nodule with mural nodularity measuring 4.7 x 4.7 x 3.3 cm.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Dominant right lower pole cystic nodule with mural nodularity. This nodule would be amenable to ultrasound-guided percutaneous biopsy. No regional adenopathy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male with CHF, atrial fibrillation/Cardiac thrombus and newly diagnosed ALL complaining of abdominal tenderness with LFT abnormalities. Evaluate for biliary obstruction and portal vein abnormalities. Limited exam as patient could be hold breath or lie in decubitus position. LIVER: Normal echogenicity of the liver measuring 12.8 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: Gallbladder is normal in echogenicity. No gallbladder wall thickening. No pericholecystic fluid. Common duct measures 2 mm in caliber. No intra-or extra hepatic ductal dilatation.PANCREAS: Not well-visualized due to overlying bowel gas.RIGHT KIDNEY: Increased in echogenicity measuring 11.1 cm in length. No hydronephrosis or shadowing calculi are noted. OTHER: Increased echogenicity of the left kidney measuring 11.7 cm in length. No hydronephrosis or shadowing calculi are noted. Normal echogenicity of the spleen measuring 10.3 cm in length.", "output": "1. Increased echogenicity of the kidneys suggestive of parenchymal dysfunction. No obstruction. 2. No evidence of biliary obstruction. Portal vein is patent. "}
{"instruction": "Generate impression based on findings.", "input": "Renal transplant. Concern for perfusional abnormality. RIGHT TRANSPLANT KIDNEY: Normal parenchymal echogenicity. Normal vascular flow identified. No hydronephrosis present.", "output": "Normal vascular flow of the transplant kidney."}
{"instruction": "Generate impression based on findings.", "input": "Female, 84 years old. Acute renal failure RIGHT KIDNEY: The right kidney measures 9.2 cm in length, with increased cortical echogenicity. A small upper pole cyst measures 0.4 x 0.3 x 0.4 cm. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.8 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The bladder is distended, without significant wall thickening.", "output": "Increased renal cortical echogenicity, compatible with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "55 years old, Female, Reason: Rule out hydronephrosis RIGHT Native KIDNEY: Kidney measures 10.0 cm in length. The cortex is thinned with moderate to severe hydronephrosis which is likely chronic in etiology. There is a nonobstructing rounded calculus within a calix of the superior pole.LEFT KIDNEY: The left native kidney is not well seen on this examination.Transplanted kidney: The transplanted kidney in the right iliac fossa measures 11.7 cm. There is a simple appearing cyst measuring 1.4 x 1.1 by 1.8 cm. Mild dilatation of the collecting system, appearing similar to the recent abdominal CT. No perinephric fluid collections. No evidence of shadowing calculus, or mass within the transplanted kidney. Pigtail catheter is visualized within the pelvis of the transplanted kidney.Bladder: The bladder is nondistended.", "output": "1.Mild dilatation in the transplanted kidney, unchanged from recent abdominal CT.2.Moderate to severe chronic hydronephrosis in the native right kidney.3.Nonobstructing right renal calculus."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old female with recurrent right upper quadrant pain. Term pregnancy. LIVER: Liver is homogeneous in echotexture. No focal hepatic abnormality.BILIARY TRACT: Multiple, dependent gallstones and sludge are present within the gallbladder without wall thickening or pericholecystic fluid. Gallbladder is not distended. The biliary tract is normal in caliber.PANCREAS: Not visualized due to bowel gas.SPLEEN: Scattered, calcified granulomata.RIGHT KIDNEY: No significant abnormalities noted. No hydronephrosis.OTHER: Left kidney appears unremarkable.", "output": "Gallstones."}
{"instruction": "Generate impression based on findings.", "input": "6-year-old male with abnormal liver function. LIVER: Liver is highly echogenic and coarsened in echotexture. Although this could represent severe fatty infiltration, other hepatic parenchymal disease cannot be excluded.GALLBLADDER, BILIARY TRACT: Gallbladder not visualized. No biliary tract dilatation.PANCREAS: Head and body normal. Tail was not well seen.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Significantly increased hepatic echogenicity. This could be due to fatty infiltration, but other hepatic parenchymal disease cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": "Male 77 years old Reason: aki on ckd History: aki RIGHT KIDNEY: Right kidney measures 13.1 cm in length. Normal cortical echogenicity and cortical medullary differentiation. No hydronephrosis. No shadowing calculi.LEFT KIDNEY: Left kidney measures 11.0 cm in length. Normal cortical echogenicity and cortical medullary differentiation. No hydronephrosis or shadowing calculi are present.BLADDER: No calculi are present within the bladder. Prostate protrudes into the inferior portion of the bladder.Other: No ascites is present. Increased echogenicity of the liver is suggestive of fatty infiltration.", "output": "1.Normal cortical medullary differentiation of the kidney's bilaterally without hydronephrosis or shadowing calculi. Prostate is likely enlarged as it protrudes into the inferior portion of the bladder.2.Increased echogenicity of the liver suggestive of hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old male with hepatitis be without delta agent. LIVER: Liver is normal in size and echotexture. No focal mass is identified. No anatomic evidence for cirrhosis. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "No interval change. No sonographic evidence for cirrhosis. No hepatic mass."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old with proven left fibroadenoma presents for follow-up ultrasound study. Focused ultrasound is performed for the left breast 2:00 position. Again seen is a hypoechoic mass measuring 10 x 7 x 10 mm (previous measurement: 11x 8 x 8 mm) with internal marker clip. There is no significant interval change in appearance and size.", "output": "Biopsy proven fibroadenoma without significant interval change in the left breast. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Hematuria RIGHT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. Right kidney 12.2 cm in lengthLEFT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. Left kidney 13.7 cm in lengthOTHER: Bladder nondistended", "output": "Negative renal ultrasound. Normal parenchymal echogenicity without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female with nontoxic thyroid nodule. RIGHT LOBE MEASUREMENTS: 1.6 x 2.0 x 5.7 cmLEFT LOBE MEASUREMENTS: 1.4 x 2 x 4.9 cm.ISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Heterogeneous in echotexture and hypervascular. There is again noted a mildly hyperechoic solid nodule in the anterior upper pole which measures 0.4 x 1 x 1.8 cm, decreased in size when compared to the prior exam. There is a suggestion of an incompletely marginated, isoechoic nodule at the posterior aspect of the lower pole which by appearance is unchanged from prior study.LEFT LOBE: Heterogeneous in echotexture and hypervascular without mass.ISTHMUS: Heterogeneous in echotexturePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Iinterval decrease in size of right thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "17-year-old female presents with a palpable mass in the right breast for 2 years, unchanged in size. No family history of breast cancer. A targeted right ultrasound was performed for the palpable area of concern in the right breast 7 to 8:00 position. On physical examination, no discrete palpable mass noted. Normal glandular tissue noted. On ultrasound, normally under tissue noted. There is no solid or cystic mass identified.", "output": "Palpable abnormality in the right breast corresponds to normal glandular tissue. Clinical correlation is recommended. Findings conveyed to the patient and her mother in detail.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Reason: new AKI RIGHT KIDNEY: The right kidney measures 10.7 cm in length. No hydronephrosis.LEFT KIDNEY: The left kidney measures 10.0 cm in length. No hydronephrosis.OTHER: 1.8 cm echogenic stone in the gallbladder fundus. The urinary bladder is decompressed by a Foley catheter.", "output": "Normal ultrasound examination of the kidneys. No hydronephrosis.Cholelithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Male, 49 years old. Acute on chronic CKD, persistent hyperkalemia. RIGHT KIDNEY: The right kidney measures 10.4 cm in length, with normal cortical echotexture. Multiple small nonobstructing renal calcifications are noted, the largest in the upper pole measuring up to 7 x 4 x 6 mm. No focal cortical lesion or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.4 cm in length, with is normal cortical echotexture. Multiple small nonobstructing renal calcifications are noted, the largest in the lower pole measuring up to 7 x 5 x 4 mm. No hydronephrosis. A lower pole simple cyst measures 1.4 x 1.2 x 1.1 cm.OTHER: The bladder is distended.", "output": "Bilateral nonobstructing renal calcifications. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old with Graves' disease. Evaluate thyroid with Doppler. RIGHT LOBE MEASUREMENTS: 7.4 x 2.8 x 2.9 cm, previously 7.3 x 4.1 x 2.0 cm.LEFT LOBE MEASUREMENTS: 6.7 x 2.3 x 2.8 cm, previously 6.3 x 2.9 x 2.0 cm.ISTHMUS MEASUREMENTS: 7 mm in thickness.RIGHT LOBE: The right thyroid gland is heterogeneous in echogenicity and contains multiple nodules, many which have imaging features of colloid nodules. The largest nodule is in the mid pole measuring 2.0 x 1.7 x 1.7 cm, previously 1.9 x 1.9 x 1.7 cm. Vascularity is slightly increased on color Doppler imaging though this may be related to the nodules.LEFT LOBE: The left thyroid lobe is heterogeneous in echogenicity and contains multiple nodules, many of which have imaging features of colloid nodules. The largest is in the lower pole measuring 3.4 x 3.4 x 2.2 cm, previously 3.0 x 2.5 x 2.1 m. Echogenic foci within this nodule may represent calcification. Vascularity is slightly increased on color Doppler imaging though this may be related to the nodules.ISTHMUS: The isthmus is heterogeneous in echogenicity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign appearing lymph nodes noted in the left neck.OTHER: No significant abnormality noted.", "output": "Heterogeneous thyroid with multiple nodules. The dominant left thyroid nodule is slightly larger in size."}
{"instruction": "Generate impression based on findings.", "input": "58-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."}
{"instruction": "Generate impression based on findings.", "input": "Female 49 years old; History: 49F with DM2 and tobacco abuse p/w acute on chronic RUQ and LUQ cramping pain worse with certain positions not related to food intake, ?gallstones, ?cholecystitis. Evaluate for hepatobiliary pathology. LIVER: The liver measures 13.3 cm in length. There is increased and coarse echogenicity of the liver parenchyma. There is a well-circumscribed echogenic focus measuring approximately 1.3 x 1.2 x 1.1 cm in segment 8 of the liver. No intrahepatic ductal dilation is seen. The main portal vein is patent. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 3.2 mm. There are multifocal, discrete, nondependent hyperechoic polyploid masses within the gallbladder fossa. No pericholecystic fluid. The common bile duct measures 7.8 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.3 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.2 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 12.0 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.", "output": "1. Coarse hepatic echotexture consistent with chronic liver disease/parenchymal dysfunction.2. Hyperechoic right lobe hepatic mass. While this may represent hemangioma, in the context of chronic liver disease is best considered indeterminate and dedicated cross-sectional imaging is recommended.3. Hyperechoic multifocal polypoid masses within the gallbladder fossa as described above also concerning for neoplasm. Further dedicated cross sectional imaging is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Palpable left nodule RIGHT LOBE MEASUREMENTS: 4.5 x 1.8 x 1.4 cm. Normal in size with normal background echotexture and vascularity.LEFT LOBE MEASUREMENTS: 4.6 x 1.7 x 1.2 cm. Normal in size with normal background echotexture and vascularity.ISTHMUS MEASUREMENTS: 2 mm in AP dimension, within normal limits.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "Normal sonographic appearance of the thyroid gland, without nodule."}
{"instruction": "Generate impression based on findings.", "input": "Male, 52 years old. Bladder cancer with recent ureteral stent placement for hydronephrosis. Recurrent AKI Suboptimal exam secondary to overlying bowel gas and portable technique.RIGHT KIDNEY: Right kidney measures 11.9 cm. Increased renal cortical echogenicity. No hydronephrosis. No perinephric free fluid. Unable to delineate stent in kidney.LEFT KIDNEY: Left kidney measures approximately 12.3 cm. Increased renal cortical echogenicity. No hydronephrosis. No perinephric free fluid. Unable to delineate stent in kidney.OTHER: Portions of ureteral stents seen in collapsed bladder, evaluation for bladder wall thickening suboptimal.", "output": "No hydronephrosis. Increased renal cortical echogenicity. Portions of ureteral stents seen in collapsed bladder.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 35 year old female with enlarged thyroid gland on exam. History of Hodgkin lymphoma s/p allogeneic stem cell transplant 2 years ago. History: Enlarged thyroid gland. Feeling of \"fullness\" in the anterior neck. RIGHT LOBE MEASUREMENTS: 5.9 x 2.4 x 2.0 cm.LEFT LOBE MEASUREMENTS: 5.8 x 1.8 x 2.3 cm.ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: No significant abnormality noted. No nodules or masses.LEFT LOBE: No significant abnormality noted. No nodules or masses.ISTHMUS: No significant abnormality noted. No nodules or masses.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Multiple mildly enlarged cervical lymph nodes without well-appreciated fatty hila. Right level 2 cervical lymph node measures 1.7 x 0.6 x 1.2 cm.Right level 3 cervical lymph node measures 1.9 x 0.6 x 1.3 cm.Left level 2 lymph node measures 1.9 x 0.6 x 1.3 cm.Left level 3 cervical lymph node measures 1.3 x 0.5 x 1.3 cm.OTHER: No significant abnormality noted.", "output": "Thyromegaly and mild cervical adenopathy as described above. No discrete thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "Concern for bladder stones. RIGHT KIDNEY: The right kidney measures 11.6 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. LEFT KIDNEY: The left kidney measures 10.6 cm in length without hydronephrosis, or shadowing nephrolithiasis. Note is made of a 1.2 cm anechoic probable simple cyst in the superior pole.URINARY BLADDER: The urinary bladder is normally distended with layering echogenic debris and trabecular thickening. No definite shadowing stone. OTHER: Fatty liver. Prostatomegaly is noted.", "output": "No discrete bladder stone is evident. Bladder wall thickening and debris is noted."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old male with thyroid cancer status post surgery. Evaluate for abnormal masses RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: Hyperechoic focus in the right thyroidectomy bed measures 1.0 cm x 0.6 cm x 0.3 cm.; stable.LEFT LOBE: No discrete nodules or masses in the left thyroidectomy bed. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable benign hyperechoic focus in the right thyroidectomy bed. "}
{"instruction": "Generate impression based on findings.", "input": "Recurrent papillary thyroid carcinoma with enlarged submandibular lymph nodes RIGHT LOBE: Status post thyroidectomy without worrisome massLEFT LOBE: Status post thyroidectomy without worrisome massISTHMUS: Status post thyroidectomy without worrisome massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No worrisome cervical lymph nodes appreciated. Specifically, no significant change in enlarged but morphologically benign-appearing left and right submandibular lymph nodes. OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy without worrisome mass or regional adenopathy. Specifically, no significant change in enlarged but morphologically benign-appearing left and right submandibular lymph nodes consistent with benign reactive lymph nodes. Accordingly, no biopsy was performed. Would recommend continued routine surveillance monitoring."}
{"instruction": "Generate impression based on findings.", "input": "Ms Yarbrough is a 17-year-old female with a complicated medical history of Lemierre's disease in 03/2016 and pericardial effusion. She now presents with a three week history of persistent bilateral breast pain (left greater than right). No discrete history of trauma, masses, overlying skin changes or nipple discharge. Bilateral whole breast ultrasound evaluation was performed for the patient's areas of concern. There is no suspicious solid or cystic mass identified in either breast.", "output": "Normal sonographic evaluation of both breasts. No sonographic evidence of 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 and her mother at time of dictation. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Right cervical nodule. Dysphagia. THYROID: Normal appearance of the thyroid gland.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: In the right neck in the submandibular region, there is a 4 x 4 x 3 mm echogenic focus in the superficial neck with calcification and dense acoustic shadowing posteriorly. The posterior aspects of this nodule are not well visualized due to shadowing. No associated vascularity is identified.", "output": "Subcentimeter densely calcified focus in the right submandibular neck. The appearance of this lesion is nonspecific and may relate to the overlying scar or is an unspecified calcified nodule. If further characterization is needed clinically, consider cross sectional imaging."}
{"instruction": "Generate impression based on findings.", "input": "59 years old, Male, Reason: Hx of stem cell transplant with new complaints of trouble urinating and starting stream History: trouble starting stream, no dysuria. Abdominal discomfort RIGHT KIDNEY: Kidney measures 9.9 cm in length. Diffusely echogenic kidney consistent with medical renal disease. No hydronephrosis or shadowing calculus. Subcentimeter right renal cyst is too small to characterize on this examination.LEFT KIDNEY: Kidney measures 11.6 cm in length. Diffusely echogenic kidneys consistent with medical renal disease. No evidence of hydronephrosis or shadowing calculus. Simple appearing left renal cyst measures 2.4 x 2.3 x 2.6 cm.BLADDER: No significant abnormalities. OTHER: Incidental note is made of gallbladder sludge without evidence of cholecystitis.", "output": "1.Echogenic kidneys consistent with medical renal disease. No evidence of hydronephrosis or shadowing stone.2.Gallbladder sludge without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "History of Hurthle Cell cancer, please evaluate for change in thyroid bed s/p total thyroidectomy and radiation therapy. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Status post thyroidectomy. Subcentimeter hypoechoic focus in the right thyroid bed is unchanged allowing for slight differences in technique.LEFT LOBE: Status post thyroidectomy. No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A few small normal morphology lymph nodes are identified in the neck.OTHER: No significant abnormality noted.", "output": "Stable examination with no interval change in subcentimeter hypoechoic focus in the right thyroid bed."}
{"instruction": "Generate impression based on findings.", "input": "Evaluation of subcutaneous seroma for possible drainage. There is an approximately 37.4 x 11.7 x 1.2 cm long, lenticular loculated fluid collection without increased vascularity along the length of the patient's prior donor site.", "output": "1. Long, lenticular, loculated fluid collection within the subcutaneous tissues along the length of the patient's scar as described above."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Bourbulas is a 80 year old female with a personal history of right breast lumpectomy in 2010 for DCIS followed by radiation therapy. She currently presents with a palpable left breast mass for the past one year. Upon physical exam at the patient's area of concern, there is a hard nonmobile mass appreciated. This site has been marked by the clinician. In the left breast 2:00 location, approximately 7 cm from the nipple, there is an irregular hypoechoic mass measuring 1.5 x 0.6 x 1.2 cm. There is minimal associated vascularity.", "output": "1.5 cm hypoechoic mass with suspicious features, corresponding to the palpable area of abnormality. Given its palpability, a surgical consultation is recommended at this. All results and recommendations were relayed to the patient and Joly Raju. The patient is not on any blood thinning medications.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old male with hepatomegaly. There is clinical concern for cirrhosis versus fatty liver. LIVER: Measures 21.1 cm. There is increased and coarse echogenicity of the parenchyma. No masses or ascites. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is an large but does not appear distended. It measures 12.0 cm in length. No stones or sludge. Wall thickness is 2.0 mm. There is no pericholecystic fluid. The common bile duct measures 3.4 mm proximally and 7.7 mm distally.PANCREAS: Partially obscured by bowel gas but visualized parts are normal in appearance.SPLEEN: Measures 10.0 cm. No abnormalities noted.KIDNEYS: The right kidney measures 10.8 cm. The cortex has normal echogenicity. There is a nonobstructing stone measuring approximately 0.6 x 0.6 x 0.4 cm. No hydronephrosis. The left kidney measures approximately 10.2 cm. The cortex has normal echogenicity. No shadowing calculi or hydronephrosis. OTHER: No significant abnormality noted.", "output": "1. Increased and coarse echogenicity of the liver parenchyma consistent with chronic liver disease/parenchymal dysfunction. No masses or ascites.2. Hepatomegaly.3. Nonobstructive right nephrolithiasis without evidence of hydronephrosis as above."}
{"instruction": "Generate impression based on findings.", "input": "History of hepatitis C. Evaluate for hepatocellular carcinoma. LIVER: The liver is mildly coarse and echogenic in echotexture. No focal suspicious lesion. No intrahepatic biliary ductal dilatation. The liver is normal in size measuring 15.9 cm in craniocaudal dimension. Normal hepatopedal portal venous blood flow at 0.3 m/s.BILIARY TRACT: Cholecystectomy. Stable mild extrahepatic biliary ductal dilatation measuring 10 mm.PANCREAS: The visualized portions of the pancreas are unremarkable.SPLEEN: The spleen is enlarged measuring 14.5 cm.RIGHT KIDNEY: The right kidney has been surgically removed. No discrete lesion in the nephrectomy bed. OTHER: The left kidney measures 12.3 cm in length without hydronephrosis. Stable 1.3 cm simple cyst.", "output": "1. Mildly coarsened echogenic hepatic parenchyma compatible with chronic liver disease. No focal hepatic lesion. 2. Mild splenomegaly. 3. Stable mild common bile duct dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for hepatocellular carcinoma. Hepatitis C. LIVER: Non-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: Obscured by bowel gas.KIDNEYS: The right kidney is 11.8 cm in length. The left kidney is 10.3 cm in length, with a 18 mm minimally complex cyst in the midpole. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 12.0 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites.", "output": "Mildly coarsened hepatic echogenicity compatible with parenchymal dysfunction, without suspicious hepatic lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old presents with probable right breast mass for one week. A targeted right ultrasound was performed. On physical exam there is a palpable thickening in the right breast at the 10:00 position 6 cm from nipple which on grayscale and color Doppler sonography corresponds to normal dense fibroglandular tissue. No solid or cystic masses are identified.", "output": "No solid or cystic mass. No sonographic evidence for malignancy. The palpable area should be managed clinically. Results were discussed with the patient at the time of examination.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for obstruction in patient with acute kidney injury. History of Crohn's. RIGHT KIDNEY: The right kidney measures 12.4 cm. The cortex is increased in echogenicity. There is no hydronephrosis, renal calculus or suspicious lesion.LEFT KIDNEY: The left kidney measures 12.9 cm. The cortex is increased in echogenicity. There is no hydronephrosis, renal calculus or suspicious lesion.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Increased echogenicity of the bilateral kidneys, without hydronephrosis or renal calculi, probably medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Female; 67 years old. Reason: hep c screen for hcc History: same LIVER: The liver measures 18.8 cm in length. The liver contour is smooth, the parenchyma is mildly increased in echogenicity. No hepatic mass is identified. The main portal vein is patent and demonstrates hepatopetal flow with peak velocity of 0.39 m/sec.BILIARY TRACT: The gallbladder is contracted. There is no pericholecystic fluid, sonographic Murphy's sign was not elicited. The proximal common bile duct is prominent measuring 9 mm, increased from 7 mm seen on April 2010 ultrasound study. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 7.1 cm in length.RIGHT KIDNEY: Right kidney measures 10.3 cm in length. The cortex is increased in echogenicity. There is no hydronephrosis or shadowing renal stone.LEFT KIDNEY: The left kidney measures 9.5 cm in length. The cortex is increased in echogenicity. A hypoechoic structure in the superior pole measures 1.1 x 1.3 x 1.1 cm and contains internal echoes and is heterogeneous. This was not definitely seen on the prior sonographic studies. There is no hydronephrosis or shadowing renal stone.", "output": "1.Hepatomegaly. Mildly echogenic liver suggestive of parenchymal dysfunction. 2.No hepatic mass.3.Bilateral echogenic kidneys compatible with medical renal disease.4.Prominent proximal common bile duct, correlation with patient's clinical history and laboratory values recommended, if there is clinical concern for choledocholithiasis, MRCP or ERCP is recommended.5.1.3 cm hypoechoic left renal structure is indeterminate. Contrast enhanced CT or MRI is recommended for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female patient with hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 6.1 x 1.8 x 1.6 cm.LEFT LOBE MEASUREMENTS: 5.9 x 1.5 x 1.2 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: The right thyroid lobe is homogeneous in echogenicity without dominant lesion.LEFT LOBE: The left thyroid lobe is homogeneous in echogenicity with a few scattered subcentimeter colloid nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: There is a 0.6 x 0.5 x 1.1 cm well circumscribed, hypoechoic nodule posterior the lower pole of the left thyroid gland.LYMPH NODES: Benign morphology lymph nodes noted.OTHER: No significant abnormality noted.", "output": "Parathyroid adenoma candidate posterior to the lower pole of the left thyroid gland. "}
{"instruction": "Generate impression based on findings.", "input": "Renal stones RIGHT KIDNEY: Contour defect consistent with partial nephrectomy again noted. No worrisome mass. Stable renal cyst. 1 x 0.6 cm echogenic focus with posterior shadowing lower pole suggestive for stone nonobstructing stone.LEFT KIDNEY: New left mild hydronephrosis associated with obstructing left UVJ/proximal ureteral calculus. Other small subcentimeter nonobstructing left renal stones unchanged.Left UVJ/proximal ureter calculus. Other small subcentimeter nonobstructing renal stones unchanged. Stable angiomyolipoma measuring 2.4 x 2.5 cm.OTHER: Bladder nondistended. Enlarged prostate again noted.", "output": "New left mild hydronephrosis associated with obstructing left UVJ/proximal ureter calculus. Other small subcentimeter nonobstructing left renal stones unchanged.Nonobstructing lower pole right renal stone."}
{"instruction": "Generate impression based on findings.", "input": "Elevated transaminase with vomiting and nodular LIVER: Coarse echogenic liver echotexture without mass. Liver length 18 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9.3 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.6 cm in lengthOTHER: Left kidney 10.7 cm in length. No ascites.", "output": "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 presents for whole breast ultrasound for dense breast screening. Personal history of benign left breast biopsy in 2007 for fibroadenoma vs phyllodes tumor. 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. Bilateral simple cysts were identified. This exam was interpreted by two radiologists.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female. Follow-up thyroid ultrasound. Please evaluate for thyroid nodules, size, location, and any abnormal lymph nodes. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.5 cm in length, 1.1 cm in AP, and 1.5 cm in transverse diameter.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 3.8 cm in length, 1.3 cm in AP, and 1.4 cm in transverse diameter.ISTHMUS MEASUREMENTS: The thyroid isthmus measures 0.2 cm in thickness.RIGHT LOBE: In the right lower pole, there is a stable appearing hypoechoic nodule measuring 1.1 x 1.2 x 1.4 cm (prior 1.4 x 1 x 1.3 cm).LEFT LOBE: Normal homogeneous echotexture of the left thyroid lobe. No discrete nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No abnormal appearing lymph nodes.OTHER: No significant abnormality noted.", "output": "Stable hypoechoic right lower pole thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "35 year old female with right upper quadrant pain. LIVER: The liver measures 18.6 cm in length. It demonstrates normal echotexture without focal lesions or biliary ductal dilatation. The main portal vein is patent and demonstrates hepatopedal flow with velocity of 0.3 m/s.GALLBLADDER, BILIARY TRACT: No shadowing gallstones or sonographic evidence of cholecystitis. No sonographic Murphy sign.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right kidney measures 12.1 cm.OTHER: Left kidney measures 11.9 cm. No focal lesions or evidence of hydronephrosis. Spleen measures 10.6 cm and exhibits normal echotexture. No ascites.", "output": "Normal examination without specific findings to account for the patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male presents with abdominal distention and generalized abdominal pain. LIVER:Measures 14.9 cm. Increased and coarse echogenicity of the liver parenchyma. Micronodular contour suggestive of early cirrhosis. No focal mass or intrahepatic biliary dilation. Mild ascites.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. Measures 0.2 cm. No pericholecystic fluid, stones, or sludge. Common duct measures 0.3 cm.PANCREAS: Evaluation is limited due to overlying bowel gas.SPLEEN: Measures 13.4 cm. Calcification in the parenchyma likely represents prior granulomatous disease.KIDNEYS: Right kidney measures 9.6 cm. Left kidney measures 11.0cm. Unremarkable echogenicity. No shadowing calculi, hydronephrosis, or focal mass. Partially imaged right-sided hydroureter. OTHER: Bilateral pleural effusions noted.", "output": "1. Increased and coarse echogenicity and micronodular contour of liver suggestive of chronic liver disease/parenchymal dysfunction and early cirrhosis. Mild ascites.2. Splenomegaly and prior granulomatous disease.3. Partially imaged right-sided hydroureter without hydronephrosis.4. Bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for growth of thyroid nodules or adenopathy RIGHT LOBE MEASUREMENTS: 3.9 x 1.2 x 1.2 cmLEFT LOBE MEASUREMENTS: 3.6 x 1.1 x 1.2 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Heterogeneous thyroid echotexture with mixed hyper and hypoechoic parenchyma typical for thyroiditis, increasing from the prior examination. Inferior nodule measures 0.9 x 0.3 x 0.6 cm. LEFT LOBE: Heterogeneous thyroid echotexture with mixed hyper and hypoechoic parenchyma typical for thyroiditis, increasing from the prior examination.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Heterogeneous thyroid echotexture with mixed hyper and hypoechoic parenchyma typical for thyroiditis. Stable right inferior lobe nodule."}
{"instruction": "Generate impression based on findings.", "input": "Acute and chronic kidney disease RIGHT KIDNEY: Mild echogenic parenchyma. No significant change in mild right hydronephrosis. No worrisome mass or stone. Right kidney 9.4 cm in length.LEFT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 13.6 in meters in length.OTHER: Bladder nondistended", "output": "Mild echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass or stone. No change in mild right hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "50 years old, Female, Reason: r/o adenopathy, recurrence History: h/o thyroid cancer MEASUREMENTS: Patient status post thyroidectomyRIGHT LOBE AREA: Again seen is a very small hypoechoic focus measuring 0.2 x 0.1 x 0.2 cm which is not significant change from prior exam.LEFT LOBE AREA: No evidence of local recurrence.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign appearing right level 3 lymph node measures 0.9 x 0.3 x 0.2 cm. benign appearing left level 3 lymph node measures 1.3 x 0.6 x 0.2 cm.OTHER: No significant abnormality noted.", "output": "1. Stable very small hypoechoic focus in the right thyroid bed.2. No significant lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Hyperthyroidism; neurofibromas RIGHT LOBE MEASUREMENTS: 4.1 x 2.0 x 1.0 cmLEFT LOBE MEASUREMENTS: 4.1 x 1.2 x 1.1 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Heterogeneous gland without noduleLEFT LOBE: Heterogeneous gland without noduleISTHMUS: Heterogeneous gland without nodulePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: 3.1 x 2.6 x 1.6 cm right level 3 mixed echogenicity nodule consistent with known neurofibroma", "output": "Heterogeneous somewhat small thyroid gland without nodule or regional adenopathy. Right level 3 mixed echogenicity nodule consistent with known neurofibroma."}
{"instruction": "Generate impression based on findings.", "input": "43 year-old male with obesity and transaminitis. LIVER: The liver is mildly coarsened and increased in echogenicity. It is normal in size, measuring 15 cm in the craniocaudal attention with no intrahepatic biliary ductal dilatation or focal hepatic lesion evident. The liver capsule is smooth. Normal hepatopetal portal venous blood flow at 24 cm/sec.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common bile duct measuring 6 mm at the level of the pancreatic head. Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid, or focal tenderness.PANCREAS: The poorly visualized pancreatic head is grossly unremarkable. SPLEEN: The spleen measures 11.2 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 evident. OTHER: The left kidney measures 10.6 cm without hydronephrosis, shadowing calculus or discrete lesion evident.", "output": "Coarse echogenic liver parenchyma most commonly seen in diffuse fatty infiltration without a discrete lesion or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Male; 53 years old. Reason: assess mid back, thoracic fluid collection History: Recently drained mid back, thoracic fluid collection There is a subcutaneous 5.5 x 3.2 x 2.4 cm complex fluid collection in the soft tissues of the back. This extends nearly to the skin surface", "output": "5.5 x 2.2 x 2.4 cm subcutaneous abscess extending nearly to the skin surface."}
{"instruction": "Generate impression based on findings.", "input": "Male 23 years old Reason: evaluate for tenderness to scalp, History: pain x over 1 yer Survey ultrasound scanning areas of tenderness on the scalp, in particularly on the right side with comparison to the left side was performed, showing no focal abnormalities.", "output": "Normal exam. No focal lesions found."}
{"instruction": "Generate impression based on findings.", "input": "83 year-old female with chronic kidney disease. RIGHT KIDNEY: No significant abnormalities noted.LEFT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted. The bladder is normal in appearance. Note is made of bilateral ureteral jets.", "output": "Unremarkable ultrasound examination of the kidneys and urinary bladder."}
{"instruction": "Generate impression based on findings.", "input": "70 year-old male with cirrhosis. Evaluate liver for for cirrhosis, evidence of HCC. LIVER: Nodular contour and heterogeneous echotexture of the liver measuring 16.3 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: Status post cholecystectomy. Common duct measures 6 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Not well-visualized due to overlying bowel gas.RIGHT KIDNEY: Measures 10.6 cm in length. No hydronephrosis or shadowing calculi are noted. Cyst at the midpole measures 2.3 cm x 2.5 cm x 3.3 cm unchangedOTHER: Spleen measures 15.5 cm in length and is normal in echogenicity.Left kidney measures 10.4 cm in length. No hydronephrosis or shadowing calculi are noted.Incompletely visualized bilateral pleural effusions.", "output": "1. Cirrhotic liver morphology with no focal hepatic lesions.2. Incompletely visualized bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Hepatomegaly by physical exam. History renal cell carcinoma status post right nephrectomy LIVER: Multiple bilateral confluent hepatic mass lesions worrisome for metastatic disease. Several these masses demonstrate probable necrosis. The largest mass in the right lobe liver measures 11 x 9.8 cm. GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: AbsentOTHER: Left kidney 10 cm in length. Multiple low attenuation foci within the spleen. Spleen length 12.6 cm. No ascites. Extensive porta hepatis and peripancreatic adenopathy.", "output": "Extensive large bilobar confluent hepatic masses worrisome for metastatic disease. Associated with regional adenopathy presumably metastatic. Possible splenic metastases."}
{"instruction": "Generate impression based on findings.", "input": "Female; 38 years old. Reason: cholecystitis? impacted stone? History: RUQ pain, prior stones, ++tender/vomiting LIVER: The liver measures 18.8 cm in length. The liver surface is smooth. The parenchyma is mildly increased in echogenicity appearing similar to the prior study. No worrisome liver mass identified. The main portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.3 m/sec.BILIARY TRACT: Cholelithiasis seen dependently within the gallbladder, measuring up to 6 x 5 mm. There is no gallbladder wall thickening or pericholecystic fluid. There is no intrahepatic biliary ductal dilatation. The common duct measures up to 6 mm in diameter.PANCREAS: The body of the pancreas is unremarkable. The head and tail are obscured by overlying bowel gas.SPLEEN: The spleen measures 9.8 cm in length and contains a 1.6 x 1.4 x 1.6 cm cyst with a fine septation, new from the prior CT.RIGHT KIDNEY: The right kidney measures 11.2 cm in length. The renal cortex is mildly increased in echogenicity. There is no hydronephrosis or shadowing renal stone.LEFT KIDNEY: Left kidney measures 12.1 cm in length. The renal cortex is mildly increased in echogenicity. There is no hydronephrosis or shadowing renal stone.", "output": "1.Hepatomegaly and hepatic steatosis. 2.Cholelithiasis without evidence of acute cholecystitis. No biliary ductal dilatation..3.Echogenic kidneys compatible with medical renal disease.4.Minimally complex splenic cyst is new compared to the prior study, correlation with patient's clinical history recommended. "}
{"instruction": "Generate impression based on findings.", "input": "73 year old male with cirrhosis status post TIPS. Evaluate TIPS patency. LIMITED ABDOMENLIVER: Measures 13.4 cm in length with coarse echotexture and nodular contour consistent with cirrhosis. No focal hepatic lesions.BILIARY TRACT: Shadowing stones within the gallbladder. No gallbladder wall thickening. No pericholecystic 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.SPLEEN: Borderline enlarged spleen measuring 13.3 cm in length.  RIGHT KIDNEY: Normal echogenicity of the right kidney measured 11.5 cm in length. Mid to upper pole cyst measures 2.6 cm x 3.2 cm x 3.9 cm. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the left kidney measuring 13.1 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "1. Cirrhotic liver morphology with no focal hepatic lesions. Patent TIPS as well as hepatic inflow and outflow vasculature.2. Cholelithiasis with no evidence of cholecystitis. 3. Right renal cyst. 4. Borderline enlarged spleen. "}
{"instruction": "Generate impression based on findings.", "input": "31-year-old female one day post renal and pancreatic transplant with anuria and elevated glucose. RENAL TRANSPLANT: Left iliac fossa transplantLOCATION: Left iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality notedCOLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels Peak systolic velocity in the adjacent iliac artery of 152 cm/s. Iliac vein is patent.Peak systolic velocity at the level of the anastomosis of 341 cm/s in the transplant renal artery and resistive index of 0.68.Parenchymal tracings demonstrate an average resistive index of 0.6. No parvus to this waveform.Transplant renal vein is patent.OTHER: No significant abnormality noted", "output": "Elevated anastomotic velocity in the transplant renal artery. Given recent surgery, this is most likely due to anastomotic edema which typically resolves."}
{"instruction": "Generate impression based on findings.", "input": "History of left renal cancer, suprapubic tube placement. Limited images of the bladder for intraoperative guidance for suprapubic tube placement demonstrate echogenic debris throughout the bladder. Additional nonspecific solid appearing material layers dependently within the bladder. Catheter balloon seen in the bladder on postprocedural images.", "output": "Ultrasound images for intraoperative guidance for suprapubic tube placement. Solid, dependent material within the bladder which is nonspecific and could reflect blood products, though neoplasm is not excluded and continued follow-up is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid carcinoma 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 mass or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old patient 2 days postpartum with elevated creatinine RIGHT KIDNEY: 10.3 cm in length. There is minimal hydronephrosis. The renal parenchymal echogenicity is heterogeneously increased. No focal lesions or stones are noted.LEFT KIDNEY: 9.0 cm in length. The renal parenchymal echogenicity is heterogeneously increased. No hydronephrosis, focal lesions, or stones are noted.BLADDER: Distended, without significant abnormality noted.OTHER: No significant abnormalities noted.", "output": "Heterogeneously increased renal parenchymal echogenicity with minimal right-sided hydronephrosis. The differential diagnosis for this appearance includes pyelonephritis or medical renal disease with physiological collecting system prominence."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female patient with HCV, cirrhosis. Evaluate for HCC. LIVER: The liver measures 16.9 cm in length, demonstrates coarsened echogenicity, and is nodular contour. There is a 1.2 x 1.0 x 1.0 cm hypoechoic lesion within the right hepatic lobe dome. 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 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 10.7 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.8 cm in length. No evidence of hydronephrosis. There is a 1.1 cm left midpole renal cyst.The spleen measures 8.5 cm in length.", "output": "1. Cirrhotic morphology of the liver with a right hepatic dome hypodense lesion; dedicated contrast enhanced liver CT/MRI is recommended for further evaluation.2. Cholelithiasis without sonographic evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Male 70 years old; Reason: liver, common bile duct eval, given worsening jaundice, abd pain History: diffuse abd pain, jaundice, scleral icterus, HCV, cirrhosis LIVER: The liver measures 14.1 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 28.8 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder surgically absent. The common bile duct measures 5.4 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 10.2 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.5 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.0 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. The liver has coarse increased echogenicity compatible with fatty infiltration/hepatocellular dysfunction. No worrisome masses or intrahepatic ductal dilation are seen.2. Bilaterally the kidneys have increased echogenicity compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "37 year-old female with abdominal distention. Evaluate for liver dysfunction and for ascites. LIVER: Echogenicity of the hepatic parenchyma is minimally coarse without focal mass. The liver measures 12.7 centimeters in length. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts.The main portal vein is patent with normal hepatopedal flow and velocity of 25.6 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is normal in appearance. There is no pericholecystic fluid, gallbladder wall thickening or cholelithiasis. The common bile duct measures 0.4 cm in diameter. PANCREAS: The head and proximal body of the pancreas are normal. The tail is obscured by bowel gas.SPLEEN: The spleen is normal in echogenicity and measures 8.7 cm in length. RIGHT KIDNEY: The right kidney measures 12.6 cm in length. Again seen is marked multifocal dilatation of the renal calyces and infundibula, without dilatation of the renal pelvis or ureter, unchanged compared to the previous study. The cortex is markedly atrophic with increased echogenicity. The amount of debris within the dilated calyces of the mid and lower moieties has decreased.LEFT KIDNEY: The left kidney measures 8.2 cm in length. There is mild pelvic calyceal dilatation. Echogenicity is increased. A subcentimeter midpole cyst without septation or solid component is again noted.URINARY BLADDER: The urinary bladder is normal in appearance.OTHER: There is no free or loculated fluid. Left adnexal cystic structure is again noted, incompletely visualized by ultrasound.", "output": "Severe hydronephrotic replacement of the right kidney with decreased amount of debris seen on today's examination. Mild pelvicalyceal dilatation and increased echogenicity of the left kidney are unchanged in appearance. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "57 years old, Female, Reason: abdominal pain History: Pt c/o abdominal pain (L-sided). Please look at kidney, liver, pancreas and spleen. Liver: The liver measures 15.2 cm in length. Mildly increased parenchymal echogenicity suggestive of fatty infiltration. Subcentimeter hypoechogenicity measuring up to 1.3 cm may represent focal fatty sparing, although is indeterminate on this ultrasound examination. 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: The spleen cannot be evaluated due to overlying bowel gas.RIGHT KIDNEY: Kidney measures 9.7 cm in length. No hydronephrosis.LEFT KIDNEY: Kidney measures 10 cm in length. No hydronephrosis.ABDOMINAL AORTA: No evidence of aneurysmal dilatation.INFERIOR VENA CAVA: No significant abnormality noted.", "output": "1.Mildly increased parenchymal echogenicity suggestive of fatty infiltration.2.Subcentimeter hepatic hypoechogenicity may represent focal fatty sparing although it is indeterminate on this ultrasound examination. Further evaluation with dedicated contrast enhanced CT or MRI may be pursued if clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis LIVER: Cirrhotic morphology without mass. Liver length 16.6 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.2 cm in length.OTHER: Left kidney 13.1 cm in length. Left upper pole benign-appearing cyst. Spleen 13.2 cm in length. Trace ascites.", "output": "Cirrhotic morphology without mass or ductal dilatation. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "Enlargement. Left testicle removed 2 years prior. RIGHT TESTIS: 3.1 x 4.6 x 2.0 cm. The testicular parenchyma is homogeneous, with normal vascularity. Minimal right hydrocele is present.LEFT TESTIS: Removed, with prosthesis in place.RIGHT EPIDIDYMIS: 9 x 9 x 11 mm. Normal in appearance, with normal vascularity. LEFT EPIDIDYMIS: Removed.OTHER: Unremarkable sonographic appearance of the right groin.", "output": "Minimal right hydrocele. Otherwise no acute abnormality evident. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Berry is a 42-year-old female presenting with clinical signs and symptoms of mastitis with associated enlarged intramammary lymph node and breast mass identified on imaging. Patient has now completed 7 days of antibiotics and returns today for a repeat ultrasound evaluation. Upon physical exam at patient's area of concern, subtle nodularity/tenderness is reidentified in the left upper outer breast. However, according to patient, this area has decreased in size compared to prior exam.A targeted left breast ultrasound was performed for the patient\u2019s area of concern. -In the left breast 2:00 location, approximately 3 cm from the nipple, there is revisualization of a mixed echogenic lesion with internal calcifications now measuring 1.7 x 0.9 x 1.9 cm, previously measuring 2.0 x 1.1 x 1.8 cm.-In the left breast 2:00 location, approximately 5 cm from the nipple, there is revisualization of an intramammary lymph node now measuring 1.3 x 0.5 cm, previously measuring 1.2 x 0.9 cm. There continues to be marked hilar flow associated with this lymph node.", "output": "Interval decrease in left breast mass and left intramammary lymph node. If patient's clinical presentation is compatible with resolving mastitis, then a repeat breast ultrasound can be performed in 4-6 weeks to ensure complete resolution of imaging findings. If symptoms are completely resolved within 4-6 weeks, then no repeat imaging is necessary. All results and recommendations were relayed to the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Change in nodules History: Thyroid nodules RIGHT LOBE MEASUREMENTS: 5.9 x 1.2 x 1.8 cm.LEFT LOBE MEASUREMENTS: 5.8 x 1.1 x 1.6 cm.ISTHMUS MEASUREMENTS: Up to 0.2 cm in thickness.RIGHT LOBE: Diffusely heterogeneous gland. Stable inferior hypoechoic subcentimeter nodule measuring 0.5 x 0.3 x 0.4 cm.LEFT LOBE: Diffusely heterogeneous gland. Stable solid upper pole nodule measuring 0.6 x 0.5 x 0.6 cm which demonstrates coarse calcification. Adjacent hyperechoic nodule measuring 0.8 x 0.7 x 0.8 cm, not well seen on 4/15/2015 examination but appearing similar to more remote outside examination.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable subcentimeter thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "27-year-old female with urinary frequency Pre-void volume of the bladder is 45.4 ml. Post void residual volume is 1.5 ml.", "output": "Normal postvoid residual volume."}
{"instruction": "Generate impression based on findings.", "input": "History of cirrhosis. Evaluate for HCC. LIVER: The liver parenchyma is diffusely coarsened and echogenic without significant nodularity. It measures 13 cm in length. No focal hepatic lesion or ascites. Normal hepatopedal portal venous blood flow at 19 cm/s.BILIARY TRACT: Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid or focal tenderness. No biliary ductal dilatation with the common duct measuring 2 mm.PANCREAS: The visualized portions of the pancreatic head and body are unremarkable.SPLEEN: The spleen measures 8.7 cm without a focal lesion.RIGHT KIDNEY: The right kidney measures 10.5 cm in length without hydronephrosis or shadowing nephrolithiasis. Color Doppler demonstrates hilar flow. Simple appearing cyst measuring up to 2.1 cm, not significantly changed.OTHER: The left kidney measures 10.7 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.", "output": "Diffusely coarsened liver parenchyma consistent with fatty infiltration and/or parenchymal dysfunction without evidence of a focal mass, biliary ductal dilatation or ascites."}
{"instruction": "Generate impression based on findings.", "input": "Renal cysts on MRI RIGHT KIDNEY: Measures 11.5 cm in length. No hydronephrosis or mass.LEFT KIDNEY: Measures 10.8 cm in length. No hydronephrosis. Left kidney midpole cyst measures 1.2 x 1.2 x 1.3 cm. An additional subcentimeter cyst is present.OTHER: The bladder is unremarkable.", "output": "Left 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": "31-year-old female with cystic fibrosis on lung transplant list. Asymmetry seen on screening mammogram. Right breast lumpectomy performed eight years ago. MAMMOGRAM:CC and ML viewsas well as two spot compression views of left were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography(BiRads Density Category D), unchanged in pattern and distribution. The previously seen circumscribed asymmetry in the lower inner left breast appears to persist on the CC view. No new asymmetries or suspicious microcalcifications are present.ULTRASOUND:On physical examination, no concerning lesion is palpated.A targeted left ultrasound was performed for the mammographic area of concern. There is a 5 x 3 x 4 mm multiseptated hypoechoic cystic lesion in the 9:00 position 2 cm from the nipple in the left breast consistent with a septated cyst. There is an additional well-circumscribed 4 x 4 x 6 cm hypoechoic lesion in the 6:00 position in the left breast, 2 cm from the nipple, which is consistent with a simple cyst.", "output": "Ultrasound revealed a septated cyst at the 9:00 position, corresponding to the circumscribed asymmetry seen on the mammogram. No further follow-up is recommended at this time unless clinically indicated.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female with bilateral milky nipple discharge for approximately 1 month. A targeted left ultrasound was performed in the left subareolar region. There is no solid or cystic mass identified.A targeted right ultrasound was performed in the right subareolar region. There is no solid or cystic mass identified.", "output": "No findings to explain patient's bilateral milky nipple discharge. No sonographic evidence of malignancy. Suggest clinical correlation for systemic causes of nipple discharge given that it is bilateral and milky. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Female 68 years old Reason: assess hydronephrosis History: worsening serum creatinine RIGHT KIDNEY: Right kidney measures 7.8 cm. significant echogenic kidney. Subcentimeter cysts are unchanged. No evidence of hydronephrosis.LEFT KIDNEY: Left kidney measures 8.1 cm. Significant echogenic kidney. Simple appearing 2.7 x 2.8 cm cyst is slightly increased in size compared to previous study. No evidence of hydronephrosis.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Bilateral significantly echogenic kidneys. Simple cysts are unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for renal stone. RIGHT KIDNEY: Right kidney measures 7.3 cm. The cortex is echogenic. Few small renal calculi are identified, the largest measuring 4 mm. No hydronephrosis is identified. Right simple cyst measures 1.1 x 1.0 x 1.0 cm. LEFT KIDNEY: Limited visualization of the left kidney. Left kidney measures 6.1 cm. The cortex is echogenic. There are probable tiny echogenic calculi, without hydronephrosis. Left renal cysts, the largest measuring 1.4 x 1.4 x 1.4 cm, with probable thin septation.URINARY BLADDER: No significant abnormalities noted.OTHER: Incidentally noted simple hepatic cyst measuring 1.7 x 1.7 x 2.0 cm. Gallbladder with layering sludge, without evidence of acute inflammation.", "output": "1.Echogenic kidneys, compatible with medical renal disease. 2.Few bilateral renal calculi, probably mostly vascular given findings on CT chest 12/19/2015. No hydronephrosis. 3.Bilateral simple cysts and additional left cyst with probable thin septations, probably benign."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female patient with abdominal distention. Evaluate for cholecystitis. (Upon review of prior imaging, the patient has had a cholecystectomy). LIVER: The liver measures 22.1 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is surgically absent. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 6 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 11.8 cm in length. There is mild hydronephrosis.OTHER: The left kidney measures 12.4 cm in length. No evidence of hydronephrosis.The spleen measures 11.2 cm in length.There is mild ascites.", "output": "1. Status post cholecystectomy as noted on prior CT.2. Hepatomegaly and mild ascites.3. Mild right hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Biopsy proven left breast invasive ductal carcinoma and DCIS. Patient has been treated with an aromatase inhibitor. Please evaluate for interval changes. On physical examination, no palpable masses were present of the left breast. A targeted left breast ultrasound was performed for the area of clinical concern. At the 12 o'clock position of the left breast, 3 cm from the nipple, a Hydromark clip is present. Previously described 19 x 15 mm mass is significantly smaller, currently measuring 9 x 5 mm.", "output": "Interval decrease in the size of left breast biopsy proven cancer. Results were discussed with the patient and her daughter.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old male with past medical history of heart and kidney transplant in 2009, now with hypoechoic mass on native and transplant kidney, please evaluate. RIGHT KIDNEY: Measures 9.9 cm in length with increased parenchymal echogenicity suggestive of medical renal disease. Anechoic lesion with thin septation measures 1.1 cm x 0.9 cm x 1.4 cm. Focal echogenic focus measures 5 mm x 4 mm x 6 mm likely a nonobstructing stone.LEFT KIDNEY: Measures 10.2 cm in length with increased parenchymal echogenicity suggestive of medical renal disease. Anechoic lesion measures 2.5 cm x 2.1 cm x 2.0 cm compatible with a benign cyst. Focal echogenic focus measures 4 mm x 2 mm x 5 mm likely a nonobstructing stone.OTHER: Right iliac fossa transplant kidney measures up to 12.2 cm in length. There is mild hydroureteronephrosis with no nephrolithiasis. Benign-appearing cyst with thin septation measures 2.8 cm x 2.6 cm x 2.5 cm.", "output": "1. Benign-appearing cysts in the native and right iliac fossa transplanted kidneys. 2. Nonobstructing stones suggested in the native kidneys.3. Mild hydroureteronephrosis of the right iliac fossa transplant kidney. No nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Renal failure, evaluate for medical renal disease RIGHT KIDNEY: The right kidney measures 12.3 cm in length. Echogenic parenchyma without significant hydronephrosis or mass.LEFT KIDNEY: The left kidney measures 11.8 cm in length. Echogenic parenchyma without significant hydronephrosis or mass.OTHER: The bladder is incompletely distended.", "output": "Medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Right-sided abdominal pain LIVER: No significant abnormalities noted. Liver length 15.9 cm GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.7 cm in lengthOTHER: Left kidney 9.3 cm in length. Spleen 10.5 cm in length. No ascites", "output": "Negative right upper quadrant ultrasound. No acute hepatobiliary abnormality."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female with breast cancer, elevated liver function tests. LIVER: Measures 13.5 cm in length. Unremarkable contour and echogenicity without discrete focal lesion. Patent portal vein with antegrade flow measuring 0.3 m/s.BILIARY TRACT: No cholelithiasis, gallbladder wall thickening, or biliary ductal dilation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.KIDNEY: Anechoic 1.7 x 1.2 cm right renal lesion in the superior pole with increased through transmission is consistent with a cyst. No hydronephrosis. OTHER: In the right adrenal region is a 2.0 x 2.0 cm round hypoechoic mass which is nonspecific and incompletely characterized.", "output": "1. 2.0 cm hypoechoic right adrenal lesion is nonspecific, and given the history of breast cancer metastasis cannot be excluded. Dedicated adrenal protocol MRI or CT is recommended for further evaluation. 2. No findings to account for the patient's elevated liver function tests."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old male with left upper pole renal mass and prior lumbar spine CT RIGHT KIDNEY: The right kidney measures 10.7 cm in length. There are shadowing calcifications without hydronephrosis which may be due to nonobstructing stones or medullary calcification. No mass identified.LEFT KIDNEY: The left kidney measures 10.8 cm in length. There is an ovoid simple -- appearing cyst arising from the extreme upper pole corresponding to the CT abnormality measuring 1.8 cm in greatest diameter. Presumably this represented a complicated cyst on prior CT. Very small lower pole simple cyst. No hydronephrosis or shadowing calculus.OTHER: No significant abnormalities noted.", "output": "Left renal cyst corresponding to CT abnormality."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old male with HCV, steatosis and cirrhosis. Evaluate for hepatocellular carcinoma. Exam is somewhat limited by significant scarring and incision sites involving the abdomen.LIVER: Liver is highly echogenic and coarsened in echotexture which may be due to fatty infiltration and/or cirrhosis. Mild hepatomegaly. There is no gross, focal hepatic mass identified. Liver capsule is smooth. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The visualized biliary tract is normal in caliber.PANCREAS: Not visualized due to bowel gas.SPLEEN: Normal in size.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No ascites.", "output": "Echogenic liver without change. No hepatic mass identified."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female with history of previous benign right lumpectomy as well as benign right breast biopsy, with result of PASH. Patient reports continued right breast and axillary pain x1 year. A targeted right ultrasound was performed for the patient\u2019s area of concern. There is no solid mass identified. Subcentimeter simple cysts are identified in the left breast at the 10:00 position.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Gallbladder stones and sludge seen on CT. Leukocytosis. LIVER: Limited evaluation. Normal parenchymal echogenicity. Normal direction and flow of the main portal vein.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Multiple subcentimeter gallstones noted. Minimal gallbladder wall thickening to 4-5 mm. Unable to assess for sonographic Murphy's sign due to prior pain medication administration.OTHER: No significant abnormalities noted. No upper abdominal ascites identified.", "output": "Cholelithiasis with minimal gallbladder wall thickening, suggestive of mild or early cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old female with chronic kidney disease, stage V. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney is highly echogenic consistent with parenchymal disease. Size is difficult to measure due to echotexture but on today's study the kidney appears to measure approximately 10.5 cm in length, larger than on the prior study due to poor visualization. There are multiple simple-appearing cysts present, the largest measuring 3.2 cm in greatest diameter. No hydronephrosis, shadowing calculus or solid mass.LEFT KIDNEY: The left kidney is highly echogenic consistent with parenchymal disease. Size is difficult to measure but the kidney approximates 9.3 cm in length. There are multiple simple-appearing cysts present, the largest measuring 2.4 cm in greatest diameter. There is no hydronephrosis, shadowing calculus or solid mass.OTHER: Bladder is decompressed.", "output": "Highly echogenic kidneys as noted previously. There has been interval enlargement of renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female with thyroid antibodies. RIGHT LOBE MEASUREMENTS: 5.0 x 2.2 x 1.6 cmLEFT LOBE MEASUREMENTS: 5.4 x 2.5 x 1.5 cmISTHMUS MEASUREMENTS: 1.3 cmRIGHT LOBE: Heterogeneous thyroid parenchyma. Primarily cystic 0.7 cm nodule in the mid posterior gland and inferior 0.6 cm spongiform nodule, favored benign.LEFT LOBE: Heterogeneous thyroid parenchyma. 0.7 cm spongiform nodule in the mid posterior gland, and primarily cystic 0.7 cm nodule inferiorly, favored benign.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Heterogeneous thyroid parenchyma with subcentimeter bilateral nodules, favored benign."}
{"instruction": "Generate impression based on findings.", "input": "90 year-old male with hematuria. RIGHT KIDNEY: The right kidney measures 8.8 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. There is a benign appearing cyst in the upper pole measuring 6.1 cm x 7.2 cm x 5.3 cm. Small echogenic focus compatible with an angiomyolipoma measuring 4 mm x 4 mm x 4 mm. LEFT KIDNEY: The left kidney measures 8.5 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. There is a benign appearing cyst in the inferior pole measuring 4.4 cm x 3.1 cm x 4.3 cm. URINARY BLADDER: The bladder is distended with trabeculation of the bladder wall and contains echogenic material likely debris or blood. There is significant postvoid residual. OTHER: Prostate is enlarged measuring 6.4 cm x 5.7 cm x 5.0 cm. Incidentally noted right hepatic lobe cyst measuring 4.4 cm x 3.1 cm x 4.3 cm and is benign in appearance.", "output": "1. Significant postvoid bladder residual with trabeculation of the bladder wall; bladder contains debris or blood associated with an enlarged prostate. 2. Benign appearing bilateral renal cysts as well as a possible small angiomyolipoma in the right kidney. 3. Incidentally noted benign appearing hepatic cyst. "}
{"instruction": "Generate impression based on findings.", "input": "Reported palpable abnormality in the anterior abdominal wall during menstruation, evaluate for hernia. At the site of the patient's reported palpable abnormality in the superficial soft tissues of the anterior abdominal wall, no abnormal masses or hernias are identified. Please note that the examination is somewhat limited by patient body habitus.", "output": "No sonographic evidence of mass or hernia in the anterior abdominal wall. Additional cross-sectional imaging can be considered for further evaluation as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Male; 25 years old. Reason: hyperparathyroidism, evaluate for mass in neck History: hyperparathyroidism RIGHT LOBE MEASUREMENTS: 4.3 x 1.8 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.2 x 1.9 x 1.2 cmISTHMUS MEASUREMENTS: 0.4 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: 1.0 x 0.9 x 0.4 cm right level 3 lymph node has a fatty hilum. 2.0 x 1.4 x 0.9 cm the left level 2 lymph node has a fatty hilum.OTHER: No significant abnormality noted.", "output": "1.No discrete thyroid nodule.2.Prominent cervical lymph nodes have a benign appearance and are likely reactive."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female with a history of hypothyroidism presents for evaluation of thyroid nodule. RIGHT LOBE MEASUREMENTS: 5.4 x 2.6 x 2.3 cm.LEFT LOBE MEASUREMENTS: 6.3 x 1.90 0.8 cm.ISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: The parenchyma appears diffusely heterogenous with lattice like background. There is a well defined, approximately 0.5 x 0.5 x 0.5 round hyperechoic focus in the inferior aspect of the right lobe that appears similar to the prior study.LEFT LOBE: The parenchyma appears diffusely heterogenous with a lattice like background.ISTHMUS: Diffusely heterogenous background as above.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Diffusely heterogenous parenchyma with lattice like background consistent with chronic thyroiditis. No worrisome mass or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: left renal mass, evaluate for change in size or characteristics. RIGHT KIDNEY: Kidney measures 10.5 cm in length. Normal parenchymal echotexture. No hydronephrosis, shadowing calculus or mass. Multiple cysts including septated cyst in the lower pole measuring up to 1.7 cm, not significantly changed.LEFT KIDNEY: Kidney measures 10.3 cm in length. Normal parenchymal echotexture. Heterogeneous predominately solid left renal mass with vascularity measuring 2.4 x 2.2 x 2.0 cm, previously 2.3 x 2.5 x 2.3 cm, not significantly changed.OTHER: No significant abnormalities noted. Bilateral ureteral jets are visualized.", "output": "Solid left renal mass which remains highly suspicious for neoplasm, not significantly changed in size."}
{"instruction": "Generate impression based on findings.", "input": "13-year-old male with history of gunshot wound to pelvis now with urinary tract infection and hematuria. Please evaluate for possible bullet erosion into bladder mucosa. The urinary bladder is normal in appearance with no significant mucosal abnormalities or internal debris. The visualized left kidney is normal in appearance.", "output": "Normal sonographic evaluation of the bladder."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old male with concern for abdominal aortic aneurysm ABDOMINAL AORTA: Abdominal artery is patent with appropriate directional flow.Proximal: 2.7 cm in AP dimensionMid: 2.0 cm in AP dimensionDistal: 2.0 cm AP dimensionRIGHT ILIAC ARTERY: Measures 1.3 cm AP dimension.LEFT ILIAC ARTERY: Measures 1.2 cm AP dimension.", "output": "Mild abdominal aortic ectasia. No aneurysmal dilatation of the abdominal aorta or right and left iliac arteries are seen."}
{"instruction": "Generate impression based on findings.", "input": "History of epidermal inclusion cyst status post excision under right breast in 4/2016, pt experiencing recurrent swelling and pain in area intermittently, no skin changes today. Evaluate for hernia or recurrent epidermal inclusion cyst. No abnormal cysts or masses are identified within the superficial soft tissues at the area of patient's concern inferior to the right breast.", "output": "No abnormal masses or fluid collections identified."}
{"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": "93 year old female with history of synthetic dysfunction of the liver. Evaluate for congestive hepatopathy, portal hypertension, and metastatic liver disease. LIVER: No masses or significant abnormalities noted.BILIARY TRACT: The gallbladder is contracted, and appears to be full of stones/sludge, with no wall thickening. No significant pericholecystic fluid. No biliary dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Increased kidney echogenicity, suggestive of medical renal disease. The right kidney measures 9.4 cm, and contains a 2 x 1.4 x 1.3 cm simple cyst.OTHER: The left kidney measures 9.7 cm, and has increased parenchymal echogenicity suggestive of medical renal disease.", "output": "1.No hepatic masses or other significant hepatic abnormality.2.Cholelithiasis as above.3.Increased kidney echogenicity, suggestive of medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal failure RIGHT KIDNEY: Markedly echogenic renal parenchyma without worrisome mass, stone, or hydronephrosis. Multiple cysts. Right kidney 9.9 cm in length.LEFT KIDNEY: Markedly echogenic renal parenchyma without worrisome mass, stone, or hydronephrosis. Multiple cysts. Left kidney 9.7 cm in length.OTHER: Bladder nondistended.", "output": "Markedly echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Renal transplant with acute renal insufficiency RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: Mild ascitesKIDNEY: No significant abnormality noted. 13.8 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 vasculature without inflow or outflow compromise.OTHER: No significant abnormality noted", "output": "Status post renal transplant without acute abnormality noted. Patent vasculature without inflow or outflow compromise."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess liver cyst for ability to drain History: + polycystic liver cysts, recent drainage of a dominant cyst. Would like to drain adjacent cysts if there is enough fluid LIVER: The liver measures 20.6 cm in length. Numerous cysts of varying sizes and complexity are present throughout the liver as more fully characterized on recent MRCP. Some of the cysts demonstrate mural nodularity but without discernible vascular flow. Some of the cysts demonstrate low level internal echoes. Largest cyst in the left lobe measures 8.2 x 9.0 x 9.7 cm. The largest in the right lobe measures 10.5 x 7.6 x 3.3 cm. Of note, the largest cyst in the right lobe on the recent MRCP measures up to approximately 16.1 cm. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.23 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: The pancreas is largely obscured.SPLEEN: No significant abnormalities noted. The spleen measures 9.2 cm in length. RIGHT KIDNEY: Kidney measures 11.5 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.6 cm in length. Normal cortical echotexture. No hydronephrosis. Superior pole cyst.OTHER: No significant abnormalities noted.", "output": "Numerous hepatic cysts of varying sizes and complexity as described above. Given complexity, follow-up with MRCP can be considered as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "34-year-old female with history of thyroid cancer status post thyroidectomy. RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: Punctate hypoechoic foci in the right thyroid bed without significant interval change.LEFT LOBE: Punctate hypoechoic foci in the left thyroid bed without significant interval change.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Subcentimeter lymph nodes without significant interval change. Hypoechoic structures measuring 1.5 cm on the right and 1.3 cm on the left time stamped 14:44 and 14:47 are unchanged compared to prior studies and consistent with submandibular glands as previously labeled. Additional imaging was performed in the supraclavicular and posterior cervical regions without evidence of lymphadenopathy.OTHER: No significant abnormality noted.", "output": "No acute interval change in subcentimeter hypoechoic foci in the left and right thyroid bed. No new regional lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "82-year-old male patient with right upper quadrant pain, gram-negative bacteremia. Evaluate gallbladder. LIVER: The liver measures 17.0 cm in length. Hepatic parenchymal echogenicity is coarsened and increased. 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 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 9.6 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.7 cm in length. No evidence of hydronephrosis.The spleen measures 6.1 cm in length.", "output": "1. Coarsened hepatic echogenicity which can be seen with hepatic parenchymal dysfunction.2. No cholelithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Male; 47 years old. Reason: r/o abdominal bleed History: anemia No free fluid is seen within the abdomen.", "output": "No free fluid."}
{"instruction": "Generate impression based on findings.", "input": "34-year-old female with history of thyroid cancer status post thyroidectomy. Evaluate for recurrence. RIGHT LOBE MEASUREMENTS: Surgically absentLEFT LOBE MEASUREMENTS: Surgically absentISTHMUS MEASUREMENTS: Surgically absentRIGHT LOBE: 0.4 cm hypoechoic focus in the right thyroid bed is unchanged compared to prior studies. No new lesions identified.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered cervical lymph nodes without significant change compared with prior studies. No new lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Stable appearance of subcentimeter hypoechoic focus in the right thyroid bed and cervical lymph nodes. No specific evidence of recurrent or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Patient is a 32-year-old female who presents with a palpable concern in her left breast. She has a history of multiple probably benign findings seen in her right breast. On physical examination, a mobile mass is appreciated at the upper inner left breast.A targeted ultrasound was performed at the area of palpable concern in the left breast. Sonographic imaging demonstrates a 7 x 5 x 8 mm oval, well-circumscribed, parallel oriented, homogeneous, and hypoechoic mass at 1:00 position of left breast, approximately 1 cm from nipple. Peripheral vascular flow around this mass is also present.", "output": "A 7 mm mass at the area of palpable concern in the left breast, probably representing a fibroadenoma. Follow up ultrasound in 6 months is recommended. Results and recommendations were discussed with the patient.The patient should also follow up with her primary care physician as clinically warranted, presuming these results are concordant with the physical exam findings. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "Epigastric pain with elevated lipase and increased LFTs LIVER: Coarse echogenic liver parenchyma without mass. Liver length 17.5 cmBILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted. Specifically, no evidence for ductal dilatation or significant peripancreatic fluid collection.SPLEEN: No significant abnormalities noted. 7.5 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 11.5 cm in lengthOTHER: Left kidney not visualized. No ascites.", "output": "Coarse echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Cholelithiasis without acute inflammation. No ascites.No evidence for pancreatic ductal dilatation or significant peripancreatic fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "NASH cirrhosis LIVER: Cirrhotic morphology again noted without mass. Liver length 13.1 cm.GALLBLADDER, BILIARY TRACT: Cholelithiasis again noted without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.8 cm in lengthOTHER: Left kidney 10.6 cm in length. Spleen 14.3 cm in length.", "output": "Stable cirrhotic morphology without mass or duct dilatation. No ascites. Cholelithiasis without acute inflammation."}
{"instruction": "Generate impression based on findings.", "input": "79-year-old male with elevated bilirubin, AKI. Evaluate for causes of elevated LFTs and AKI. LIVER: Normal echogenicity of the liver measuring 18.3 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate directional flow; peak velocity measures 14.7 cm/sec.GALLBLADDER, BILIARY TRACT: Sludge within the gallbladder. No pericholecystic fluid. No gallbladder wall thickening. Common bile duct measures 3 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are unremarkable.SPLEEN: Normal echogenicity of the spleen measuring 10.5 cm in length.KIDNEYS: Thinned echogenic right kidney measuring 10.1 cm in length. No hydronephrosis or shadowing calculus are noted.Thinned echogenic left kidney measuring 9.9 cm in length. No hydronephrosis or shadowing calculus are noted.ABDOMINAL AORTA: The midabdominal aorta measures 2.2-cm x 2.9 cm x 2.5 cm. No evidence of aneurysm.INFERIOR VENA CAVA: The visualized IVC is normal in caliber with appropriate directional flow.OTHER: Foley catheter within a decompressed bladder limits evaluation.", "output": "1. Thinned echogenic kidneys bilaterally suggestive of parenchymal dysfunction. 2. Sludge within the gallbladder. No evidence of cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: distended abdomen; r/o hepatomegaly, ascites LIVER: The liver measures 17.8 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 0.27 m/s.BILIARY TRACT: Gallbladder not visualized and may be surgically absent. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4 mm in diameter.PANCREAS: Not well visualized.SPLEEN: No significant abnormalities noted. The spleen measures 8.5 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.OTHER: No ascites.", "output": "Increased hepatic echogenicity suggestive of parenchymal dysfunction/fatty infiltration. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male patient in ICU, AMS, septic shock without a source. Evaluate for acalculous cholecystitis and ascites. Limited evaluation secondary to patient body habitus.LIVER: The liver measures 15.5 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is mildly hydropic measuring up to 13 cm. There are no gallstones. The gall bladder wall measures approximately 4 mm in thickness. There is no intrahepatic biliary ductal dilatation. The common duct measures 12 mm in diameter, similar to a recent CT.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 7.6 cm in length. No evidence of hydronephrosis. OTHER: The left kidney and spleen are poorly visualized.There is trace ascites.", "output": "1. Mildly hydropic gallbladder. 2. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs and fatigue LIVER: Mildly coarse liver echotexture without mass. Liver length 14.4 cm. Limited Doppler interrogation the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: Cholelithiasis and gallbladder sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 12.4 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 9.9 cm in lengthOTHER: Left kidney 10 cm in length. No ascites", "output": "Mildly coarse liver echotexture raises the possibility of fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Cholelithiasis and gallbladder sludge without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old male patient with suspected acute cholecystitis. History of hepatitis B. LIVER: The liver measures 12.5 in length and has increased echogenicity. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is distended and contains what appears to be a combination of sludge and shadowing gallstones. The gallbladder wall measures approximately 3-4 mm in thickness. The patient reported mild pain with sonographic palpation. There is no significant pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 5 mm in diameter.PANCREAS: The pancreas is poorly visualized on this examination.RIGHT KIDNEY: The right kidney measures 8.6 in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.2 cm in length. No evidence of hydronephrosis.The spleen measures 8.7 in length.", "output": "1. Hydropic gallbladder containing gallstones though no definite pericholecystic inflammatory changes; these findings may represent early acute cholecystitis. Correlate with lab values and consider HIDA scan if clinically warranted.2. Hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "Elevated liver enzymes LIVER: Coarse echogenic liver echotexture without mass. Liver length 17.3 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.9 cm in length OTHER: Left kidney 10.6 cm in length. Spleen 7.7 cm in length. No ascites", "output": "Coarse echogenic liver echotexture consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Elevated liver enzymes. History of liver transplantation. LIVER: Non-cirrhotic liver morphology. Increased and coarsened parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.BILIARY TRACT: No biliary ductal dilation. 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 10.9 cm in length. The left kidney is 11.1 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 13.8 cm in length, without focal lesions evident.OTHER: Small amount of perihepatic ascites.", "output": "1. Increased hepatic echogenicity, compatible with parenchymal dysfunction.2. Small amount of perihepatic ascites."}
{"instruction": "Generate impression based on findings.", "input": "81-year-old female for follow-up of small, complex renal cysts. RIGHT KIDNEY: The right kidney measures approximately 10.9 cm in length. There are 2 small, complex cyst identified in the right kidney, one in the upper pole measuring approximately 1.2 cm in greatest diameter and a second in the upper pole as well measuring 0.9 cm in greatest diameter. These contain scattered internal echoes but no solid component or thick septation. No hydronephrosis or shadowing calculus.LEFT KIDNEY: The left kidney measures 10.2 cm in greatest length. Small cysts identified in prior CT are not definitely visualized on this study, due to small size and somewhat limited view. No hydronephrosis or shadowing calculus. OTHER: Bladder poorly distended.", "output": "Mildly complex, small right renal cysts. Although one appears slightly larger than on prior CT, the appearance remains consistent with a benign cyst.Very small left renal cysts not identified, indirectly suggesting stability."}
{"instruction": "Generate impression based on findings.", "input": "HCV LIVER: Mildly coarse echogenic liver echotexture without mass. Liver length 14.2 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. 10 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.3 cm in lengthOTHER: Left kidney 11.1 cm in length. No ascites", "output": "Mildly coarse echogenic liver echotexture consistent with chronic liver disease without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old male with history of abdominal ascites. LIVER: Measures 21.8 in length. Cirrhotic hepatic 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: Significantly loculated abdominal ascites. Small right pleural effusion.", "output": "1. Cirrhotic liver morphology with increased echogenicity consistent with chronic liver disease. No suspicious focal lesion identified. Patent portal vein. 2. Significantly loculated abdominal ascites.3. Small right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "Viral hepatitis C LIMITED ABDOMENLIVER: Cirrhotic morphology. 4.8 x 4 cm hyperechoic mass within the right lobe with indistinct margins. Liver length 21.3 cmBILIARY TRACT: Gallbladder sludge and stones without ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: Spleen length 18.5 cm RIGHT KIDNEY: No significant abnormalities noted. 9.6 cm in lengthOTHER: Left kidney 11.5 cm in length. Moderate ascites.", "output": "Cirrhotic morphology with worrisome right lobe hepatic mass highly suspicious for hepatocellular carcinoma. Gallbladder sludge and stones without acute inflammation or ductal dilatation. Moderate splenomegaly with moderate ascites.Extensive collaterals in region of main portal vein suggestive for cavernous transformation. Main portal vein demonstrates reversal of portal venous flow."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old male with decreased urine output status post partial nephrectomy RIGHT KIDNEY: Measures 9.0 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. Postoperative changes of right partial mastectomy.LEFT KIDNEY: Measures 11.4 cm in length. 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. No nephrolithiasis or hydronephrosis. 2. Status post right partial nephrectomy. "}
{"instruction": "Generate impression based on findings.", "input": "History of left inner thigh abscess status post drainage. Targeted grayscale and color Doppler ultrasound evaluation of the left inner thigh demonstrates a 2.2 x 1.0 cm subdermal locule of fluid and surrounding subcutaneous fat edema/induration. Internally there is echogenic material which is presumably iatrogenic gauze/drain.", "output": "2.2 x 1.0 cm inner thigh fluid collection with surrounding soft tissue changes suggestive of cellulitis and/or edema. Internally there is echogenic material which is presumably iatrogenic gauze/drain."}
{"instruction": "Generate impression based on findings.", "input": "Biliary colic LIVER: Non-cirrhotic liver morphology. Mildly increased parenchymal echogenicity. 21 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 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 13.1 cm in length. The left kidney is 13.4 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 15.7 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No significant ascites identified.", "output": "Hepatosplenomegaly with increased hepatic echogenicity, compatible with parenchymal dysfunction. "}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter. Evaluate for suspicious nodules. History of outside hospital fine-needle aspiration of multiple nodules, mostly benign. Pathology here read as benign. RIGHT LOBE MEASUREMENTS: 5.6 x 1.9 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.9 x 2.1 x 1.6 cmISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: 1.5 x 1.0 x 0.8 cm right superior pole mildly hypoechoic nodule with cystic foci, appearance compatible with a benign colloid nodule. Additional inferior pole colloid nodule.LEFT LOBE: 2.5 x 1.9 x 1.3 cm mildly hypoechoic solid thyroid nodule in the inferior left thyroid lobe/isthmus with questionable punctate echoes and vascularity.ISTHMUS:1.4 x 0.7 x 1.4 cm mildly hypoechoic nodule with small cystic components, appearance compatible with a benign pulmonary nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multinodular goiter. 2.5 cm left thyroid lobe/isthmus hypoechoic solid-appearing nodule subsequently underwent fine-needle aspiration."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with acute kidney failure. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 11.5 cm in length. There is moderate to marked hydronephrosis and visualized proximal hydroureter with good parenchymal preservation. There is a 3.5 cm simple-appearing cyst arising from the upper pole. No shadowing calculus or solid mass.LEFT KIDNEY: The left kidney measures approximately 12.7 cm in length. There is moderate hydronephrosis and visualized proximal hydroureter with good parenchymal preservation. No focal mass or shadowing calculus.OTHER: Limited views of the urinary bladder demonstrate poor distention but infiltrating mass consistent with the patient's known extension of prostate cancer present.Limited views of the liver demonstrate hyperechoic metastatic disease.", "output": "1. Significant, bilateral hydronephrosis is unchanged from prior CT.2. Infiltrating mass involving the bladder wall.3. Liver metastases identified."}
{"instruction": "Generate impression based on findings.", "input": "Female 81 years old Reason: evaluate calcification History: calcification on CT scan RIGHT LOBE MEASUREMENTS: 5.3 x 3.0 x 2.8 cm.LEFT LOBE MEASUREMENTS: Patient reports no history of surgery, however there appears to have been a left thyroidectomy.ISTHMUS MEASUREMENTS: 0.6 cm.RIGHT LOBE: Background echogenicity of the right thyroid lobe is heterogeneous with some cystic components. No discrete nodules are identified. No shadowing calcifications are definitely identified.LEFT LOBE: Patient is likely status post left thyroidectomy.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small benign-appearing lymph nodes are present in the left and right neck, the largest of which on the right level 2 measuring 1.6 x 0.4 x 0.9 cm.OTHER: No significant abnormality noted.", "output": "Enlarged and heterogeneous right thyroid lobe with some cystic components without discrete nodule. Punctate calcification not visualized."}
{"instruction": "Generate impression based on findings.", "input": "Female, 77 years old. Anuric Examination is limited due to body habitus and patient positioning.RIGHT KIDNEY: The right kidney measures 10.8 cm in length. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.7 cm in length. No shadowing stones or hydronephrosis.OTHER: The bladder is not visualized, likely decompressed.", "output": "Limited examination. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency with worsening creatinine ULTRASOUND KIDNEYSRIGHT KIDNEY: Mildly echogenic renal parenchyma without mass, stone, or hydronephrosis. Large perinephric hematoma again noted measuring 12.2 x 8.7 x 12 cm. Right kidney 9.1 cm in length.LEFT KIDNEY: Mildly echogenic renal parenchyma without mass, stone, or hydronephrosis. 12 cm in lengthOTHER:Bladder nondistended.", "output": "Echogenic renal parenchyma consistent with medical renal disease/clinical dysfunction without mass, stone, or hydronephrosis. No change in the large right perinephric hematoma.Patent renal vasculature bilaterally. Specifically, no evidence for renal vein thrombosis."}
{"instruction": "Generate impression based on findings.", "input": "75-year-old male with history of right thyroid nodule, incidental finding on cervical spine MRI. RIGHT LOBE MEASUREMENTS: 5.5 x 2.8 x 2.1 cmLEFT LOBE MEASUREMENTS: 3.1 x 2.0 x 1.2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Solitary right thyroid nodule measures 2.7 x 2.1 x 1.7 cm. It is centrally cystic and peripherally solid with scattered macrocalcifications within the solid component.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": "Solitary cystic and solid right thyroid nodule as described above."}
{"instruction": "Generate impression based on findings.", "input": "Female, 87 years old. AKI RIGHT KIDNEY: The right kidney measures 8.2 cm in length, with increased cortical echogenicity. Multiple nonobstructing stones are identified, the largest in the upper pole measures 0.7 x 0.3 x 1.0 cm. No obstructing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 7.7 cm in length, with increased cortical echogenicity. Multiple nonobstructing stones are identified, a stone in the upper pole measuring 0.6 x 0.4 x 1.2 cm, and a stone in the midpole measuring 0.7 x 0.6 x 0.5 cm. No obstructing stones or hydronephrosis.OTHER: The bladder is decompressed, with Foley catheter in place.", "output": "1.Multiple bilateral nonobstructing renal stones. No hydronephrosis.2.Increased renal cortical echogenicity, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male with upper abdominal pain. Elevated lipase consistent with pancreatitis. Evaluate for cholelithiasis. LIVER: The liver parenchyma is mildly coarsened. No intrahepatic biliary ductal dilatation is evident. The liver measures 15 cm in craniocaudal dimension. Note is made of a 2.7-cm right hepatic lobe simple-appearing cyst. There is normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: The common bile duct is mildly prominent, measuring 7 mm at the hilum, unchanged. A normally distended gallbladder is noted without gallstones, wall thickening, pericholecystic fluid, or focal tenderness. PANCREAS: The pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 9.9 cm in length without a discrete lesion.RIGHT KIDNEY: The right kidney is malrotated as seen on the prior CT. It measures 11.1 cm in length without hydronephrosis, shadowing calculus or a discrete lesion evident. Color Doppler demonstrates hilar blood flow.OTHER: The left kidney measures 10.9 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident.", "output": "1. The pancreas is obscured by overlying bowel gas shadowing. 2. No evidence of cholelithiasis or acute cholecystitis as clinically questioned. 3. Stable prominence of the common bile duct. 4. Mildly coarsened hepatic parenchyma suggesting diffuse fatty infiltration and/or parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old male with acute kidney failure. Ultrasound guidance was provided for biopsy of left kidney.", "output": "Ultrasound guidance."}
{"instruction": "Generate impression based on findings.", "input": "19-year-old woman complaining of left breast tenderness No family history of breast cancer. A targeted left ultrasound was performed for the patient\u2019s area of concern. The area of concern in the 9:00 position and retroareolar region corresponded with normal-appearing breast tissue. A 5 x 4 mm cyst is noted within this tissue. No large cyst or other mass lesion is noted.", "output": "The area of concern corresponds with normal breast tissue. No sonographic evidence for malignancy. Results and recommendations were discussed with the patient.Breast pain should be managed clinically.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Asymmetrical enlarged thyroid RIGHT LOBE MEASUREMENTS: 6.1 x 1.7 x 1.5 cmLEFT LOBE MEASUREMENTS: 5.9 x 2.2 x 2.7 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Scattered subcentimeter benign-appearing hypoechoic nodules.LEFT LOBE: 3.6 x 1.8 x 2.3 cm dominant mixed cystic and solid nodule within the midportion of 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": "Dominant mixed cystic and solid nodule within the midportion of the left thyroid gland. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old female patient with elevated transaminase. LIVER: The liver measures 16.6 cm in length. 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 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 10.8 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.9 cm in length. No evidence of hydronephrosis.The spleen measures 10.8 cm in length.", "output": "No specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Male 58 years old Reason: eval for cholecystitis History: septic shock This study is limited due to patient's surgical bandages and mental status.LIVER: Coarse echotexture of the liver. No focal liver lesions. Liver measures 14.2 cm.BILIARY TRACT: Gallbladder is contracted, therefore cannot be optimally evaluated. Gallstones are present within the gallbladder.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: Spleen measures 13.2 cm. There is a hypoechoic focus within the spleen which likely represents an infarct.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Coarse echotexture of the liver. Mild splenomegaly. Likely an infarct in the spleen. Cholelithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal distention, acute liver failure history of chemotherapy LIVER: Liver parenchyma is mildly echogenic. No focal hepatic lesions.. No intrahepatic biliary ductal dilation. The portal vein is patent with normal directional flow. Moderate perihepatic ascites.GALLBLADDER, BILIARY TRACT: Nonspecific gallbladder wall thickening in the setting of ascites it measures 11 mm. Gallbladder sludge is noted.PANCREAS: The pancreas is obscured.RIGHT KIDNEY: Measures 11 cm. No mass or hydronephrosis.OTHER: Spleen measures 8.5 cm. left kidney measures 10.4 cm without hydronephrosis or mass.", "output": "Heterogeneous hepatic echotexture with perihepatic ascites. The main portal vein is patent.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Female, 94 years old. Aortic stenosis, HTN, h/o CKD with worsening CKD. RIGHT KIDNEY: The right kidney measures 8.2 cm in length with increased cortical echogenicity. Multiple cystic lesions again noted. An upper pole simple cyst measures 2.3 x 1.9 x 2.0 cm. Extrarenal pelvis, similar to prior. 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, limiting evaluation.", "output": "1.Increased renal cortical echogenicity compatible with medical renal disease. No hydronephrosis.2.Right renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "History of esophageal varices heavy alcohol use in the past, evaluate for cirrhosis LIVER: Liver measures 15 cm with diffuse coarse echotexture suggesting underlying parenchymal disease. A new oval circumscribed hypoechoic mass is identified in possibly segment 5 of right lobe of liver that measures 2.2 x 1.4 x 2 cm.GALLBLADDER, BILIARY TRACT: Distended gallbladder with multiple small gallstones are mobile in nature. Normal gallbladder wall thickness noted. No pericholecystic fluid noted. Common hepatic duct measures within normal limits. No intrahepatic biliary ductal dilatation.PANCREAS: Head and body of pancreas appears unremarkable. The tail of pancreas not visualized due to overlying bowel gas.KIDNEY: Right kidney measures 11.3 cm and left kidney 11.5 cm. Normal echotexture of the kidneys noted. In the right upper pole there is a new simple cyst that measures 1.6 x 2.1 x 1.6 cm. Redemonstrated is a simple cyst in the midpole of left kidney that measures 2 x 1.6 x 1.4 cm.No renal stones noted.OTHER: No ascites.", "output": "1. Diffuse coarse echotexture of the background liver parenchyma with a new hypoechoic liver lesion suspicious for HCC. Further evaluation with MRI of the liver with contrast is recommended.2. New right renal simple cyst.3. Cholelithiasis without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old male patient with positive Murphy sign. Evaluate for cholecystitis. LIVER: The liver measures 13.2 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.27 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder contains stones and sludge. There is gallbladder wall thickening measuring up to 6 mm in certain areas. No significant pericholecystic fluid is identified. Sonographic Murphy's sign is negative, however, the patient is currently medicated. 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 is atrophic and echogenic measuring 6 cm in length. No evidence of hydronephrosis. OTHER: The left kidney is not visualized on this examination.The spleen measures 13.1 cm in length.There is a right pleural effusion.", "output": "1. Cholelithiasis with mild gallbladder wall thickening; these findings could represent acute cholecystitis. A HIDA scan can be obtained for further evaluation if clinically warranted. 2. Right pleural effusion.3. Atrophic right kidney."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old female patient with abdominal pain. Assess for kidney stones and gallstones. LIVER: The liver measures 12.7 cm in length. 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 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. No shadowing stone is identified.OTHER: The left kidney measures 10.2 cm in length. No evidence of hydronephrosis. No shadowing stone is identified.The spleen measures 10.0 cm in length.", "output": "No specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male with history of viral hepatitis B, evaluate for liver cancer. LIVER: No focal hepatic lesions or biliary dilatation. The liver is normal in size, measuring approximately 11 cm.GALLBLADDER, BILIARY TRACT: Several mobile gallstones are seen.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Cholelithiasis without findings of cholecystitis. No focal hepatic masses."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old male with history of thyroid cancer status post thyroidectomy presents for follow-up. 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: There are several lymph nodes noted throughout the neck.Right neck level 2: There is approximately 1.1 x 0.9 x 0.4 cm lymph node with benign morphology.Left neck level 3: There is an approximately 0.6 x 0.5 x 0.3 cm lymph node with benign morphology.Left neck level 3: There is an approximately 0.6 x 0.4 x 0.4 cm lymph node with benign morphology.Left neck level 4: There is approximately 1.4 x 0.7 x 0.5 cm lymph node with benign morphology.OTHER: No significant abnormality noted.", "output": "1. Surgical changes of a thyroidectomy without evidence of recurrence. Lymph nodes noted on exam have benign morphology."}
{"instruction": "Generate impression based on findings.", "input": "22-year-old male with hyperthyroidism/Graves' disease. Suboptimal examination secondary to motion artifact. RIGHT LOBE MEASUREMENTS: 6.1 x 2.1 x 2.3 cmLEFT LOBE MEASUREMENTS: 5.3 x 2.6 x 2.5 cmISTHMUS MEASUREMENTS: Unable to accurately measure due to patient inability to cooperate with the examination.RIGHT LOBE: Diffusely enlarged and heterogenous but predominately hyperechoic with associated increased vascularity. No definitive nodules are identified. LEFT LOBE: Diffusely enlarged and heterogenous but predominately hyperechoic with associated increased vascularity. No definitive nodules are identified. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Findings consistent with the stated history of Grave's disease, as detailed above. "}
{"instruction": "Generate impression based on findings.", "input": "66 year old female with a personal history of palpable left breast lump. Three standard views of both breasts with repeat left CC and MLO views and additional spot compression right CC, superior left CC, superior right MLO, and superior left ML 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). There is a marker overlying the left breast immediately inferior to the nipple, corresponding to the palpable area of concern. In this region is a lobulated, obscured mass which measures approximately 2.0 x 1.8 cm. There is a focal asymmetry in the left upper outer breast, relatively low suspicion on full field views. An additional focal asymmetry is present in the right upper outer quadrant at posterior depth, most likely a lymph node. Additional focal asymmetry in the right upper outer breast at mid depth is only evaluated with on the CC compression and partially disperses. An additional asymmetry in the right ML view is low suspicion. Patient declined the completion of spot compression views, which is a limitation, though all areas of asymmetry were evaluated on ultrasound. ULTRASOUND", "output": "1.Lobulated mass in the left breast corresponding to the palpable area of concern, suspicious for malignancy. Ultrasound-guided biopsy is recommended. Mammogram and ultrasound findings as well as recommendation for ultrasound-guided biopsy were discussed with the patient and the patient's son, who both verbalized understanding. Written and verbal instructions were provided to the patient to hold her daily aspirin for 5 days prior to biopsy.2.Other typically benign findings as described above. A 6 month follow up bilateral mammogram is suggested to ensure stability of these typically benign findings.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Female 83 years old; Reason: CKD - evaluate size, echogenicity History: elevated creatinine, microalbuminuria RIGHT KIDNEY: The right kidney measures 10 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Right renal simple appearing cyst measures 2.1 x 2.1 x 2.4 cm.LEFT KIDNEY: The left kidney measures 10.3 cm in length. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. Left simple appearing renal cyst measures 6.4 x 4.2 x 6.2 cm.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "1.Increased echogenicity of bilateral kidneys suggestive of medical renal disease, without evidence of hydronephrosis, shadowing calculi, or mass.2.Bilateral renal cysts, as above."}
{"instruction": "Generate impression based on findings.", "input": "53 year old female with alcoholic cirrhosis and increasing right upper and lower quadrant pain. Prior paracentesis. LIVER: Mildly enlarged and coarsely echogenic. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction the main portal vein.GALLBLADDER, BILIARY TRACT: Dependent sludge and gallstones within the gallbladder. The gallbladder wall is prominent and associated with ascites but not grossly thickened. The biliary tract is normal in caliber.PANCREAS: Limited by bowel gasRIGHT KIDNEY: No significant abnormalities noted.OTHER: Splenomegaly. Mild ascites, improved when compared to prior exam.", "output": "Gallbladder contains stones and dependent sludge without obvious complication.Coarsely echogenic and mildly enlarged liver.Ascites.Splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Reason: serial evaluation of liver morphology History: abdominal distension/ascites LIVER: The liver measures 17.8 cm in length, mildly enlarged. Mildly heterogeneous, echogenic hepatic parenchyma with a mildly nodular contour. The portal vein is patent with normal directional hepatopetal portal venous blood flow, peak velocity of 49.5 cm/s, however demonstrates a pulsatile waveform. The hepatic veins appear dilated. No focal mass.GALLBLADDER, BILIARY TRACT: Echogenic shadowing gallstones in a collapsed gallbladder. No evidence of acute pericholecystic inflammation. The gallbladder wall measures 0.4 cm. The common bile duct measures 0.2 cm. No biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.2 cm in length. No hydronephrosis or shadowing stonesLEFT KIDNEY: The left kidney measures 10.5 cm in length. No hydronephrosis. Subcentimeter nonobstructive shadowing calculus.OTHER: The spleen measures 11.9 cm in length. Moderate volume ascites.", "output": "1. Dilated hepatic veins with pulsatile portal venous waveform, consistent with congestive heart failure.2. Mild hepatomegaly and mildly heterogeneous hepatic parenchyma and nodular contour, which is suggestive of hepatic parenchymal dysfunction.3. Moderate volume ascites.4. Cholelithiasis without evidence of acute inflammation.5. Subcentimeter non-obstructing left renal calculus."}
{"instruction": "Generate impression based on findings.", "input": "36 female with abdominal distention and primary biliary cirrhosis. Evaluate for ascites. Limited evaluation of the abdomen and pelvis demonstrates no evidence for ascites..", "output": "No ascites identified."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodule RIGHT LOBE MEASUREMENTS: 2.4 x 2.1 x 4.5 cmLEFT LOBE MEASUREMENTS: 1.7 x 1.4 x 5.3 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Stable predominantly solid mid pole nodule measuring 1.8 x 1.3 x 2.4 cm.LEFT LOBE: Stable subcentimeter benign colloid cyst measuring 0.3 x 0.3 x 0.4 cm.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. No change in bilateral thyroid nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Female, 31 years old. Leukocytosis, positive UA, nausea/vomiting RIGHT KIDNEY: The right kidney measures 12.4 cm in length, with normal echotexture. A midpole simple cyst measures 2.1 x 1.4 x 2.0 cm, unchanged from prior CT imaging. No shadowing stones or hydronephrosis. No perinephric collections.LEFT KIDNEY: The left kidney measures 10.9 cm in length, with normal echotexture. A lower pole cyst measures 1.9 x 1.8 x 2.4 cm with no surrounding hypervascularity. No shadowing stones. Minimal pelvocaliectasis. No perinephric collections.OTHER: The bladder is incompletely distended, with wall thickening.", "output": "1.No perinephric collections. Bilateral renal cysts and minimal left pelvocaliectasis. 2.Bladder wall thickening."}
{"instruction": "Generate impression based on findings.", "input": "History colon cancer with abdominal pain and elevated alk phos LIVER: Diffusely heterogeneous and echogenic liver. 4.1 x 3 x 2.7 segment 7 right lobe hypoechoic liver mass. Liver length is 17.9 cmGALLBLADDER, BILIARY TRACT: Gallbladder sludge and stones with mild gallbladder wall thickening. Negative Murphy's sign. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.6 cm in length.OTHER: Left kidney 10.5 cm in length. Spleen 10.1 cm in length. Mild ascites.", "output": "Diffusely heterogeneous and echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without ductal dilatation.  Right lobe liver mass worrisome for neoplasm; both primary and metastatic etiologies should be considered. Would recommend correlation with dedicated liver contrast cross-sectional imaging.Gallbladder stones and sludge with mild gallbladder wall thickening probably secondary to the presence of mild ascites. No convincing evidence to suggest acute inflammation at this time."}
{"instruction": "Generate impression based on findings.", "input": "Male; 63 years old. Reason: eval transplanted kidney; hydronephrosis per OSH report History: see above RENAL TRANSPLANT: LOCATION: Left iliac fossa.PERITRANSPLANT TISSUES: No peritransplant collections. KIDNEY: Transplant kidney measures 11.9-cm. Normal cortical echotexture.COLLECTING SYSTEM/URETER: No hydronephrosis.URINARY BLADDER: Decompressed with Foley catheter in place.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels Peak systolic velocity in the adjacent iliac artery of 70 cm/sec.Left iliac artery-transplant artery anastomosis is patent. Normal arterial and venous flow to and from the transplant kidney with velocity measurements below. Few nonspecific mild parvus tardus arterial waveforms within the transplant kidney, but otherwise, waveforms were within normal limits.Transplant renal artery:Anastomosis: Peak systolic velocity 1.2 m/sec, RI 0.9Mid: Peak systolic velocity 0.7 m/sec, RI 0.91Hilum: Peak systolic velocity 0.4 m/sec, RI 0.89Transplant kidney segmental and arcuate arteries with resistive indices ranging from 0.61 to 0.86.OTHER: Lower abdominal ascites.", "output": "1. Few nonspecific mild parvus tardus waveforms within the transplant kidney, but no other findings to suggest a transplant renal artery stenosis.2. No hydronephrosis.3. Ascites."}
{"instruction": "Generate impression based on findings.", "input": "67 year old male patient with history of papillary thyroid carcinoma. Evaluate for evidence of recurrence. RIGHT LOBE: Status post thyroidectomy without evidence of residual tissue or disease recurrence.LEFT LOBE: Status post thyroidectomy without evidence of residual tissue or disease recurrence.ISTHMUS: Status post thyroidectomy without evidence of residual tissue or disease recurrence.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No specific evidence of disease recurrence or regional lymphadenopathy. "}
{"instruction": "Generate impression based on findings.", "input": "Urinary tract infection, recurrent RIGHT KIDNEY: Atrophic echogenic native right kidney mass or hydronephrosis. Punctate nonobstructing stones.. Right kidney 10.2 cm in length.LEFT KIDNEY: Atrophic echogenic native left kidney without mass or hydronephrosis. Punctate nonobstructing stones. Left kidney 0.8 cm in length.OTHER: Unremarkable left iliac fossa renal transplant with normal echogenicity. No mass, stone, or hydronephrosis. 12.4 cm in length. No perinephric collection.", "output": "Atrophic echogenic native kidneys with nonobstructing punctate stones. No evidence for hydronephrosis or worrisome mass. Unremarkable left iliac fossa renal transplant without evidence for mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female presents with mass in left lower quadrant of abdomen. There is a well-defined isoechoic lesion measuring approximately 5.7 x 1.5 x 3.8cm in the subcutaneous tissue. No microcalcifications.", "output": "1. There is a well-defined discrete isoechoic lesion in the subcutaneous tissue of the left lower quadrant of the abdomen as described above, most likely a lipoma."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old female with right arm pain and swelling. Evaluate for retained catheter fragments. There is severe and significant subcutaneous edema present. Biceps is heterogeneously echogenic which could be inflammatory in nature. No obvious soft tissue foreign body. Limited evaluation of the veins of the upper extremity demonstrate patency without obvious foreign body. No focal fluid collection.", "output": "Findings cellulitis. Heterogeneity of the biceps musculature without defined fluid collection or foreign body."}
{"instruction": "Generate impression based on findings.", "input": "76 years old, Male, Reason: evaluate biliary tree for obstruction; evaluate pancreas for abscess/pseuodocyst History: sepsis, elevated liver enzymes Technically difficult exam, especially in the left upper quadrant, due to patient's inability to lay decubitus and large body habitus.LIVER: The liver is enlarged measuring 22.1 cm in length. Innumerable confluent hypoechoic masses within the hepatic parenchyma are suspicious for metastatic malignancy. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.15 m/s.BILIARY TRACT: The gallbladder is collapsed without definite evidence of cholelithiasis. No evidence of cholecystitis. No evidence of intrahepatic or extra hepatic biliary ductal dilatation. The common bile duct measures 6 mm in diameter.PANCREAS: The pancreas is not well-visualized on this exam.SPLEEN: The spleen is not well visualized on this exam. RIGHT KIDNEY: Kidney measures 13.9 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney is not well visualized.OTHER: No significant abnormalities noted.", "output": "1.Innumerable confluent hypoechoic masses in the liver are consistent with metastatic malignancy. 2.The gallbladder appears contracted without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: HCC routine surveillance History: HCV cirrhosis LIVER: Heterogeneous, coarse hepatic echotexture and nodular contour compatible with cirrhosis. The liver measures 16.1 cm in length. The portal vein is patent with normal hepatopedal portal venous blood flow, maximum flow rate 22.3 cm/s. No focal masses.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. Several echogenic gallstones are noted in the gallbladder neck. The gallbladder wall measures 0.2 cm. The common bile duct measures 0.3 cm. No intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.4 cm in length. No hydronephrosis.LEFT KIDNEY: The left kidney measures 10.1 cm in length. No hydronephrosis.SPLEEN: The spleen measures 9.4 centers in length.OTHER: No ascites.", "output": "1. Cirrhotic liver without focal mass.2. Cholelithiasis without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old female with multinodular goiter with benign cytology of larger left lobe nodules. Evaluate for change in nodules. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 7.2 x 2.1 x 1.6 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 6.4 x 3.2 x 1.9 cm.ISTHMUS MEASUREMENTS: The thyroid isthmus measures 0.4 cm in thickness.RIGHT LOBE: Heterogenous multinodular echotexture. The predominantly isoechoic nodule of the posterior mid pole measuring 1 x 0.8 x 1.0 cm is stable in size and appearance (prior 1 x 1 x 0.9 cm). The hypoechoic nodule of the inferior right pole is stable in size and appearance measuring 1 x 0.7 x 0.9 cm (prior 1 x 0.9 x 1.1 cm).LEFT LOBE: Heterogenous multinodular echotexture. The predominantly cystic lesion of the left mid pole is stable in size and appearance measuring 2.7 x 1.5 x 2.5 cm (prior 2.7 x 1.7 x 2.7 cm). The heterogenous isoechoic nodule of the left lower pole measuring 2.4 x 1.6 x 1.7 cm is similar in size and appearance (prior 2.6 x 1.7 x 1.9 cm).ISTHMUS: Stable isthmic nodule measuring 0.4 x 0.4 x 0.5 cm (prior 0.4 x 0.5 x 0.6 cm).PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral thyroid nodules without significant interval change."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis. Hepatocellular carcinoma status post ablation. LIVER: Limited evaluation. Coarsened parenchymal echogenicity. Deep hyperechoic right hepatic lobe lesion is again seen, incompletely evaluated. The TIPS and portal vein are patent, with normal direction of blood flow.OTHER: No significant abnormalities noted. No ascites identified in the upper abdomen.", "output": "Patent TIPS and main portal vein. "}
{"instruction": "Generate impression based on findings.", "input": "Weight gain and proteinuria. Evaluate for hydronephrosis. LEFT ILIAC FOSSA TRANSPLANT KIDNEY: The kidney measures 12.8 cm in length without hydronephrosis. Color Doppler demonstrates hilar blood flow. Mildly echogenic parenchyma. Note is made of a 1.6 x 1.8 cm inferior simple appearing cyst. No shadowing nephrolithiasis.URINARY BLADDER: Urinary bladder is decompressed with a Foley.OTHER", "output": "No hydronephrosis as clinically questioned."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with history of primary hyperparathyroidism and right lobe nodule. RIGHT LOBE MEASUREMENTS: 5.5 x 2.2 x 1.7 cmLEFT LOBE MEASUREMENTS: 5.2 x 2.0 x 1.3 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: 0.6 x 0.6 cm nodule in the right upper pole and 0.8 x 0.6 cm nodule in the inferior pole with spongiform morphologic features, favor benign.LEFT LOBE: 0.8 x 0.5 cm nodule in the mid polar region and 0.6 x 0.4 cm nodule in the superior pole with spongiform morphologic features, favor benign.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Bilateral subcentimeter nodules with spongiform morphologic features, most likely benign."}
{"instruction": "Generate impression based on findings.", "input": "Male 54 years old; Reason: Probably right thyroid nodule, ? nodule or LN History: none RIGHT LOBE MEASUREMENTS: 6.8 x 2.3 x 2.4 cm.LEFT LOBE MEASUREMENTS: 4.8 x 1.6 x 1.1 cm.ISTHMUS MEASUREMENT: 0.6 cm.RIGHT LOBE: Diffusely heterogenous gland without discrete nodule. Hypovascular. Right-sided thyromegaly.LEFT LOBE: More homogenous than compared to the right but still mildly heterogenous gland. No discrete nodule or mass. The left side's dimensions are within normal limits.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted. OTHER: No significant abnormality noted.", "output": "1.Diffusely heterogenous gland and enlarged right side; may represent thyroiditis in the burnt out stage (given the hypovascularity) versus an asymmetric goiter. Correlate with thyroid laboratory values."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 74 yo male with htn, CKD History: ckd, never had renal u/s RIGHT KIDNEY: The right kidney measures 10.1 cm in length. Unremarkable renal parenchymal echogenicity and echotexture. No hydronephrosis or shadowing renal calculi.LEFT KIDNEY: The left kidney measures 11.1 cm in length. Unremarkable renal parenchymal echogenicity and echotexture. No hydronephrosis or shadowing renal calculi. Anechoic left upper pole cyst measures 4.6 x 4.2 x 5.2 cm.OTHER: Multiple geographic hyperechoic lesions in the liver may represent multifocal hepatic steatosis or multiple hemangiomas. Mildly nodular prostate.", "output": "1. No acute renal abnormality.2. Multiple hepatic hemangiomas or multifocal hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "Female, 30 years old. Reason: new contrast-induced nephropathy History: new contrast-induced nephropathy RIGHT KIDNEY: The right kidney measures 12.1 cm in length, with increased cortical echogenicity. No focal lesion or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.5 cm in length, with increased cortical echogenicity. No focal lesions or hydronephrosis.OTHER: The bladder is decompressed. An approximately 4 cm hypoechoic lesion in the pelvis is noted, with internal vascularity.", "output": "1.Findings compatible with medical renal disease. No hydronephrosis.2.A 4 cm hypoechoic pelvic lesion is nonspecific, but suspicious for a metastatic lesion. A fibroid is felt to be less likely. Dedicated pelvic imaging can be performed for further evaluation as clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Normal parenchymal echogenicity without mass. Liver length 17.9 cm.GALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.2 cm in lengthOTHER: Left kidney 10.8 cm in length. Spleen 11.5 cm in length. No ascites.", "output": "Cholelithiasis without acute inflammation or ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Pleuritic chest pain Nondiagnostic exam secondary to contrast extravasation. Limited images through the level of the superior mediastinum.", "output": "Incomplete exam secondary to contrast extravasation. Nondiagnostic for pulmonary embolism. Limited images through the level of the superior mediastinum."}
{"instruction": "Generate impression based on findings.", "input": "History mononucleosis and flank pain, evaluate for splenomegaly and hemorrhage LIVER: The liver measures 13.2 cm. The echotexture is normal without evidence of focal lesion.BILIARY TRACT: No biliary ductal dilation. The gallbladder is normal.PANCREAS: The visualized portions of the pancreatic head and body are normal. SPLEEN: The spleen measures 8.5 cm. No evidence of perisplenic collection.KIDNEYS: The right kidney measures 7.6 cm. The left kidney measures 8.6 cm.", "output": "No evidence of splenomegaly or perisplenic collection."}
{"instruction": "Generate impression based on findings.", "input": "Renal cell carcinoma status post partial nephrectomy RIGHT KIDNEY: No significant abnormalities noted. 9.6 cm in length LEFT KIDNEY: Status post partial nephrectomy. No worrisome mass, stone, or hydronephrosis. Left kidney 11.2 cm in lengthOTHER: Bladder nondistended", "output": "Negative renal ultrasound. Status post partial left nephrectomy without evidence for worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old female with a history of hepatitis C presents for evaluation of liver. LIVER:Measures 4.6 cm. There is increased and coarse echogenicity of the parenchyma. No focal mass or ascites. There is a dirty shadowing arising from the biliary system, consistent with pneumobilia.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. As above, there is dirty shadowing arising from the biliary system consistent with pneumobilia. The common bile duct measures 5.1 mm.PANCREAS: Evaluation the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 6.7 cm without sonographic abnormalities. Of note, much of the spleen is shadowed out.KIDNEYS: Right kidney measures 8.5 cm. Left kidney measures 8.0 cm. The kidneys are echogenic bilaterally. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "1. Coarse echogenic liver consistent with chronic liver disease/parenchymal dysfunction. No mass or ascites.2. Echogenic kidneys consistent with medical renal disease/parenchymal dysfunction. No hydronephrosis.3. There is dirty shadowing arising from biliary system consistent with pneumobilia, which was also seen on prior CT.4. Surgical changes of a prior cholecystectomy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Assess right thigh hematoma History: S/P panniculectomy, on anti-coagulation w/ bleed, assess extent Within the superficial soft tissues of the right inguinal region, there is a multilobulated heterogeneous mass which lacks internal vascularity and which is compatible with reported history of hematoma measuring up to approximately 8 cm. There is increased echogenicity within the surrounding soft tissues. The associated vasculature is not assessed.", "output": "Complex mass within the right inguinal region compatible with hematoma measuring up to approximately 8 cm. Surrounding edema. Associated vasculature not assessed."}
{"instruction": "Generate impression based on findings.", "input": "68 years Male with history of chronic kidney disease now with worsening creatinine and shortness of breath. RIGHT KIDNEY: Kidney measures 10.3 cm in length. Increased parenchymal echogenicity is suggestive of medical renal disease/parenchymal dysfunction. No hydronephrosis or shadowing calculus. Multiple simple appearing cysts.LEFT KIDNEY: Kidney measures 10.6 cm in length. Increased parenchymal echogenicity is suggestive of medical renal disease/parenchymal dysfunction. No hydronephrosis or shadowing calculus. Multiple simple appearing cysts. Largest left renal cyst measures 3.8 x 3.2 x 3.9 cm, similar to prior.BLADDER: No significant abnormalities. OTHER: No ascites visualized.", "output": "1.Echogenic kidneys suggesting medical renal disease.2.No hydronephrosis.3.Multiple renal cysts which demonstrate simple appearance on this examination."}
{"instruction": "Generate impression based on findings.", "input": "Thyromegaly with thyroid nodules RIGHT LOBE MEASUREMENTS: 5.2 x 1.9 x 1.3 cmLEFT LOBE MEASUREMENTS: 6.9 x 3.4 x 4.2 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: 0.6 x 1 x 0.8 cm solid nodule within the midportion of the right thyroid gland. Multiple subcentimeter benign-appearing colloid cysts.LEFT LOBE: The left lobe of the thyroid isthmus was placed by multiple large predominantly solid nodules. The largest nodule measures 4.1 x 2.9 x 1.3 cm.ISTHMUS: Multiple subcentimeter benign-appearing colloid cysts.PARATHYROID GLANDS: 0.6 x 0.7 cm hypoechoic extrathyroidal focus projecting posterior to the inferior aspect of the right thyroid gland.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Left lobe of thyroid replaced by multiple large solid nodules. The largest of these nodules is amenable to ultrasound-guided percutaneous biopsy.1 cm solid right thyroid nodule.Hypoechoic extrathyroidal focus projecting posterior to the inferior margin of the right thyroid gland; this lesion is suggestive for a parathyroid adenoma. Would recommend correlation with PTH and calcium levels."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B LIVER: Coarse echogenic liver echotexture again noted without mass. Liver length 15.5 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 11.7 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 12.2 cm in lengthOTHER: Left kidney 11.5 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": "Ms. Tomasi is a 21 year old female presenting with a palpable abnormality in the right breast for the past one week. Upon physical exam at the palpable area of concern, a soft, mobile mass is appreciated in the right upper inner breast.A targeted right breast ultrasound was performed for the palpable area of concern. In the right breast two o'clock location (approximately 3 cm from the nipple), there is an ovoid, hypoechoic solid mass measuring 1.9 x 0.6 x 1.5 cm. There is minimal amount of associated vascularity.In addition, just adjacent to the solid mass is a small anechoic lesion measuring 0.7 cm, compatible with a simple cyst.", "output": "Sonographic findings likely represent a fibroadenoma. However, given the palpability, a surgical consultation is recommended at this time. All results and recommendations were relayed to the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Severe epigastric and right upper quadrant abdominal pain. LIVER: The liver is normal in morphology, echogenicity and size measuring 19 cm in craniocaudal dimension. No focal liver lesion or biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 0.23 m/s.BILIARY TRACT: Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid or focal tenderness. No intra or extrahepatic biliary ductal dilatation with the common duct measuring 2 mm.PANCREAS: The visualized portions of the pancreatic head and body are normal. The distal pancreatic body and tail are obscured by overlying bowel gas shadowing.SPLEEN: Splenomegaly measuring 16 cm in length without a focal lesion.RIGHT KIDNEY: The right kidney measures 9 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 10.7 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.", "output": "No specific findings to account for the patient's right upper quadrant and epigastric pain. Nonspecific splenomegaly measuring 16 cm without a focal lesion."}
{"instruction": "Generate impression based on findings.", "input": "Female 65 years old; Reason: s/p renal transplant 5-18-2000 History: proteinuria Ultrasound guidance and technical assistance provided for a right iliac fossa transplanted kidney biopsy by the nephrology service. 2 passes were reportedly performed. On the provided images, no peritransplant hematoma delineated.", "output": "Sonographic assistance provided for renal transplant biopsy by the clinical service."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female with history of Nissen fundoplication, now with right upper quadrant pain. LIVER: Normal in size and echotexture. There is at least one hepatic cyst measuring 1.6 cm in greatest diameter.BILIARY TRACT: Dependent sludge within the gallbladder without shadowing gallstone, wall thickening or pericholecystic fluid. Mild prominence of the extrahepatic biliary tract without intrahepatic dilatation, likely within normal limits for this patientPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: 1.6 cm rounded echogenic cortical mass in the right kidney corresponds to angiomyolipoma on recent CT. OTHER: No significant abnormalities noted.", "output": "Small amount of gallbladder sludge.Angiomyolipoma right kidney."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with prior thyroidectomy for thyroid cancer. Evaluate for recurrent disease. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: In the inferior right bed there is a masslike area although less echogenic than the focus identified on prior exams. This measures approximately 1 x 0.5 x 1.2 cm.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": "Less echogenic soft tissue focus in the right thyroidectomy bed when compared to prior study. If desired, this would be amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "History of abdominal pain and transaminitis, evaluate for cholecystitis. BILIARY TRACT: The gallbladder is mildly hydropic but lacks significant wall thickening or associated pericholecystic fluid. No gallstones identified. No biliary ductal dilatation. The common bile duct measures up to 5.5 mm in diameter. The sonographic Murphy's sign is negative.", "output": "Hydropic gallbladder. Given lack of associated inflammatory changes or cholelithiasis, acute cholecystitis is considered less likely."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old peripartum woman with clinical diagnosis of postpartum lactational mastitis without improvement on antibiotics presents for right and left breast abscess, aspiration requested by the clinical team. Aspiration of right breast abscess is performed. Aspiration of left breast abscess was performed before this procedure. ULTRASOUND", "output": "Successful ultrasound-guided aspiration of the right breast abscess. Obtained was 1 cc of blood-tinged pus which was sent to the lab for gram stain and culture as ordered by the clinical service.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Reason: known gallstone with intermittent abdominal pain LIVER: The liver measures 12.3 cm in length. Unremarkable hepatic parenchyma. The portal vein is patent with normal directional hepatopedal flow, peak velocity 19.7 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: There is a shadowing echogenic stone in the neck of the gallbladder without evidence of acute inflammation. No pericholecystic fluid or gallbladder wall thickening. The gallbladder wall measures 0.3 cm. The common bile duct measures 0.3 cm. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 9.3 cm in length. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.8 cm in length. No shadowing stones or hydronephrosis.OTHER: No ascites. The bladder is unremarkable and ureteral jets are visualized bilaterally. The spleen measures approximately 9 cm in length.", "output": "Cholelithiasis without evidence of acute inflammation or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid carcinoma status post resection RIGHT LOBE: Status post thyroidectomy without massLEFT LOBE: Status post thyroidectomy. Slightly smaller hypoechoic focus within the left thyroid bed measuring 0.4 x 0.4 x 0.2 cm.ISTHMUS: 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. Slight decrease in size of hypoechoic focus within the left thyroid bed. No new worrisome mass or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Hepatic transplant LIVER: Status post liver transplant. No mass lesion. Liver length 17.3 cm Limited Doppler interrogation of main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: Gallbladder absent. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma. Benign renal cyst unchanged. No worrisome mass, stone, or hydronephrosis. Right kidney 12.2 cm in length.OTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. 12.2 cm in length. Spleen 9.9 cm in length. No ascites.", "output": "Status post liver transplant without worrisome mass or ductal dilatation. No ascites. Echogenic renal parenchyma raises the possibility of medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Enlargement of left scrotum RIGHT TESTIS: 3.7 x 1.9 x 2.8 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristics.LEFT TESTIS: 4.4 x 2.2 x 3 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristicsRIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Large left hydrocele. Benign left scrotal pearl.", "output": "No intratesticular mass. Bilaterally symmetric Doppler flow characteristics. Large left hydrocele. Benign left scrotal pearl."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old female with hot thyroid nodule on PET scan. RIGHT LOBE MEASUREMENTS: 3.7 x 1.6 x 1.6 cmLEFT LOBE MEASUREMENTS: 4 x 1.4 x 1.4 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Heterogeneous in echotexture. Heterogeneous iso to mildly hyperechoic nodule in the upper pole of the right lobe measuring 1.0 x 1.3 x 1.9 cm. Solid and lobulated hypoechoic nodule in the lower pole measuring 0.6 x 0.7 x 0.6 cm.LEFT LOBE: Heterogeneous in echotexture. No defined mass.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "2 solid right thyroid nodules which are nonspecific. This smaller, quite hypoechoic nodule has a more worrisome configuration."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old female with right thyroid mass on prior CT RIGHT LOBE MEASUREMENTS: 6.1 x 1.5 x 1.5 cmLEFT LOBE MEASUREMENTS: 5.8 x 1.2 x 1.2 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: In the midportion of the right lobe is a complex solid nodule with cystic components measuring approximately 2.1 x 2.0 x 2.1 cm. This has a complete hypoechoic halo. Small cyst is present in the right lobe.LEFT LOBE: Small cyst identified.ISTHMUS: In the isthmus there is a spongiform-appearing nodule measuring 0.4 x 0.7 x 0.6 cmPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Dominant right lobe nodule which has a non--- specific appearance. Other, smaller nodules appear benign."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female with thyromegaly. RIGHT LOBE MEASUREMENTS: 8.6 x 3.5 x 4 cmLEFT LOBE MEASUREMENTS: 9.8 x 3.2 x 3.6 cmISTHMUS MEASUREMENTS: 1.6 cmRIGHT LOBE: Mildly heterogeneous. There is a discrete ovoid homogeneously hypoechoic nodule which is solid measuring 0.8 x 1.3 x 1.1 cm. There are several other very small hypoechoic nodules as well as.LEFT LOBE: Mildly heterogeneous. No measurable nodule identified.ISTHMUS: Mildly heterogeneous. No measurable nodule identified.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffuse thyromegaly with nondescript right thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "24-year-old female with history of palpable right periareolar lump for 2 1/2 months, with no significant change. Patient reporting history of mild trauma to the right breast. On the physical exam, there is a 1cm mobile area of induration in the right upper outer periareolar breast.A targeted right ultrasound was performed for the patient\u2019s area of concern, revealing a 0.9 x 0.4 x 0.7 cm echogenic superficial avascular mass compatible with fat necrosis. A second adjacent similar smaller mass measuring 0.6 x 0.3 x 0.3 cm is also identified", "output": "Right periareolar palpable subcentimeter masses compatible with fat necrosis. No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Molloy is a 26 year old female presenting for a short term 6 month follow-up for a probable intramammary lymph node in the left breast. Upon physical exam at the patient's area of concern, a soft mobile mass is appreciated.In the left breast 4:00 location, approximately 1 cm from the nipple, there is an oval hypoechoic lesion with central fatty hilum measuring 0.5 x 0.4 cm. This appears similar in size and appearance when compared to the prior ultrasound examination and is compatible with a benign intramammary lymph node. No suspicious cystic or solid mass is identified.", "output": "Benign intramammary lymph node in the left breast. No sonographic evidence of malignancy. No additional imaging workup is necessary this time.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter RIGHT LOBE MEASUREMENTS: 8.6 x 4.1 x 4.6 cmLEFT LOBE MEASUREMENTS: 6.8 x 3.6 x 2.1 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: No change in diffuse multinodular gland without discrete measurable nodule.LEFT LOBE: No change in diffuse multinodular gland without discrete measurable nodule.ISTHMUS: No change in diffuse multinodular gland without discrete measurable nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable multinodular goiter without worrisome mass or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old female with history of gallstones and worsening right upper quadrant pain. LIVER: Limited evaluation of the liver demonstrates no gross abnormality.GALLBLADDER, BILIARY TRACT: Gallbladder is again noted to contain multiple, dependent gallstones as as well as a nondependent somewhat echogenic focus in the anterior wall which could represent a polyp or nonshadowing, adherent gallstone. This measures 0.4 cm in maximum diameter. Gallbladder wall is not thickened and no pericholecystic fluid is identified. The biliary tract is normal in caliber.PANCREAS: Not evaluatedRIGHT KIDNEY: Limited views demonstrate no gross abnormalityOTHER: No significant abnormalities noted.", "output": "Gallstones without obvious complication. No change from prior exam."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with renal failure. Proteinuria with lupus. Ultrasound guidance was provided for biopsy of native right kidney.", "output": "Ultrasound guidance"}
{"instruction": "Generate impression based on findings.", "input": "75-year-old female complains of right upper quadrant pain. Evaluate for hepatobiliary pathology. LIVER:Measures 15.4 cm. Mildly heterogenous parenchyma. No focal mass, ascites, or intrahepatic biliary dilation. Portal vein is patent with hepatopedal flow. An approximately 0.5 x 1.6 x 1.0 cm well-defined hypoechoic area adjacent to the liver likely represents a lymph node.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. Wall measures 0.3 cm. There are multiple dependent echogenic foci within the lumen, consistent with cholelithiasis. No pericholecystic fluid. Equivocal sonographic Murphy's sign. Common bile duct measures 10.0 cm.PANCREAS: Evaluation the pancreas limited due to overlying bowel gas.SPLEEN: Measures 9.4 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 10.7 cm. Left kidney measures 10.2 cm. Unremarkable echogenicity. No focal mass, hydronephrosis, or shadowing calculi. OTHER: No significant abnormality noted.", "output": "1. Cholelithiasis with equivocal Murphy's sign. Consider HIDA scan.2. Heterogenous echotexture of liver parenchyma consistent with chronic liver disease and fatty infiltration/parenchymal dysfunction. No focal mass or ascites."}
{"instruction": "Generate impression based on findings.", "input": "Right groin lymphadenopathy Lobules of normal-appearing fat are noted in the region of the patient's palpable abnormality. No abnormal vascularity is noted in this area. No soft tissue mass or lymph node is identified.", "output": "Normal subcutaneous fat. No soft tissue mass or lymphadenopathy identified."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female with hypothyroidism and history of abnormal thyroid imaging. RIGHT LOBE MEASUREMENTS: 6.3 x 2.8 x 2.2 cmLEFT LOBE MEASUREMENTS: 5.3 x 2.2 x 1.5 cmISTHMUS MEASUREMENTS: 0.7 cm minimally heterogeneous in echotexture. At the junction of the right lobe and isthmus there is a rounded almost isoechoic mass which is slightly heterogeneous in echotexture measuring 1.6 x 1.8 x 1.7 cm.RIGHT LOBE: Mildly heterogeneous in echotexture. Mass as noted above.LEFT LOBE: Mildly heterogeneous in echotexture. No focal mass. There is a solitary, dense 4 mm calcification in the upper pole of the left lobe medially without a defined, associated mass.ISTHMUS: Mildly heterogeneous in echotexture. Mass as noted above.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Enlarged gland with likely focal nodule at the junction of right lobe and isthmus.Solitary, coarse left lobe calcification without associated mass."}
{"instruction": "Generate impression based on findings.", "input": "Alcoholic cirrhosis LIVER: Cirrhotic morphology without mass. Liver length 13 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without ductal dilatation or acute inflammationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 8.3 centimeters in lengthOTHER: Left kidney 8.5 cm in length. Spleen 9.2 cm in length. No ascites.", "output": "Cirrhotic morphology without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Reason: pre-total pancreatectomy with autologous islet cell transplant due to chronic pancreatitis. Please evaluate abdominal organs and doppler portal vein of the liver to r/o clots and portal vein hypertension. LIVER: The liver measures at least 16 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 0.27 m/s. The right and left portal veins also appear patent.BILIARY TRACT: Gallbladder surgically absent. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4 mm in diameter.PANCREAS: Decreased echogenicity within the visualized portions of the pancreas nonspecific but may be related to chronic pancreatitis.SPLEEN: The measures 12.3 cm in length. RIGHT KIDNEY: Kidney measures 10.4 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": "Normal hepatic parenchyma without mass or duct dilatation. Patent portal vein with normal directional flow. "}
{"instruction": "Generate impression based on findings.", "input": "History breast cancer with thyroid nodules on outside scan RIGHT LOBE MEASUREMENTS: 6.6 x 1.1 x 1.9 cmLEFT LOBE MEASUREMENTS: 5.8 x 1.1 x 1.3 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Diffusely heterogeneous gland with reticular background associated with increased vascularity. No discrete noduleLEFT LOBE: Diffusely heterogeneous gland with reticular background associated with increased vascularity. No discrete nodule.ISTHMUS: Diffusely heterogeneous gland with reticular background associated with increased vascularity. No discrete nodulePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland with reticular background associated with increased vascularity suggestive for acute on chronic thyroiditis. No nodule. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate TIPS patency. LIMITED ABDOMENLIVER: Cirrhotic morphology again noted without mass. Liver length 10.4 cm BILIARY TRACT: Status post cystectomy. No ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 14.7 cm in length RIGHT KIDNEY: No significant abnormalities noted. 10.5 cm in lengthOTHER: Left kidney 11.9 cm in length. No ascites.", "output": "Patent TIPS catheter. Expected hepatofugal flow undivided left portal vein. No ascites.Cirrhotic liver without mass."}
{"instruction": "Generate impression based on findings.", "input": "Female 70 years old Reason: re-eval thyroid nodules RIGHT LOBE MEASUREMENTS: 5.8 x 2.3 x 2.3 cm.LEFT LOBE MEASUREMENTS: 4.2 x 1.7 x 2.0 cm.ISTHMUS MEASUREMENTS: 0.4 cm.RIGHT LOBE: Multinodular and mildly heterogeneous thyroid. Heterogeneous nodule in the right inferior thyroid measures 1.9 x 1.1 x 1.4 cm, not significantly changed.LEFT LOBE: Multinodular mildly heterogeneous thyroid. Ovoid, spongiform nodule in the inferior left thyroid measures 1.1 x 0.9 x 0.8 cm, not significantly changed.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable thyroid nodules as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "Worsening graft function and ultrasound guidance for transplant biopsy Ultrasound guidance was provided for transplant kidney biopsy. Transplant kidney was in the right iliac fossa and 2 passes were made", "output": "Guidance for kidney transplant biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine and oliguria RIGHT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 13.4 cm in lengthLEFT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 14.5 cm in length.OTHER: Bladder nondistended", "output": "Mildly echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with chronic kidney disease. RIGHT KIDNEY: Left kidney measures approximately 9.5 cm in length and is highly echogenic consistent with parenchymal disease. There is no hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 10.3 cm in length and is highly echogenic consistent with parenchymal disease. There is no hydronephrosis, shadowing calculus or mass.OTHER: Bladder incompletely distended", "output": "Echogenic kidneys without significant change."}
{"instruction": "Generate impression based on findings.", "input": "Elevated liver enzymes LIVER: Stable cirrhotic morphology without mass. Liver length 16.2 cm. Limited evaluation of the main portal vein demonstrates a patent portal vein with normal directional flow. Main portal vein velocity 34 cm/s.GALLBLADDER, BILIARY TRACT: Mild gallbladder wall thickening unchanged. Gallbladder sludge without acute inflammation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.5 cm in length. OTHER: Left kidney 10.2 cm in length. Mild ascites.", "output": "Stable cirrhotic morphology without mass or ductal dilatation. Main portal vein patent with normal directional flow. Mild ascites."}
{"instruction": "Generate impression based on findings.", "input": "22-year-old female patient with thyroid cancer status post surgery and I-131 with palpable left supraclavicular node. Question of abnormal masses, nodes. Patient reports currently having a cold. RIGHT LOBE: Status post thyroidectomy without residual or recurrent tissue identified.LEFT LOBE: Status post thyroidectomy without residual or recurrent tissue identified.ISTHMUS: Status post thyroidectomy without residual or recurrent tissue identified.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is a right level three nondescript lymph node measuring 1.0 x 0.7 x 0.3 cm. An additional nondescript left level three lymph node measures 1.0 x 0.4 x 2.5 cm. A benign morphology lymph node in the left supraclavicular region measures 0.7 x 0.3 x 1.4 cm.OTHER: No significant abnormality noted.", "output": "1. Status post thyroidectomy without residual or recurrent tissue identified in the thyroid bed.2. Non-descript borderline enlarged bilateral level III lymph nodes; these may be reactive in etiology, however, should be followed. "}
{"instruction": "Generate impression based on findings.", "input": "40 year old female with history of cervical cancer. Elevated creatinine and history of hydronephrosis. RIGHT KIDNEY: The right kidney measures 14.5 cm in length. There is moderate hydronephrosis, increased from the prior studies. No shadowing calculus or discrete lesion is evident. Color Doppler demonstrates hilar blood flow.LEFT KIDNEY: The left kidney measures 14.4 cm in length with minimal collecting system prominence, similar to the prior study. Color Doppler demonstrates hilar blood flow. No focal lesion or shadowing calculus is identified.URINARY BLADDER: The urinary bladder is partially distended. No ureteral jets are visualized.OTHER: No significant abnormalities noted.", "output": "Moderate right hydronephrosis has slightly progressed and minimal left collecting system prominence is similar to the prior study.These findings were relayed to the ordering service (Dr. Hassenfritz) at 1010 on 01/07/2015."}
{"instruction": "Generate impression based on findings.", "input": "Female 58 years old Reason: evaluating for ascites History: weight gain in cirrhosis patient, also abdominal distention and DOE Four quadrant ultrasound demonstrates no evidence of ascites.", "output": "No evidence of ascites."}
{"instruction": "Generate impression based on findings.", "input": "Bilateral testicular pain RIGHT TESTIS: 4.5 x 2.5 x 3.0 cm. Normal parenchymal echotexture and vascularity.LEFT TESTIS: 4.5 x 2.3 x 3.2 cm. Normal parenchymal echotexture and vascularity.RIGHT EPIDIDYMIS: 6 mm epididymal cyst noted. No significant abnormalities noted.LEFT EPIDIDYMIS: 6 mm epididymal cyst noted. No significant abnormalities noted.OTHER: No significant abnormalities noted. No evidence of hydrocele or varicocele.DOPPLER", "output": "No evidence of testicular torsion. No specific findings to account for the patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "22-year-old with history of palpable area of concern in the right breast. The patient presented for ultrasound 6 months ago and findings at that time were compatible with a prominent fat lobule versus fibroadenoma. A targeted right ultrasound was performed for the palpable area of concern. There is no suspicious solid or cystic mass identified. A mixed echogenicity area in the right breast 5 o'clock position measures 1.7 x 0.9 cm. On these images, it is more compatible with a prominent fat lobule rather than a fibroadenoma.", "output": "Finding at the site of palpable concern is probably a prominent fat lobule. The patient will follow-up with Dr. Jaskowiak today. As long as physical exam findings are not concerning, routine clinical follow-up would be recommended thereafter until she begins normal screening mammography.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Persistent primary hyperparathyroidism RIGHT LOBE MEASUREMENTS: 5 x 1.3 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.1 x 0.7 x 1.7 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Stable subcentimeter mixed cystic and solid nodules. Reference inferior nodule measures 0.6 x 0.4 x 0.7 cm.LEFT LOBE: Stable subcentimeter mixed cystic and solid nodules. Reference midpole nodule measures 0.4 x 0.4 x 0.5 cm.ISTHMUS: Stable isthmic hypoechoic solid nodule measuring 1.1 x 0.4 x 0.9 cm.PARATHYROID GLANDS: 0.5 x 0.4 x 0.4 hypoechoic possibly extrathyroidal nodule projecting posterior to the midportion of the left thyroid gland.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Hypoechoic subcentimeter focus projecting posterior to the midportion of the left thyroid gland. While this may represent a peripheral intrathyroidal nodule, it may alternatively represent an extrathyroidal focus and potential parathyroid adenoma candidate. Would recommend correlation with nuclear medicine study performed later this day.Stable subcentimeter bilateral thyroid nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Status post mastectomy of the right breast and implant placement. Small palpable area of concern noted by patient and physician. A targeted right ultrasound was performed for the patient\u2019s area of concern. There is no solid or cystic mass identified. There is a slight contour irregularity along the implant in this region. However, there is no suspicious cystic or solid mass or evidence of a lymph node at the site marked by the clinical service.", "output": "No sonographic evidence for malignancy. Clinical follow-up is recommended for this finding.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Female 63 years old; Reason: 63 yo female with proteinuria, needs US guidance for renal bx History: proteinuria Ultrasound guidance for biopsy of the right kidney. 2 passes were made.", "output": "1.Ultrasound guidance for biopsy of the right kidney as above."}
{"instruction": "Generate impression based on findings.", "input": "Male 56 years old; Reason: eval for hcc History: hbc LIVER: The liver measures 15.9 cm in length. There is coarse echogenicity of the liver parenchyma. A 1.0 x 0.6 x 0.5 round well-defined hyperechoic lesion is noted in the liver that was noted on prior examination and appears unchanged and is consistent with a hepatic hemangioma. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 18.4 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 3.2 mm. No stones are seen. No pericholecystic fluid. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 11.9 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.4 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.9 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 liver disease/parenchymal dysfunction. Again seen is a hyperechoic lesion in the liver that appears unchanged c/w a hepatic hemangioma. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B LIVER: Unremarkable echogenicity without mass. Liver length 15.3 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9.6 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.7 cm in lengthOTHER: Left kidney 10 cm in length. No ascites.", "output": "Unremarkable liver without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Ms. McCauley is a 52 year old female with known left breast cancer. Dr. Jaskowiak palpated a left axillary lymph node. She presents today for ultrasound evaluation of this area. Targeted left axillary ultrasound was performed. In the left axilla, there is an enlarged lymph node identified, measuring 1.7 x 0.8. In addition, there is abnormal non-hilar vascular flow seen in this lymph node.", "output": "Abnormal left axillary lymph node. An US-guided biopsy with clip placement should be performed for further evaluation. All results and recommendations were relayed to Dr. Jaskowiak and the patient. The patient will undergo an US-guided biopsy of this abnormal left axillary lymph node later today. She does not take any blood thinning medications.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old male with history of thyroid nodule. Reevaluate. RIGHT LOBE MEASUREMENTS: 6.3 x 2.3 x 1.7 cm.LEFT LOBE MEASUREMENTS: 6.3 x 2.2 x 2.0 cm.ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: Normal homogeneous thyroid echotexture. No focal lesion, calcification, or hypervascularity.LEFT LOBE: Normal homogeneous thyroid echotexture. No focal lesion, calcification, or hypervascularity.ISTHMUS: 0.5 x 0.4 x0.9 cm hypoechoic isthmus nodule is again noted, not significantly changed in size. New punctate shadowing calcific focus. No hypervascularity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Hypoechoic isthmus nodule not significantly changed in size, but with newly seen calcification. Continued follow-up is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Elevated bilirubin, alk phos, and ascites. LIVER: Nodular liver contour suggestive of chronic liver disease, with 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 11.4 cm in length. The left kidney is 11.8 cm in length. The parenchymal echogenicity is increased. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9.0 cm in length, without focal lesions evident.OTHER: Small amount of ascites noted. Small right pleural effusion identified.", "output": "1. Nodular liver morphology suggestive of chronic liver disease. Small amount of ascites. 2. Mildly increased renal parenchymal echogenicity, suggestive of medical renal disease. 3. Small right pleural effusion. Please see the separate report for the recent CT Chest for further evaluation of the thorax."}
{"instruction": "Generate impression based on findings.", "input": "Transaminitis and setting of workup for heart transplant LIVER:Liver measures 16.3 cm with mild coarse echotexture. No focal lesions noted.Portal vein demonstrates normal flow directionality and patency.GALLBLADDER, BILIARY TRACT: Wasn't distended gallbladder without any gallstones or pericholecystic fluid or gallbladder wall thickening.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. Spleen measures 12.5 cm.KIDNEYS: Right kidney measures 10.7 cm and left measures 11.3 cm. No hydronephrosis or focal lesion within the kidneys. Normal echotexture of the kidneys noted. ABDOMINAL AORTA: Balloon pump noted in the proximal and mid aorta. Mid aorta measures 1.9 x 1.8 cm. Distal aorta measures 2 x 2 cm. No evidence of aneurysmal dilatation or atherosclerotic plaques.INFERIOR VENA CAVA: PatentOTHER: Partially distended bladder.", "output": "Mild coarse echotexture of the liver probably related to parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Female 58 years old; Reason: 57 yo woth HBV please screen for HCC History: none LIVER: The liver measures 20.2 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 18.5 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 0.9 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 5.7 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 8.9 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.3 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. A simple renal cyst is seen measuring 1.1 cm x 1.1 cm x 0.8 cm.OTHER: No ascites is seen.", "output": "Hepatomegaly. A coarse echogenic liver is again seen, compatible with fatty infiltration/hepatocellular dysfunction. No new worrisome masses or ascites."}
{"instruction": "Generate impression based on findings.", "input": "Increasing LFTs with right upper quadrant pain LIVER: Coarse echogenic liver parenchyma again noted without mass. Liver length 17.1 cm.GALLBLADDER, BILIARY TRACT: Gallbladder is collapsed. Gallbladder wall thickening again noted without pericholecystic fluid. Questionable punctate cholelithiasis again noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic renal parenchyma with without mass, stone, or hydronephrosis. Right kidney 11 cm in lengthOTHER: Echogenic left renal parenchyma without hydronephrosis. Left kidney 10.9 cm in length. Spleen 14.8 cm in length.", "output": "Coarse echogenic liver again noted consistent with parenchymal dysfunction without mass or ductal dilatation. Gallbladder wall thickening again noted without pericholecystic fluid. However, the gallbladder is collapsed and therefore this diffuse wall thickening is best considered nonspecific. Questionable punctate cholelithiasis.Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Female 38 years old; enlarged thyroid gland on exam RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 5.2 x 1.6 x 1.7 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 5.0 x 1.9 x 1.9 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.8 cm.RIGHT LOBE: The right lobe is heterogeneous with a reticular pattern seen throughout. No dominant nodules are identified.LEFT LOBE: The left lobe is heterogeneous with a reticular pattern seen throughout. No dominant nodules identified.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted. OTHER: Inferior and posterior to the left thyroid lobe there are two round extrathyroidal hypoechogenic foci, the superior one measuring measuring 1.3 cm x 0.8 cm x 1.1 cm at the inferior foci measuring 1.0 cm x 0.9 cm x 0.6 cm.", "output": "1.The thyroid gland demonstrates a heterogeneous reticular pattern compatible with chronic thyroiditis. No dominant nodules or suspicious adenopathy are identified.2.Inferior/posterior to the left thyroid lobe, two extrathyroidal hypoechogenic foci are seen which may represent parathyroid adenomas or possibly reactive lymph nodes. Correlate with calcium and PTH levels. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: History of hepatitis C, assess for cirrhosis LIVER: Echogenic liver and coarse echotexture may reflect parenchymal dysfunction/hepatic steatosis. Small volume of ascites. The portal vein is patent. Normal portal venous hepatopedal blood flow, 22.8 cm/s. The liver measures 16.3 cm in length.BILIARY TRACT: No significant abnormalities noted. No intrahepatic or extrahepatic biliary ductal dilatation. No stones or intraluminal sludge. The gallbladder is contracted, limiting evaluation of wall thickness. The common hepatic duct measures 4 mm.PANCREAS: Obscured by bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.9 cm in length. Small 1.1 x 7 cm anechoic cyst. No hydronephrosis.LEFT KIDNEY: The left kidney measures 10.9 cm in length. No hydronephrosis. OTHER: No significant abnormalities noted.", "output": "Echogenic liver may reflect parenchymal dysfunction/hepatic steatosis. Small volume ascites."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old male patient with cirrhosis. Evaluate for HCC and TIPS patency. LIMITED ABDOMENLIVER: The liver measures 14.4 cm in length and demonstrates increased, coarsened echogenicity. There is a new 2.4 x 2.2 x 2.5 cm hyperechoic lesion within the right hepatic lobe without significant vascularity on color Doppler imaging.BILIARY TRACT: The gallbladder contains scattered subcentimeter hyperechoic foci which may represent gallbladder polyps versus nonshadowing stones. There is no 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 proximal body of the pancreas demonstrate normal echogenicity. The remaining pancreas is visualized secondary to overlying bowel gas.SPLEEN: The spleen measures 20.5 cm in length. RIGHT KIDNEY: The right kidney measures 11.5 cm in length and contains a 1.3 cm inferior pole renal cyst. There is no evidence of hydronephrosis.OTHER: The left kidney measures 14.1 cm in length. No evidence of hydronephrosis.", "output": "1. Cirrhotic morphology of the liver with a new hyperechoic right hepatic lobe lesion; dedicated MRI of the liver is recommended for further evaluation.2. Patent TIPS and hepatic vasculature.3. Splenomegaly.4. Subcentimeter non-shadowing echogenic foci within the gallbladder may represent polyps vs non-shadowing stones.Finding 1. Communicated via phone to G. Reddy at 1358 hrs on 11/4/2015."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess for liver lesions History: HCV and mild cirrhosis LIVER: The liver measures 13.3 cm in length and is mildly 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 0.17 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 3 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 7.1 cm in length. RIGHT KIDNEY: Kidney measures 9.4 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.5 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No ascites.", "output": "Mildly cirrhotic liver morphology without suspicious focal lesions identified. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old female status post BMT, worsening bilirubin, jaundice. Evaluate for VOD versus obstruction. LIMITED ABDOMENLIVER: Enlarged measuring 21.0 cm in length and is heterogeneous in echotexture. No focal hepatic lesions. BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic 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 visualized portions are unremarkable. SPLEEN: Spleen is enlarged measuring 16.2 cm in length.  RIGHT KIDNEY: Measures 12.1 cm in length and is normal in echogenicity. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 12.6 cm in length and is normal in echogenicity. No hydronephrosis or shadowing calculi are noted.Abdominal ascites.Incompletely visualized bilateral pleural effusions.", "output": "1. Hepatosplenomegaly with heterogeneous echotexture of the liver suggestive of parenchymal dysfunction/infiltration. Patent inflow and outflow hepatic vasculature.2. Abdominal ascites and bilateral pleural effusions. "}
{"instruction": "Generate impression based on findings.", "input": "Follow-up thyroid nodules RIGHT LOBE MEASUREMENTS: 5.2 x 1.9 x 1.3 cmLEFT LOBE MEASUREMENTS: 4.3 x 1.6 x 1.1 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: No significant change in right upper lobe 2.1 x 0.7 x 1.2 cm predominantly cystic nodule with mild peripheral nodularity.LEFT LOBE: Stable subcentimeter hypoechoic upper pole nodule measuring 0.3 x 0.1 x 0.2 cmISTHMUS: No significant abnormality noted.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": "46-year-old female patient with history of gallbladder attack and nausea/vomiting. Evaluate for abnormality. LIVER: The liver measures 16.4 cm in length. Hepatic parenchymal echogenicity is increased. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There are numerous shadowing gallstones without pericholecystic fluid or gallbladder wall thickening. Sonographic Murphy's sign is negative. 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 10.3 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 8.5 cm in length. No evidence of hydronephrosis.The spleen measures 9.1 cm in length.", "output": "1. Cholithiasis without sonographic evidence of acute cholecystitis.2. Hepatic steatosis. "}
{"instruction": "Generate impression based on findings.", "input": "Male 64 years old Reason: Evaluate chronic elevated transaminases r/o fatty liver vs cirrhosis History: Chronic elevated transaminases LIVER: Liver measures 13.4 cm. Normal echogenicity. No focal liver lesions.BILIARY TRACT: Cholelithiasis without sonographic evidence of cholecystitis. There is mild gallbladder wall thickening likely secondary to chronic changes. No evidence of intra or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 8.9 cm.RIGHT KIDNEY: Bilateral echogenic kidneys. Right kidney measures 6.3 cm. No evidence of hydronephrosis. OTHER: No significant abnormalities noted.", "output": "Cholelithiasis. Slight atrophic and echogenic right kidney."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old female for follow-up thyroid nodule. RIGHT LOBE MEASUREMENTS: 4.3 x 1.6 x 1.2 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.5 x 1 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Again noted in the right lobe is a mildly heterogeneous solid nodule with internal cystic components. There are internal bright reflectors some of which are clearly comet tail artifacts consistent with colloid. The mass is not significantly changed when compared to the prior study measuring 2.1 x 2.2 x 2.8 cm.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 lobe nodule. No adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old male with multiple myeloma and right upper quadrant pain. The examination is, however, unfortunately limited due to patient's inability to turn. In addition, patient would not allow completion of exam of the left abdomen.LIVER: Liver parenchyma is mildly echogenic. This is nonspecific and does not appear likely to be due to fatty infiltration given no evidence of fatty infiltration on PET scan/CT from 4/22/2016 there is no focal hepatic abnormality.GALLBLADDER, BILIARY TRACT: No gallstones are identified. There is a trace of pericholecystic fluid. There is mild, asymmetric wall thickening involving the gallbladder with an appearance suggestive of adenomyosis. There is not diffuse gallbladder wall thickening. Patient was not tender over the gallbladder. The visualized biliary tract is normal in caliber.PANCREAS: The head and body are normal. The tail was not well seen.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Limited examination with trace of pericholecystic fluid without gross gallstones. Possible adenomyosis of the gallbladder.. Findings are felt unlikely to be due to acute cholecystitis.Mildly echogenic liver."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female recalled from screening for further evaluation of asymmetries bilaterally. No current breast complaints. LEFT BREAST DIGITAL DIAGNOSTIC MAMMOGRAPHY: Three standard 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. The focal asymmetry in the right outer retroareolar region disperses into normal breast parenchyma on spot compression. The asymmetry in the left upper inner and left lower inner breast persists with spot compression.TARGETED LEFT BREAST ULTRASOUND: There is no evidence of a cystic or solid mass in the left upper inner or left lower inner breast.", "output": "High probability benign asymmetric glandular tissue in the left breast. No mammographic evidence of malignancy. Comparison to previous mammograms from outside institution would be helpful in determining stability. If the patient cannot obtain prior mammograms for comparison and as long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended in 6 months. Results and recommendation 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": "47-year-old male patient with elevated LFTs. LIVER: The liver measures 18.3 cm in length. No focal hepatic lesion is identified. Hepatic parenchymal echogenicity is slightly increased. No focal 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 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 10.9 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.6 cm in length. No evidence of hydronephrosis.The spleen measures 10.1 cm in length.", "output": "Increased hepatic echogenicity which can be seen with hepatic steatosis/hepatic parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIMITED ABDOMENLIVER: Coarse echogenic liver echotexture without mass. Liver length 14.4 cm.BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation.OTHER: Spleen 7.6 cm in length. Right kidney 11 cm in length. Left kidney 10 cm in length.", "output": "Coarse echogenic liver echotexture suggestive for parenchymal dysfunction/chronic liver disease without mass or ductal dilatation. Gallbladder sludge without acute inflammation.Patent hepatic vessels with normal directional flow."}
{"instruction": "Generate impression based on findings.", "input": "34-year-old male with a history of hepatitis B and a gallbladder polyp. Presents for HCC screening. LIVER: The liver is normal in morphology, echogenicity and size, measuring 16.2 cm in length. No discrete lesion is identified. No intrahepatic biliary ductal dilatation. Normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: A normally distended and folded over gallbladder is present. Noted again is a mildly echogenic, non-shadowing nondependent focus measuring 4 x 3 x 4 mm along the gallbladder wall, compatible with a polyp, not significantly changed in size accounting for differences in technique.No diffuse wall thickening, pericholecystic fluid, or focal tenderness.No extrahepatic biliary ductal dilatation.PANCREAS: The visualized portions of the pancreatic body and head are unremarkable.SPLEEN: The spleen is normal in morphology, echogenicity, and size, measuring 10.1 cm in length.RIGHT KIDNEY: The right kidney measures 10.4 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 11 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow.", "output": "No focal hepatic lesion. Stable subcentimeter gallbladder polyp."}
{"instruction": "Generate impression based on findings.", "input": "Right upper abdominal quadrant pain LIVER: Non-cirrhotic liver morphology. 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 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 11.4 cm in length. The left kidney is 10.6 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 10.7 cm in length, without focal lesions evident.", "output": "Increased hepatic parenchymal echogenicity suggestive of steatosis. No specific findings otherwise to account for the patient's right upper quadrant abdominal pain."}
{"instruction": "Generate impression based on findings.", "input": "Female 55 years old Reason: assess for biliary duct pathology, assess liver morphology LIVER: Mildly increased echogenicity of the liver, which is nonspecific and may be secondary to hepatic dysfunction. No focal hepatic lesion. Liver measures 14.1 cm in length. BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Sludge is present in the gallbladder. No gallbladder wall thickening. Negative Murphy's sign.PANCREAS: Pancreas not well-visualized secondary to overlying bowel gas.SPLEEN: Spleen is difficult to visualize but measures 10.8 cm in length.KIDNEYS: Right native kidney measures 5.9 cm. Left native kidney measures 4.7 cm. Both native kidneys are atrophic. Left lower quadrant renal transplant is visualized, normal in echotexture, with a mildly prominent collecting system.OTHER: Trace free fluid.", "output": "1.No intra or extrahepatic biliary ductal dilatation. 2.Mild prominence of renal collecting system of the transplanted kidney."}
{"instruction": "Generate impression based on findings.", "input": "Female, 48 years old. Acute renal failure. Rule out obstruction. RIGHT KIDNEY: The right kidney measures 13.6 cm in length with mildly increased cortical echogenicity. No focal lesion or hydronephrosis.LEFT KIDNEY: The left kidney measures 13.1 cm in length with mildly increased cortical echogenicity. No focal lesion or hydronephrosis.OTHER: The bladder is decompressed.", "output": "Increased renal cortical echogenicity compatible with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "51 years old, Male, Reason: recurrent pancreatitis eval for gallstones History: pancreatitis LIVER: The liver measures 16.8 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 0.4 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The patient had a lot of epigastric pain during the exam. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct is dilated measuring 8 mm in diameter.PANCREAS: No identified focal mass within the pancreas. The pancreas appears mildly edematous. Ultrasound is insensitive for specific findings of pancreatitis.SPLEEN: No significant abnormalities noted. The spleen measures 7.6 cm in length. RIGHT KIDNEY: Kidney measures 11.7 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.1 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.No evidence of cholelithiasis, choledocholithiasis, or cholecystitis.2.No evidence of pancreatic mass."}
{"instruction": "Generate impression based on findings.", "input": "Ms Lear is a 45-year-old female with a personal history of left breast cyst aspirated in 2006, dense breasts, and apparently enlarged left axillary lymph node noted on recent whole breast ultrasound. Patient presenting for further sonographic evaluation of the left axilla. No palpable abnormality. A targeted left axillary ultrasound was performed. A total of three normal lymph nodes with normal morphology and hilar vascularity were identified in the left axilla. No abnormal axillary lymph nodes are identified.", "output": "No abnormal axillary lymph nodes identified by ultrasound. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually, due next in July 2017."}
{"instruction": "Generate impression based on findings.", "input": "84 year old male with hyperbilirubinemia. The study was very limited as the patient did not want to lie flat and resisted the exam.LIVER: The liver is normal in morphology, echogenicity and size, measuring 13.2 cm in craniocaudal dimension. No intrahepatic biliary ductal dilatation or focal hepatic lesion is identified. There is normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: A normally distended gallbladder is present with sludge but no wall thickening, pericholecystic fluid, or focal tenderness. The common duct measures 3 mm in caliber at the hilum, within normal limits.PANCREAS: The visualized portions of the pancreatic head and body are unremarkable.SPLEEN: The spleen is poorly visualized.RIGHT KIDNEY: The right kidney measures 9.3 cm in length without hydronephrosis or shadowing calculus.OTHER: The left kidney is poorly visualized. Note is made of a moderate right pleural effusion.", "output": "1. Limited examination as described above without biliary ductal dilatation. 2. Biliary sludge without specific evidence of acute cholecystitis.3. At least moderate right pleural effusion.4. No right hydronephrosis. Non-visualized left kidney."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury RIGHT KIDNEY: 10.2 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 11.8 cm in length. 1.6 cm benign-appearing cyst in the midpole. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury RIGHT KIDNEY: 11.1 cm in length. Mild hydronephrosis, with stent in place. No suspicious lesions are evident. LEFT KIDNEY: 10.3 cm in length. Mild hydronephrosis. The stent is not clearly visualized, likely due to technical factors. No suspicious lesions are evident. BLADDER: CollapsedOTHER: No significant abnormality noted.", "output": "Mild hydronephrosis bilaterally."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old male with history of multiple myeloma/plasmacytoma with abnormal liver function. Sepsis. Exam is somewhat limited by inability to turn the patient.LIVER: Coarsely echogenic without focal abnormality. Gross hepatomegaly. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Likely small polyp in the gallbladder. No gross, shadowing gallstones, wall thickening or pericholecystic fluid. The patient could not, however, be turned into Hgb disposition. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: Bilateral pleural effusions.", "output": "Echogenic, enlarged liver.Normal biliary tract on limited exam with small gallbladder polyp.Bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Parker is a 17 year old female presenting with a nontender palpable lump in the left breast x1 month. Targeted left breast ultrasound was performed for the patient's area of concern.In the left breast 4:00 location, approximately 3 cm from the nipple, there is a macrolobulated hypoechoic mass identified measuring 2.9 x 1.7 x 2.6 cm. Moderate associated vascularity is present.", "output": "High probability benign morphology mass of the left breast, likely representing a fibroadenoma. However, given the size and palpability, a surgical consultation is recommended at this time. All results and recommendations were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation. "}
{"instruction": "Generate impression based on findings.", "input": "Recurrent hoarseness and difficulty swallowing for 6 months, nontoxic goiter RIGHT LOBE MEASUREMENTS: 4.9 x 1.8 x 1.9 cm, normal echotexture and sizeLEFT LOBE MEASUREMENTS: 4.9 x 2.1 x 2.2 cm, normal echotexture and sizeISTHMUS MEASUREMENTS: 4 mmRIGHT LOBE: Subcentimeter small mostly cystic nodule in the midpole of the right lobe measures 0.4 x 0.2 x 0.4 cm.LEFT LOBE: A large solid hypoechoic nodule with adjacent halo in the left mid pole measures 1.7 x 1.2 x 1.7 cm with minimal peripheral blood flow.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: left lateral level 2 neck lymph node measuring 0.7 x 0.8 cm with effaced hilum is noted.OTHER: No significant abnormality noted.", "output": "Dominant solid hypoechoic nodule with adjacent halo in the left thyroid gland is amenable to FNA.Subcentimeter left lateral level 2 neck lymph node with effaced hilum is indeterminate. "}
{"instruction": "Generate impression based on findings.", "input": "80-year-old female with chronic kidney disease. Evaluate bladder emptying. Prevoid bladder is almost completely empty measuring 4.3 x 4.6 x 2 cm with a volume of 20 cc. Post void film was there is almost complete emptying with a volume of 2.8 cc.", "output": "Almost complete emptying of nondistended bladder."}
{"instruction": "Generate impression based on findings.", "input": "Graves' disease RIGHT LOBE MEASUREMENTS: 9 x 3.1 x 3.1 cmLEFT LOBE MEASUREMENTS: 9.3 x 3.2 x 3.2 cmISTHMUS MEASUREMENTS: 1 cmRIGHT LOBE: Diffusely heterogeneous gland without discrete nodule. Mildly increased diffuse vascularity.LEFT LOBE: Diffusely heterogeneous gland without discrete nodule. Mildly increased diffuse vascularityISTHMUS: Diffusely heterogeneous gland without discrete nodule. Mildly increased diffuse vascularityPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland without discrete nodule with mildly increased diffuse vascularity; findings consistent with Graves' disease. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female with a small thyroid nodule in the left lobe. Please evaluate for interval changes. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4 x 1.2 x 1.4 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 3.2 x 0.9 x 1.3 cm.ISTHMUS MEASUREMENTS: The thyroid isthmus measures 0.2 cm in thickness.RIGHT LOBE: In the right upper thyroid pole, there is a 0.9 x 0.6 x 0.7 cm heterogenous hyperechoic nodule. The measurements are unchanged when including the hypoechoic rim on the prior exam. Heterogeneous echotexture of the right thyroid lobe.LEFT LOBE: Heterogeneous echotexture the left thyroid lobe. No discrete nodules on the left.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No suspicious cervical lymphadenopathy.OTHER: No significant abnormality noted.", "output": "1. Stable subcentimeter heterogenous hyperechoic nodule of the right upper thyroid pole.2. Heterogenous thyroid gland. No discrete nodules on the left."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female with right breast palpable lump for 1-2 months. The patient also has a history of congestive heart failure and sarcoidosis. Three standard views of both breasts with 3 spot compression views of right breast and 2 spot compression views of 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. An 18 mm focal asymmetry with irregular margins is present at the 2:00 position of the right breast which persists with spot compression. This corresponds to the palpable tiangular marker. A mole marker is placed over the sebaceous cyst in the left axilla. Spot compression of an oval enlarged right axillary lymph node was performed. Additional spot compression of an asymmetry in the left central breast mid depth disperses into benign-appearing glandular tissue. ULTRASOUND", "output": "Palpable right breast mass as described above is suspicious for neoplasm. Additionally an 8 mm lymph right axillary lymph node demonstrates cortical thickening which could represent malignancy or possibly sarcoidosis given the patient's clinical history. Ultrasound-guided biopsies of both the right breast mass and right axillary lymph node are recommended. This was discussed with the patient who agreed to participate in the Allan Penn research trial. Sharon Harris will contact the patient with further instructions. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Mesothelioma with abdominal distention Moderate free-flowing ascites throughout the abdomen and pelvis", "output": "Moderate free-flowing ascites throughout the abdomen and pelvis."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old male with hepatitis C and cirrhosis. Evaluate for hepatocellular carcinoma. LIVER: Liver is normal in size. The echotexture is mildly and coarsely echogenic without significant change. There is no focal hepatic mass identified. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Intrahepatic very tract is normal in caliber. Common duct is mildly prominent without change and within normal limits for this patient.PANCREAS: No significant abnormalities noted.SPLEEN: Normal in size.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No ascites.", "output": "Stable examination without evidence for hepatic mass."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female with persistent right lower quadrant pain. Normal white count. No thick-walled blind-ending bowel to suggest appendicitis. Trace of fluid identified in the right lower quadrant.", "output": "No ultrasound evidence for appendicitis. Trace of fluid in the right lower quadrant."}
{"instruction": "Generate impression based on findings.", "input": "27 year old woman with history of painful left sided breast mass felt with menstrual cycle two weeks ago. No significant family history. A targeted left ultrasound was performed for the palpable area of concern. There is currently no palpable mass. Ultrasound shows normal fibroglandular tissue but no solid or cystic mass.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter RIGHT LOBE MEASUREMENTS: 5.7 x 2.6 x 1.5 cmLEFT LOBE MEASUREMENTS: 7.2 x 2.6 x 2 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Stable subcentimeter hypoechoic nodules.LEFT LOBE: Stable mixed cystic and solid left thyroid nodules. Upper pole nodule measures 0.7 x 0.8 x 0.3 cm. Lower pole nodule measures 1.1 x 1 x 0.7 cm.ISTHMUS: Interval increase in size of mixed cystic and solid right isthmus nodule now measuring 2 x 2.4 x 1.2 cm; this is comparison to 1.6 x 0.7 x 1.8 cm on 7/18/2014.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Interval increase in size of mixed cystic and solid right isthmic nodule. Other thyroid nodules stable. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female with history of hepatitis C. Evaluate for portal hypertension. LIVER:The liver measures 13.4 cm. There is increased, coarse echogenicity and nodular contour of the liver. The liver has a cirrhotic morphology. The main portal vein is patent with normal hepatopedal flow with velocity of 17 cm/s. No ascites or intrahepatic biliary dilation.GALLBLADDER, BILIARY TRACT: The gallbladder wall measures 0.2 cm and the common duct measures 0.4 cm. The gallbladder is nondistended. No evidence of stones, sludge, or pericholecystic fluid.PANCREAS: Evaluation the pancreas limited by overlying bowel gas.SPLEEN: The spleen measures 14.8 cm without sonographic abnormalities.KIDNEYS: The right kidney measures 12.2 cm. No hydronephrosis, shadowing calculus or mass.The left kidney measures 11.7 cm. No focal mass or shadowing calculi. Anechoic area arising from the left kidney represents an enlarged extrarenal pelvis with associated mild prominence of the intrarenal collecting systemOTHER: No significant abnormality noted.", "output": "1. Increased echogenicity and nodular contour of liver consistent with cirrhosis. The main portal vein is patent with normal hepatopedal flow as described above2. Splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate thyroid cysts History: evaluate for growth RIGHT LOBE MEASUREMENTS: 6.7 x 3.3 x 2.9 cm.LEFT LOBE MEASUREMENTS: Asymmetrically small measuring 3.4 x 1.1 x 1.0 cm.ISTHMUS MEASUREMENTS: Up to 2 mm in thickness.RIGHT LOBE: Mildly heterogeneous background parenchymal echotexture. Multiple predominantly cystic nodules. The largest is in the superior pole measuring 2.3 x 1.3 x 1.5 cm and is entirely cystic, compatible with benignity. LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Calcified plaque incidentally noted in the right carotid artery near the bifurcation.", "output": "1.Multiple benign morphology predominantly cystic nodules within the right thyroid.2.Calcified plaque incidentally noted in the right carotid artery near the bifurcation. Dedicated vascular imaging can be considered as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "Male 36 years old; Reason: 36 yo with HCV please eval for HCC History: none LIVER: The liver measures 13.0 cm in length. There is increased and coarse 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 16.2 cm/s. GALLBLADDER/BILIARY TRACT:The gallbladder wall measures 1.0 mm.No stones are seen, however debris and two subcentimeter hyperechoic nondependent lesions are seen, consistent with gallbladder polyps. The largest of these measures approximately 0.5 x 0.3 x 0.4 cm.No pericholecystic fluid.The common bile duct measures 2.0 mm in diameter.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 8.4 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.4 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.6 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 texture of the liver consistent with chronic liver disease/parenchymal dysfunction. No masses or ascites.2. Gallbladder polyps; the largest of these is approximately 0.5 cm in the largest dimension."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate stents, hydronephrosis, evidence of obstruction History: recurrent fevers RIGHT KIDNEY: The right kidney measures 12.1 cm in length. There is mild to moderate hydronephrosis, new since prior exam. A nephroureteral stent is partially imaged in the renal pelvis.LEFT KIDNEY: The left kidney measures 11.6 cm in length. There is mild hydronephrosis, slightly worse compared to the prior exam. A nephroureteral stent is partially imaged in the renal pelvis.OTHER: Nephroureteral stents are imaged within the urinary bladder.", "output": "1. New right-sided mild to moderate hydronephrosis.2. Mild left-sided hydronephrosis, slightly worse since the prior study."}
{"instruction": "Generate impression based on findings.", "input": "23-year-old female with history of left excisional biopsy for a fibroadenoma 2 years ago in Florida presents for a follow-up ultrasound of the left upper outer quadrant and entire right breast as prior ultrasound demonstrated few cysts in the right breast. Strong family history of breast cancer in mother at the age of 38. A entire right breast and targeted superior left breast ultrasound was performed for the patient\u2019s area of concern. No evidence of any suspicious solid mass noted. Multiple simple and complex cysts identified in both breast, largest measuring 4 x 7 mm in the left breast.", "output": "No sonographic evidence for malignancy. Simple and complex subcentimeter cysts in both breast.Annual screening mammogram is recommended starting at the age of 28 given the age of mother's diagnosis of breast cancer.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "History of thyroid cancer status post thyroidectomy. Possible palpable lesion on the right, just lateral and superior to the thyroid. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy. No residual thyroid tissue identified.LEFT LOBE MEASUREMENTS: Status post thyroidectomy. No residual thyroid tissue identified. ISTHMUS MEASUREMENTS: Status post thyroidectomy. No residual thyroid tissue identified. RIGHT SURGICAL BED: Surgical clip identified in the lateral thyroid bed, near the region of patient's palpable interest. No significant abnormality noted.LEFT SURGICAL BED: No significant abnormality noted.ISTHMUS SURGICAL BED: No significant abnormality noted.PARATHYROID GLANDS: Not identified.LYMPH NODES: Normal morphology noncalcified lymph nodes bilaterally, measuring up to 13 mm and appearing similar to 11/14/14. OTHER: No significant abnormality noted.", "output": "Surgical clips and normal morphology lymph nodes identified. No suspicious findings."}
{"instruction": "Generate impression based on findings.", "input": "Renal transplant RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality noted. 10.7 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 vessels without inflow or outflow compromise.OTHER: No significant abnormality noted", "output": "Patent renal transplant vascular without inflow or outflow compromise."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs and weight loss LIVER: Coarse echogenic liver echotexture without mass. Liver length 15.5 cmBILIARY TRACT: Gallbladder absent. No significant ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 10 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 9.4 cm in lengthOTHER: Left kidney not visualized. No ascites.", "output": "Coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Status post cholecystectomy. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "59 year old male patient status post DDRT with decreased urine output, baseline ultrasound. RENAL TRANSPLANT: LOCATION: Left iliac fossa.PERITRANSPLANT TISSUES: No perinephric fluid collection is identified.KIDNEY: The transplant kidney measures 8 cm in length.COLLECTING SYSTEM/URETER: There is mild pelvocaliectasis.URINARY BLADDER: The bladder is decompressed with a Foley catheter.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels The transplant renal vein is patent.There is decreased diastolic flow with increased RI of the mid/hilum transplant renal artery and segmental arteries. Velocities and RI are as follows:Transplant renal artery anastomosis: 47 cm/s with RI of 0.44Transplant renal artery mid: 72 cm/s with RI of 0.96Transplant renal artery hilum: 50 cm/s with RI of 0.90RI range for segmental arteries: 0.85 to 1.0RI range for arcuate arteries: 0.50 to 0.69OTHER: No significant abnormality noted", "output": "1. Increased intrarenal resistive indices which can be seen with parenchymal dysfunction.2. Patent transplant renal vein.3. Mild pelvocaliectasis. "}
{"instruction": "Generate impression based on findings.", "input": "76-year-old male with a history of hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 3.2 x 1.7 x 1.7 cmLEFT LOBE MEASUREMENTS: 3.7 x 1.3 x 1.3 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Note is made of a 5 x 5 x 3 mm anechoic nodule along the inferior pole of the left lobe of the thyroid without internal vascularity, suggestive of a cyst.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: There is a 1.0 x 1.0 x 1.0 cm heterogeneous, but predominantly hypoechoic nodule along the posterior aspect of the inferior pole of the left lobe of the thyroid with associated internal vascularity.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.0-cm nodule along the inferior pole of the left lobe of the thyroid, which may represent a parathyroid adenoma candidate.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Thyromegaly on exam with dysphasia RIGHT LOBE MEASUREMENTS: 6.6 x 2.4 x 1.6 cmLEFT LOBE MEASUREMENTS: 7.3 x 2.7 x 1.9 cmISTHMUS MEASUREMENTS: Sir .1 cmRIGHT LOBE: Normal parenchymal echogenicity. Midpole hypoechoic subcentimeter nodule measuring 0.3 x 0.4 x 0.2 cmLEFT LOBE: Normal parenchymal echogenicity. Multiple solid and spongiform nodules. A representative midpole nodule measures 0.9 x 1 x 0.6 cm.ISTHMUS: Normal parenchymal echogenicity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Normal side thyroid gland without evidence for enlargement or parenchymal heterogeneity. Multiple left thyroid nodules as described."}
{"instruction": "Generate impression based on findings.", "input": "Marked hepatomegaly. Hepatitis C. LIVER: Cirrhotic liver morphology. 18 cm in length. 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 10.7 cm in length. The left kidney is 12.2 cm in length. The renal parenchyma is echogenic bilaterally. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 12.2 cm in length, without focal lesions evident.OTHER: Bilateral pleural effusions are partially imaged. Mild amount of ascites.", "output": "1. Cirrhosis and mild hepatomegaly. Mild ascites.2. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Chronic renal disease RIGHT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Right renal cyst. Right kidney 9.6 cm in length.LEFT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Left renal cyst. Left kidney 9.4 cm in length.OTHER: Bladder nondistended", "output": "Echogenic parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old female patient with abdominal distention. Evaluate for ascites. Targeted ultrasound performed for evaluation of ascites demonstrates fluid within the bilateral lower quadrants. A right pleural effusion is noted.", "output": "1. Mild lower abdominal ascites.2. Right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "HCV LIVER: Coarse echogenic liver again noted without mass. Liver length 15 cmGALLBLADDER, BILIARY TRACT: Gallbladder removed. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.8 cm in lengthOTHER: Left kidney 9.8 cm in length. Minimally complex left renal cyst. Spleen 8.8 cm in length. No ascites", "output": "Coarse echogenic liver again noted consistent with chronic liver disease without mass or ductal dilatation. Status post cholecystectomy. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female presents with right upper quadrant pain. Evaluate for cholelithiasis. LIVER:The liver measures 21.7 cm. There is mildly increased echogenicity of the liver parenchyma. No focal masses, ascites, intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. Wall thickness measures 0.2 cm. Negative sonographic Murphy's sign. No pericholecystic fluid. An approximately 0.3 x 0.4 cm hyperechoic foci in the gallbladder is consistent with a gallbladder polyp. No sludge. The common bile duct measures 0.2 cm.PANCREAS: Evaluation the pancreas is limited by overlying bowel gas.SPLEEN: The spleen measures 10.6 cm. No sonographic abnormalities.KIDNEYS: The right kidney measures 11.4 cm left kidney measures 12.1 cm. The cortex disease have normal echogenicity. OTHER: No significant abnormality noted.", "output": "1. Increased echogenicity of liver consistent with chronic liver disease/parenchymal dysfunction. No focal masses or ascites.2. Hepatomegaly.3. Gallbladder polyps without evidence of cholelithiasis or cholecystitis."}
{"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: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not identified.LYMPH NODES: Benign-appearing lymph nodes. The cervical lymph nodes are decreased in size compared to prior, measuring up to 8 mm, previously 16 mm.OTHER: No significant abnormality noted.", "output": "No evidence of recurrent disease. Decreased size of the previously prominent cervical lymph nodes."}
{"instruction": "Generate impression based on findings.", "input": "Female 74 years old; Reason: history of papillary thyroid carcinoma with new tenderness on right anterior cervical area, difficult to palpate area of concern on exam History: tenderness in right anterior cervical area The patient is status post total thyroidectomy.RIGHT THYROIDECTOMY BED: No suspicious lesions are seen within the thyroidectomy bed.LEFT THYROIDECTOMY BED: No suspicious lesions are seen within the thyroidectomy bed.LYMPH NODES: No suspicious adenopathy noted. On the right at level 1 there is a enlarged lymph node measuring 1.4 cm x 1.0 cm x 2.9 cm. On the left at level 1 lymph node is identified measuring 1.3 cm x 10.9 cm x 2.4 cm.", "output": "No suspicious lesions within the thyroidectomy bed concerning for recurrence. A level 1 cervical lymph node is seen on the right and left favored to be reactive. No suspicious regional adenopathy is identified."}
{"instruction": "Generate impression based on findings.", "input": "Reason: enlarged thyroid History: Crohn's disease, fatigue RIGHT LOBE MEASUREMENTS: 5.0 x 1.7 x 1.4 cm. LEFT LOBE MEASUREMENTS: 4.7 x 1.4 x 0.7 cm. ISTHMUS MEASUREMENTS: 0.2 cm. RIGHT LOBE: No significant abnormality noted. Normal parenchyma without nodules or masses.LEFT LOBE: No significant abnormality noted. Normal parenchyma without nodules or masses.ISTHMUS: No significant abnormality noted. Normal parenchyma without nodules or masses.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Prominent benign-appearing right level 3 cervical lymph node measures 2.2 x 1.1 x 0.5 cm. Prominent benign-appearing level 3 cervical lymph node measures 2.4 x 0.9 x 0.3 cm.OTHER: No significant abnormality noted.", "output": "No discrete thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Right thigh/hip region, hx of Girdlestone. Developed abscess. S/p IR drain. Eval for reaccumulation of fluid. Needed prior to OR tomorrow. Complex superficial heterogenous collection measuring 1 cm is noted lateral to the drain. This collection appears to connect to a deep collection in the upper/outer part of the thigh measuring approximately 5.7 x 3.9 cm.", "output": "Superficial heterogenous collection which appears to be connected to a deep complex collection in the upper/outer part of the thigh, as above."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal alkaline phosphatase LIVER: Echogenic coarse liver echotexture again noted without mass. Liver length 15.7 cmBILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9.3 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 11.7 cm in lengthOTHER: Left kidney 11.6 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture again noted consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Cholelithiasis without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Elevation in LFTs LIVER: Coarse echogenic liver parenchyma without mass. Liver length 13.6 cm.GALLBLADDER, BILIARY TRACT: Gallbladder absent. Mild bilobar intrahepatic ductal dilatation and mild dilatation of the extra hepatic duct with maximal diameter of 1.2 cm. The distal aspect of the common bile duct is obscured by gas.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.4 cm in lengthOTHER: Left kidney 11.2 cm in length. Spleen 11.6 cm in length.", "output": "Mild bilobar intrahepatic ductal dilatation and mild dilatation of the extra hepatic duct as described. The distal aspect of the common duct is obscured by gas and evaluation of the distal common bile duct could not be performed. Correlation with CT or MRCP would be helpful if the distal common bile duct needs to be evaluated. Coarse echogenic liver parenchyma consistent with fatty infiltration/chronic liver disease without mass. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old male with acute kidney injury. Evaluate for obstruction. RIGHT KIDNEY: Measures 9.6 cm in length. Increased renal echogenicity without hydronephrosis, nephrolithiasis, or mass.LEFT KIDNEY: Measures 9.7 cm in length. Increased renal echogenicity without hydronephrosis, nephrolithiasis, or mass.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Increased renal echogenicity consistent with medical renal disease. "}
{"instruction": "Generate impression based on findings.", "input": "Possible primary hypogonadism; decreased by mouth and decreased axillary pubic hair growth. RIGHT TESTIS: 3.4 x 1.2 x 2.4 cm. Diffusely heterogeneous gland without mass. Bilaterally symmetrical venous flow. No appreciable arterial waveform could be appreciated.LEFT TESTIS: 3.4 x 1.2 x 1.8 cm. Diffusely heterogeneous gland without mass. Bilaterally symmetrical venous flow. No appreciable arterial waveform could be appreciatedRIGHT EPIDIDYMIS: No significant abnormalities noted..LEFT EPIDIDYMIS: Subcentimeter left epididymal cyst.OTHER: No significant abnormalities noted.", "output": "Slightly small testicular size bilaterally. No mass lesion. While bilaterally symmetric normal venous flow is noted, no appreciable arterial waveforms could be appreciated in either testis. Findings raise the possibility of diminished arterial flow/inflow compromise."}
{"instruction": "Generate impression based on findings.", "input": "Female 72 years old; Reason: r/o hcc History: hcv, cirrhosis LIVER: The liver measures 17.8 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 29.7 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.5 mm. A single shadowing echogenic foci is seen within the gallbladder measuring 1.1 cm x 0.7 cm. No pericholecystic fluid. Negative sonographic Murphy sign. The common bile duct measures 2.7 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 13.0 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 13.2 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. Mild hepatomegaly. The liver has coarse increased echogenicity compatible with fatty infiltration/hepatocellular dysfunction. No masses or ascites are seen.2. Cholelithiasis without evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Female 65 years old Reason: left level 1b lymph node biopsy, fna History: eval lymph node Written informed consent was obtained. Patient was prepped and draped in sterile fashion. Skin was anesthetized with lidocaine. Cytology is present. Large node in the left submandibular area identified by CT was targeted.Under ultrasound guidance 4, 25 g. fine-needle aspirates were obtained and submitted for cytologic analysis. 3 were processed routinely and the fourth sample was placed in media for flow cytometry.Less than 5 cc blood loss. Patient recovered uneventfully and was discharged to home in good condition.", "output": "Successful fine-needle aspiration biopsy left neck nodes."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain, epigastric pain, rule out cholecystitis LIVER: Liver measures 16.4 cm with mild increased echogenicity suggestive of hepatic steatosis. No intrahepatic biliary ductal dilatation.GALLBLADDER, BILIARY TRACT: Gallbladder is contracted with gallbladder wall thickening measuring 5 mm. Patient has known gallbladder stones in comparison with the prior CT dated 2/2/2010. A few stones appear to be impacted in the neck of the gallbladder, largest measuring 13 mm. Common hepatic duct measures up to 4 mm within normal limits. No evidence of stones or soft tissue mass within the common bile duct. No evidence of pericholecystic fluidPANCREAS: Head of pancreas as visualized appears unremarkable. Body and tail of pancreas is not visualized.RIGHT KIDNEY: Right kidney measures 10.5 cm and left kidney measures 10.5 cm. No hydronephrosis. Normal echotexture noted.OTHER: No ascites", "output": "Contracted gallbladder with impacted gallstones in the neck of the gallbladder. No intrahepatic biliary ductal dilatation or pericholecystic fluid.Hepatic steatosis"}
{"instruction": "Generate impression based on findings.", "input": "Intraoperative exam. Suprapubic catheter placement guidance. The bladder is identified. Suprapubic catheter and balloon are noted in the bladder status post catheter placement.", "output": "Suprapubic catheter balloon noted in the bladder."}
{"instruction": "Generate impression based on findings.", "input": "70 year-old female with popliteal pain. Evaluate for Baker's cyst. RIGHT LOWER EXTREMITY:Note is made of a 5.1 x 0.8 x 1.3 cm, anechoic cystic structure along the posterior medial aspect of the right knee, extending from the level of the medial head of the gastrocnemius muscle. There is no internal vascularity.LEFT LOWER EXTREMITY:Note is made of a 5.2 x 0.8 x 2.0 cm, anechoic cystic structure along the posterior medial aspect of the left knee, extending from the expected level of the medial head of the gastrocnemius muscle. There is no internal vascularity.", "output": "Bilateral cystic collections along the posteromedial aspects of the knee, which appear most consistent with Baker's cysts. "}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female with history of thyroid cancer and thyroidectomy. Evaluate for recurrent disease. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massesLEFT LOBE: In the left thyroid bed there is again noted a predominantly hypoechoic nodule with an echogenic portion measuring 0.3 x 0.5 x 0.5 cm without change. This may represent a lymph node. No new abnormalities are identifiedISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable ultrasound. No change in predominantly hypoechoic focus in the left thyroid bed."}
{"instruction": "Generate impression based on findings.", "input": "85-year-old female with history of cirrhosis. LIVER: Cirrhotic liver morphology with diffusely increased echogenicity. No worrisome hepatic mass or lesion. The liver measures 13.1 cm in length. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts.The main portal vein is patent with normal hepatopedal flow and velocity of 20.8 cm/s.GALLBLADDER, BILIARY TRACT: Cholelithiasis is noted. There is no pericholecystic fluid or gallbladder wall thickening. The common bile duct measures 0.8 cm in diameter. PANCREAS: The head and proximal body of the pancreas are normal. The tail is obscured by bowel gas.SPLEEN: The spleen is normal in echogenicity and measures 7.5 cm in length. RIGHT KIDNEY: Status post right nephrectomy.LEFT KIDNEY: The left kidney measures 10.3 cm in length and shows normal echotexture. No mass, stone or hydronephrosis.URINARY BLADDER: The urinary bladder is normal in appearance.OTHER: There is no free or loculated fluid.", "output": "Cirrhotic liver morphology without worrisome mass. Uncomplicated cholelithiasis. Prominence of the common bile duct without dilatation."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old man with history of papillary thyroid cancer status post thyroidectomy 6 years ago. The patient is status post total thyroidectomy.RIGHT THYROID BED: No significant abnormality noted.LEFT THYROID BED: There is a hyperechoic area in the upper left thyroid bed measuring 0.6 x 0.5 x 0.4 cm, stable from the prior examination. Additionally, there is a hyperechoic 0.5 x 0.2 cm area also stable from the prior examination.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy noted.OTHER: No significant abnormality noted.", "output": "Stable examination without evidence of recurrent disease or lymphadenopathy.1."}
{"instruction": "Generate impression based on findings.", "input": "66 year old female who was recalled from screening mammogram for new focal asymmetry in the right upper outer breast with an adjacent partially circumscribed mass. 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 almost entirely fatty(BiRads Density Category A), unchanged in pattern and distribution. 6 mm round circumscribed benign morphology mass persist on spot compression views in the right breast upper-outer quadrant. No additional lesions/masses identified adjacent to it.Ultrasound: Targeted right upper-outer quadrant ultrasound was performed that demonstrated a simple cyst that measures 5 x 4 x 6 mm at 10:00 position. Adjacent to it is a small complex cyst that measures 2 x 2 mm. No suspicious cystic or solid mass noted.", "output": "Subcentimeter simple and complex cyst right breast 10:00 position on mammogram and ultrasound. No sonographic or mammographic evidence of malignancy. As long as patient's physical examination remains unchanged, annual screening mammogram is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old male with renal insufficiency and abnormal, heterogeneous kidneys on prior CT. RIGHT KIDNEY: The right kidney measures approximately 11.6 cm in length. Cortex is abnormally echogenic and mildly heterogeneous. There is no evidence for renal mass, hydronephrosis or shadowing calculus.LEFT KIDNEY: The left kidney measures approximately 11.2 cm in length. Cortex is abnormally echogenic and mildly heterogeneous. There is no evidence for renal mass, hydronephrosis or shadowing calculus.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Echogenic kidneys consistent with parenchymal [disease.] Preservation of renal size suggests that this is relatively acute."}
{"instruction": "Generate impression based on findings.", "input": "Female 83 years old Reason: ?cholecystitis History: ct scan suggestive LIVER: There is a simple cyst measuring 1.6 cm in the right lobe of the liver. There are other small cystic lesions within the liver.GALLBLADDER, BILIARY TRACT: Gallbladder is significantly distended with significant wall thickening, sludge and stones. Sonographic Murphy sign is positive. These findings are consistent with acute cholecystitis. Small amount of sludge is noted.Common bile duct measures 7 mm. There are internal echoes within the common bile duct suggestive of cortical ascites.PANCREAS: Cannot be evaluated due to overlying bowel gas.RIGHT KIDNEY: Slightly echogenic kidney with multiple cysts. No evidence of hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Cholelithiasis and acute cholecystitis with small amount of sludge in the common bile duct.Multiple small hepatic cysts."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old female with thyroid nodule. RIGHT LOBE MEASUREMENTS: 5.3 x 2.1 x 3.0 cmLEFT LOBE MEASUREMENTS: 5.0 x 1.7 x 1.7 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Dominant right nodule with spongiform morphologic features measures 2.6 x 1.7 x 1.3 cm, favor a benign etiology. Prominently cystic with a peripheral solid component inferior right thyroid nodule measures 0.8 x 0.8 x 0.6 cm, also favor a benign etiology.LEFT LOBE: 0.8 x 0.7 x 0.3 cm hypoechoic nodule.ISTHMUS: 1.1 x 0.7 x 0.2 cm hypoechoic nodule at midline.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered cervical lymph nodes with overall benign morphologic features.OTHER: No significant abnormality noted.", "output": "Dominant right thyroid nodule with spongiform morphologic features favored benign, and other smaller nodules as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "Nephrolithiasis. RIGHT KIDNEY: 11.2 cm in length. Unremarkable renal parenchymal echogenicity. 1.5 cm benign appearing cyst noted. No suspicious lesions are evident. Several subcentimeter echogenic foci are noted, without hydronephrosis.LEFT KIDNEY: 13.1 cm in length. Unremarkable renal parenchymal echogenicity. 2-3 cm benign appearing cysts noted. No suspicious lesions are evident. Subcentimeter echogenic focus in the lower pole is again noted, without hydronephrosis.BLADDER: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral subcentimeter nonobstructing nephrolithiasis, similar to prior."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Miller is a 19 year old female with a palpable left breast mass. Family history of breast carcinoma in her maternal grandmother and paternal grandmother. Prior ultrasound demonstrated a high probability benign fibroadenoma. A targeted left breast ultrasound was performed. In the area of palpable concern in the left breast at the 11:00 position, approximately 6 cm from the nipple, there is a parallel-oriented oval, circumscribed, hypoechoic mass measuring 1.5 x 0.8 x 1.4 cm with internal vascularity, previously measuring 1.5 x 0.8 x 1.6 cm. Sonographic findings are compatible with a benign fibroadenoma. No other suspicious lid or cystic masses are identified.", "output": "Stable benign fibroadenoma of the left breast. No sonographic evidence of malignancy. All results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C and alcoholic cirrhosis. Recent increase in LFTs. Concern for thrombosis. LIVER: Cirrhotic liver morphology. 15 cm in length. Coarsened increased parenchymal echogenicity, compatible with parenchymal dysfunction. No focal hepatic lesions. The previously seen subcentimeter benign-appearing cyst is not identified.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Focal adenomyomatosis is again noted. Otherwise unremarkable 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 8.8 cm in length. The left kidney is 11.5 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 9.0 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.DOPPLER", "output": "1. Cirrhotic liver morphology without suspicious lesion.2. Patent portal vein, hepatic arteries, and hepatic veins, with normal waveforms."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 86M w abdominal pain, nausea, vomiting x1, bacteremia of unclear source, elevated LFTs LIVER: The liver measures 13.4 cm in length. Echogenic hepatic parenchyma. The main portal vein is patent with normal directional hepatopedal blood flow, peak velocity 25.4 cm/s.GALLBLADDER, BILIARY TRACT: There is amorphous adherent intraluminal debris and irregular circumferential gallbladder wall thickening up to 3 mm without gallbladder wall vascularity. There is intrahepatic biliary ductal dilatation. The distal common bile duct measures 0.5 cm. No pericholecystic fluid or shadowing stones. Negative sonographic Murphy's sign. PANCREAS: No significant abnormalities noted. The body and tail are obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 8.0 cm in length. The left kidney measures 9.8 cm in length. Echogenic renal parenchyma. Trace perinephric fluid. No hydronephrosis or shadowing stones.OTHER: The spleen measures 7.9 cm. There is trace perisplenic fluid. Mildly enlarged prostate.", "output": "1. Irregular gallbladder wall thickening and/or sludge as described above with intrahepatic biliary ductal dilatation. MRCP is recommended for further evaluation.2. Findings consistent with hepatic steatosis or parenchymal dysfunction.3. Findings consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female patient with Hashimoto's thyroiditis. Evaluate left thyroid nodule. RIGHT LOBE MEASUREMENTS: 1.2 x 1.5 x 5.3 cm.LEFT LOBE MEASUREMENTS: 1.1 x 1.8 x 4.5 cm.ISTHMUS MEASUREMENTS: 4 mm in thickness.RIGHT LOBE: The right thyroid lobe is mildly heterogeneous in echogenicity compatible prior history of Hashimoto's thyroiditis. No discrete nodule is identified.LEFT LOBE: The left thyroid lobe is mildly heterogeneous in echogenicity. A hypoechoic nodule seen in the mid pole measures approximately 0.4 x 0.2 x 0.2 cm, similar to the prior study.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology lymph nodes are noted bilaterally.OTHER: No significant abnormality noted.", "output": "Heterogeneous thyroid gland compatible with history of Hashimoto's thyroiditis without dominant thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old male with epigastric pain. Evaluate for cholecystitis. LIVER: Liver is highly and somewhat heterogeneously echogenic with decreased penetration of sound most likely due to fatty infiltration. No gross, focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. Visualized biliary tract is normal in caliber.PANCREAS: Limited by body habitus and bowel gas.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "No evidence for cholecystitis.Irregular fatty liver."}
{"instruction": "Generate impression based on findings.", "input": "Nausea, vomiting, and diarrhea. 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. Contracted gallbladder, which limits evaluation. No shadowing gallstone or pericholecystic fluid is evident.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 12.2 cm in length. The left kidney is 12.5 cm in length. The renal parenchyma is echogenic bilaterally. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 10.3 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.", "output": "1. No evidence of cholecystitis. 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": "Ms. Vaci is a 58 year old female who returns today for six-month follow-up of clustered cysts seen on ultrasound. She has a personal history of left breast cyst aspiration. Family history of breast cancer in her maternal aunt diagnosed at the age of 65. Upon physical exam at the sonographic area of concern, no discrete mass is appreciated.Targeted right breast ultrasound was performed. Again seen in the 3:00 position of the right breast approximately 2 cm from the nipple is a small cluster of cysts measuring 3 x 3 x 3 mm, unchanged from the prior exam.", "output": "Stable cluster of cysts in the right breast. No sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually, due next in March 2016. All results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Male 64 years old Reason: 64 yo with HTn adn new CKD (?AKI) perofrm renal us for eval of size shape and echogenicitiy as well as blood flow History: 64 yo with HTn adn new CKD (?AKI) perofrm renal us for eval of size shape and echogenicitiy as well as blood flow ULTRASOUND KIDNEYSRIGHT KIDNEY: Right kidney measures 11.2 cm. Echogenic kidney. Multiple subcentimeter cysts. No evidence of hydronephrosis.LEFT KIDNEY: Left kidney measures 10.9 cm. Echogenic kidneys. Multiple cysts largest measuring 2 cm diameter. No hydronephrosis.OTHER:No significant abnormalities noted.", "output": "Normal Doppler study. Bilateral echogenic kidneys and simple cysts"}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male follow-up on AAA ABDOMINAL AORTA: Proximal: 3.4 cm in AP dimension (3.6 cm previously)Mid: 3.6 cm in AP dimension (3.9 cm previously)Distal: 4.4 cm in AP dimension (4.1 cm previously)Plaque is seen within the distal abdominal aorta representing approximately 40% narrowing. Flow is patent throughout the aorta.ILIAC ARTERY: Left iliac artery measures 2.0 cm x 3.0 cm x 1.8 cm. The right iliac artery measures 2.4 cm x 2.5 cm x 2.3 cm.", "output": "Abdominal aortic aneurysm is stable without significant change from prior study. Plaque is seen within the distal aorta representing the 40% narrowing. There is mild dilatation of the right common iliac artery."}
{"instruction": "Generate impression based on findings.", "input": "HCV cirrhosis LIVER: Coarse echogenic liver echotexture without mass. Liver length 18.8 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.6 cm in lengthOTHER: Left kidney 11.5 cm in length. Spleen 13.1 cm in length. No ascites.", "output": "Mild hepatomegaly with coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites. Cholelithiasis without acute inflammation."}
{"instruction": "Generate impression based on findings.", "input": "Female 58 years old Reason: low grade lymphoma/CLL evaluate for intra-abdominal adenopathy, r/o hydronephrosis History: low grade lymphoma/CLL evaluate for intra-abdominal adenopathy, r/o hydronephrosis LIVER: Mildly coarse and heterogeneous echotexture of the liver. Again seen is a hyperechoic lesion, most consistent with hemangioma measuring 1.4 x 1.0 cm, unchanged. Main portal vein is patent with a peak velocity of 23.9 cm/s.BILIARY TRACT: Gallbladder is normal in appearance. No gallstones. No intra or extra hepatic biliary ductal dilatation. Common bile duct measures 3 mm. There is a small lymph node adjacent to the neck of the gallbladder near the porta hepatis measuring 1.0 x 1.2 x 1.0 cm.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. Adjacent to the pancreatic head there is a hypoechoic nodule which may represent a peripancreatic lymph node measuring 2.8 x 2.2 cm.SPLEEN: Spleen is normal in appearance measuring 12.0 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 10 cm. Left kidney measures 9.3 cm. OTHER: No significant abnormality.", "output": "1.Mildly enlarged peripancreatic and porta hepatis lymph nodes.2.Hyperechoic focus in the liver likely represents a hemangioma, unchanged."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female patient with history of thyroid cancer. Three year follow-up study. Evaluate for adenopathy, recurrence. RIGHT LOBE: Status post thyroidectomy without evidence of residual parenchymal tissue.LEFT LOBE: Status post thyroidectomy without evidence of residual parenchymal tissue.ISTHMUS: Status post thyroidectomy without evidence of residual parenchymal tissue.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-morphology lymph nodes are noted bilaterally.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy without evidence of disease recurrence or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Male 38 years old Reason: 38M with left groin pain History: rule out inguinal hernia No significant abnormality is seen in the area of discomfort. No hernia is seen and there is no inguinal lymphadenopathy.", "output": "No significant abnormality is seen in the area of discomfort. "}
{"instruction": "Generate impression based on findings.", "input": "67 years old, Male, Reason: renal mass History: renal mass RIGHT KIDNEY: Kidney measures 10.6 cm in length. Normal echotexture. Complex renal lesion measures slightly smaller than on the prior study now measuring 1.5 x 1.4 x 1.5 cm, previously measuring 1.8 x 1.6 x 1.7 cm.LEFT KIDNEY: Kidney measures 11 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.Other: The prostate is markedly enlarged and lobulated measuring 8.1 x 5.0 x 6.5 cm.", "output": "1.Stable complex lesion in the right kidney which can be further characterized with dedicated kidney CT or MRI. Continued follow-up imaging is recommended.2.Markedly enlarged prostate."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old female with prior embolization of hemorrhagic left angiomyolipoma for follow-up. RIGHT KIDNEY: The right kidney measures 11.6 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 11.6 cm in length. There is no hydronephrosis or shadowing calculus. There is again noted a complex mass arising from the upper pole which is predominantly echogenic with a hypoechoic portion. This measures 3.1 x 3.5 x 4.3 cm, unchanged or slightly decreased in the interim. The appearance of the mass is quite similar. No perirenal abnormality.OTHER: No significant abnormalities noted.", "output": "Stable to slight decrease in left renal angiomyolipoma."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old female with history of left lower inner palpable lump, previously negative diagnostic ultrasound examination at outside hospital. Patient denies any residual palpable abnormality in her left breast, and presents for repeat left breast ultrasound. Targeted ultrasound along the 9:00, 8:00, 7:00 and 6:00 radiants reveals no solid or cystic mass.", "output": "No sonographic evidence of 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: 1 - Negative.RECOMMENDATION: CD - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "15-year-old male presents with a history of left renal stricture status post pyeloplasty presents with left flank pain. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. 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: 0 Left: 3, appearing similar to the prior examination.   Length*** Right: 11 cm Left: 13 cm   Mean for age: 10.2 cm  Range for age: 9 - 11.5 cmADDITIONAL OBSERVATIONS: Echogenic focus with posterior shadowing in the left kidney measuring 1.2 x 1 cm.", "output": "1. Non-obstructing left renal calculus. 2. Chronic grade 3 hydronephrosis. *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": "14-year-old female with history of excisional biopsy of a left breast mass demonstrating a multilobulated 5.3 cm juvenile fibroadenoma last year. Prior ultrasound dated 10/2/14 demonstrated benign morphology, masses, most likely compatible with fibroadenomatas. A targeted bilateral breast ultrasound was performed for the palpable area of concern. Right breast 10 o'clock position, the benign morphology mass measures 1.9 x 0.8 x 2.3 cm, unchanged from prior study. In the left breast at 3 o'clock position, the lobulated mass measures 1.9 x 0.8 x 2.4 cm, slightly increased in size from prior ultrasound when it measured 1.6 x 0.9 x 2.1 cm.", "output": "Known bilateral breast masses most likely fibroadenomas, slightly increased in size from prior study given difference in operator dependence.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old male with recently noted hepatic lesion on CT presents for further characterization with ultrasound. LIVER:The liver measures 13.1 cm. The liver has normal echogenicity. No worrisome masses, ascites, or intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow. There is an approximately 1.3 x 1.0 x 0.7 cm round anechoic mass with posterior acoustic shadowing consistent with a simple cyst.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended. No stones or sludge. No pericholecystic fluid. The gall bladder wall measures approximately 0.2 cm. The common bile duct measures approximately 0.4 cm.PANCREAS: Evaluation is limited by overlying bowel gas.SPLEEN: The spleen measures 10.4 cm. No sonographic abnormalities noted.KIDNEYS: The right kidney measures 10.8 cm. The cortex has normal echogenicity. No shadowing calculi or hydronephrosis.The left kidney measures 12.2 cm. The cortex has normal echogenicity. There are several punctate shadowing echogenic foci consistent with renal stones, none of which are obstructing. No hydronephrosis. OTHER: No significant abnormality noted.", "output": "1. Benign liver cyst corresponds to hypoattenuating lesion seen on recent CT.2. Nonobstructing nephrolithiasis on the left as above."}
{"instruction": "Generate impression based on findings.", "input": "Distended abdomen with sepsis LIVER: Hepatomegaly without mass. Liver length 21.5 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic renal parenchyma again noted. Right renal cyst. Right kidney 10.7 cm in length.OTHER: Spleen 11.2 cm in length. Complex loculated perisplenic and perihepatic ascites again noted", "output": "Cholelithiasis without acute inflammation or ductal dilatation. No change in complex loculated perisplenic and perihepatic ascites; infection cannot be excluded. "}
{"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. Multiple simple cysts were identified bilaterally. No suspicious cystic or solid mass is present.This exam was interpreted by two radiologists.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Reason: ? liver pathology, ascites History: ascites, sob LIVER: Possible micronodular contour may be seen in cirrhosis. The liver measures 16.8 cm in length. The portal vein is patent. Normal portal venous hepatopedal blood flow is noted, 18.6 cm/second.GALLBLADDER, BILIARY TRACT: Distended gallbladder with intraluminal sludge. The gallbladder wall measures 0.2 cm. The common hepatic duct measures 0.5 cm. The common bile duct measures 0.6 cm. No intrahepatic or extrahepatic biliary ductal dilatation. PANCREAS: Prominent pancreatic duct without dilatation.RIGHT KIDNEY: The right kidney measures 7.9 cm. Large anechoic right renal cyst measures 5.6 x 6.0 x 6.0 cm.LEFT KIDNEY: The left kidney measures 7.0 cm in length. Anechoic left renal cyst measures 2.8 x 4.0 x 2.5 cm.SPLEEN: The spleen measures 9.2 cm in length.OTHER: Large volume of ascites.", "output": "1. Large volume ascites and possible micronodular contour of the liver may be seen in cirrhosis.2. Distended gallbladder with intraluminal sludge."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Rule out pyelonephritis History: fever, ESRD s/p renal transplant TRANSPLANT KIDNEY: The transplant kidney in the right iliac fossa measures 12.2 cm in length. The renal echogenicity and echotexture is normal. There is no hydronephrosis. There is no evidence of perinephric edema or focal fluid collections.OTHER: No significant abnormalities noted.", "output": "Transplant kidney without hydronephrosis or specific evidence of pyelonephritis."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old male with pancreatitis on CT. LIVER: Liver is highly echogenic. Although nonspecific, prior CT is highly suggestive of fatty liver. The small mass noted in the left lobe of the liver on CT has been demonstrated represent a cyst. No other focal hepatic abnormality.BILIARY TRACT: Gallbladder is adequately visualized and is normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: Not imagedSPLEEN: Not imagedRIGHT KIDNEY: Not imaged OTHER: No significant abnormalities noted.", "output": "Limited exam without gallstones or biliary dilatation. Fatty liver."}
{"instruction": "Generate impression based on findings.", "input": "Liver and renal failure of unknown known cause LIVER:Coarse echogenic liver echotexture with irregular contour suggestive for cirrhotic morphology without mass. Liver length 19.4 cmGALLBLADDER, BILIARY TRACT: Gallbladder absent. No ductal dilatation.PANCREAS: No significant abnormality noted.SPLEEN: Moderately severe splenomegaly. 20 cm in length.KIDNEYS: Echogenic renal parenchyma without mass, stone, or hydronephrosis. Right kidney 18.7 cm in length ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Trace ascites.", "output": "Enlarged cirrhotic liver without mass or ductal dilatation. Mid main portal vein stenosis/thrombosis with velocity gradient as described. Main portal vein flow remains pedal. Hepatic arteries and veins patent. Trace ascites. Moderately severe splenomegaly. Echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without 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. 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. Images were double read by Dr. Kulkarni and Dr. Schacht.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Elevated liver enzymes and acute kidney injury. LIVER:Mild hepatomegaly with the liver measuring 19.2 cm in length. The parenchymal echotexture is echogenic and coarsened compatible with steatosis. No intrahepatic or extrahepatic biliary ductal dilatation. The main portal vein is patent with hepatopedal flow velocity of 30 cm/s.GALLBLADDER, BILIARY TRACT: No cholelithiasis. The gallbladder is unremarkable. The common bile duct measures 5 mm in diameter.PANCREAS: No significant abnormality noted.SPLEEN: The spleen is mildly enlarged measuring 13.5 cm in length.KIDNEYS: Right kidney is normal in size and echotexture measuring 11.7 cm. No hydronephrosis. Left kidney is normal in size measuring 11.1 cm in length. No hydronephrosis.ABDOMINAL AORTA: The proximal abdominal aorta is normal in size. The maximum diameter of 2.0 cm. Linear echogenic focus within the aorta compatible with an ECMO catheter. The mid and distal aorta are obscured by bowel gas.INFERIOR VENA CAVA: The inferior vena cava is patent with normal multiphasic flow. Linear echogenic focus within the inferior vena cava compatible with an ECMO catheter.OTHER: Left pleural effusion. No ascites.", "output": "1.Echogenic hepatic parenchyma compatible with hepatic steatosis. No biliary ductal dilatation. Normal-appearing gallbladder.2.Left pleural effusion. No ascites.3.ECMO catheters in the normally sized abdominal aorta and inferior vena cava."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female. Evaluation prior to LVAD placement. Proximal, mid and distal bowel aorta are normal in caliber without evidence for aneurysm. Bifurcation is poorly visualized due to bowel gas.Limited evaluation of the inferior vena cava demonstrates patency.", "output": "No evidence for AAA. Patent IVC."}
{"instruction": "Generate impression based on findings.", "input": "Status post cholecystectomy with pancreatitis with hepatic hypodensities on CT LIVER: Coarse echogenic liver echotexture without worrisome mass. The previously noted hypoattenuating subcentimeter foci seen on the recent CT could not be visualized on the current examination. Liver length 16.1 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: Status post cholecystectomy. No ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 14.5 cm in lengthRIGHT KIDNEY: Right renal cyst. Right kidney 13.6 cm in length. OTHER: Left renal cyst. Left kidney 13.1 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without worrisome mass. Previously noted subcentimeter hypoattenuating foci seen on the recent CT could not be visualized on the current examination. No ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B. Evaluate for HCC. LIVER: Non-cirrhotic liver morphology. Increased parenchymal echogenicity, suggestive of steatosis. 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 10.6 cm in length. The left kidney is 10.9 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 10.9 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No significant free fluid is identified.", "output": "Increased hepatic echogenicity, compatible with steatosis. No suspicious hepatic lesions identified."}
{"instruction": "Generate impression based on findings.", "input": "Hyperthyroidism RIGHT LOBE MEASUREMENTS: 4.6 x 1.6 x 1.9 cmLEFT LOBE MEASUREMENTS: 5.2 x 1.1 x 1.3 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: 1.5 x 0.8 x 1.2 cm spongiform nodule with comet tail artifact.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": "Right spongiform nodule with benign characteristics. Otherwise unremarkable thyroid gland. No evidence for thyromegaly or increased vascularity. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "History of gallbladder polyp. LIVER: The liver is normal in morphology, contour and echogenicity. It measures 15 cm in craniocaudal dimension. No focal liver lesion or intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 32 cm/s.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 3 mm. Normally distended gallbladder. Demonstrated again is a sessile 5 mm nonmobile non-shadowing avascular probable gallbladder polyp currently measuring 5 mm compared to 3 mm previously. The gallbladder is otherwise normally distended without gallbladder wall thickening, pericholecystic fluid, shadowing gallstones or focal tenderness.PANCREAS: The visualized portions of the pancreatic body and head are normal. Normal caliber main pancreatic duct. The distal body and tail are obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 9.2 cm in length without a focal abnormality.RIGHT KIDNEY: The right kidney measures 10 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. OTHER: The left kidney measures 10.3 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion.", "output": "Probable 5 mm gallbladder polyp, increased from 3 mm previously, continued follow up recommended."}
{"instruction": "Generate impression based on findings.", "input": "Male, 73 years old. Gross hematuria and Mod blood on UA RIGHT KIDNEY: The right kidney measures 9.4 cm in length, with mild parenchymal loss. An upper pole simple cyst measures 2.1 x 1.8 x 2.5 cm. Additional scattered smaller cysts noted. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.1 cm in length, with normal echotexture. No shadowing stones or hydronephrosis.OTHER: The urinary bladder is nondistended. A shadowing stone within the bladder measures approximately 3 cm in diameter.", "output": "1.Large bladder stone. No hydronephrosis.2.Renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "11-year-old female with history of AML L status post stem cell transplant who presents with vomiting and anorexia in the setting of an elevated lipase. The liver and spleen demonstrate diffuse, markedly hypointense signal on T2-weighted imaging.The remainder of the upper abdomen is normal in appearance.", "output": "Marked hypointensity of the liver and spleen on T2-weighted imaging is consistent with iron deposition. The pancreas is normal in appearance. "}
{"instruction": "Generate impression based on findings.", "input": "Chronic kidney disease stage III. Nephrocalcinosis. RIGHT KIDNEY: 9.4 cm in length. The renal parenchyma is echogenic. Medullary calcifications are noted, compatible with the given history of nephrocalcinosis. No suspicious lesion or hydronephrosis is seen.LEFT KIDNEY: 10.7 cm in length. The renal parenchyma is echogenic. Medullary calcifications are noted, compatible with the given history of nephrocalcinosis. No suspicious lesion or hydronephrosis is seen.BLADDER: Contracted.OTHER: No significant abnormalities noted.", "output": "1. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease.2. Medullary calcifications compatible with nephrocalcinosis."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male. Evaluate soft tissues for an abdominal hernia. A few bowel loops are noted without clear visualization of a fascial defect or surrounding hernia sac. Intraluminal bowel gas causes extensive shadowing and limits the evaluation.", "output": "Superficial bowel loops are partially visualized without clear identification of a fascial defect or surrounding hernia sac. Further evaluation with CT is recommended. Of note, fat-containing umbilical hernia is visualized on the prior 2011 CT exam."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with history of kidney stones. RIGHT KIDNEY: The right kidney measures 13.1 cm in length without hydronephrosis or shadowing calculus. There is a 4.7 x 3.4 x 5.0 cm interpolar mildly complex cyst, unchanged accounting for differences in technique.LEFT KIDNEY: The left kidney measures 12.9 cm in length without hydronephrosis. There is a 1.4 x 1.6 x 1.5 cm interpolar simple appearing cyst. There are at least two shadowing echogenic foci consistent with persistent non-obstructing nephrolithiasis, the largest of which measures 1.7 cm. URINARY BLADDER: The urinary bladder is collapsed and thus poorly visualized.OTHER: No significant abnormalities noted.", "output": "Persistent non-obstructing left nephrolithiasis the largest of which measures 1.7 cm. Bilateral simple to minimally complex cysts."}
{"instruction": "Generate impression based on findings.", "input": "Acute lymphoblastic leukemia with right upper quadrant pain LIVER: Mildly heterogeneous liver echotexture without mass. Liver length 13.5 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.1 cm in lengthOTHER: Left kidney 10.8 cm in length. Spleen 9.1 cm in length. No ascites", "output": "Mildly heterogeneous liver echotexture raises the possibility of fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Unremarkable gallbladder. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Smith is a 40-year-old female who was recalled from screening for right breast calcification and left breast focal asymmetry. Three standard views of both breasts as well as 3 additional right spot magnification views and 3 additional left 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, unchanged in pattern and distribution. Again seen are round, highly likely benign morphology, loosely grouped calcifications in the right upper outer breast.Additionally, the focal asymmetry in the left upper inner breast persists on spot compression views though with typically benign features.Subsequently targeted left breast ultrasound was performed.ULTRASOUND", "output": "Oval, mixed echogenicity lesion in the left upper inner breast, which may represent developing fat necrosis or a complicated cyst. Typically benign morphology loosely grouped calcifications in the right upper outer breast. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 6 months to ensure stability. Results and recommendation 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": "Right renal mass RIGHT KIDNEY: 9.0 cm in length. The mildly heterogeneous hypoechoic lesion in the inferior pole measures 9 x 9 x 10 mm. This previously measured 12 x 9 x 10 mm and is unchanged when measured similarly and accounting for differences in technique. No hydronephrosis.LEFT KIDNEY: 10.7 cm in length. No suspicious lesion identified. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Unchanged nonspecific right renal lesion since 10/14/2011, without development of new suspicious features."}
{"instruction": "Generate impression based on findings.", "input": "Palpable right scrotal mass RIGHT TESTIS: 4.7 x 3.3 x 2.3 cm. No intratesticular mass. Bilaterally symmetric unremarkable Doppler flow characteristicsLEFT TESTIS: 5.2 x 3.2 x 2.2 cm. No intratesticular mass. Bilaterally symmetric and unremarkable Doppler flow characteristicsRIGHT EPIDIDYMIS: Benign-appearing right epididymal cyst.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Small bilateral varicoceles", "output": "No intratesticular mass. Bilaterally symmetric unremarkable Doppler flow characteristics. Benign-appearing right epididymal cyst. Small bilateral varicoceles."}
{"instruction": "Generate impression based on findings.", "input": "Left scrotal mass RIGHT TESTIS: 5.3 x 2.4 x 3.4 cm. No intratesticular mass. Symmetric bilateral Doppler flow characteristicsLEFT TESTIS: 4.3 x 2.1 x 2.9 cm. No intratesticular mass. Symmetric bilateral Doppler flow characteristicsRIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Bilateral moderate varicoceles.", "output": "No intratesticular mass. Bilateral moderate varicoceles."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant abdominal pain LIVER: Mildly echogenic liver echotexture without mass. Liver length 15 cmGALLBLADDER, BILIARY TRACT: Mild diffuse gallbladder wall thickening with trace pericholecystic fluid. Stones and sludge. No ductal dilatation. A Murphy's sign could not be elicited due to the patient's pain medicationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9 cm in lengthOTHER: Left kidney 9.4 cm in length. Spleen 9.7 cm in length. No ascites.", "output": "Mild diffuse gallbladder wall thickening with trace pericholecystic fluid associated with stones and sludge. No ductal dilatation. A Murphy's sign could not be elicited due to the patient's pain medication; acute cholecystitis is suspected."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old woman called back for mass in the right upper-outer 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), unchanged in pattern and distribution. The macrolobulated mass in the right upper-outer breast persists on additional views. An ultrasound is recommended for further evaluation.ULTRASOUND:On physical exam, there is no palpable abnormality.Targeted grayscale and color Doppler ultrasound of the right breast was performed for the mammographic area of concern. In the right breast 11:00 position 7 cm from the nipple, there is an indeterminant 1.6 x 1.0 x 1.1 cm lobulated hypoechoic mass, corresponding to finding on mammogram. There is mild internal vascularity and posterior acoustic shadowing. An ultrasound-guided biopsy is recommended.Additionally, in the right breast at the 10:00 position 7 cm from nipple, there is a lobulated mass measuring 6 x 6 x 4 mm with internal vascularity, also indeterminate and could represent a lymph node. Ultrasound-guided biopsy is recommended.Also in the right breast 10:00 position 7 cm from nipple, superficial depth there is a well-circumscribed oval hyperechoic mass measuring 4 x 4 mm with internal vascularity, consistent with fat necrosis.", "output": "Two suspicious masses in the right upper outer breast as described measuring up to 1.6 cm for which ultrasound-guided biopsy is recommended. The findings and recommendations were discussed with the patient at the time of the exam.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Male 53 years old Reason: Pt with heart failure Fever chest pain abnl lfts please eval liver for cause History: hypotension LIVER: Liver measures 15.5 cm. Normal echogenicity of the liver. No focal lesions.GALLBLADDER, BILIARY TRACT: There are multiple gallstones in the gallbladder. There is mild gallbladder wall thickening. No evidence of pericholecystic fluid. Common bile duct is dilated measuring up to 8mm. No evidence of intra or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.RIGHT KIDNEY: Right kidney is unremarkable measuring 12.6 cm. No evidence of hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Cholelithiasis without sonographic evidence of cholecystitis. Common bile duct is borderline dilated. No evidence of intrahepatic biliary dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Male, 25 years old. History of tethered cord, neurogenic bladder. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 11.4 cm in length, with normal cortical echogenicity. No focal lesion or hydronephrosis.LEFT KIDNEY: The left kidney measures 13.0 cm in length, with normal cortical echogenicity. Mild pelviectasis, compatible with extrarenal pelvis. No hydronephrosis. No focal renal lesion.OTHER: The bladder is distended, with wall trabeculation. Bilateral ureteral jets are noted.", "output": "1.Findings consistent with neurogenic bladder.2.No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Metastatic bladder cancer LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Normal appearance of the gallbladderPANCREAS: Not visualized.ASCITES: MinimalOTHER: Large heterogeneous pelvic mass identified, partially imaged. Moderate right-sided hydronephrosis, similar to the prior CT.", "output": "1. Minimal ascites.2. Large heterogeneous pelvic mass, partially imaged. If further evaluation is necessary, CT is recommended.3. Persistent moderate right hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "27 years old, Female, Reason: goiter History: goiter RIGHT LOBE MEASUREMENTS: 4.3 x 1 1.7 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.4 x 1.6 x 1.7 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: The right thyroid lobe is diffusely heterogeneous without nodules.LEFT LOBE: The left thyroid lobe is diffusely heterogeneous without nodules.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 thyroid which can be seen in chronic thyroiditis."}
{"instruction": "Generate impression based on findings.", "input": "Left thyroid nodule. RIGHT LOBE MEASUREMENTS: 4.6 x 1.7 x 2.6 cmLEFT LOBE MEASUREMENTS: 6.1 x 3.1 x 2.8 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Within the superior aspect of the right lobe there is a 1.7 x 1.2 x 1.8 cm heterogeneous nodule containing vascularity.LEFT LOBE: There is a heterogeneous nodule within the left midpole measuring 1.9 x 1.8 x 2.1 cm. This nodule contains vascularity, as well as punctate and dystrophic calcifications, compatible with findings identified on prior CT. A left lower pole heterogeneous nodule measures 1.1 x 1.3 x 1.3 cm contains calcifications and vascularity.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Multiple enlarged abnormal-appearing lymph nodes. For example, right level 2 cervical lymph node measures 2.6 x 2.2 x 1.3 cm. A representative right level 2/3 lymph node measures 2.0 x 1.5 x 1.4 cm. Left supraclavicular level 4 lymph node measures 2.1 x 2.1 x 1.5 cm.OTHER: No significant abnormality noted.", "output": "1.Bilateral heterogenous thyroid nodules which contain calcifications, suspicious for malignancy. Recommend FNA of the largest left nodule.2.Abnormal cervical adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Richardson is a 37 year old female presenting after call back during screening examination. Family history includes a sister diagnosed with breast cancer twice, once at age 19 and once at age 21. An ML view and three spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. Ultrasound was subsequently performed.MAMMOGRAM:The breast parenchyma is composed of scattered fibroglandular density (BiRads Density Category B), unchanged in pattern and distribution. Again demonstrated in the right upper, outer breast is a small, circumscribed mass measuring approximately 8 mm. This likely represents an intramammary lymph node.ULTRASOUND:Targeted right upper-outer quadrant ultrasound was performed. A 7 x 4 mm benign intramammary lymph node identified on ultrasound. No suspicious cystic or solid mass 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: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old with known benign masses in both breasts Whole bilateral breast ultrasound is performed.Right breast:A circumscribed, oval shaped, hypo-/isoechoic mass, measuring 28 x 13 x 25 mm (previously 26x 10 mm), at 10:00 position 5 cm from nippleA hypoechoic oval mass, measuring 5 x 4 x 5 mm (previously 5 x 8 mm) at 4:00 position, 5 cm from nippleLeft breast:A circumscribed hypoechoic, oval mass measuring 23 x 15 x 31 mm (previously 25 x 11 mm) at retroareolar regionThere are no new masses in either breast.", "output": "No sonographic evidence for malignancy. Benign masses in both breasts without significant changes. Screening mammogram is recommended at age 40. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Male 83 years old Reason: pulsatile abdominal aorta, left lower quadrant pain The proximal abdominal aorta measures 2.7 x 2.4 cm. The mid aorta measures 2.1 x 2.3 cm. The distal aorta measures 2.0 x 2.4 cm. There is calcification along the wall of the distal abdominal aorta. Normal arterial waveform is noted in the aorta. The left iliac artery has a normal arterial waveform and measures 1.4 x 1.5 cm.The right iliac artery is somewhat obscured by overlying bowel gas, however measures 1.3 cm in AP diameter. Normal arterial waveform is noted in the right iliac artery.", "output": "Normal appearance of the abdominal aorta without aneurysm."}
{"instruction": "Generate impression based on findings.", "input": "Renal stone RIGHT KIDNEY: No mass, stone, or hydronephrosis. Right kidney 11.7 cm in length.LEFT KIDNEY: Stable nonobstructing left renal stone. Stable lower pole nonobstructing stone measuring 1 x 0.7 x 0.3 cm. Stable upper pole cyst. Left kidney 13.7 cm in length.OTHER: Bladder nondistended", "output": "Stable nonobstructing left renal stone."}
{"instruction": "Generate impression based on findings.", "input": "History of hepatitis C. Evaluate for HCC. LIVER: The liver capsule is smooth. The liver echogenicity is within normal limits. The liver measures 18 cm in length. No discrete lesion is identified. No intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 21 cm/s.BILIARY TRACT: Normally distended gallbladder without dependent gallstones, wall thickening, pericholecystic fluid or focal tenderness. No extrahepatic biliary ductal dilatation with the common duct measuring 3 mm. Echogenic 3 mm nondependent nonmobile lesion, likely a small polyp.PANCREAS: The visualized portions of the pancreatic body and head are unremarkable. The remainder of the pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 8 cm in length without a focal lesion.RIGHT KIDNEY: The right kidney measures 12.2 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 12.4 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.", "output": "No focal liver lesion. Probable 3 mm gallbladder polyp."}
{"instruction": "Generate impression based on findings.", "input": "History of right thyroid lobe nodules. RIGHT LOBE MEASUREMENTS: 6.2 x 2.5 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.6 x 1.9 x 1.7 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: The background thyroid parenchyma is homogeneous and normal in echogenicity. 1.7 x 1.4 x 0.9 cm superior pole isoechoic solid nodule with mild vascularity but no definite microcalcifications. Previously this measured 1.6 x 1.4 x 1.0 cm.Inferior and more dorsal to the above lesion is a hypoechoic 7 x 6 x 5 mm nodule with suspected microcalcifications. The lesion previously measured 7 x 6 x 5 mm.LEFT LOBE: 4 mm cyst in the interpolar region. The thyroid parenchyma is normal in echogenicity.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable size of the 2 right thyroid lobe nodules. Correlate with prior outside hospital biopsy results."}
{"instruction": "Generate impression based on findings.", "input": "HCV cirrhosis LIVER: Stable cirrhotic morphology without mass. Liver length 13.9 cmGALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma again noted. No mass, stone, or hydronephrosis. Right kidney 8 cm in lengthOTHER: Echogenic parenchyma again noted left kidney without mass or hydronephrosis. Left kidney 8.2 cm in length. Spleen 7.3 cm in length. No ascites.", "output": "Stable cirrhotic morphology without mass or ductal dilatation. No ascites. Stable echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old male with history of hematuria and urinary retention. Chronic kidney disease. RIGHT KIDNEY: Slightly increased parenchymal echogenicity, without additional significant abnormalities noted. The right kidney measures 10.1 cm. There is a simple cyst in the right kidney midpole measuring 1.5 cm in diameter.LEFT KIDNEY: Slightly increased parenchymal echogenicity, without additional significant abnormalities noted. The left kidney measures 11.4 cm. There is a simple cyst in the left kidney lower pole.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Stable exam, with bilateral slightly hyperechoic kidneys and small cysts. No additional significant abnormality is noted to explain the patient's hematuria. In the setting of ongoing hematuria, consider CT urography for more sensitive/specific evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Female 60 years old Reason: Screen for HCC History: Cirrhosis LIVER: Liver measures 14.1 cm in length. Increased hepatic echogenicity consistent with fatty infiltration/chronic liver disease. Nodular contour of the liver consistent with cirrhosis. Main portal vein is patent with the peak velocity of 21 cm/s. No hepatic masses identified.BILIARY TRACT: Patient is status post cholecystectomy. No intrahepatic or extrahepatic biliary ductal dilatation. Common bile duct is within normal limits measuring 5 mm.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas..SPLEEN: Spleen is normal in appearance measuring 9.6 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Left kidney measures 15.6 cm in length. Right kidney measures 12.1 cm in length.OTHER: No significant abnormalities noted.", "output": "Cirrhotic liver morphology without suspicious hepatic mass."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 44 yo F w/ lower abdominal pain, N/V, CT shows thickened gallbladder. Evaluate for cholecystitis. BILIARY TRACT: Cholelithiasis with shadowing stones throughout the gallbladder. Equivocal gallbladder wall thickening measuring up to 3.4 mm. No definite 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.", "output": "Cholelithiasis and equivocal gallbladder wall thickening raising the possibility of acute cholecystitis. Nuclear medicine HIDA scan could be considered for additional evaluation as clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "year old female who was recalled from screening mammogram for mass in the left breast. No current breast complaints. MAMMOGRAM: 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 composed of scattered fibroglandular density, unchanged in pattern and distribution. Focal asymmetry in the left breast lower inner quadrant measuring approximately 5 mm persists on additional views. An ultrasound is recommended for further evaluation.ULTRASOUND:On physical exam, there is a keloid in the left breast 9:00 position.Targeted grayscale and color Doppler ultrasound of the left breast lower inner quadrant performed. In the left breast 9:00 position 2 cm from the nipple, there is a 5 x 3 x 5 mm cluster of cysts. This correlates with the findings on mammogram. No solid component or septation. No internal vascularity.", "output": "Left breast 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."}
{"instruction": "Generate impression based on findings.", "input": "Patient being evaluated for LVAD. Right upper quadrant ultrasound to evaluate for cirrhosis. Biliary disease and ascites. LIVER:The liver is mildly echogenic without dominant lesion. No intrahepatic biliary ductal dilatation. Measures 18.2 cm in length. Portal vein is patent with flow toward the liver on color Doppler imagingGALLBLADDER, BILIARY TRACT: Small amount of sludge and tiny gallstone noted within the gallbladder.PANCREAS: Obscured by overlying bowel gas.SPLEEN: No focal lesions. The spleen measures 12.6 cm in length.KIDNEYS: No hydronephrosis of either kidney. The right kidney measures 12.2 cm in length and the left kidney measures 9.3 cm in length probable cyst at the upper pole on the right.ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No ascites. Trace left pleural effusion. Thick-walled bladder.", "output": "No ascites. Mildly echogenic liver without focal lesion. Mild splenomegaly suggesting portal hypertension. Mildly echogenic kidneys compatible medical renal disease. Gallstones and sludge."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old female with small left renal mass for follow-up. RIGHT KIDNEY: The right kidney measures 11.1 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 10.9 cm in length. Echotexture is normal. No hydronephrosis or shadowing calculus. There is again noted a small, exophytic mass arising from the upper pole measuring 0.6 x 0.7 x 0.8 cm without significant change. This is rounded and hypoechoic although definite cystic characteristics cannot be demonstrated.OTHER: No significant abnormalities noted.", "output": "Stable, small left renal mass."}
{"instruction": "Generate impression based on findings.", "input": "71 year-old female with NASH cirrhosis. Evaluate for HCC. LIVER: Cirrhotic liver morphology measuring 14.0 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate hepatopetal flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No intra or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: The right kidney is not well assessed however hyperechoic focus again seen in expected region of mid to upper pole measuring 3.3 cm x 3.1 cm x 3.3 cm, not significantly changed. No definite hydronephrosis or shadowing calculi.OTHER: Left kidney is also not well assessed however it appears to be in the expected region. No definite hydronephrosis or shadowing calculi. The spleen measures 9.5 cm in length. Multiple echogenic foci are again seen the largest of which measures 1.5-cm x 1.8 cm x 1.5 cm.", "output": "1. Cirrhotic liver morphology with no focal lesion. 2. Hyperechoic foci in the right kidney and spleen are not significantly changed."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodule RIGHT LOBE MEASUREMENTS: 1.3 x 1.1 x 3.2 cmLEFT LOBE MEASUREMENTS: 1.6 x 1.3 x 3.5 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Heterogeneous gland without mass.LEFT LOBE: Heterogeneous gland. 1.1 x 0.8 x 1.4 solid mid pole nodule.ISTHMUS: Heterogeneous glandPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Heterogeneous thyroid gland with solid left midpole nodule. This nodule is amenable to ultrasound-guided biopsy. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for gallstone History: RUQ pain LIVER: The liver measures 15.5 cm in length. Unremarkable hepatic parenchyma. The portal vein is patent with normal directional hepatopedal flow, peak velocity 29.9 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: Stone filled, contracted gallbladder without signs of acute inflammation. The common bile duct measures 0.4 cm. No pericholecystic fluid or gallbladder wall thickening. No biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 9.6 cm in length. Unremarkable renal parenchyma. No hydronephrosis or shadowing stones.LEFT KIDNEY: The left kidney measures 9.4 cm in length. Unremarkable renal parenchyma. No hydronephrosis or shadowing stones.OTHER: The spleen measures 9.6 cm in length.", "output": "Cholelithiasis without evidence of acute inflammation or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Hyperparathyroidism RIGHT LOBE MEASUREMENTS: 5.2 x 1.4 x 2.2 cmLEFT LOBE MEASUREMENTS: 5.3 x 1.6 x 1.4 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: 1.1 x 1 x 1.2 cm predominantly solid hypoechoic nodule left lower poleISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: 1.8 x 1.5 x 1.9 cm extrathyroidal hypoechoic lesion projecting inferior and posterior to the right thyroid gland.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Extrathyroidal hypoechoic lesion projecting inferior and posterior to the right thyroid gland consistent with suspected parathyroid adenoma.Predominantly solid hypoechoic lesion lower pole left thyroid gland; this lesion is amenable to ultrasound-guided percutaneous biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Enlarged right submental lymph node Slight interval decrease in size of right submandibular lymph node now measuring 1.6 x 0.7 x 2.8 cm; this is in comparison to 2.4 x 0.8 x 3 cm on 4/14/2016. Other mildly enlarged right level 2 and 3 lymph nodes are again noted and also demonstrate a benign reactive morphology.", "output": "Slight interval decrease in size of right submandibular lymph node. This node and other mildly enlarged level 2 and level 3 right cervical lymph nodes are again noted and demonstrate benign reactive morphology."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female with cirrhosis, HCC screening LIVER: Coarse echogenicity of the liver measuring 13.0 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: Shadowing stones within the gallbladder which is not well distended limiting evaluation for wall thickening. No pericholecystic fluid. Sonographic Murphy's sign is negative. Common duct measures 5 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Distal body and tail are obscured by overlying bowel gas. Remaining portions of the visualized pancreas unremarkable.RIGHT KIDNEY: Measures 9.8 cm in length. No hydronephrosis or shadowing calculi noted.OTHER: Normal echogenicity of the spleen measuring 11.8 cm in length.Left kidney measures 10.3 cm in length. No hydronephrosis or shadowing calculi noted.", "output": "1. Coarse echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesions. 2. Cholelithiasis with no definite evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules RIGHT LOBE MEASUREMENTS: 5.7 x 1.7 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.5 x 1.7 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Heterogeneous gland. 1 x 0.9 x 0.7 cm predominantly solid lower pole nodule.LEFT LOBE: Heterogeneous gland. 0.3 x 0.2 x 0.3 cm hypoechoic nodule lower poleISTHMUS: Heterogeneous glandPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Heterogeneous thyroid gland. Subcentimeter bilateral lower pole nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "40 year-old female with history of thyroid cancer post surgery. Follow-up nodules left thyroid bed. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massesLEFT LOBE: There are again noted somewhat lobulated soft tissue masses in the left thyroid bed with an appearance suggestive of prominent but morphologically normal lymph nodes rather than separate masses. These are unchanged, measuring 0.4 x 0.7 x 0.6 centimeter, 0.6 x 0.7 by 1.3 cm and 0.2 x 0.6 x 1.3 cm.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. Presumed lymph nodes left thyroid bed."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old female with enlarged thyroid gland. RIGHT LOBE MEASUREMENTS: 4.2 x 1.6 x 1.0 cmLEFT LOBE MEASUREMENTS: 5.2 x 1.9 x 1.7 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Solid mixed hyper and hypoechoic nodule posteriorly in the middle-inferior right thyroid lobe measures 1.8 x 1.1 x 1.0 cm.LEFT LOBE: Solid primarily hyperechoic nodule in the mid left thyroid lobe measures 1.5 x 0.9 x 2.3 cm. Adjacent posterior smaller nodule with spongiform features, most likely benign.ISTHMUS: Solid mixed hyper and hypoechoic nodule in the isthmus measures 1.9 x 1.0 x 1.9 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered cervical lymph nodes with overall benign morphologic features.OTHER: No significant abnormality noted.", "output": "Multinodular thyroid as described above with solid dominant nodules which are amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Thompson is a 61 year old female presenting with bilateral palpable masses, which have increased in size when compared to the prior ultrasound examination. Patient previously had a fine-needle aspiration of right breast mass with findings consistent with fat necrosis. Upon physical exam of both breasts, there are bilateral large tender palpable masses appreciated (right greater than left). These sites were identified by the patient and Dr. Chhablani.In the right breast 2:00 location, approximately 4 cm from the nipple, there continues to be vague hyperechoic areas with mildly increased vascularity. This finding appears very similar to prior ultrasound exam from April 2015.In the left breast 10:00 location, approximately 5 cm from the nipple, there are similar ultrasound findings consistent with vague hyperechoic areas with mildly increased vascularity. This finding is also very similar to prior ultrasound exam from March 2015.", "output": "Vague areas of mixed echogenicity at the areas of palpable concern in both breasts, suggestive of fat necrosis. Given that these areas have increased in size and are palpable, a palpation-guided biopsy is recommended for confirmation of findings. All results and recommendations were relayed to the patient and Dr. Chhablani at time of examination. Per discussion with Dr. Chhablani , the patient will be off of her Coumadin for 4 days prior to the biopsy.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "CNS lymphoma with FDG uptake right testis RIGHT TESTIS: Testis dimensions 3.7 x 2.3 x 3.2 cm. 1.6 x 1.3 x 1.4 cm discrete hypoechoic lesion within the right testicle with indistinct margins corresponding to the PET-positive lesion seen on the recent PET/CT scan.LEFT TESTIS: Testis dimensions 3.5 x 2.1 x 2.9 cm. No intratesticular mass.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Bilateral hydroceles, left greater than right", "output": "1.6 x 1.3 x 1.4 cm hypoechoic lesion within the right testicle with indistinct margins corresponding to the PET-positive lesion seen on the recent PET/CT scan. Findings consistent with intratesticular lymphoma focus, although a primary neoplasm cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old female with acute renal failure. Evaluate for hydronephrosis. RIGHT KIDNEY: Right kidney is highly echogenic and small, measuring approximately 8.9 cm in length. There is a simple cyst measuring 2.3 cm in greatest diameter arising from the upper pole. No hydronephrosis, shadowing calculus or obvious solid mass.LEFT KIDNEY: The left kidney is highly echogenic and small, measuring approximately 9.3 cm in length. There is no hydronephrosis, shadowing calculus or mass.OTHER: The bladder is collapsed with Foley catheter. Uterus appears large for age. Moderate to marked ascites. Bilateral pleural effusions.", "output": "1. Echogenic, small kidneys without obstruction.2. Ascites.3. Bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Shortness of breath. Thyroid nodules. RIGHT LOBE MEASUREMENTS: 3.9 x 1.2 x 1.8 cm. Normal in size with normal background echotexture and vascularity.LEFT LOBE MEASUREMENTS: 3.5 x 1.9 x 1.5 cm. Normal in size with mildly heterogeneous echotexture and normal vascularity.ISTHMUS MEASUREMENTS: 4 mm in AP dimension.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: Mild background heterogeneity, with a 5 mm mildly hypoechoic nodule identified in the superior pole. No suspicious features are evident.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing lymph nodes identified.OTHER: No significant abnormality noted.", "output": "5 mm left thyroid nodule, without suspicious features evident."}
{"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 suspicious solid or cystic mass identified. This examination was double read by Dr. Kulkarni.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old male with elevated bilirubin. LIVER: Liver is normal in size and is mildly echogenic consistent with parenchymal disease. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein GALLBLADDER, BILIARY TRACT: Gallbladder is mildly distended, and contains extensive sludge, but no shadowing calculi are identified. The gallbladder wall is not thickened and no focal pericholecystic fluid is identified. Biliary tract is not dilated. PANCREAS: Very limited due to bowel gasRIGHT KIDNEY: No significant abnormalities noted.OTHER: Bilateral pleural effusions. Ascites.", "output": "Mildly distended gallbladder with sludge.Ascites.Pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Female; 84 years old. Reason: concern for abscess History: indurated wound Diffuse subcutaneous edema of the lower back in the area of induration. No fluid collection is identified.", "output": "Diffuse subcutaneous edema without drainable abscess."}
{"instruction": "Generate impression based on findings.", "input": "Known left breast mass, patient describes slight decrease since the prior ultrasound. A targeted left 9:00 ultrasound was performed for the patient\u2019s area of concern. Reidentified is a predominantly hyperechoic round circumscribed mass compatible with fat necrosis. This has decreased slightly compared to prior measurements, now measuring 1.2 x 1.0 x 0.4 cm. Previously, this measured 1.3 x 1.0 x 0.6 cm. No internal vascularity is noted.", "output": "Finding remains compatible with fat necrosis. If there is any increase in size a repeat study could be considered, but otherwise, no specific imaging follow up is suggested.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "63 year old female who was recalled from screening mammogram for incompletely characterized mass in the left superior breast. Mammogram: An ML view 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 almost entirely fatty(BiRads Density Category A), unchanged in pattern and distribution. 5 mm round circumscribed mass with lucency in the center most likely represents a benign intramammary lymph node.Ultrasound: Targeted left upper-outer quadrant ultrasound was performed. Benign morphology 5 x 4 mm hypoechoic mass is identified in the left breast 1:00 position without definite peripheral blood flow which could represent a complex cyst or a benign intramammary lymph node with central fatty hilum. No suspicious cystic or solid mass noted.", "output": "Benign morphology subcentimeter mass in the left breast most likely represents a complex cyst or a benign intramammary lymph node. 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": "52-year-old male with right upper quadrant pain, hyperbilirubinemia LIVER: Measures 16 cm in length. Mildly 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": "1.No evidence of cholelithiasis, cholecystitis, or biliary obstruction.2.Increased hepatic echogenicity suggestive of hepatic steatosis or parenchymal disease."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal failure with rising creatinine RIGHT KIDNEY: Echogenic renal parenchyma again noted without mass, stone, or hydronephrosis. Right kidney 9.8 cm in lengthLEFT KIDNEY: Echogenic renal parenchyma again noted without mass, stone, or hydronephrosis. Left kidney 11.8 cm in length.OTHER: Bladder nondistended", "output": "Echogenic renal parenchyma again noted consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female with thyromegaly. RIGHT LOBE MEASUREMENTS: 7 x 2.8 x 2.2 cmLEFT LOBE MEASUREMENTS: 7 x 2.9 x 2.3 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Within the mid right lobe there is a small complex cystic nodule measuring 0.5 x 0.6 cm. Parenchyma mildly heterogeneous LEFT LOBE: Parenchyma mildly heterogeneousISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffuse thyromegaly. Small complex cystic mass right thyroid."}
{"instruction": "Generate impression based on findings.", "input": "Worsening renal function RIGHT KIDNEY: 6.4 cm in length. Atrophic in appearance with echogenic renal parenchyma. No focal lesions or hydronephrosis.LEFT KIDNEY: 7.3 cm in length. Atrophic in appearance with echogenic renal parenchyma. No focal lesions or hydronephrosis.BLADDER: Distended, without significant abnormality noted. Left ureteral jet noted.OTHER: No significant abnormalities noted.", "output": "Atrophic kidneys without hydronephrosis, compatible with chronic kidney disease."}
{"instruction": "Generate impression based on findings.", "input": "Scrotal edema, assess for etiology RIGHT TESTIS: Normal echotexture without focal mass. Normal vascularity.LEFT TESTIS: Normal echotexture without focal mass. Normal vascularity.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Moderate right hydrocele, small left hydrocele.", "output": "Right greater than left hydroceles. The testicles are normal in appearance."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Re-assessment of abdominal aortic aneurysm size History: AAA noted on screening LIVER: The liver is echogenic, suggesting hepatic steatosis. Partially imaged hepatic cysts.AORTA: The maximum abdominal aortic diameter measurement is 3.4 cm just superior to the iliac bifurcation. Prior maximum diameter of 3 cm.The proximal common iliac arteries measure 1.3 x 1.3 cm and 1.8 x 1.9 cm in maximum diameter.The arterial wave form is normal, velocity measures 94.8 cm/s.", "output": "Aneurysmal dilatation of the abdominal aorta with maximum diameter of 3.4 cm just superior to the iliac bifurcation (prior maximum diameter was 3 cm on 5/14/2015). "}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female with a nodule of the thyroid isthmus on physical exam. RIGHT LOBE MEASUREMENTS: 18 x 21 x 45 mm.LEFT LOBE MEASUREMENTS: 15 x 19 x 5 mm.ISTHMUS MEASUREMENTS: 3 mm.RIGHT LOBE: Partly septated cystic, partly solid nodule measuring 11 x 8 mm.LEFT LOBE: Mostly solid nodule measuring 9 x 11 mm appears largely spongiform.ISTHMUS: A partly cystic, partly solid 8 x 5 x 13 mm nodule within the right isthmus is visualized with spongiform features.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered, subcentimeter lymph nodes.OTHER: No significant abnormality noted.", "output": "Multinodular goiter with many of the lesions consistent with colloid."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old female was recalled from screening mammogram for small partially circumscribed mass in the left upper-outer quadrant . Mammogram: An ML view 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, unchanged in pattern and distribution. 5 mm circumscribed oval benign morphology mass in the left upper outer quadrant persist on spot compression views. Lateral to it is a benign intramammary lymph node is noted based on morphology.Ultrasound: A benign intramammary lymph node is identified at 2:00 position of the left breast. A simple cyst with through transmission measuring 6 x 4 mm identified at 3:00 position most consistent with the mammographic finding. No suspicious cystic or solid mass noted.", "output": "Simple cyst identified in the left breast 3:00 position with a mammographic correlate. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Female 65 years old; Reason: R/O HCC History: HCV, cirrhosis LIVER: The liver measures 15.4 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 28.7 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.5 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 3.2 mm in diameter. The pancreatic duct is visualized measuring 3.7 mm.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 10.9 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 9.9 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "There is coarse increased echogenicity of the liver which is compatible with fatty infiltration/hepatocellular dysfunction. No worrisome masses are seen."}
{"instruction": "Generate impression based on findings.", "input": "Female 73 years old; Reason: rule out recurrence thyroid cancer History: none The patient is status post total thyroidectomy.RIGHT THYROIDECTOMY BED: Small hypoechoic focus in the right thyroidectomy bed measuring 0.2 cm x 0.2 cm x 0.2 cm not well visualized on prior ultrasound.LEFT THYROIDECTOMY BED: No foci worrisome for recurrence. A benign-appearing node is redemonstrated in the left thyroidectomy bed measuring 0.7 cm x 0.5 cm x 0.7 cm. This was previously measured 0.7 cm x 0.3 cm x 0.5 cm.LYMPH NODES: No suspicious adenopathy noted. OTHER: Slow flow is demonstrated within the right internal jugular vein.", "output": "1.New small hypoechoic focus within the right thyroidectomy bed measuring 0.2 cm x 0.2 cm x 0.2 cm. Favor a benign etiology however special attention should be paid to this location on further surveillance ultrasounds.2.No suspicious regional adenopathy is identified.3.Slow flow is demonstrated in the right internal jugular vein. "}
{"instruction": "Generate impression based on findings.", "input": "39-year-old male with elevated alkaline phosphatase, pre-heart transplant evaluation. LIVER: Slight coarse echogenicity of the liver measuring 20.1 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: Normal echogenicity of 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.SPLEEN: Normal echogenicity measuring 11.6 cm in length.KIDNEYS: Right kidney measures 10.4 centers in length. No hydronephrosis or shadowing calculi are noted. Limited evaluation of the left kidney measuring 10.2 cm in length. No definite hydronephrosis or shadowing calculi are noted.ABDOMINAL AORTA: The proximal visualized aorta is patent measuring 2.0 cm x 1.8 cm x 0.8 cm. The remaining abdominal aorta is obscured by overlying bowel gas.INFERIOR VENA CAVA: The visualized IVC is patent with appropriate directional flow.OTHER: Bladder is well distended with no significant abnormalities noted. The prostate is visualized and is unremarkable.", "output": "Slight coarse echogenicity of the liver suggestive of parenchymal dysfunction/fat infiltration. No focal hepatic lesions. "}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female presenting with concern for palpable lesion in right breast for 2 to 3 months. Pain in both breasts for 8 months. No family history of breast cancer. A targeted ultrasound was performed of the right breast at the site of palpable concern (2:00, 3cm FN). There is no solid or cystic mass identified. Dense breast tissue is identified, and corresponds to palpated area on physical exam.", "output": "No sonographic evidence for malignancy. As long as these results are concordant with physical exam, routine clinical follow-up is recommended until the age of 40, when screening mammography would normally began.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old female patient with history of papillary thyroid carcinoma. RIGHT LOBE: Status post thyroidectomy without residual or recurrent parenchymal tissue identified.LEFT LOBE: Status post thyroidectomy without residual or recurrent parenchymal tissue identified.ISTHMUS: Status post thyroidectomy without residual or recurrent parenchymal tissue identified.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There are multiple enlarged lymph nodes within the right level II and III lymph node stations. The largest level II node measures 2.1 x 0.8 x 1.6 cm and is non-descript in morphology. This appears larger compared to the prior study.Multiple enlarged lymph nodes are noted within the left level II and level III lymph node stations. The largest level II node measures 1.8 x 2.3 x 1.0 cm. OTHER: No significant abnormality noted.", "output": "1. No specific evidence of residual or recurrent tissue within the thyroidectomy bed.2. Enlarged bilateral lymph nodes, right greater than left, with increased size of a right level II lymph node; this is amenable to biopsy if clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "Anemia and syncope LIVER: Coarse and echogenic liver parenchyma without mass. Liver length 16 cm. Limited Doppler interrogation of the main portal vein demonstrate a patent portal vein with normal directional flow.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9.7 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 11.7 cm in lengthOTHER: Atrophic left kidney. 8.1 cm in length. No ascites", "output": "Coarse and echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No hepatosplenomegaly. No ascites. Atrophic left kidney."}
{"instruction": "Generate impression based on findings.", "input": "HPV LIVER: Mildly coarse echogenic liver echotexture again noted without mass. Liver length 16.4 cm.BILIARY TRACT: Cholelithiasis again noted without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 7.4 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.3 cm in lengthOTHER: Left kidney 10.7 cm in length. No ascites", "output": "Mildly coarse liver echotexture again noted consistent with chronic liver disease without mass or ductal dilatation. Stable cholelithiasis without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Heart transplant status, rule out infection to bilateral groins In the right groin area there is a small linear hypoechoic band arising anteriorly from the femoral vessels which could represent a post procedural tract/fluid collection. No suspicious abnormality noted in the left groin area.", "output": "As aboveCLINICAL INFORMATION:Retained prior partial impella graft right subclavian, leukocytosisCOMPARISON: NoneTECHNIQUE: Grayscale and Doppler ultrasound of bilateral chest wall performedFINDINGS:Small fluid collection identified in the left upper chest wall measures 2.5 x 1.8 x 0.5 cm. No evidence of any fluid collection or abscess along the right upper chest wall."}
{"instruction": "Generate impression based on findings.", "input": "Male 78 years old Reason: unexplained weight loss r/o liver, kidney pathology History: unexplained weight loss r/o liver, kidney pathology LIVER: Liver measures 15.5 cm. Hepatic veins and IVC are slightly dilated likely secondary to heart failure. No focal liver lesions. Punctate calcifications within the liver.BILIARY TRACT: Gallbladder is slightly contracted. No evidence of gallstones or intra or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Both kidneys are echogenic compatible with medical renal disease. Right kidney measures 14.8 cm. There are multiple cysts within the right kidney. One of the cyst is complex and measures 7.3 x 4.7 cm with layering echogenic material within the cyst. Other cysts appear simple.Left kidney measures 12.8 cm. Multiple simple appearing cysts are also noted within the left kidney. OTHER: No significant abnormalities noted.", "output": "Bilateral severely echogenic kidneys with multiple renal cysts. One of the cysts in the right kidney contains layering echogenic material likely representing debris. However contrast enhanced dedicated renal protocol CT or MR is recommended for further evaluation of this lesion."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old male with cirrhosis, CKD. Screening for hepatoma. LIVER: Coarse hepatic echotexture with mildly cirrhotic liver morphology . Numerous hepatic cysts again noted without significant interval change. Scattered 2 mm echogenic foci which were not visualized on prior studies. Otherwise, no new suspicious masses are identified.BILIARY TRACT: Cholelithiasis and biliary sludge. No sonographic Murphy's sign or biliary ductal dilation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Echogenic kidneys. Renal cysts without significant interval change. No hydronephrosis.OTHER: Interval development of mild ascites.", "output": "1. Scattered 2 mm echogenic foci which were not visualized on prior studies are too small to completely characterize. Continued attention to these areas are recommended on subsequent examinations. 2. Otherwise, cirrhotic liver morphology with coarsened hepatic echotexture and numerous hepatic cysts without significant interval change. 3. Mild ascites new since previous.4. Cholelithiasis and biliary sludge."}
{"instruction": "Generate impression based on findings.", "input": "Acute and subacute hepatic failure; heart failure LIMITED ABDOMENLIVER: Stable mildly cirrhotic liver morphology without mass. Liver length 16.1 cm.BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 10.3 cm in length RIGHT KIDNEY: No significant abnormalities noted. 10 cm in length.OTHER: Mild ascites", "output": "Stable cirrhotic morphology without mass or ductal dilatation. Patent portal vessels with normal directional flow. Mild ascites. Cholelithiasis without acute inflammation."}
{"instruction": "Generate impression based on findings.", "input": "HCV LIVER: Coarse echogenic liver echotexture without mass. Liver length 14.8 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.2 cm in lengthOTHER: Left kidney 11.7 cm in length. Spleen 11 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture consistent with chronic liver disease without mass or ductal dilatation. No ascites"}
{"instruction": "Generate impression based on findings.", "input": "Cardiomyopathy with possible hepatic dysfunction LIVER: Mildly coarse liver echotexture without mass. Liver length 18.2 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: 9.7 cm in lengthOTHER: Left kidney 11.1 cm in length. Spleen 13 cm in length. No ascites", "output": "Mild hepatomegaly associated with mildly coarse liver echotexture. Findings suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "HCV LIVER: Stable left hepatic lobe minimally complex peripheral cystic lesion measuring 4.5 x 2.4 cm. Coarse echotexture of the liver unchanged. No worrisome mass. Liver length 16.1 cm.GALLBLADDER, BILIARY TRACT: Stable subcentimeter gallbladder polyp measuring 0.3 x 0.5 cm. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.4 cm in length OTHER: Left kidney 10.7 cm in length. Spleen 9 cm in length. No ascites.", "output": "Stable coarse liver echotexture consistent with chronic liver disease without worrisome mass or ductal dilatation. No ascites. Stable minimally complex left peripheral hepatic cyst. Stable subcentimeter gallbladder polyp."}
{"instruction": "Generate impression based on findings.", "input": "Status post cholecystectomy with epigastric pain LIVER: No significant abnormalities noted. Liver length 14.9 cmGALLBLADDER, BILIARY TRACT: Status post cholecystectomy. Mild dilatation of extrahepatic bile duct again noted with maximal diameter of 0.6 cm. No evidence for intraductal mass or stone. No intrahepatic ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.5 cm in lengthOTHER: Left kidney 11.5 cm in length. Spleen 10.4 cm in length. No ascites.", "output": "Mild dilatation of extrahepatic bile duct again noted status post cholecystectomy without evidence for intraductal mass or stone. No intrahepatic ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 68 years old; Reason: Concern for increased abdominal girth. History of colon cancer. Family history of ovarian cancer. Please evaluate for ascites. There is no ascites seen in the 4 quadrants.", "output": "No ascites as described above."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old with pain in the left upper outer breast. A targeted left ultrasound was performed for the patient\u2019s area of pain. There is no solid mass identified. Dense fibroglandular elements are present, as is a several millimeter sized cyst.", "output": "No sonographic evidence for malignancy. Dense fibroglandular tissue near the site of palpable concern and a small cyst. Clinical follow-up is recommended for the patient's pain.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Reason: of liver hbv, screen for hepatocellular carcinoma LIVER: The liver measures 15.3 cm in length. The liver parenchymal echotexture is coarse. 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: Several shadowing gallstones without associated 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: Oval hypoechoic structure adjacent to the pancreas measuring up to 1.2 cm most likely represents peripancreatic lymph node.SPLEEN: Not well visualized.RIGHT KIDNEY: Kidney measures 10.0 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 11.6 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Course hepatic echotexture compatible with chronic liver disease without focal mass. 2.Cholelithiasis without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Female, 44 years old. Lupus nephritis No perinephric collection seen post biopsy.", "output": "Right kidney biopsy, please refer to procedural report for full details."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for cholecystitis LIVER: Liver measures 21.8 cm, increased in size with diffuse increased echogenicity suggestive of fatty infiltration. Echotexture appears mildly coarse. Multiple bilobar hypoechoic solid-appearing lesions are identified throughout the liver, some of them appears subcapsular in location, reference lesion measures 2.2 x 1.7 cm in the right lobe with no definite flow on Doppler imaging.Portal vein appears patent.GALLBLADDER, BILIARY TRACT: Distended gallbladder without gallstones. Sonographic Murphy sign is negative. No gallbladder wall thickening or pericholecystic fluid.PANCREAS: Not well visualized due to overlying bowel gas.KIDNEY: No evidence of renal stones or hydronephrosis.OTHER: Spleen measures 9.2 cm appears unremarkable", "output": "Hepatomegaly with diffuse coarse echotexture. Bilobar hepatic somewhat solid appearing lesions. Differential is a large spectrum including metastasis disease or infectious/inflammatory process. Further evaluation with liver CT protocol is recommended.Distended gallbladder without cholecystitis"}
{"instruction": "Generate impression based on findings.", "input": "Female 49 years old Reason: R popliteal mass History: R popliteal pain No masses is seen in the popliteal fossa. No evidence of Baker's cyst. Normal blood flow is seen in the popliteal artery and vein.", "output": "Normal exam."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old male with HBV, screening for HCC. LIVER:The liver measures 13.8 cm in length. There is increased echogenicity within the liver; unchanged. There is an area of increased echogenicity in the left lobe which represents previously seen hepatic hemangioma on prior ultrasound and CT. This measured 3.6 cm x 3.8 cm and is similar in size to prior ultrasound in 2015. No new worrisome masses are seen within the liver. A cyst seen within the left lobe of the liver measures 1.4 cm x 0.7 cm and is stable in size from prior ultrasound. The portal vein is patent with hepatopetal flow, measuring 21.1 cm/s.GALLBLADDER, BILIARY TRACT: There are two subcentimeter polyps along the gallbladder wall. The larger polyp measures 0.5 cm x 0.4 cm, and the smaller polyp measures 0.4 cm x 0.3 cm.. There is minimal amount of sludge seen within the gallbladder. The gallbladder wall measures 1.6 mm, which is normal. The common bile duct measures 3.8 mm, which is normal caliber. PANCREAS: No significant abnormality noted.SPLEEN: The spleen measures 9.5 cm. No significant abnormality noted.KIDNEYS: The right kidney is 11.3 cm in length. No worrisome mass, stones, or hydronephrosis is seen within the right kidney. The left kidney measures 12 cm in length. No worrisome mass, hydronephrosis, or stones are seen in the left kidney.", "output": "1. Echogenic liver, compatible with chronic liver disease. No new worrisome masses within the liver.2.Hemangioma in the left lobe of the liver seen on prior ultrasound and CT is stable in size, not as well-visualized as prior CT.3. Two subcentimeter polyps visualized along the gallbladder wall."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old male patient with right upper quadrant discomfort. Evaluate for biliary etiology. LIVER: The liver measures 15.1 cm in length. Hepatic parenchymal echogenicity is slightly 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. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 6 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 11 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.3 cm in length. No evidence of hydronephrosis.The spleen measures 12.8 cm in length.", "output": "Increased hepatic parenchymal echogenicity which can be seen with hepatic steatosis/hepatic parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old female with worsening renal function. RIGHT KIDNEY: Measures 8.9 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 8.1 cm in length. Increased echogenicity without hydronephrosis or nephrolithiasis. 0.7 cm hypoechoic structure in the left mid kidney without definite through transmission. URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.", "output": "1. Increased renal echogenicity consistent with medical renal disease. No hydronephrosis or nephrolithiasis. 2. 7 mm hypoechoic structure in the left mid kidney is incompletely characterized. Recommend follow up examination in one year to confirm stability. "}
{"instruction": "Generate impression based on findings.", "input": "36-year-old male with renal transplant and elevated creatinine. Ultrasound guidance was provided for biopsy of the transplanted kidney in the right iliac fossa.", "output": "Ultrasound guidance"}
{"instruction": "Generate impression based on findings.", "input": "41 year old female who was recalled from screening mammogram for left breast asymmetry. No family history of breast cancer. ML and laterally exaggerated CC views, as well as five 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 persistent mass in the upper outer left breast. This is felt more likely to represent a lymph node. ULTRASOUND: On physical examination, no palpable abnormality is identified.Targeted ultrasound of the left breast was performed for the mammographic area of concern. At the 2:00 position of the left breast, 12 cm from the nipple, there is a circumscribed, hypoechoic mass measuring 0.4 x 0.6 cm with suggestion of a fatty hilum with vascularity, suggesting a benign intramammary lymph node.", "output": "Hypoechoic mass a the 2:00 position of the left breast, likely representing a benign appearing intramammary lymph node. Follow up left breast mammogram, and possible ultrasound, in 6 months to assess stability.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "Ms. NAISHIA L WALKER is a 16 years old female with a personal history of palpable masses in the right breast. ULTRASOUND:On physical examination, palpable masses were noted in the low right axillary tail as well as in the right breast at the 11:00 position, approximately 3 cm from the right nipple.A targeted right ultrasound was performed for the palpable area of concern. A multilobulated well-circumscribed hypoechoic mass is present at the 11:00 position, approximately 3 cm from the nipple, which measures 15 x 13 x 17 mm. There is an additional well-circumscribed hypoechoic lesion superior to this mass, which may represent a lobulation or an additional mass. In the right axilla/lower axillary tail, there are two well-circumscribed hypoechoic lesions. The larger measures 17 x 10 x 19 mm, and the smaller, which is lateral and anterior measures 9 x 5 x 9 mm. The total extent of these two masses measures approximately 2.5 cm.", "output": "Palpable circumscribed hypoechoic masses in the right axilla/lower axillary tail and right breast most consistent with benign fibroadenomas. Surgical consultation and short-term follow-up is recommended.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old female with acute renal insufficiency. RIGHT KIDNEY: The right kidney measures 12.4 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 11.4 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.URINARY BLADDER: Fully decompressed with Foley catheter.OTHER: No significant abnormalities noted.", "output": "Normal echotexture. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Prominent thyroid on examination. History salivary gland carcinoma. RIGHT LOBE MEASUREMENTS: 1.3 x 1.1 x 3.6 cmLEFT LOBE MEASUREMENTS: 1 x 1.1 x 3.5 cmISTHMUS MEASUREMENTS: 0.1 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: 0.3 x 0.3 x 0.3 lower pole hypoechoic noduleISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Normal sized thyroid gland. Subcentimeter hypoechoic left thyroid nodule. No adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain and mild transaminitis. LIVER: The liver measures 16.3 cm in length. The liver is smooth in contour with normal echogenicity. No focal lesions are seen. The portal vein flow is normal in direction and velocity. GALLBLADDER, BILIARY TRACT: There is a 3 mm echogenic focus along the gallbladder wall, which may represent a small polyp or adherent gallstone. No evidence of cholecystitis. No biliary ductal dilation. PANCREAS: No significant abnormalities noted in the visualized pancreatic head and body. The pancreatic tail are obscured by bowel gas.RIGHT KIDNEY: 12.3 cm in length and normal in appearance. OTHER: No significant abnormalities noted.", "output": "1. No specific hepatic abnormality evident.2. 3 mm gallbladder polyp versus adherent stone, without cholecystitis or biliary ductal dilation."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant and epigastric pain. Elevated lipase, alkaline phosphatase and AST. LIVER: The liver is coarse and echogenic with mild posterior shadowing. No focal lesion is evident. It measures 18.3 cm in length. No intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 28 cm/s.BILIARY TRACT: The common duct measures 4 mm. Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid or focal tenderness.PANCREAS: The pancreatic head is partially imaged without a discrete abnormality. The remainder of the pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 6.6 cm in length without a focal lesion.RIGHT KIDNEY: The right kidney measures 11.2 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 11 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.", "output": "Coarse echogenic liver most commonly seen in diffuse fatty infiltration.No biliary ductal dilatation, gallstones or evidence of acute cholecystitis. Limited evaluation of the pancreas."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female with a history of thyroid cancer status post thyroidectomy, radiation, and chemotherapy. 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: There is a prominent but morphologically benign lymph node measuring approximately 1.4 x 0.4 x 0.4 cm in the lateral left neck level 4 that was noted on the prior study.OTHER: No significant abnormality noted.", "output": "1. Surgical changes of a thyroidectomy without evidence of recurrence."}
{"instruction": "Generate impression based on findings.", "input": "Female 46 years old; Reason: suprapubic tube placement History: OR suprapubic tube placement Ultrasound guidance provided for suprapubic urinary bladder catheter placement. Postprocedural imaging demonstrates catheter within urinary bladder, correlation with procedural report recommended.", "output": "Ultrasound guidance provided for suprapubic urinary bladder catheter placement, please see procedural report. "}
{"instruction": "Generate impression based on findings.", "input": "Male 53 years old Reason: Metastatic pancreatic cancer on IRB 14-0081; needs biopsy of liver mass, 3-4 cores 17 gauge or larger, Laura Hoffman 7912 to provide kit and to pick up sample. History: Metastatic pancreatic cancer Previously seen ascites has been removed. Previously identified lesion in the inferior aspect of the right lobe of the liver is not visible by ultrasound. Noted is made of decrease SUV in that lesion on most recent PET/CT suggesting response to therapy. On the noncontrast CT portion of that PET/CT, the lesion is visible but ill-defined and small probably not amenable to CT-guided biopsy.", "output": "Plan biopsy canceled for reasons described above. Discussed with clinical service at the time."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with question of abnormal mass over the left lateral epicondyle. Physical examination demonstrates a hard, palpable abnormality overlying the lateral epicondyle.No soft tissue mass is evident as clinically queried. Irregular cortical margin of the lateral epicondyle corresponding to that seen on the prior radiograph is compatible with history of prior trauma. Shadowing foci overlying the radiocapitellar joint correlates with well-corticated ossicles seen on radiograph.", "output": "No soft tissue mass is evident as clinically queried. Findings reflecting prior trauma and osteoarthritis as described above correlating with that seen on the prior radiograph. An orthopedic consult/MR elbow may be considered if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "53 years old, Male, Reason: r/o obstruction History: r/o obstruction RIGHT KIDNEY: Kidney measures 10.2 cm in length. Normal echotexture. No hydronephrosis or shadowing calculus. Small right renal cyst measuring up to 1.9 cm.LEFT KIDNEY: Kidney measures 12.2 cm in length. Normal echotexture. No hydronephrosis or shadowing calculus.Bladder: No significant abnormalities noted.", "output": "No evidence of hydronephrosis. No emergent findings to explain patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "82-year-old male with left groin pain. Dense vascular calcification is seen within the common femoral artery and bifurcation vessels. No mass or fluid collection is noted within the groin. There is no evidence for hernia.", "output": "Other than vascular calcification, no abnormality seen.Relief of symptoms as noted above."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old male patient with increasing AST/ALT. History of hepatitis C. LIVER: The liver measures 17.4 cm in length. Hepatic parenchymal echogenicity is increased. 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 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. OTHER: The left kidney measures 10.4 cm in length. No evidence of hydronephrosis.The spleen measures 11 cm in length.", "output": "1. Increased hepatic echogenicity which can be seen with chronic liver disease/hepatic parenchymal dysfunction. 2. No focal hepatic lesion. "}
{"instruction": "Generate impression based on findings.", "input": "58 year old with history of right mastectomy in July 2014 for breast cancer. Two palpable abnormalities in the right mastectomy bed. Two sites of palpable abnormality are marked on by Dr. Jaskowiak. Focused ultrasound is performed. Ultrasound for the site of large skin mark, more medially located, shows normal tissue without any abnormal findings. Ultrasound for the site of smaller skin mark, centrally located, shows a focal fatty tissue, possibly a fat necrosis.", "output": "No sonographic evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "68 years old, Female, Reason: abnormal masses History: thyroid cancer MEASUREMENTS: Patient status post thyroidectomyRIGHT LOBE AREA: No significant abnormality noted. No evidence of local recurrence.LEFT LOBE AREA: No significant abnormality noted. No evidence of local recurrenceISTHMUS AREA: No significant abnormality noted. No evidence of local recurrencePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing right level 2 lymph node with a fatty hilum is identified measuring 1.5 x 0.4 x 0.8 cm. benign appearing left level 2 lymph node with a fatty hilum is identified measuring 1.7 x 0.3 x 1.0 cm.OTHER: No significant abnormality noted.", "output": "No evidence of local recurrence in the thyroidectomy bed or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: please evaluate for patency of all hepatic vasculatures Persistent markedly heterogeneous hepatic echotexture. The main main, right, and left portal veins are patent. Portal venous blood flow is slowed however demonstrates normal directional hepatopedal blood flow. The common and proper hepatic arteries are patent and demonstrate normal directional blood flow.Peak portal venous velocities:Main portal vein: 12.5 cm/sRight portal vein: -12.2 cm/sLeft portal vein: 16.2 cm/sPeak hepatic arterial velocities:Proper hepatic artery: 81.0 cm/sRight hepatic artery: -87.6 cm/sLeft hepatic artery: 59.1 cm/sSplenic vein peak velocity: -21.4 cm/s. Splenic artery not identified.", "output": "Patent portal venous system and hepatic arteries with slow portal venous hepatopedal blood flow."}
{"instruction": "Generate impression based on findings.", "input": "Female 51 years old Reason: r/o recurrence History: h/o hurthle cell thyroid cancer. 1 year follow up study MEASUREMENTS: Patient is status post thyroidectomy.RIGHT LOBE: No residual recurrent tissue in the right thyroid lobe.LEFT LOBE: No residual or recurrent tissue in the left thyroid lobe.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Small benign-appearing lymph nodes are present. A right level 3 lymph node measures 0.3 x 0.3 x 0.9 cm.OTHER: No significant abnormality noted.", "output": "No evidence of recurrent or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Female 47 years old; Reason: enlarged thyroid on exam - evaluate History: enlarged thyroid RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 5.4 x 1.5 x 1.9 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.7 x 1.1 x 1.5 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.4 cm.RIGHT LOBE: Right lobe is heterogeneous. A hypoechoic, possibly complex cystic nodule is seen in the right superior thyroid lobe. This measures 0.3 x 0.5 x 0.5 cm. A second cystic nodule demonstrating comet tail artifact is found in the midportion of the right lobe. This nodule measures 0.6 cm x 0.3 cm x 0.4 cm.LEFT LOBE: The left lobe is heterogeneous with no dominant nodules identified.ISTHMUS: No significant abnormalities are noted.LYMPH NODES: No suspicious adenopathy noted. A level 3 lymph node is identified on the right that measures 2.5 cm x 0.5 cm x 0.8 cm. This is slender, hypoechoic, and has a fatty hilum", "output": "1.Two right-sided thyroid nodules are seen. In the superior portion of the right lobe, there is a possibly complex cystic nodule measuring 0.3 cm x 0.5 cm x 0.5 cm. Inferior to that is a another nodule representing a colloid cyst measuring 0.6 cm x 0.3 cm x 0.4 cm. No dominant nodules are seen on the left. No suspicious adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old male with history of hepatitis C who presents for evaluation of cirrhosis and hepatocellular carcinoma. LIVER: The liver is mildly coarse in echotexture with smooth contour. No evidence of hepatic mass. The main portal vein is patent with peak velocity of 0.2 m/s.BILIARY TRACT: Echogenic focus within the gallbladder measures 0.5 x 0.5 x 0.2 cm without vascularity, likely a polyp. Gallbladder wall measures 0.2 cm without evidence of pericholecystic fluid. No intra or extrahepatic biliary ductal dilatation. The common bile duct measures 0.4 cm in diameter.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen is normal echotexture and measures 9 cm in length.KIDNEYS: The right kidney measures 10.1 cm in length and the left kidney measures 10.2 cm in length without evidence of hydronephrosis. OTHER: No significant abnormalities noted.", "output": "1.No findings to suggest cirrhosis or hepatic mass.2.5 mm gallbladder polyp."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Fox is a 16 year old female presenting with a palpable left breast mass since June 2016. Targeted left breast ultrasound was performed for the patient's area of concern.In the left breast 10:00 location, approximately 5 cm from the nipple, there is a macrolobulated hypoechoic mass identified measuring 3.4 x 1.6 x 2.8 cm. There is moderate associated vascularity.", "output": "High probability benign mass of the left breast, likely representing a fibroadenoma. Given its palpability, a consultation with a breast surgeon is recommended at this time. All results and recommendations were discussed with the patient and her grandmother.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Male; 61 years old. Reason: HCV please assess for cirrhosis and assess for mass LIVER: The liver is enlarged measuring 18.2 cm in length. The liver surface is smooth, the parenchyma is heterogeneous with a coarse echotexture. No focal hepatic lesion is identified. The main portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.35 m/sec.BILIARY TRACT: There is no cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. Gallbladder polyposis measuring up to 4 x 3 x 4 mm. The common bile duct measures 7 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 9.6 cm in length.RIGHT KIDNEY: The right kidney measures 9.5 cm in length. The renal parenchyma is echogenic. There is no hydronephrosis or shadowing renal stone. LEFT KIDNEY: The left kidney measures 10.4 cm in length. The renal parenchyma is echogenic. There is no hydronephrosis or shadowing renal stone.", "output": "1.Hepatomegaly. Heterogeneous, coarse liver suggestive of hepatic steatosis/parenchymal dysfunction.2.No focal hepatic lesion.3.Gallbladder polyposis.4.Echogenic kidneys suggestive of medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "27-year-old female with history of hepatitis B carrier, screen for HCC. LIVER: Coarsened hepatic echotexture without discrete focal lesion. Patent main portal vein.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 hepatic echotexture consistent with diffuse parenchymal disease or fatty infiltration. No discrete hepatic lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "19-year-old female with palpable mass in the left breast for 2-3 weeks. Family history of breast carcinoma in her maternal and paternal grandmother. With physical exam, a small soft mobile mass is palpated at 11:00 position in the left breast. With focused ultrasound, there is an oval, circumscribed hypoechoic mass measuring 15 x 8 mm with increased blood flow at left 11:00 position, likely a fibroadenoma.", "output": "Palpable mass in the left breast, which is likely a fibroadenoma. Clinical correlation is recommended.Results and recommendations were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "History of hepatitis C, evaluate for hepatocellular carcinoma. LIVER: The liver measures 18.4 cm in length. Mildly increased parenchymal echogenicity. Focal circumscribed mass within the right hepatic lobe measuring 5.6 x 4.4 x 4.4 cm which demonstrates heterogenous echotexture. 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. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common hepatic 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 8.1 cm in length. RIGHT KIDNEY: Kidney measures 11.9 cm in length. Normal cortical echotexture. Focal solid mass in the lower pole measuring 4.2 x 3.9 x 3.9 cm. LEFT KIDNEY: Kidney measures 11.1 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Mass in the right lobe of the liver which is non-specific but suspicious for neoplasm. 2.Mass in the lower pole of the right kidney which is non-specific but suspicious for neoplasm. Dedicated cross-sectional imaging with contrast is recommended for further characterization of both masses. Ordering provider, PHO, MAI T (#9208) not pageable, so findings were e-mailed to her. Recommendation for follow-up also entered into the follow-up tool."}
{"instruction": "Generate impression based on findings.", "input": "Hashimoto's, small nodule RIGHT LOBE MEASUREMENTS: 5.4 x 1.2 x 1.4 cmLEFT LOBE MEASUREMENTS: 6.1 x 1.3 x 1.7 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Heterogeneous echotexture.LEFT LOBE: Heterogeneous echotexture. Subcentimeter nodule in the left thyroid lobe is stable compared to the prior exam.ISTHMUS: Heterogeneous echotexture.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.", "output": "Stable left thyroid lobe nodule."}
{"instruction": "Generate impression based on findings.", "input": "Female, 68 years old. Rise in creatinine. Evaluate for renal obstruction/abnormality RIGHT KIDNEY: The right kidney measures 9.7 cm in length, with mildly increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney is poorly visualized but measures approximately 10.2 cm in length. No definite shadowing stones or hydronephrosis.OTHER: The bladder is distended without significant wall thickening. Increased hepatic echogenicity.", "output": "1.Mildly increased renal cortical echogenicity suggests medical renal disease. No hydronephrosis.2.Increased hepatic echogenicity compatible with fatty infiltration parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Reason: elevated alkaline phosphatase, abdominal pain. LIVER: The liver measures 21 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 0.36 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 12.0 cm in length. RIGHT KIDNEY: Kidney measures 8.1 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass. There is a cystic area inferior to the right kidney which is likely related to patient's known AML as characterized on prior prior CT.LEFT KIDNEY: Kidney measures 13.4 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "Hepatomegaly with coarse hepatic echotexture suggestive of parenchymal dysfunction. No associated biliary ductal dilatation or evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Female 40 years old Reason: Outside Request: ruq abd pain and gas, had gall bladder removed 2007 r/o stone in the billary tree vs pancreatic duct vs other LIMITED ABDOMENLIVER: The liver measures 17.0 cm. Diffuse parenchymal echotexture compatible with hepatic steatosis. No focal hepatic lesions. Portal vein is patent with normal directional flow.BILIARY TRACT: No intra or extrahepatic biliary ductal dilation. The common bile duct measures 4 mm in diameter. Status post cholecystectomy.PANCREAS: No significant abnormality noted.KIDNEYS: Right kidney measures 10.7 cm. Left kidney measures 11.4 cm. No hydronephrosis or mass.SPLEEN: Spleen measures 8.3 cm.OTHER: No significant abnormalities noted.", "output": "1.Hepatic steatosis.2.No evidence of biliary or pancreatic ductal dilation."}
{"instruction": "Generate impression based on findings.", "input": "Bilateral thyroid nodules RIGHT LOBE MEASUREMENTS: 1.9 x 1.6 x 5.3 cmLEFT LOBE MEASUREMENTS: 1.8 x 2 x 5 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Stable subcentimeter benign-appearing nodules. Mid pole nodule again measures 0.4 x 0.3 x 0.6 cm. Lower pole mixed cystic and solid nodule measures 0.4 x 0.3 x 0.4 cm.LEFT LOBE: No significant abnormality noted.ISTHMUS: Stable subcentimeter isthmic benign-appearing nodule measuring 0.3 x 0.2 x 0.4 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable bilateral subcentimeter nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female with upper abdominal pain, evaluate for gallbladder pathology. LIVER: Measures 17.3 in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Collapsed gallbladder without evidence of 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": "1. Collapsed gallbladder without evidence of cholelithiasis or cholecystitis. 2. Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease. "}
{"instruction": "Generate impression based on findings.", "input": "History of hepatitis C with cirrhosis. LIVER: The liver is mildly coarse in echotexture. It measures 15 cm in length. No focal lesion or intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 27 cm/s.BILIARY TRACT: Partially distended gallbladder with mild asymmetric wall thickening with comet tail artifact suggestive of focal adenomyomatosis. No shadowing gallstones, pericholecystic fluid or focal tenderness.No extrahepatic biliary ductal dilatation with the common duct measuring 5 mm.PANCREAS: The visualized pancreatic head and body is unremarkable.SPLEEN: The spleen measures 12.8 cm in length without a focal lesion.RIGHT KIDNEY: The right kidney measures 10.8 cm in length. Note is made of an 11 mm shadowing nonobstructive stone. Superior pole simple appearing cyst. No hydronephrosis. OTHER: The left kidney measures 11.2 cm in length. A nonspecific 9 mm hypoechoic focus may represent a renal pyramid. No hydronephrosis or shadowing nephrolithiasis. Color Doppler demonstrates hilar blood flow.", "output": "Coarse liver echotexture without a focal lesion or biliary ductal dilatation.Focal gallbladder adenomyomatosis.11 mm nonobstructive right renal calculus."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury. RIGHT KIDNEY: The right kidney measures 12.5 cm. No hydronephrosis or renal calculus is identified.LEFT KIDNEY: The left kidney measures 11.1 cm. No hydronephrosis or renal calculus identified.URINARY BLADDER: Bladder distended with anechoic fluid.OTHER: No significant abnormalities noted.", "output": "No evidence of hydronephrosis or renal calculi. Kidneys are normal in appearance."}
{"instruction": "Generate impression based on findings.", "input": "Palpable area of concern in the right axilla. A targeted right ultrasound was performed for the patient\u2019s area of concern. A normal morphology low right axillary lymph node is identified at the patient's site of concern, measuring up to 1.1 cm. There is no suspicious solid or cystic mass identified.", "output": "Normal morphology lymph node seen at the site of concern noted by the patient. No suspicious finding.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old female with right abdominal pain. LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Within the region of the right adnexa there is a mildly complex 5 x 6.1 x 6.7 cm cystic mass which would be best evaluated by dedicated pelvic ultrasound.", "output": "Complex cystic mass right adnexa."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female patient with some atypia on thyroid nodule biopsy, but size is stable. Evaluate for growth of nodules. RIGHT LOBE MEASUREMENTS: 4.5 x 1.8 x 2.1 cm.LEFT LOBE MEASUREMENTS: 3.6 x 1.0 x 1.0 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: Heterogeneous solid nodule in the superior pole measures 0.8 x 0.6 x 0.6 cm, previously 0.7 x 0.5 x 0.7 cm. This nodule is not significantly changed in appearance since the prior study. In the mid right lobe, there is a larger heterogeneous solid nodule which measures 1.6 x 1.4 x 2.5 cm, previously 1.6 x 1.2 x 2.4 cm, without significant interval change in size or appearance.There is a hypoechoic solid lesion adjacent to the inferior pole measuring 0.8 x 0.6 x 0.4 cm, previously 0.6 x 0.4 x 0.7 cm, also not significantly changed in size or appearance. LEFT LOBE: Left thyroid lobe is heterogeneous in echogenicity without new focal discrete nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Stable right thyroid nodules.2. No significant change in a solid hypoechoic lesion adjacent to the inferior pole of the right thyroid gland."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid carcinoma status post thyroidectomy with palpable lymph node left lateral neck RIGHT LOBE: Status post thyroidectomy without mass.LEFT LOBE: Status post thyroidectomy without mass.ISTHMUS: Status post thyroidectomy without mass.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: 2.1 x 1.1 cm complex mixed cystic and solid focus within the superior aspect of level 5 on the left. The appearance of this mixed cystic and solid focus is very different from the previously noted posterior left lateral neck cystic focus.OTHER: No significant abnormality noted.", "output": "Complex mixed cystic and solid focus within the superior aspect of level 5 on the left. The appearance of this focus is very different from the previously noted posterior left lateral complex cystic focus. While this may represent postoperative change, it is best considered indeterminate. This lesion is amenable to ultrasound-guided percutaneous biopsy; alternatively if biopsy is not performed, would pay special attention to this lesion on future surveillance scans."}
{"instruction": "Generate impression based on findings.", "input": "Alpha-1 antitrypsin deficiency. LIVER: Micronodular liver contours and mildly coarsened hepatic echogenicity, compatible with chronic liver disease. 16.6 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 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 4.8 cm simple appearing cyst in the superior pole. The left kidney is 11.6 cm in length, with a 1.6 cm simple appearing cyst in the inferior pole. 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 ascites is identified.", "output": "No suspicious liver lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "Right flank pain RIGHT KIDNEY: Normal parenchymal echogenicity. Mild right hydronephrosis. Benign renal cysts. Right kidney 9.9 cm in length.LEFT KIDNEY: Normal parenchymal echogenicity. No hydronephrosis. Benign renal cyst. Left kidney 9.7 cm in length.OTHER: Bladder nondistended", "output": "Mild right hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female with marginal zone lymphoma, scleroderma, vasculitis who presents with persistent microscopic hematuria. Evaluate for renal disease. RIGHT KIDNEY: The right kidney measures 12.6 cm in length. No hydronephrosis. Normal echogenicity.LEFT KIDNEY: The left kidney measures 11.6 cm in length. No hydronephrosis. Left mid pole renal cyst measuring 2.7 x 2.6 x 3 cm. Otherwise, normal echogenicity.URINARY BLADDER: The urinary bladder is partially distended without acute abnormality.OTHER: Interval enlargement of left pleural effusion.", "output": "1. Left-sided simple renal cyst. Otherwise normal parenchymal echogenicity. No hydronephrosis.2. Interval enlargement of left pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "24-year-old female with right upper quadrant pain. LIVER: Liver is normal in size but appears mildly echogenic which could be due to fatty infiltration. No focal hepatic abnormality.GALLBLADDER, BILIARY TRACT: Biliary tract is normal in caliber. There are small, dependent gallstones in the gallbladder without wall thickening or pericholecystic fluid.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Limited views of left kidney and spleen demonstrate no abnormality.", "output": "Small, dependent gallstones in the gallbladder without complication.Likely mild fatty liver."}
{"instruction": "Generate impression based on findings.", "input": "30 year-old male with history of abdominal pain. Evaluate for CSF -oma. LIVER: No significant abnormalities noted. Liver measures 16 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. No biliary dilatation or gallstones.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. The right kidney measures 8.6 cm.OTHER: No significant abnormalities noted. The left kidney measures 10.2 cm. The spleen measures 11.5 cm, and is within normal limits. No loculated fluid collections.", "output": "No loculated fluid collections, or other acute abnormalities."}
{"instruction": "Generate impression based on findings.", "input": "Female 73 years old; Reason: eval for nodules History: symptomatic neck fullness in area of thyroid RIGHT LOBE MEASUREMENTS: 1.8 x 1.5 x 4.7 cmLEFT LOBE MEASUREMENTS: 1.7 x 1.3 x 5.9 cmISTHMUS MEASUREMENT: 0.44 cmRIGHT LOBE: Small heterogenous nodule in the right thyroid lobe measures 0.7 x 0.4 x 0.6 cm.LEFT LOBE: Heterogenous in the left thyroid lobe measures 1.4 x 0.9 x 1.1 cm.ISTHMUS: Heterogenous complex nodule with irregular margins in the isthmus measuring 1.5 x 1.2 x 1.0 cm.LYMPH NODES: Benign-appearing right neck node in level 1B measuring 1.5 x 0.9 x 0.6 cm. Additional lymph node in level 2 of the left neck measures 2.0 x 0.9 x 0.5 cm.OTHER: No significant abnormality noted.", "output": "Multiple heterogenous nodules in the thyroid most suggestive of goiter. Dominant complex nodule with irregular margins in the isthmus is amenable to fine-needle aspiration if clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female complains of right upper quadrant pain. Evaluate for gallbladder pathology. LIVER:The liver measures approximately 15.8 cm. There is increased and coarse echotexture of the parenchyma. No mass, ascites, or intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder appears normal without stones or sludge. The gallbladder wall measures approximately 0.2 cm. The common bile duct measures 0.1 cm. No pericholecystic fluid.PANCREAS: Evaluation the pancreas is limited due to overlying bowel gas.SPLEEN: The spleen measures 7.5 cm without sonographic abnormalities.KIDNEYS: The right kidney measures 10.1 cm. The cortex has increased echogenicity. No shadowing calculi, worrisome mass, or hydronephrosis. The left kidney measures 10.0 cm. The cortex has increased echogenicity. No shadowing calculi, or worrisome mass, or hydronephrosis. OTHER: No significant abnormality noted.", "output": "1. Increased, coarse echotexture of the liver consistent with chronic liver disease/parenchymal dysfunction. No masses or ascites.2. Increased echogenicity of the kidneys consistent with medical renal disease/parenchymal dysfunction. No stone, worrisome mass, or hydronephrosis.3. No sonographic evidence of biliary pathology."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. Right kidney 10.5 cm in lengthLEFT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. Left kidney 10.7 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": "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. Scattered simple cysts are present bilaterally. 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": "Ms. Wells is a 67 year old woman who presents for further imaging evaluation of the left lower inner breast mass seen on screening mammogram with tomosynthesis on 8/23/2016. She has a history of simple cysts within the left breast. Full field left ML and spot compression left CC and ML 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. A circumscribed oval mass at approximately the left 7:00 position is again seen. 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: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Hyperparathyroidism. Evaluate for renal stones. RIGHT KIDNEY: 9.3 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 9.3 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: CollapsedOTHER: No significant abnormality noted.", "output": "No definite nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter RIGHT LOBE MEASUREMENTS: 6.6 x 3.1 x 3.7 cmLEFT LOBE MEASUREMENTS: 5. 2 x 2 x 2.8 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Multiple predominantly solid nodules. A representative mid pole nodule measures 3.9 x 2.6 x 4.6 cm.LEFT LOBE: Multiple predominantly solid nodules. A representative mid pole nodule measures 2.2 x 1.9 x 1.7 cm.ISTHMUS: A predominantly solid isthmic nodule measures 1.1 x 0.9 x 1.3 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple bilateral predominantly solid thyroid nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Hyperkalemia and renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 12.8 cm in lengthLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 12.1 cm in length.OTHER: Bladder collapsed around Foley. Trace ascites.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid carcinoma 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": "HBV/HIV. Evaluate for HCC. LIVER: 14 cm in length. Mildly heterogeneous hepatic echotexture. Non-cirrhotic liver morphology. No focal hepatic lesions. Patent portal vein with hepatopetal flow. BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilation. Normal sonographic appearance of the gallbladder.PANCREAS: The pancreas is obscured by overlying bowel gas. SPLEEN: 7.4 cm in length. No significant abnormalities noted.RIGHT KIDNEY: 8.6 cm in length. A subcentimeter simple cyst is noted in the superior pole. No significant abnormalities noted. LEFT KIDNEY: 9.1 cm in length. A subcentimeter simple cyst is noted in the superior pole. No significant abnormalities noted. OTHER: No significant abnormalities noted. No ascites visualized.", "output": "Mildly heterogeneous hepatic echotexture reflecting hepatic dysfunction, without sonographic evidence of cirrhosis or hepatocellular carcinoma. "}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male with history of metastatic pancreatic cancer presents with a right groin mass. Evaluate for hernia. The right inguinal canal contains fat and vessels with no bowel. On Valsalva, the hernia orifice opens without protrusion of bowel.There are enlarged right inguinal lymph nodes.", "output": "1. Right inguinal hernia without bowel.2. Right inguinal lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Female 51 years old Reason: 51 yo female, need US guidance for bx History: AKI Gray scale ultrasonographic images were provided for the nephrology service for an ultrasound-guided biopsy of the left kidney.", "output": "Gray scale ultrasonographic images were provided for the nephrology service for an ultrasound-guided biopsy of the left kidney."}
{"instruction": "Generate impression based on findings.", "input": "Female with right-sided thyroid enlargement, right-sided throat pain. RIGHT LOBE MEASUREMENTS: 4.9 cm x 3.1 cm x 2.4 cm. LEFT LOBE MEASUREMENTS: 3.2 cm x 1.5 cm x 2.4 cm. ISTHMUS MEASUREMENTS: 3 mm in thickness.RIGHT LOBE: Multiple spongiform colloid nodules are noted, the largest of which measures 1.4 cm x 1.3 cm x 1.2 cm.LEFT LOBE: Spongiform colloid nodule is noted measuring 1.1 cm x 0.8 cm x 1.2 cm. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Left cervical lymphadenopathy is noted, the largest of which measures 2.5 cm x 1.5 cm x 1.3 cm. The remaining measure as follows: 1.2 cm x 0.9 cm x 1.0 cm, the other measures 0.8 cm x 1.0 cm x 1.2 cm and the other visualized lymph node measures 0.9 cm x 0.7 cm x 1.0 cm. These lymph nodes are heterogeneous and hypoechoic in echotexture. OTHER: No significant abnormality noted.", "output": "1. Left cervical lymphadenopathy, morphology is worrisome for neoplastic etiology. 2. Bilateral spongiform colloid thyroid nodules favoring a benign process. "}
{"instruction": "Generate impression based on findings.", "input": "52 year old female with history of cirrhosis, evaluate for HCC. LIVER: The liver has coarse echogenicity, and subtle contour nodularity. Liver measures approximately 13 cm. No biliary dilatation. No pain during exam. No discrete mass identified.BILIARY TRACT: No biliary dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: Small left renal cyst is unchanged in size or appearance.", "output": "Cirrhotic liver morphology, without evidence of mass or other significant abnormality."}
{"instruction": "Generate impression based on findings.", "input": "30 year-old female right upper quadrant pain. The study is slightly limited due to the patient's body habitus and resulting poor ultrasound penetration.LIVER: The liver parenchyma is mildly coarse and echogenic without a discrete lesion or definite intrahepatic biliary ductal dilatation. It is normal in size, measuring 14.5 cm in craniocaudal dimension. The liver capsule is within normal limits. Normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common bile duct measuring 2 mm. Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid or focal tenderness.PANCREAS: Limited evaluation of the pancreatic head is unremarkable.SPLEEN: The spleen measures 10.5 cm in length.RIGHT KIDNEY: The right kidney measures 10.7 cm in length without hydronephrosis. OTHER: The left kidney measures 10 cm in length without hydronephrosis.", "output": "No cholelithiasis or other specific findings to account for the patient's symptoms. Mildly coarse liver parenchyma may represent diffuse fatty infiltration/parenchymal dysfunction. "}
{"instruction": "Generate impression based on findings.", "input": "69-year-old female with hypercalcemia, hyperparathyroidism. Evaluate for abnormal parathyroids. RIGHT LOBE MEASUREMENTS: 4.3 cm x 1.2 cm x 1.4 cmLEFT LOBE MEASUREMENTS: 4.5 cm x 0.9 cm x 1.4 cmISTHMUS MEASUREMENTS: 3 mm in thicknessRIGHT LOBE: Multiple nodules are noted. At the mid to upper pole a hypoechoic cystic appearing nodule measures 7 mm x 5 mm x 3 mm. Additional hypoechoic mixed solid cystic nodule at the inferior pole measures 4 mm x 4 mm x 6 mm. A second inferior pole mixed solid cystic hypoechoic nodule measures 1.0 cm x 0.8 cm x 0.6 cm. LEFT LOBE: Hypoechoic mixed solid cystic nodule at the mid pole measures 4 mm x 2 mm x 4 mm.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 nodules as described above. No sonographic evidence of parathyroid adenoma. Please refer to same day nuclear medicine parathyroid SPECT/CT study for additional findings. "}
{"instruction": "Generate impression based on findings.", "input": "81-year-old female with thyroid cancer status post surgery and radioablation. RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: Redemonstration of a hypoechoic structure in the right thyroid bed with increasing coarse calcifications measuring 0.7 x 0.5 x 0.5 cm, not significantly changed in size compared with prior studies. Also noted is a 0.4 cm hypoechoic focus either in the inferior right thyroid bed or just outside of the thyroid bed, not seen on prior studies.LEFT LOBE: Redemonstration of a hypoechoic calcified structure in the left thyroid bed measuring 1.2 x 0.7 x 1.1 cm, not significantly changed compared with prior studies.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered subcentimeter cervical lymph nodes without definite benign or malignant features.OTHER: No significant abnormality noted.", "output": "1. Subcentimeter hypoechoic focus either in or just outside of the right inferior thyroid bed not seen on prior studies is nonspecific. Continued attention is recommended to this region on subsequent examinations.2. Otherwise, calcified hypoechoic foci in the right and left thyroid bed are not significantly changed in size. The degree of calcification appears increased on the right. 3. Scattered subcentimeter cervical lymph nodes are without definite benign or malignant features."}
{"instruction": "Generate impression based on findings.", "input": "Right hydronephrosis status post nephrostomy tube ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures 9.9 cm in length. Moderate right hydronephrosis. Right nephrostomy tube has been inadvertently removed. Stone again noted in the mid ureter.LEFT KIDNEY: The left kidney measures 7.4 cm in length and appears echogenic compatible medical renal disease. No hydronephrosis in the left kidney. 4 cm lower pole cyst again noted.OTHER:Bladder was collapsed around a Foley catheter and cannot be evaluated.", "output": "Moderate right hydronephrosis with obstructing ureteral calculus. The right nephrostomy tube has been inadvertently removed. Medical renal disease of the left kidney. Findings discussed with interventional radiology."}
{"instruction": "Generate impression based on findings.", "input": "Nontoxic single thyroid noduleHistory of benign FNA of the midpole left thyroid lesion in August 2014 RIGHT LOBE MEASUREMENTS: 3.7 x 1.5 x 1.2 cm, normal echotextureLEFT LOBE MEASUREMENTS: 3.4 x 1.5 x 1.5 cm, normal echotexture ISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: Heterogenous spongiform morphology nodule in the lower pole with echogenic foci with ringdown artifact probably suggesting colitis measures 0.7 x 0.7 x 0.7 cm, unchanged from prior study.Mid gland nodule is also unchanged measures 0.8 x 0.4 x 0.7 mm, previously measured 0.6 x 0.6 x 0.4 cmLEFT LOBE: Lower lobe solid homogeneous nodule measures 1.2 x 1 x 1 cm, previously measured 1.2 x 1.3 x 1 cm. No definite calcifications noted.ISTHMUS: Small nodule by the isthmus measures 0.5 x 0.5 x 0.4 cm, mostly unchanged from prior study.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Level 2 lymph node on the right measures 1.8 x 0.4 x 0.7 cm, demonstrates normal morphology.Index lymph node on the left measures 1.6 x 0.5 x 0.9 cm, unchanged from prior study, and also demonstrates normal morphology.OTHER: No significant abnormality noted.", "output": "Stable bilateral nodules."}
{"instruction": "Generate impression based on findings.", "input": "Female 55 years old; Reason: r/o mass History: transaminitis LIVER: The liver measures 20 cm in length. There is coarse and heterogeneous echogenicity of the liver parenchyma. No focal hepatic lesions, however there is a hypoechoic mass seen juxtaposed adjacent to the liver which represents inferior aspect of the heart in cross section. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.1 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 3.1 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9.6 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 9.7 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.2 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.", "output": "1. Coarse and heterogenous echotexture of liver consistent with diffuse hepatic parenchymal dysfunction. No masses are seen."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old male with elevated bilirubin. Evaluate for right upper quadrant abnormality. LIVER: Measures 18.2 cm in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: There is gallbladder wall thickening up to 0.6 cm. A punctate echogenic focus is noted in the gallbladder lumen which may possibly represent a small stone, however this is equivocal. There is no 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: Mildly enlarged spleen measures 14.7 cm, without discrete focal lesion.KIDNEY: Increased renal echogenicity without hydronephrosis, nephrolithiasis, or solid mass.OTHER: No significant abnormalities noted.", "output": "1. Marked gallbladder wall thickening raises suspicion of acute cholecystitis in this clinical setting. There is an equivocal small gallstone, and acalculous cholecystitis is also a differential consideration. 2. Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease.3. Increased renal echogenicity consistent with medical renal disease, without hydronephrosis.4. Mild splenomegaly. "}
{"instruction": "Generate impression based on findings.", "input": "Male 32 years old Reason: 32 y.o. Male with left thyroid nodule. History: thyroid nodule RIGHT LOBE MEASUREMENTS: 4.3 x 1.6 x 1.4 cm.LEFT LOBE MEASUREMENTS: 4.1 x 1.4 x 1.3 cm.ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: Heterogeneous background thyroid. At the inferior portion of the right thyroid lobe is a hypoechoic nodule which also appears to be external to the thyroid measuring 0.9 x 0.6 x 0.7 cm, possibly representing a parathyroid gland.LEFT LOBE: Heterogeneous background thyroid. At the inferior portion of the left thyroid lobe there is a hypoechoic nodule unchanged in size measuring 1.1 x 0.8 x 1.0 cm. This nodule may be external to the thyroid representing a parathyroid gland. A second nodule is also unchanged in size measuring 1.5 x 0.5 x 1.0 cm along the inferior portion of the left thyroid lobe.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: The two inferior parathyroid glands may be visualized, as detailed above.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Unchanged thyroid nodules. The most inferior nodules bilaterally may be external to the thyroid and represent parathyroid glands."}
{"instruction": "Generate impression based on findings.", "input": "51 years old, Female, Reason: evaluate for neck mass History: neck mass for past 4 months, freely mobile and nontender RIGHT LOBE MEASUREMENTS: 5.4 x 1.4 x 1.8 centimetersLEFT LOBE MEASUREMENTS: 5.2 x 1.4 x 1.8 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Hypoechoic spongiform nodule in the inferior right thyroid lobe without peripheral capsule measures 0.6 x 2.5 x 0.4 cm, which is favored to represent colloid nodule. There is no calcification within this nodule.LEFT LOBE: Solid appearing left inferior thyroid lobe nodule has a discontinuous hypoechoic rim measuring 1.0 x 0.7 x 0.4 cm. This nodule is amenable to biopsy. There is no calcification within this nodule.ISTHMUS: There is an anechoic well defined, semi-complex 1.8 x 1.4 x 0.6 centimeter nodule which partially deforms the trachea. There is not significant nodularity within the cystic structure itself. There is thyroid tissue around this entire structure. The structure may represent a minimally complex colloid cyst or less likely a thyroglossal duct cyst.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Midline anechoic cystic structure which minimally deforms the trachea is favored to represent a mildly complex colloid cyst versus less likely a thyroglossal duct cyst.2. Solid appearing left inferior lobe nodule is indeterminate on this exam and is amenable to biopsy.3. Subcentimeter spongiform right thyroid nodule is favored to represent a colloid cyst."}
{"instruction": "Generate impression based on findings.", "input": "CKD. RIGHT KIDNEY: 10.5 cm in length. The renal parenchyma is of increased echogenicity, without focal lesions. No nephrolithiasis or hydronephrosis.LEFT KIDNEY: 11.1 cm in length. The renal parenchyma is of increased echogenicity, without focal lesions. No nephrolithiasis or hydronephrosis. BLADDER: No significant abnormality noted.OTHER: Enlarged prostate noted. No free fluid identified.", "output": "Increased renal parenchymal echogenicity without hydronephrosis, compatible with medical renal 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": "Thyroid nodules RIGHT LOBE MEASUREMENTS: 4.4 x 1.5 x 1.4 cmLEFT LOBE MEASUREMENTS: 4 x 1.5 x 1.4 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: Multiple subcentimeter nodules identified in the right lobe, mostly partly cystic partly solid in nature especially in the midpole that measures 0.8 x 0.6 x 0.7 cm.LEFT LOBE: A large partly cystic partly solid nodule identified in the midpole that measures 2 x 1.2 x 1.3 cm with minimal peripheral blood flow.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal morphology level 3 right neck lymph nodes and level 2 left neck lymph nodes noted.OTHER: No significant abnormality noted.", "output": "Dominant left thyroid partly cystic partly solid nodule amenable to FNA."}
{"instruction": "Generate impression based on findings.", "input": "Male, 72 years old. Urinary frequency dysuria, nocturia, hesitency RIGHT KIDNEY: The right kidney measures 7.9 cm in length, with normal cortical echogenicity. A lower pole simple cyst measures 2.0 x 2.0 x 2.2 cm. No renal stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.2 cm in length, with normal cortical echogenicity. No renal stones, masses, or hydronephrosis.OTHER: The bladder is incompletely distended.", "output": "No renal stones or hydronephrosis."}
{"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. Revisualization of a lobulated hypoechoic mass in the right upper outer breast measuring approximately 0.9 cm, stable in size and appearance when compared to prior ultrasound exams. There is no solid or cystic mass identified.", "output": "Stable fibroadenoma of the right breast. No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female with flank pain. RIGHT KIDNEY: The right kidney measures 10.8 cm in length. Echotexture appears normal. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 10.7 cm in length. Echotexture appears normal. No hydronephrosis, shadowing calculus or mass.OTHER: Urinary bladder is incompletely distended.", "output": "Normal appearance of the kidneys. No shadowing calcification or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old male with HCV cirrhosis. Screening for hepatocellular carcinoma. LIVER: Liver is normal in size and diffusely, coarsely echogenic which is nonspecific. No focal mass is identified. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The visualized biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.SPLEEN: Mildly enlarged as previously seen.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No gross abnormality involving the left kidney.", "output": "Stable examination. Echogenic liver without mass."}
{"instruction": "Generate impression based on findings.", "input": "52 year old female who was recalled from screening mammogram for 13-mm bilobed asymmetry in the medial right breast with a possible correlate in the inferior right breast . Mammogram: An ML view and two spot compression and spot magnification 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. Bilobed asymmetry in question disperses into normal breast tissue. Loosely scattered calcifications were noted in the right upper outer quadrant on the ML view and further evaluated with spot magnification views. Most of them later on ML view, suggestive of milk of calcium. Multiple benign morphology, masses in the lateral right breast are unchanged.Ultrasound: Targeted medial right breast ultrasound was performed to evaluate the mammographic area in question. No suspicious cystic or solid mass noted. Normal glandular tissue 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: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female with history of goiter, hyperthyroidism. RIGHT LOBE MEASUREMENTS: 6.4 x 2.2 x 2.0 cmLEFT LOBE MEASUREMENTS: 8.3 x 2.4 x 2.1 cmISTHMUS MEASUREMENTS: 1.0 cmRIGHT LOBE: Small hypoechoic part solid/part cystic nodes in the lower pole measuring up to 1.0 cm without microcalcifications.LEFT LOBE: Predominantly solid nodule in the left inferior pole with prominent cystic spaces measures 2.6 x 1.8 x 1.7 cm.ISTHMUS: Large mixed solid and cystic lesion in the isthmus/left lower pole measures 3.1 x 3.3 x 2.2 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered cervical lymph nodes with overall benign morphologic featuresOTHER: No significant abnormality noted.", "output": "Two large solid and cystic nodules in the isthmus and left lower pole as described above are amenable to biopsy as warranted clinically."}
{"instruction": "Generate impression based on findings.", "input": "Female 42 years old; Reason: r/o growth of nodules, adenopathy, worrisome features History: h/o thyroid nodules. US in 5/14 showed stable nodule on one side, and decreased on the other. However, stable nodule was possibly subtly larger, so this will be a one year follow up study RIGHT LOBE MEASUREMENTS: 5 x 1.8 x 1.7 cm, previously 4.9 x 1.9 x 1.9 cm.LEFT LOBE MEASUREMENTS: 5.1 x 1.6 x 2.2 cm, previously 5.4 x 1.8 x 1.7 cm.ISTHMUS MEASUREMENT: 0.4 cm, previously 0.5 cm.RIGHT LOBE: Again noted is predominantly hypoechoic lesion in the right inferior lobe, measuring 1.7 x 1.2 x 1.4 cm, as compared to 1.8 x 1.6 x 1.2 cm on the prior exam, slightly decreased in size. This was reportedly previously biopsied demonstrating colloid nodule. No vascularity or microcalcifications are noted within the nodule.LEFT LOBE: Again noted is predominantly hyperechoic and solid nodule with cystic components in the left inferior lobe measuring 1.5 x 1.3 x 0.9 cm, previously 1.6 x 1.4 x 1.2 cm, slightly decreased in size as compared to the prior exam. No microcalcifications noted. Peripheral vascularity is noted.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Slight interval decrease in size of bilateral thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female with history of laparoscopic partial colectomy and recurrent abdominal pain over the incision. Evaluate for hernia. The abdominal wall was examined from the subxiphoid area down to the umbilicus in the midline with and without Valsalva. No sonographic evidence of a hernia is present.", "output": "No sonographic evidence for a incisional hernia is seen. If indicated, may consider a CT for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C. Evaluate for hepatocellular carcinoma. LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. Normal portal venous blood flow and direction. The previously seen hyperechoic lesion near the capsule compatible with hemangioma is not evident on the current examination. An additional subcentimeter hyperechoic lesion is seen in the right lobe, likely also representing a hemangioma.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Normal appearance of the gallbladderPANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney is 11.1 cm in length. The left kidney is 10.7 cm in length, with a subcentimeter benign-appearing cyst in the inferior pole. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 11.2 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites.", "output": "No suspicious hepatic lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 26 yo female with presumed gallstones; please evaluate for abnormalities History: gallstones LIVER: The liver measures 13.2 cm in length. Unremarkable hepatic parenchymal echotexture and echogenicity. The portal vein is patent with normal directional hepatopedal flow, peak velocity of 31.1 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: Multiple echogenic shadowing stones are noted in the dependent portion of the gallbladder and within the gallbladder neck. No evidence of pericholecystic inflammation or fluid. The gallbladder wall measures 0.3 cm. The common bile duct measures 0.3 cm. No intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.5 cm in length. Normal renal echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.7 cm in length. Normal renal echogenicity. No shattering stones or hydronephrosis.OTHER: The spleen measures 9.3 cm in length. The bladder is decompressed, limiting its evaluation.", "output": "1. Cholelithiasis without evidence of acute inflammation or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "34-year-old female with right upper quadrant pain. Nausea, vomiting and pancreatitis. LIVER: Irregularly echogenic which may be due to fatty infiltration. No gross focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: The gallbladder contains dependent stones and sludge without significant wall thickening. No definite pericholecystic fluid on this exam. The biliary tract is normal in caliber.PANCREAS: Diffusely enlarged. No loculated peripancreatic fluid collections.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Gallstones without obvious complication.Enlarged pancreas."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Coarse echogenic liver echotexture again noted without mass. Liver length 14.8 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.3 cm in length.OTHER: Left kidney 12.2 cm in length. Spleen 11.7 cm in length. No ascites.", "output": "Stable coarse echogenic liver echotexture consistent with chronic liver disease without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male status post ex vivo hepatectomy, now with increasing output in drains, increasing creatinine. Evaluate flow through portal vein, evaluate kidneys. LIVER: Status post right hepatectomy. Remaining liver parenchyma is increased in echogenicity and measures 16.5 cm in length. Left portal vein is patent with appropriate directional flow; peak velocity measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No intrahepatic biliary ductal dilatation. Common duct is not well visualized.PANCREAS: Visualized portions of the pancreas are unremarkable.SPLEEN: Measures 14.1 cm in length and is normal in echogenicity.KIDNEYS: Right kidney measures 12.6 cm in length and is increased in echogenicity. No hydronephrosis or shadowing calculi are noted. Left kidney measures 11.5 cm in length and is increased in echogenicity. Mild pelvicaliectasis which was seen on prior CT dated 2/10/2015. No hydronephrosis or shadowing calculi are noted. ABDOMINAL AORTA: Proximal aorta measures 2.2 cm x 1.9 cm x 2.4 cm and is patent with appropriate directional flow.INFERIOR VENA CAVA: The visualized IVC is patent with appropriate directional flow.OTHER: Right pleural effusion. Trace ascites.", "output": "1. Status post right hepatectomy with increased echogenicity of the remaining liver parenchyma suggestive of parenchymal dysfunction/fatty infiltration. Patent left portal vein. 2. Trace ascites. Right pleural effusion. 3. Increased echogenicity of the kidneys suggestive of parenchymal dysfunction. Mild left pelvicaliectasis. No hydronephrosis. "}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and tomosynthesis were performed 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. Focal asymmetry in the left upper outer breast appears more conspicuous on prior exams with distortion seen on tomosynthesis and further evaluation with spot compression views and ultrasound is recommended.No microcalcifications.", "output": "Focal asymmetry in the left upper outer breast appears more conspicuous on prior exams with distortion seen on tomosynthesis and further evaluation with spot compression views and ultrasound is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EC - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs, assess for biliary pathology. LIVER:The liver measures 22.6 cm in length. This is enlarged. There is coarse increased echogenicity within the liver. No new worrisome masses are noted. No intrahepatic ductal dilation. No ascites. The portal vein is patent with hepatopetal flow measuring 23.6 cm/s.GALLBLADDER, BILIARY TRACT: There is sludge/debris noted within the gallbladder. No stones are visualized. The gallbladder wall measures 3 mm, this is normal. There is no pericholecystic fluid. The common bile duct measures 0.6 cm.PANCREAS: No significant abnormality noted.SPLEEN: The spleen measures 10.6 cm in length. No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 11.9 cm in length. The cortex is of normal echogenicity. There is no hydronephrosis, stones or worrisome masses noted. LEFT KIDNEY: The left kidney measures 13.1 cm in length. The cortex has normal echogenicity. There is no hydronephrosis, no stones, no worrisome masses noted.BLADDER: No significant abnormalities noted.", "output": "1. Hepatomegaly, there is also coarse increased echogenicity within the liver consistent with fatty liver/parenchymal dysfunction. No new worrisome masses, no intrahepatic ductal dilation, and no ascites.2. Sludge/debris is noted within the gallbladder, but there are no stones and no findings to suggest acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Two month old male with hydrocephalus seen on serial head ultrasounds from baseline CT. There is no evidence of intracranial hemorrhage, mass or edema. The lateral ventricles are markedly enlarged, most noted in the occipital horn of the left lateral ventricle, which contains an external drainage catheter. The third ventricle is mildly enlarged, and the fourth ventricle demonstrates normal volume. Ventricular volumes are grossly stable from recent ultrasound exams, given differences in imaging technique. The ventricles remain midline. The basal cisterns are normal in size and configuration. The myelination pattern is within normal limits. There is mild encephalomalacia left parietal lobe near the enlarged occipital horn of the left lateral ventricle.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.", "output": "Stable hydrocephalus and associated left parietal encephalomalacia as described."}
{"instruction": "Generate impression based on findings.", "input": "23-year-old female with flank pain. Evaluate for stone. RIGHT KIDNEY: The right kidney measures 9.4 cm in length. There is no hydronephrosis, shadowing calculus or mass. Echotexture is normal.LEFT KIDNEY: Left kidney measures 9.5 cm in length. There is no hydronephrosis, shadowing calculus or mass. Echotexture is normal.OTHER: Bladder incompletely distended.", "output": "No evidence for nephrolithiasis or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old female patient with postprandial pain, nausea. Evaluate for gallstones. LIVER: The liver measures 13.7 cm in length. Hepatic parenchymal echogenicity is increased. 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 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 9.6 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.9 cm in length. No evidence of hydronephrosis.The spleen measures 9.1 cm in length.", "output": "1. Increased hepatic parenchymal echogenicity which can be seen with hepatic steatosis.2. No cholelithiasis. "}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.OTHER: No ascites", "output": "Gallbladder sludge without acute inflammation or ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid carcinoma 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 mass or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Ascites. Renal dysfunction. Varices. LIVER: 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 9.5 cm in length. The left kidney is 10 cm in length. The renal parenchyma is echogenic. No suspicious renal lesions are evident. No hydronephrosis is seen.BLADDER: No significant abnormality noted.SPLEEN: 8.5 cm in length, without focal lesions evident.AORTA: Patent with normal waveforms. Atherosclerotic calcifications are noted. The maximal diameter measures 2 cm in the mid abdominal aorta, without aneurysmal dilation. The remainder of the distal aorta is not well visualized due to overlying bowel gas.IVC: Patent.OTHER: Right pleural effusion, partially imaged. No significant ascites noted.", "output": "1. Coarsened hepatic echogenicity, compatible with chronic liver disease.2. Echogenic renal parenchyma without hydronephrosis, compatible medical renal disease.3. Right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old with MRI guided biopsy performed or earlier this year. The patient had episodes of bilateral axillary pain and left breast pain for which targeted ultrasound is performed. A targeted bilateral ultrasound was performed for her areas of episodic pain. There is no solid or cystic mass identified. Lymph nodes in each axilla are present, symmetric in size and morphology. These maintain normal fatty hila and hilar predominant blood flow. This includes the largest left axillary lymph node which measures up to 2.1 cm and appears more normal in morphology today compared to the prior ultrasound. At the left breast 12:00 location site of previous pain, no suspicious cystic or solid mass is identified.", "output": "No suspicious findings at the sites of the patient's pain. Symmetric lymph nodes nodes are present in each axilla. Presuming these findings are concordant with physical examination, routine imaging follow-up appropriate for her risk profile is recommended.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Elevated bilirubin and fever LIVER: No significant abnormalities noted. Main portal vein patent with normal directional flow. Liver length 19.3 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.4 cm in lengthOTHER: Right pleural effusion. Trace ascites.", "output": "Mild hepatomegaly without worrisome mass or ductal dilatation. Unremarkable gallbladder without acute inflammation. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "Hematuria. History of bladder diverticulum status post repair. Right-sided nephroureteral stent. RIGHT KIDNEY: The nephroureteral stent is imaged within the right renal pelvis. The pigtail portion of it is not well seen. There is new moderate right-sided hydroureteronephrosis. The right kidney measures 10.9 cm in length. No shadowing nephrolithiasis. The cortex is mildly echogenic and thinned.LEFT KIDNEY: The left kidney measures 10.7 cm in length without hydronephrosis or shadowing nephrolithiasis. The renal cortex is echogenic and mildly thinned. Color Doppler demonstrates hilar blood flow.URINARY BLADDER: The urinary bladder is normally distended with anechoic urine. Previously seen bladder diverticulum is not seen. The nephroureteral stent is noted coiled within the bladder lumen. A left-sided ureteral jet is seen.OTHER: No significant abnormalities noted.", "output": "New moderate right-sided hydroureteronephrosis suggestive of nephroureteral stent malfunction. Although the nephroureteral stent tip is seen within the renal pelvis, the pigtail portion cannot be demonstrated.Findings were paged to urology service 9772 at 1345 on 12/15/2015."}
{"instruction": "Generate impression based on findings.", "input": "Palpable left breast mass and axillary region presents for left breast ultrasound.Patient weighs over 400 pounds and cannot stand. Mammography cannot be performed. Patient's inpatient bed cannot be revealed into the mammography suite, therefore ultrasound was performed in Mitchell ultrasound suite A targeted left breast and axillary ultrasound was performed for the palpable area of concern. On physical examination, inverted left nipple noted with skin changes and puckering. At least 4 cm palpable mass noted in the left nipple 10 to 12:00 position and left axillary region.Multiple irregular hypoechoic masses are identified in the left retroareolar region, largest measuring 4.8 x 3 cm. The masses are inseparable from the nipple. Skin thickening noted. Superior breast demonstrates skin thickening with mild edema.At least 4 abnormal enlarged axillary lymph nodes identified, largest measuring 5.3 x 6.3 cm.", "output": "Limited examination, ultrasound performed in Mitchell ultrasound suite. Mammography cannot be performed as patient weighs 400 pounds and is immobile.Multifocal masses in the left retroareolar region with skin thickening and nipple retraction, inseparable from the nipple highly suspicious for malignancy.At least 4 abnormal enlarged left axillary lymph nodes noted. Given these findings, and rheumatoid breast cancer cannot be ruled out.Findings and recommendations were discussed with Joly Jose.FNA based on palpability is recommended.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "64 years old, Male, Reason: kidney stones History: stones RIGHT KIDNEY: Kidney measures 9.3 cm in length. Normal echotexture. Nohydronephrosis. Shadowing nonobstructing calculi in the lower pole appearing similar to prior exam.LEFT KIDNEY: Kidney measures 9.2 cm in length. Normal echotexture. Nohydronephrosis. Shadowing nonobstructing calculi in the lower pole appearing similar to prior exam.Bladder: The bladder is nondistended.", "output": "Nonobstructing renal calculi in the lower poles of each kidney. No evidence of hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old female with palpable mass right breast underwent ultrasound-guided core biopsy with benign results. As per outside hospital report, these results were discordant. Patient presents for a right breast repeat ultrasound. A targeted right ultrasound was performed for the palpable area of concern. Hypoechoic area with a clip surrounding it identified in the right breast 9:00 position corresponding to the palpable abnormality measuring 1 x 0.7 mm. No peripheral blood flow identified. This area was biopsied, targeting appears adequate and clip is in appropriate location. Outside Hospital pathology reveals benign etiology which is concordant with imaging.", "output": "Palpable abnormality right breast 9:00 position postbiopsy, pathology revealed benign results. This is concordant. Follow-up right breast ultrasound can be performed in 6 months to confirm stability.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "52 year old male patient with new onset of renal failure. Pre-renal picture of FE urea concerning for renal artery stenosis or hypovolemia. Evaluate for hydronephrosis, echogenicity, and/or renal artery stenosis. ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures 10.3 cm in length. Renal cortical echogenicity is within normal limits. No evidence of hydronephrosis.LEFT KIDNEY: The left kidney measures 10.4 cm in length. Renal cortical echogenicity is within normal limits. No evidence of hydronephrosis. Two subcentimeter hyperechoic foci within the left upper pole are noted.OTHER: The bladder is decompressed.", "output": "1. No evidence of hydronephrosis and patent bilateral renal arteries.2. Two subcentimeter hyperechoic foci within the left upper pole; follow up ultrasound is recommended in 6 months to confirm stability."}
{"instruction": "Generate impression based on findings.", "input": "74 years old, Female, Reason: Liver injury from hypotension or other etiology? History: elevated AST, ALT, bili LIVER: The liver measures 14.6 cm in length. Increased hepatic parenchymal echogenicity is consistent with fatty infiltration. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.4 m/s. BILIARY TRACT: Patient status post cholecystectomy. Common bile duct measures 3 mm.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 10.2 cm in length. Normal echogenicity. No hydronephrosis.LEFT KIDNEY: Kidney measures 9.0 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No evidence of ascites", "output": "1.Increased hepatic parenchymal echogenicity is consistent with fatty infiltration. 2.No evidence of ascites or splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B LIVER: Coarse echogenic liver echotexture again noted without mass. Liver length 20.8 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Atrophic echogenic right kidney again noted. Right kidney 9.2 cm in length.OTHER: Spleen 9.4 cm in length. Right iliac fossa renal transplant 12.9 cm in length. Left kidney absent. No ascites.", "output": "Coarse echogenic liver echotexture again noted consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Moderate hepatomegaly. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "84 year-old female with dyspnea on exertion, chronic. Evaluate for change in size of nodules. RIGHT LOBE MEASUREMENTS: 2.1-cm x 3.8 cm x 2.0 cm.LEFT LOBE MEASUREMENTS: 5.4 cm x 3.5 cm x 2.5 cmISTHMUS MEASUREMENTS: 6 mm in thickness. RIGHT LOBE: Multiple colloid nodules are noted, the largest of which measures 1.1 cm x 0.9 cm x 1.6 cm containing an internal septation not significantly changed.LEFT LOBE: Multiple colloid nodules which overall not significantly changed. Additional heterogeneous predominantly solid nodule in the lower pole is more conspicuous on today's exam measuring 3.0 cm x 3.2 cm x 3.4 cm which is not significantly changedISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Calcification is noted in the left common carotid artery with turbulent flow proximal and distal to the thrombus noted.", "output": "1. Bilateral colloid nodules not significantly changed. Heterogeneous predominantly solid nodule in the left lower pole not significantly changed.2. Calcification is noted in the left common carotid artery with narrowing. Recommend dedicated duplex sonogram further evaluation. "}
{"instruction": "Generate impression based on findings.", "input": "History of palpable left breast mass. A targeted left ultrasound was performed for the patient\u2019s area of concern. There is no solid or cystic mass identified. Normal breast tissue is seen superficial to her implant.", "output": "No sonographic evidence for malignancy. Clinical follow up with a breast surgeon is suggested to ensure that physical exam findings are concordant with negative imaging.BIRADS: 1 - Negative.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "78-year-old male with history of cellulitis. Concern for abscess between the rectum and scrotum. There is an ill-defined subcutaneous mildly hypoechoic region measuring 2.2 x 0.9 cm which is mildly hypervascular. This is nonspecific and may represent granulation tissue. There is no loculated fluid collection to suggest an abscess.", "output": "No abscess. Nonspecific ill-defined focus in the region of interest may represent granulation tissue."}
{"instruction": "Generate impression based on findings.", "input": "Male; 72 years old. Reason: pancreas/RUQ History: increasing amylase, abdominal pain LIVER: The liver measures 17.6 cm in length. The liver surface is smooth, the parenchyma is heterogeneous in echotexture. No focal hepatic lesion is identified. There is mild ascites. The main portal vein is patent and demonstrates hepatopetal flow with a peak velocity of 0.3 m/sec.BILIARY TRACT: There is no cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. The common duct measures 6 mm in diameter. There is no intrahepatic biliary ductal dilatationPANCREAS: The pancreas is obscured by overlying bowel gas.SPLEEN: The spleen measures 7.8 centimeters in length.KIDNEYS The right kidney measures 15.9 cm in length. Multiple anechoic lesions are seen in the right kidney, largest measures 5.2 x 5.3 x 4.4 cm. There is no hydronephrosis or shadowing renal stone. The left kidney measures 19.8 cm in length and contains multiple and lesions, the largest measures 10.6 x 10.9 x 1.8 cm. There is no hydronephrosis or shadowing renal stone. OTHER: Bilateral pleural effusions.", "output": "1.Limited evaluation of the pancreas due to overlying bowel gas.2.No cholelithiasis or evidence of acute cholecystitis.3.Multiple simple appearing renal cysts bilaterally. The largest on the left measures up to 10.9 cm.4.Heterogeneous liver parenchyma compatible with hepatic steatosis/parenchymal dysfunction.5.Bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old male patient with EtOH cirrhosis, ascites, hepatic encephalopathy. Evaluate for portal vein thrombus. LIVER: The liver measures 14.0 cm in length, demonstrate coarsened hepatic echotexture, and is nodular in contour. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: There are gallstones. The gallbladder wall measures 5 mm in diameter, which is not significant setting of ascites. 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 pancreas is poorly visualized on this examination.RIGHT KIDNEY: The right kidney measures 9.4 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. There is a 1.1 cm right upper pole exophytic renal cyst.OTHER: The left kidney measures 8.7 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis.The spleen measures 9.6 cm in length.There is mild to moderate ascites.", "output": "1. Cirrhotic morphology of liver with patent portal vein.2. Cholelithiasis with nonspecific gallbladder wall thickening.3. Mild to moderate ascites.4. Medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal failure RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or obstruction. 11.6 cm in length.LEFT KIDNEY: Atrophic echogenic parenchyma without mass, stone, or obstruction. 7.7 cm in lengthOTHER: Diffuse wall thickening of the bladder", "output": "Atrophic left kidney; bilateral echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction. Diffuse bladder wall thickening; may be secondary to acute or chronic inflammation"}
{"instruction": "Generate impression based on findings.", "input": "Ms. Owens is a 49 year old female with a personal history of left breast pain at the 3:00 position and small breast cysts. Targeted grayscale and color ultrasound of the left breast at the 1:00 and 3:00 positions. Multiple small, subcentimeter benign morphology cysts are visualized within the left breast, specifically at the 1:00 position. The most prominent of which measures approximately 0.5 x 0.2 x 0.6 cm about 3 cm from the nipple. At the area of patient pain at 3:00 position, no significant abnormality is visualized by ultrasound. Normal fibroglandular tissue is seen.", "output": "No ultrasonographic evidence of malignancy or other significant abnormality. Benign-appearing cysts are visualized, specifically outlined above. 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": "28 year old female with history of abdominal wall hernia repair at age 11 now with periumbilical pain. Evaluate for hernia recurrence. Post surgical changes of hernia repair with mesh placement is noted with no evidence of hernia recurrence at rest and with Valsalva maneuver.", "output": "Postsurgical changes with no evidence of hernia recurrence."}
{"instruction": "Generate impression based on findings.", "input": "34-year-old male with proteinuria. Ultrasound guidance was provided for right renal biopsy.", "output": "Ultrasound guidance."}
{"instruction": "Generate impression based on findings.", "input": "Right lower extremity soft tissue lesion. Extensive subcutaneous edema. 4.9 x 1.4 x 3.8 cm heterogeneous avascular complex nonloculated collection.", "output": "4.9 x 1.4 x 3.8 cm heterogeneous avascular complex nonloculated collection favoring a hematoma. No surrounding inflammatory changes."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old female with right upper quadrant pain. Exam is somewhat limited by body habitus and patient's inability to be appropriately positioned.LIVER: Highly echogenic, likely due to diffuse fatty infiltration. There is hepatomegaly with the liver measuring at least 21 cm in length. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder contains small amount of dependent sludge as well as small shadowing gallstones. There is no wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: Not adequately visualized due to bowel gas.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Hepatomegaly with fatty liver.Small amount of sludge and small gallstones in the gallbladder without complication."}
{"instruction": "Generate impression based on findings.", "input": "Status post renal transplant with bacteremia and elevated creatinine RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality noted. 12.5 cm in lengthCOLLECTING SYSTEM/URETER: Expected mild hydronephrosis again noted.URINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels Renal transplant vasculature patent without evidence for inflow or outflow compromise. However, persistent diastolic dampening again noted.OTHER: No significant abnormality noted", "output": "Renal transplant vasculature patent without evidence for inflow or outflow compromise; however, persistent diastolic dampening again noted suggestive for increased parenchymal resistance pattern. No significant hydronephrosis. No perinephric collection."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old male with right upper quadrant pain. Evaluate for gallstone or cholecystitis LIVER: The liver is normal in echotexture and measures 13.4 cm in length. Main portal vein is patent with peak systolic velocity measuring 0.2 m/s.GALLBLADDER, BILIARY TRACT: Gallbladder wall measures 0.2 cm without evidence of pericholecystic fluid or cholelithiasis. Sonographic negative Murphy's sign. Common bile duct measures 0.2 cm in diameter.PANCREAS: No significant abnormalities noted.KIDNEY: Right kidney is normal in echotexture and measures 12.3 cm in length without evidence of hydronephrosis.Left kidney is normal in echotexture and measures 12.8 cm in length without evidence of hydronephrosis.OTHER: No significant abnormalities noted.", "output": "No findings to suggest cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female with small left thyroid bed nodule after thyroidectomy. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massLEFT LOBE: There is again noted in the left thyroid bed a medial, hypoechoic nodular density measuring approximately 0.2 x 0.4 x 0.4 cm without significant changeISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable nodular density left thyroid bed."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female with left upper breast/lower axillary swelling. Recent screening mammogram dated 9/25/2015 was within normal limits. A targeted left ultrasound was performed for the patient\u2019s area of concern. There is no solid or cystic mass identified. Normal glandular tissue noted.", "output": "No sonographic evidence for malignancy corresponding to the area of swelling/pain in the left lower axillary/upper breast region.Annual screening mammogram is recommended.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old male with a history of multiple renal cysts and angioleiomyoma, request follow up image study. RIGHT KIDNEY: The right kidney measures 13.4 cm in length and is noted to have a 7.0 x 6.1 x 5.3 cm simple cyst which previously measured 7.6 x 6.1 x 5.2 cm. An additional smaller cyst in the upper pole of the right kidney measures 2.0 x 2.5 x 3.1 cm, previously measured 3.6 x 3.2 x 2.8 cm.LEFT KIDNEY: The left kidney measures 14.0 cm in length and demonstrates a 6.3 x 5.6 x 5.0 cm cyst with a thin internal septation in the lower pole and which measured 7.6 x 5.8 x 5.1 cm previously. There is a 2.6 x 3.0 x 2.4 cm hyperechoic area in the superior pole of the right kidney which previously measured 2.6 x 3.0 x 2.0 cm and likely represents a angiomyolipoma.OTHER: Fluid in the midabdomen correlates with the patient's penile reservoir seen on previous CT.", "output": "1.Left renal angiomyolipoma which is not significantly changed in size.2.Multiple similar appearing bilateral renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male with acute kidney failure. Ultrasound guidance was provided for biopsy of the left kidney.", "output": "Ultrasound guidance."}
{"instruction": "Generate impression based on findings.", "input": "27-year-old female with hyperthyroidism, outside hospital uptake and scan consistent with possible toxic nodule and left lobe. Assess for left lobe nodule. RIGHT LOBE MEASUREMENTS: 4.4 cm x 1.8 cm x 1.6 cmLEFT LOBE MEASUREMENTS: 5.0 cm x 1.8 cm x 1.3 cmISTHMUS MEASUREMENTS: 1 mm thicknessRIGHT LOBE: Hypervascular with multiple subcentimeter hypoechoic nodules are noted.LEFT LOBE: Hypervascular with multiple subcentimeter hypoechoic nodules are noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Findings suggestive of thyroiditis."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female patient with HCV, cirrhosis. Evaluate for HCC. LIVER: The liver measures 13.3 cm in length. Hepatic parenchymal echogenicity is increased. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.1 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 9.4 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.2 cm in length. No evidence of hydronephrosis. There is a 1.5 x 2.1 cm left lower pole renal cyst, previously 2.3 x 2.6 cm.The spleen measures 10.4 cm in length.", "output": "1. Increased hepatic parenchymal echogenicity which can be seen with chronic liver disease. No focal hepatic lesion identified.2. Left lower pole renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "Right-sided abdominal pain LIVER: Numerous confluent bilobar mass lesions consistent with metastatic disease again noted. GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right kidney 11.8 cm in length.OTHER: Left kidney 11.2 cm in length. No ascites.", "output": "Numerous confluent bilobar hepatic lesions consistent with metastatic disease. No ascites. Collapsed gallbladder without ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "33 year old female with epigastric pain for 4 days. Pain colicky in nature. Evaluate for gallstones. LIVER: Normal echogenicity of the liver measuring 14.0 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: Dense shadowing in the expected region of the gallbladder consistent with collapsed gallbladder containing multiple stones. No pericholecystic fluid. Sonographic Murphy's sign is negative. Common bile duct measures 5 mm in thickness. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: Normal echogenicity measuring 10.1 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney is normal echogenicity measuring 10.2 cm in length. No hydronephrosis or shadowing calculus are noted.Normal echogenicity of the spleen measuring 11.1 cm in length.", "output": "Findings consistent with collapsed gallbladder containing multiple stones. No evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Male 62 years old; Reason: 62M with AIHA/ITP and splenomegaly, now with conjugated bilirubinemia and elevated tranaminases, ?biliary obstruction, ?venous congestion, ?portal vein clot, ?size of splenomegaly History: 62M with AIHA/ITP and splenomegaly, now with conjugated bilirubinemia and elevated tranaminases, ?biliary obstruction, ?venous congestion, ?portal vein clot, ?size of splenomegaly LIVER: The liver measures 16.8 cm in length. There is slightly 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 20.1 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.9 mm. Sludge is visualized within the gallbladder as seen on the prior ultrasound. However, there is an irregularly thickened wall with several echogenic polypoid foci not visualized on the prior ultrasound. These do not demonstrate shadowing. The patient was unable to be placed in a decubitus position. No discrete stones are visual. 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 19.1 cm and is heterogeneous with areas of hypoechogenicity seen.RIGHT KIDNEY: The right kidney measures 11.7 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.1 cm in length. The cortex has normal echogenicity. A shadowing echogenic foci seen within the lower pole measuring 1.4 cm x 0.7 cm x 1.0 cm. A renal cyst is seen measuring 5.5 cm x 3.6 cm x 4.7 cm per no hydronephrosis or worrisome masses are seen.OTHER: No ascites is seen.", "output": "1. The liver has increased echogenicity compatible with hepatocellular dysfunction. No focal hepatic masses or intrahepatic ductal dilation. No ascites. The portal vein is patent with hepatopetal flow.2. Several polyploid non-shadowing foci are seen along an irregularly thickened gallbladder wall. This was not visualized on prior ultrasound. Evaluation of these lesions is limited as patient was not able to change position. These lesions may represent adherent sludge but gallbladder carcinoma cannot be excluded. Sludge is redemonstrated within the gallbladder.3. Splenomegaly is present with hypoechoic areas within it, compatible with possible splenic infarction seen on prior CT.4. A nonobstructing renal calculi seen in the left kidney as seen on prior CT. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Male; 64 years old. Reason: hematuria History: hematuria RIGHT KIDNEY: The right kidney measures 12.2 cm in length. There are two simples cysts in the midpole, the largest measures a 2.7 x 3.0 x 3.1 cm. No hydronephrosis, shadowing renal stone, or suspicious lesion is identified.LEFT KIDNEY: The left kidney measures 11.9 cm in length. There is a 0.7 x 0.6 x 0.7 cm simple cyst. No hydronephrosis, shadowing renal stone or suspicious lesion is identified.BLADDER: The bladder is partially distended and incompletely evaluated.OTHER: The prostate measures 5.8 x 4.5 x 5.6 cm.", "output": "1.Bilateral simple renal cysts.2.Enlarged prostate."}
{"instruction": "Generate impression based on findings.", "input": "61 years old, Female, Reason: evaluate ruq for biliary stones, patient presented with pancreatitis History: pancreatitis LIVER: The liver is mildly enlarged measuring 19.4 cm in length. Increased echogenicity of the liver is consistent with fatty infiltration. Small hepatic cyst is again identified similar appearance recent CT of the abdomen. No suspicious 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 5 mm in diameter.PANCREAS: Increased heterogeneity of the pancreas is consistent with known pancreatitis.SPLEEN: No significant abnormalities noted. The spleen measures 7.6 cm in length. RIGHT KIDNEY: Kidney measures 10.1 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.8 cm in length. Normal echotexture. No hydronephrosis or shadowing calculus. Mildly complex bilobed renal cyst seen on this ultrasound is not definitely seen on the prior CT.OTHER: No significant abnormalities noted.", "output": "1.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis.2.Mildly complex bilobed renal cyst seen on this ultrasound is not definitely identified on the prior CT. Follow-up is recommended at 6 months to ensure stability.3.Fatty infiltration of the liver. Stable hepatic cysts."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female patient with several, subcentimeter, hypervascular foci in the liver seen in 2012. Follow-up liver lesions. LIVER: The liver measures 17.3 cm in length. 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 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 10.2 cm in length. There is prominence of the right renal collecting system which may reflect an extra renal pelvis.OTHER: The left kidney measures 11.5 cm in length. There is prominence of the left renal collecting system which may reflect an extra renal pelvis.The spleen measures 9.8 cm in length.The right pleural effusion is noted.", "output": "1. No focal hepatic lesion is detected on this sonographic examination; however, contrast enhanced CT with arterial phase is recommended to accurately compare to prior studies.2. Right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "35-year-old female with thyromegaly and hypothyroidism. RIGHT LOBE MEASUREMENTS: 4.9 x 1.5 x 1.5 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.6 x 1.1 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Diffusely heterogeneous without mass.LEFT LOBE: Diffusely heterogeneous. There is a single, small cystic mass in the mid upper pole with comet tail artifact consistent with a small colloid cyst. No solid mass.ISTHMUS: Diffusely heterogeneous without mass.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous thyroid with small, benign appearing mass on the left."}
{"instruction": "Generate impression based on findings.", "input": "56 years Female with history of chronic thyroiditis and enlarged thyroid. RIGHT LOBE MEASUREMENTS: 3.7 x 1.2 x 1.1 cmLEFT LOBE MEASUREMENTS: 3.3 x 0.9 x 0.9 cmISTHMUS MEASUREMENTS: 0.1 cm in thickness. RIGHT LOBE: Heterogenous echotexture and increased vascularity without discrete nodules. Single hyperechoic focus with posterior shadowing in the mid lobe measures 0.5 x 0.3 x 0.4 cm and is compatible with a coarse calcification.LEFT LOBE: Heterogenous echotexture and increased vascularity without discrete nodules. ISTHMUS: Heterogenous echotexture without discrete nodules. PARATHYROID GLANDS: No significant abnormalities.LYMPH NODES: A few normal-appearing lymph nodes are noted. For example, a right level 2 lymph node measures 1.2 x 0.2 x 0.8 cm.OTHER: No significant abnormalities.", "output": "Small, heterogenous thyroid compatible with history of chronic thyroiditis. Single coarse calcification in the right lobe."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Cirrhotic liver morphology. 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 9.7 cm in length. The left kidney is 9.1 cm in length. Multiple bilateral angiomyolipomas are again seen. The previously seen 4.5 cm lesion in the left kidney is incompletely visualized by ultrasound. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 12.4 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No significant ascites is noted in the upper abdomen.", "output": "1. Cirrhotic liver morphology without suspicious hepatic lesions.2. Renal angiomyolipomas, better evaluated on the prior CT. "}
{"instruction": "Generate impression based on findings.", "input": "58-year-old female patient with enlarged thyroid. RIGHT LOBE MEASUREMENTS: 5.3 x 2.2 x 1.7 cm.LEFT LOBE MEASUREMENTS: 4.6 x 1.8 x 1.3 cm.ISTHMUS MEASUREMENTS: 4 mm in thickness.RIGHT LOBE: The right thyroid gland is diffusely heterogeneous without discrete, dominant thyroid lesion.LEFT LOBE: The left thyroid gland is diffusely heterogeneous without discrete, dominant thyroid lesion.ISTHMUS: The isthmus is diffusely heterogeneous.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology lymph nodes are noted bilaterally.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous thyroid gland which may represent sequela of chronic inflammation/thyroiditis. No dominant thyroid lesion is identified. "}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B LIVER: Coarse echogenic liver echotexture again noted without mass. Liver length 15.6 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Stable right renal cyst. Right kidney 10 cm in lengthOTHER: Stable minimally complex left renal cyst. Left kidney 12.4 cm in length. Spleen 11.7 cm in length. No ascites", "output": "Stable coarse echogenic liver consistent with chronic liver disease without mass or ductal dilatation. Cholelithiasis without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Rosenberger is a 51 year old female with a personal history of left breast mastectomy for left breast cancer and sentinel lymph node biopsy in 2005. Patient presents with a new self-palpated left axillary lump. Upon physical exam at the patient's area of concern, nodular tissue is identified.Targeted ultrasound of the left axilla at the area of concern was performed. There is no sonographic abnormality to correlate with the palpable area of concern. No abnormal lymph nodes are noted.", "output": "No sonographic evidence of 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 recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Fever. Elevated bilirubin. LIVER: Non-cirrhotic liver morphology. Coarsened parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Contracted gallbladder, which limits evaluation. Minimal gallbladder wall thickening is nonspecific in the setting of ascites. No gallstones or pericholecystic fluid.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 12.9 cm in length. The left kidney is 11.4 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 17.9 cm in length, without focal lesions evident.OTHER: Small amount of ascites identified.", "output": "1. Coarsened hepatic echogenicity, compatible with parenchymal dysfunction.2. Splenomegaly.3. Ascites. "}
{"instruction": "Generate impression based on findings.", "input": "Ulnar nerve irritation Ultrasound of the elbow and forearm demonstrates a normal course, size and echogenicity of the ulnar nerve. There is a small amount of hypoechogenicity and hypervascularity anterior to the ulnar nerve near its course within the cubital tunnel which is thought to represent a small amount of postsurgical scarring and inflammation. Following flexion and extension, the ulnar nerve remains within the tunnel and there is no evidence of subluxation.Evaluation of the common flexor tendon demonstrates normal echogenicity. The anterior band of the ulnar collateral ligament also is unremarkable.", "output": "Essentially normal course and appearance of the ulnar nerve with no evidence of subluxation on manipulation. A small amount of hypoechogenicity and hypervascularity anterior to the nerve within the cubital tunnel is thought to be postsurgical in nature."}
{"instruction": "Generate impression based on findings.", "input": "Male, 87 years old. BPH. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 9.7 cm in length, with cortical thinning. A lower pole simple cyst measures 1.1 x 1.1 x 1.4 cm, unchanged. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.2 cm in length with cortical thinning. A lower pole simple cyst measures 1.2 x 0.8 x 0.9 cm. No shadowing stones or hydronephrosis.OTHER: The bladder is distended and the prostate is enlarged. Soft tissue projection into the posterior wall of the bladder likely represents the median lobe of the prostate.", "output": "Enlarged prostate. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: please eval thrombus in IVC; compare to previous US History: hx of thrombus in IVC There is echogenic material within the suprarenal IVC. The infrarenal IVC is partially patent. The left and right common iliac veins are grossly patent. The aorta appears normal.", "output": "Unchanged thrombus within the IVC."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female with refractory hypoglycemia without history of diabetes. Morbid obesity. Evaluate for evidence of hepatic cirrhosis. LIVER: Mild hepatomegaly without gross, focal abnormality. No definite morphology to suggest cirrhosis. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Gallbladder appears normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: Not visualized due to bowel gas.SPLEEN: Mildly enlarged.RIGHT KIDNEY: Poorly visualized due to body habitus. There is suggestion of atrophy and parenchymal thinning.OTHER: No ascites. Small, bilateral pleural effusions. Left kidney cannot be visualized.", "output": "No obvious evidence for cirrhosis.Question atrophy right kidney.Minimal pleural effusions.No ascites."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female complains of right upper quadrant pain. LIVER:Measures 13.4 centers. Normal echogenicity. No ascites, focal mass, or intrahepatic biliary dilation.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. The wall measures 0.3 cm. No stones or sludge. No pericholecystic fluid. The common hepatic duct measures 0.4 cm.PANCREAS: Evaluation the pancreas limited due to overlying bowel gas.SPLEEN: Measures 9.1 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 9.7 cm. Left kidney measures 10.4 cm. Normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "1. Normal ultrasound of the abdomen. No evidence of cholelithiasis, nephrolithiasis, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "31 year-old female with right upper quadrant pain, cholelithiasis, evaluate for common bile duct stone. LIVER: Coarse echotexture of the liver measuring 19.7 cm in length. No focal hepatic lesion.GALLBLADDER, BILIARY TRACT: Several shadowing stones with layering sludge within the gallbladder. No pericholecystic fluid. No gallbladder wall thickening. Mild prominence of the common bile duct which appears to taper distally with no evidence of shadowing choledocholithiasis.PANCREAS: Pancreatic duct caliber at upper limits of normal. The pancreas is not well assessed due to overlying bowel gas.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 11.3 cm in length. No hydronephrosis.OTHER: Normal echogenicity of the left kidney measuring 10.9 cm in length. No hydronephrosis. Normal echogenicity of the spleen measuring 10.3 cm in length.", "output": "1. Cholelithiasis and sludge without evidence of cholecystitis. 2. Mild prominence of the common bile duct proximally however appears to taper distally with no definite evidence of echogenic choledocholithiasis. 3. Pancreatic duct at upper limits of normal, however pancreas not well assessed due to overlying bowel gas. 4. Course echotexture of the liver suggestive of parenchymal dysfunction/fatty infiltration. Stable mild hepatomegaly. "}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules RIGHT LOBE MEASUREMENTS: 5 x 1.7 x 1.5 cmLEFT LOBE MEASUREMENTS: 5.3 x 1.6 x 1.7 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Diffusely heterogeneous gland without mass.LEFT LOBE: Diffusely heterogeneous gland. Hypoechoic nodule with rim calcification within the mid pole measuring 0.8 x 0.8 x 0.7 cm. Mixed echogenicity nodule with indistinct borders arising from the lower pole measuring 1.3 x 0.6 x 0.8 cm.ISTHMUS: Diffusely heterogeneous gland without massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous thyroid gland. Hypoechoic nodule with rim calcification within the midpole left thyroid gland. Mixed echogenicity nodule with indistinct borders arising from the lower pole of the left thyroid gland; this lesion would be amenable to percutaneous ultrasound-guided biopsy.Would suggest correlation with outside prior studies when these are available for comparison.No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Renal transplant. Pain over transplant site. TRANSPLANT KIDNEY: Located in the left iliac fossa. 13.3 cm in length. Unremarkable renal parenchymal echogenicity. Minimal prominence of the collecting system noted. No suspicious lesions are evident. No perinephric fluid collections identified.BLADDER: Distended. No significant abnormality noted.OTHER: Small amount of pelvic free fluid identified", "output": "No specific findings to account for the patient's symptoms. Unremarkable sonographic appearance of the transplant kidney."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs, liver lesion. LIVER: The liver measures 13.1 cm in length. There is increased and heterogeneous parenchymal echogenicity. A 7 mm hyperechoic focus in the right lobe of the liver has not significantly changed. 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 previously described possible gallbladder polyp is not visualized on this examination. 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.SPLEEN: No significant abnormalities noted.The spleen measures 10.6 cm in length. RIGHT KIDNEY: Kidney measures 10.0 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.4 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Subcentimeter echogenic focus in the liver unchanged and likely representing a hemangioma.2.Heterogeneous hepatic echotexture suggesting chronic liver disease/hepatic steatosis.3.Subcentimeter gallbladder polyp not visualized on this examination."}
{"instruction": "Generate impression based on findings.", "input": "Worsening creatinine with new malignancy. RIGHT KIDNEY: Mildly echogenic parenchyma. No change in mild hydronephrosis. 12.1 cm in length.LEFT KIDNEY: No significant abnormalities noted. 11.1 cm in lengthOTHER: Bladder nondistended. Moderate ascites again noted.", "output": "No change in mild right hydronephrosis. Mildly echogenic parenchyma raises the possibility of parenchymal dysfunction. Moderate ascites."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Philbin is a 55 year old female with a personal history of right breast lumpectomy in 2011 with positive margins. She had an additional biopsy for new calcifications of the right breast in 2013 with results of DCIS. Since then patient has declined additional treatment/surgery. Family history of breast cancer in mother, maternal grandmother, and paternal grandmother. She presents today for a surgeon detected mass in the right medial breast. The skin has been marked by Dr. Chhablani. Targeted ultrasound was performed of the medial right breast at the site marked by the clinical service. In the right breast 3:00 location, there is no suspicious cystic or solid mass appreciated.", "output": "No suspicious finding at the site of palpable concern. The patient will follow up with Dr. Chhablani. The BiRads code below reflects the known DCIS in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Reason: pancreatitis, rule out gallstones History: acute pancreatitis LIVER: The liver measures 15.7 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 0.2 m/s.BILIARY TRACT: There is a single rounded, echogenic focus within the gallbladder fundus measuring up to 6 mm in diameter with associated probable twinkle artifact which is favored to represent a single gallstone over a solitary polyp. No 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: The pancreatic parenchyma demonstrates mildly decreased echogenicity which is nonspecific but can be seen in pancreatitis. The visualized pancreatic duct is nondilated.SPLEEN: The spleen measures 9.1 cm in length. Scattered echogenic foci within the spleen may reflect calcifications related to prior granulomatous infection.RIGHT KIDNEY: Kidney measures 9.8 cm in length. Normal cortical echotexture. No hydronephrosis, shadowing calculus, or mass. Renal cyst.LEFT KIDNEY: Kidney measures 10.1 cm in length. Normal cortical echotexture. No hydronephrosis, shadowing calculus, or mass. Renal cyst.OTHER: No significant abnormalities noted.", "output": "Rounded structure within the gallbladder favored to reflect cholelithiasis rather than polyp. No sonographic evidence of acute cholecystitis or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old female with history of thyroid cancer status post thyroidectomy RIGHT LOBE MEASUREMENTS: Surgically absentLEFT LOBE MEASUREMENTS: Surgically absentISTHMUS MEASUREMENTS: Surgically absentRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: 1.9 x 1.5 x 0.7 cm right mid level 3 lymph node with internal echogenic foci is suspicious for nodal metastatic disease.OTHER: No significant abnormality noted.", "output": "Right mid-level 3 lymph node suspicious for nodal metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Female, 74 years old. AKI, abdominal pain. LIVER: The liver measures 19.3 cm, with coarse echotexture, and no focal lesion.The main portal vein is patent, with to-and-fro flow pattern.GALLBLADDER, BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilatation. The common bile duct measures 0.3 cm. Gallbladder wall thickness is normal. Gallstones are noted.PANCREAS: The visualized portions of the pancreas are normal.RIGHT KIDNEY: 13.1 cm in length, with increased cortical echogenicity. A right upper pole simple cyst measures 1.2 x 1.0 x 1.3 cm. No hydronephrosis.LEFT KIDNEY: 11.0 cm in length, with increased cortical echogenicity. No focal lesion or hydronephrosis.SPLEEN: 8.7 cm in length, without focal lesion.ABDOMINAL AORTA: The abdominal aorta is normal in caliber throughout its course. The proximal abdominal aorta measures 2.7 x 2.1 cm. The mid abdominal aorta measures 2.6 x 2.5 cm. The distal abdominal aorta is obscured.INFERIOR VENA CAVA: IVC is mildly enlarged.OTHER: The bladder is distended and appears normal.", "output": "1.Cholelithiasis without evidence of acute cholecystitis or biliary ductal dilatation.2.Bidirectional flow in the portal vein, likely at least partially related to a known history of heart failure.3.Findings compatible with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Male 61 years old Reason: hydronephrosis History: hydronephrosis RIGHT KIDNEY: Kidney measures 10.7 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass. 1.4 x 1.4 x 1.0 cm exophytic anechoic lesion arising from a superior pole consistent with a simple renal cyst, unchanged from the prior CT examination.LEFT KIDNEY: Kidney measures 10.2 cm in length. There is mild/moderate hydronephrosis and hydroureter extending into the pelvis and measuring up to 1.4 cm in cross-sectional dimension. There is a shadowing hyperechoic focus in the superior pole collecting system consistent with a nonobstructing renal stone, measuring 0.7 x 1.0 x 0.6 cm. There is an additional shadowing hyperechoic focus in the proximal left ureter measuring 1.7 x 1.2 x 0.8 cm compatible with a nonobstructing ureteral stone.OTHER: No significant abnormalities noted.", "output": "1.Mild/moderate hydronephrosis of the left kidney, with associated hydroureter extending into the pelvis, the etiology of which is uncertain.2.Nonobstructing stone in the proximal left ureter as well as the left superior pole collecting system as detailed above.3.Normal renal cortical echogenicity bilaterally."}
{"instruction": "Generate impression based on findings.", "input": "47-year-old female with hematuria. RIGHT KIDNEY: The right kidney measures 9.5 cm in length without hydronephrosis or shadowing calculus. No discrete lesion is evident.LEFT KIDNEY: The left kidney measures 10.2 cm in length without hydronephrosis or shadowing calculus. No discrete lesion is evident.URINARY BLADDER: The urinary bladder is partially distended with anechoic urine. No ureteral jets are visualized.OTHER: Incidental note is made of a rounded hyperechoic right hepatic lobe lesion measuring 2.8 x 1.9 x 2.6 cm.", "output": "1. No hydronephrosis or shadowing calculus.2. Incidental note is made of a 2.8 cm right hepatic lobe hyperechoic rounded lesion. Although this likely represents a benign hemangioma in the absence of chronic liver disease, confirmation with a dedicated liver CT exam or MRI is suggested."}
{"instruction": "Generate impression based on findings.", "input": "20 year-old female with diffuse abdominal pain, mostly epigastric. CT showed ductal dilatation. Evaluate for cholelithiasis or cholecystitis. LIVER: Echogenicity of the hepatic parenchyma is normal. GALLBLADDER, BILIARY TRACT: The gallbladder is normal in appearance. There is no pericholecystic fluid, gallbladder wall thickening or cholelithiasis. The common bile duct measures 0.5 cm in diameter with an intrahepatic position and at the porta hepatis. The extrahepatic common bile duct measures 0.6 cm.", "output": "Minimal prominence of the intrahepatic biliary ducts without dilatation. No cholelithiasis. "}
{"instruction": "Generate impression based on findings.", "input": "Male; 60 years old. Reason: complete abdominal ultrasound for heart transplant evaluation History: pre-cardiac transplant evaluation LIVER: The liver has a smooth contour. Liver measures 17.3 cm in length. The parenchyma is normal in echotexture. There is no focal hepatic mass identified. The main portal vein is patent and demonstrates normal direction of flow with a peak velocity of 0.29 m/sec.BILIARY TRACT: The gallbladder has an anechoic lumen. There is no gallbladder wall thickening. There is no intrahepatic biliary ductal dilatation. Common duct measures 2 mm in diameter. PANCREAS: The imaged head of the pancreas is normal. The body and tail are obscured by bowel gas.KIDNEYS: The right kidney measures 12.2 cm. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present. A hypoechoic band in the right kidney raises the question of a duplicated collecting system. The left kidney measures 12.3 cm. The cortex is normal in echogenicity. SPLEEN: The spleen measures 13.6 cm. in length. ABDOMINAL AORTA: Proximal portion: 1.6 x 1.8 x 2.2 cmMid portion: 1.7 x 1.7 x 1.8 cmDistal portion: 1.6 x 2.0 x 2.1 cmINFERIOR VENA CAVA: The imaged portions are patent.", "output": "1.Focal hypoechoic band in the right kidney raises the question of a duplicated collecting system, this may be correlated with cross-sectional imaging if clinically warranted.2.Hepatomegaly."}
{"instruction": "Generate impression based on findings.", "input": "43 year old female who has a complaint of new palpable left breast mass with tenderness. History of bilateral breast cysts. Clinical service requests ultrasound given her history of cysts. A targeted left ultrasound was performed for the patient\u2019s area of concern. At the 12 o'clock position of the left breast, 2 cm from the nipple there is a well-circumscribed anechoic cyst measuring 1.5 x 1.6 x 1.8 cm. Numerous surrounding subcentimeter simple appearing cysts are also noted.", "output": "Benign, simple cyst at the 12 o'clock position of the left breast, corresponding to patient's palpable abnormality. No sonographic evidence of malignancy. As long as the patient's physical examination remains unchanged, bilateral diagnostic mammogram is recommended annually, which the patient will be due for in September 2015. Results and recommendation were discussed with the patient. Additionally, the patient will discuss her symptomatic cyst with Donna Christian today. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Right testicular pain RIGHT TESTIS: 6 x 3 x 2.6 cm. No intratesticular mass.LEFT TESTIS: 5.3 x 3.3 x 2.2 cm. No intratesticular massRIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: Borderline bilateral varicoceles.DOPPLER: Bilaterally symmetric unremarkable Doppler flow characteristics", "output": "No intratesticular mass. Bilaterally symmetric unremarkable Doppler flow characteristics. Borderline bilateral varicoceles."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Right Hip Mass There is a heterogeneous hypoechoic solid mass in the subcutaneous soft tissues overlying the right hip, measuring approximately 7.3 x 4.3 x 5.8 cm. The lesion demonstrates limited internal vascularity. No other lesions are identified.", "output": "Soft tissue mass overlying the right hip could represent a lipoma, however follow-up imaging with MRI is recommended."}
{"instruction": "Generate impression based on findings.", "input": "15-year-old female with lupus nephritis. Assist with native kidney biopsy. Ultrasound guidance was provided for a right kidney biopsy. The procedure was performed by the nephrology service.", "output": "Ultrasound guidance was provided for a right kidney biopsy. The procedure was performed by the nephrology service."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Smith is a 16 year old female presenting with a physician detected mass in the right breast. The patient herself does not palpate any abnormality. Upon physical exam at the palpable area of concern, a soft, mobile nontender mass is appreciated in the right lower, inner breast.A targeted right breast ultrasound was performed for the palpable area of concern. In the right breast 5 o'clock location, approximately 2 cm from the nipple, there is a 3.0 x 1.1 x 2.0 cm lobulated hypoechoic solid mass. There is moderate amount of associated vascularity.", "output": "Sonographic findings compatible with a fibroadenoma. Due to the size and palpability of this lesion, a surgical consultation is recommended at this time. All results and recommendations were relayed to the patient and her mother at time of dictation.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female with history of BRCA mutation. Status post bilateral prophylactic mastectomy with reconstruction in February 2009 with incidental DCIS on the left side now presents with a palpable left breast lump. Dr. Jaskowiak marked the skin over the lump at 2:00 position in the left breast. The lump is superficial, and code-like appearance. Focused ultrasound shows a circumscribed, elongated hypoechoic lesion without blood flow measuring 38 x 2 x 13 mm. It could be thrombosed vessel or flat shaped fibrous tissue.", "output": "High probability benign palpable lump in the left 2:00 position. Result was discussed with Dr. Jaskowiak. BIRADS: 3 - Probably benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "The patient submitted outside mammogram dated 8/7/12. Submitted outside study was compared to the current mammogram dated 12/18/15. Focal asymmetry in the right upper outer breast appears new and additional spot compression views and possibly ultrasound are recommended.", "output": "New focal asymmetry in the right upper outer breast, for which additional spot compression views and possibly ultrasound are recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "67 year old male with elevated LFTs, evaluate for Budd-Chiari. LIMITED ABDOMENLIVER: Measuring 17.6 cm in length and is normal in echogenicity. BILIARY TRACT: Gallbladder is normal in echogenicity. Gallbladder wall measures 4 mm in thickness likely related to ascites. No pericholecystic fluid. Sonographic Murphy's sign is negative. Common bile duct measures 3 mm in caliber. No intra or extrahepatic biliary ductal dilatation. PANCREAS: The tail is obscured by overlying bowel gas. The remaining portions are normal in echogenicity with no pancreatic ductal dilatation.SPLEEN: Spleen measures upper limits of normal at 12.3 cm in length and is normal in echogenicity.  RIGHT KIDNEY: Measures 10.7 cm in length and is normal in echogenicity. OTHER: Heterogeneous collection in the left lower quadrant likely correlates with known hematoma given findings on recent CT.Small bilateral pleural effusions. Small perihepatic ascites. Left kidney measures 11.9 cm in length and is normal in echogenicity.", "output": "1. The portal veins, hepatic arteries and veins are patent with appropriate velocity and flow. 2. Heterogeneous collection in the left lower quadrant likely correlates with known hematoma given findings on recent CT.3. Small bilateral pleural effusions and perihepatic ascites. "}
{"instruction": "Generate impression based on findings.", "input": "66-year-old woman with a ventral hernia on physical exam. No history of abdominal surgery. There is tenderness in the area and the patient is concerned that the hernia is expanding. In the midline, superior to the umbilicus, there are two fascial defects with protruding fat. The most superior has a neck which measures 1.9 cm in transverse dimension and 0.8 cm craniocaudal while the more inferior defect measures 1.8 cm in transverse dimension and 0.7 cm craniocaudal. No bowel or fluid is seen within the hernias despite provocative maneuvers including Valsalva and standing. These defects correspond to small fat containing hernias also seen on prior CT sagittal image #60.", "output": "Two small midline supraumbilical fat-containing ventral hernias."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female with right upper quadrant pain, diarrhea, vomiting. LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: No cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "No cholelithiasis or sonographic evidence of acute cholecystitis. No specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "75-year-old male post thyroidectomy for thyroid cancer. Follow-up abnormal left neck lymph node. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomy centimeters.RIGHT LOBE: No mass in the bedLEFT LOBE: No mass in the bedISTHMUS: No mass in the bedPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Again noted at level 2 in the left neck is a lymph node which has a relatively normal shape of fold morphology internally is a indistinct. However, this is unchanged in the prior study measuring 0.4 x 0.8 x 0.9OTHER: No significant abnormality noted.", "output": "Stable level 2 left neck lymph node."}
{"instruction": "Generate impression based on findings.", "input": "Female, 54 years old. Elevated creatinine and potassium. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 11.6 cm in length, with mildly increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 12.1 cm in length, with mildly increased cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The urinary bladder is not visualized.", "output": "Increased renal cortical echogenicity, compatible with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis with rising LFTs; history portal venous thrombosis LIVER: Heterogeneous echogenic liver parenchyma with cirrhotic morphology. No obvious mass.GALLBLADDER, BILIARY TRACT: No worsening ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.7 cm in lengthOTHER: Limited Doppler interrogation of the main portal vein demonstrates no normal flow in the region of the main portal vein. No ascites.", "output": "Occlusive thrombosis of the main portal vein with no appreciable Doppler flow within the main portal vein. Heterogeneous echogenic liver parenchyma with cirrhotic morphology without mass or worsening ductal dilatation. No ascites"}
{"instruction": "Generate impression based on findings.", "input": "Female 68 years old Reason: Patient with thyroid nodules. RIGHT LOBE MEASUREMENTS: Patient is status post right thyroidectomy.LEFT LOBE MEASUREMENTS: 4.7 x 1.5 x 1.4 cmISTHMUS MEASUREMENTS: 1.3 cmRIGHT LOBE: Status post right thyroidectomy.LEFT LOBE: Normal appearance of the left thyroid lobe.ISTHMUS: Nodule in the isthmus, demonstrated to be a colloid-type nodule by biopsy, is unchanged in size measuring 1.5 x 1.0 x 1.4 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Unchanged isthmus colloid nodule."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male patient with persistently elevated LFTs. Evaluate for any hepatic abnormalities. LIVER: The liver measures 14.5 cm in length. There is a subcentimeter right hepatic cyst. Main portal vein flow is hepatopetal and measures 0.1 m/sec.GALLBLADDER, BILIARY TRACT: There is a subcentimeter non-shadowing echogenic focus within the gallbladder neck which does not appear to move with dependent positioning. No pericholecystic fluid or gallbladder thickening is identified. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 4 mm in diameter.PANCREAS: The pancreas is poorly visualized on this examination.RIGHT KIDNEY: The right kidney measures 12.7 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 13.0 cm in length. No evidence of hydronephrosis.The spleen measures 7.3 cm in length.", "output": "1. Subcentimeter non-shadowing echogenic focus within the gallbladder neck may represent a gallbladder polyp vs a non-shadowing stone.2. No sonographic evidence of acute cholecystitis. 3. Right hepatic cyst."}
{"instruction": "Generate impression based on findings.", "input": "Fever and abdominal tenderness in patient with renal transplant RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality noted. 10.5 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 vasculature without inflow or outflow compromise.OTHER: Bladder nondistended", "output": "Unremarkable renal transplant; patent vasculature."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old male with history of abnormal LFTs and hepatic steatosis. Assess liver morphology. LIVER: Diffusely increased hepatic parenchymal echogenicity, consistent with history of hepatic steatosis. Additionally, there is a focal hyperechoic abnormality in the central parenchyma which measures approximately 9 mm. Although this focal abnormality is most likely a benign hemangioma, given his background of hepatic steatosis this should receive special attention on future ultrasound imaging. No biliary dilatation or other significant abnormality.GALLBLADDER, BILIARY TRACT: No gallbladder wall thickening, pericholecystic fluid or gallstones. 3 x 3 x 4 mm gallbladder wall polyp.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right kidney measures 10.4 cm.OTHER: No significant abnormalities noted. Left kidney measures 10.5 cm. Spleen is within normal limits, measuring 10 cm. Limited view of the pancreas due to overlying bowel gas.", "output": "1.Findings consistent with hepatic steatosis.2.Focal, 9-mm hyperechoic abnormality is most likely a benign hemangioma, however should be given special attention on future ultrasound evaluations given this patient's background of hepatic steatosis.3.Tiny gallbladder polyp as above."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal LFTs; prediabetes LIVER: Unremarkable liver echogenicity without mass. Liver length 15 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.1 cm in lengthOTHER: Left kidney 10.4 cm in length. Spleen 8.3 cm in length. No ascites.", "output": "Negative right upper quadrant ultrasound; specifically no evidence for hepatobiliary abnormality."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old female with new self palpated left breast lumps. Two paternal aunts diagnosed with breast cancer. A targeted left ultrasound was performed for the palpable areas of concern at 6:00, 2 cm from the nipple and 1:00, 2 cm from the nipple.. Normal glandular tissue was identified. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy corresponding to palpable area of concern.2 masses identified in the right breast on 6/5/2015 for which surgical consultation is recommended.BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "71 year old male with bleeding and elevated INR. Evaluate liver for cirrhosis or amyloid involvement. LIVER: The liver measures 17.6 cm in length. Mildly coarsened and echogenic parenchyma is compatible with fatty infiltration. No significant capsular nodularity to suggest cirrhosis. No focal lesions or biliary ductal dilatation. The main portal vein is patent and demonstrates hepatopedal flow with velocity of 0.4 m/s.GALLBLADDER, BILIARY TRACT: No shadowing gallstones or sonographic evidence of cholecystitis. No sonographic Murphy sign.PANCREAS: Not visualized due to overlying bowel gas.NATIVE KIDNEYS: Bilateral atrophic native kidneys are present.OTHER: Transplant kidney in right iliac fossa measures 13.4 cm with normal echotexture. No peritransplant fluid collection or evidence of hydronephrosis. Spleen measures 13.6 cm and exhibits normal echotexture. No ascites.", "output": "1.Unremarkable transplant kidney in right iliac fossa with bilateral atrophic native kidneys.2.Mild fatty liver infiltration. No sonographic evidence of cirrhosis or suspicious focal hepatic lesions."}
{"instruction": "Generate impression based on findings.", "input": "Male 44 years old; Reason: any sign of liver or gallbladder pathology History: RUQ pain LIVER: The liver measures 17.3 cm in length. There is coarse increased echogenicity of the liver parenchyma. There are 3 echogenic lesions within the left lobe, the largest measuring 1.4 cm x 1.0 cm x 0.9 cm. These are not seen on prior CT with PE protocol. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 19.5 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.3 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 2.9 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9.8 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.5 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen. A renal cyst is seen at the upper pole measuring 0.9 cm x 1.0 cm x 1.0 cm.LEFT KIDNEY: The left kidney measures 12.6 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: Urinary bladder is visualized appears decompressed", "output": "1. There is coarse increased echogenicity within the liver compatible with infiltration/hepatocellular dysfunction.2. Three hyperechoic lesions are seen within the left lobe of the liver not visualized on prior CT with PE protocol. While these lesions may represent benign hemangiomas, they are indeterminate on ultrasound and recommend a dedicated CT with IV contrast for further characterization.3. No evidence of cholelithiasis or acute cholecystitis is seen."}
{"instruction": "Generate impression based on findings.", "input": "History of hepatitis C and alcohol use. Evaluate for HCC. LIVER: The liver is normal in echogenicity. The liver contour and capsule is smooth. The liver measures 16.7 cm in length. No focal liver lesion or intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 24 cm/s.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 3 mm. Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid or focal tenderness.PANCREAS: The visualized pancreatic head and body are unremarkable.SPLEEN: The spleen measures 11.1 cm in length without a focal lesion.RIGHT KIDNEY: The right kidney measures 11.3 cm in length. Note is made of a 2.0 cm simple appearing cyst. No hydronephrosis or shadowing nephrolithiasis. Color Doppler demonstrates hilar blood flow.OTHER: The left kidney measures 13.1 cm in length without hydronephrosis, shadowing nephrolithiasis or suspicious lesion. A 1.2 cm simple appearing cyst is noted in the interpolar region. Color Doppler demonstrates hilar blood flow.", "output": "No suspicious liver lesion."}
{"instruction": "Generate impression based on findings.", "input": "Male 79 years old Reason: 78M with history of Bosniak 2 cysts, assess for interval growth or changes History: as above RIGHT KIDNEY: The right kidney measures 11.3 cm. Multiple renal cysts are again identified. A mildly complex septated cyst is identified in the upper pole of the right kidney. This measures 9.1 x 8.6 x 8.6 cm and is not significantly changed allowing for differences in imaging technique. The interpolar cyst with dependent calcification is also subjectively stable in size. Hyperechoic renal parenchyma.LEFT KIDNEY: The left kidney measures 12.1 cm. Multiple renal cysts are again identified. The largest is within the midpole and measures 6.3 cm in maximum dimension and is not significantly changed allowing for differences in imaging technique. Additional anechoic left renal cysts are also stable. There is no hydronephrosis. Hyperechoic renal parenchyma.OTHER: The urinary bladder is incompletely distended. Allowing for this no significant abnormality. The prostate remains enlarged.", "output": "No substantial interval change compared to prior with reference measurements given above."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for cholecystitis, biliary ductal dilation, also kidney injury History: concern for acute pancreatitis and acute renal failure LIVER: The liver measures 17.3 cm in length. The liver parenchymal echotexture is normal. There are several cystic structures within the liver, some of which contain mildly thickened internal septations. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.16 m/s.BILIARY TRACT: Contracted gallbladder. Cholelithiasis. Gallbladder wall thickening which is nonspecific in the setting of ascites. The sonographic Murphy's sign is negative. No intrahepatic biliary ductal dilatation is present. The common hepatic duct measures 7.6 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: Poorly visualized.RIGHT KIDNEY: Poorly visualized. Kidney measures 9.9 cm in length. No frank hydronephrosis.LEFT KIDNEY: Poorly visualized. Kidney measures 10.2 cm in length. No frank hydronephrosis.ABDOMINAL AORTA: Proximal aorta within normal limits. Middle and distal aorta obscured.INFERIOR VENA CAVA: No gross abnormality, though poorly visualized.OTHER: Mild abdominal ascites. Pleural effusions. Bladder collapsed with Foley.", "output": "1.Contracted gallbladder with cholelithiasis and wall thickening which is nonspecific in the setting of ascites. Acute cholecystitis cannot be excluded on the basis of the study. Correlation with laboratory values and clinical history is recommended. Nuclear medicine HIDA scan can be considered for additional evaluation as warranted.2.Abdominal ascites and pleural effusions.3.No frank hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male with worsening renal function. Evaluate size and echogenicity. RIGHT KIDNEY: Measures 11.3 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. The largest right renal cyst measuring 2.1 cm in diameter has a thin septation but no solid component. LEFT KIDNEY: Measures 11.8 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. 2.7 cm exophytic cyst in the mid polar region has a thin septation but no solid component.URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: No significant abnormalities noted.", "output": "1. Increased renal echogenicity consistent with medical renal disease. 2. Minimally complex renal cysts as described above. No nephrolithiasis, hydronephrosis, or suspicious solid lesions."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male with nausea, evaluate for gallstones. LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. The imaged portions of the common bile duct appear unremarkable. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Status post cholecystectomy. No abnormalities to account for the patient's symptoms. "}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female with right upper outer anterior circumscribed mass on screening mammogram of 10/4/2016, recalled for further mammographic and sonographic evaluation. Full field right ML, with additional CC and ML spot compression views 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. Within the right upper outer anterior breast, a circumscribed partially obscured isodense oval mass measuring 1.0 cm is reidentified.RIGHT BREAST ULTRASOUND:Targeted ultrasound of the right upper outer breast, 10:00 position 2 cm from the nipple, was performed and revealed few similar adjacent circumscribed homogenously hypoechoic parallel masses with posterior acoustic enhancement spanning 1.8 x 1.2 cm. The largest mass measures 1.0 x 0.7 x 1.2 cm and presents internal vascularity.", "output": "Few circumscribed oval right upper outer anterior masses, largest measuring 1.2 cm. Ultrasound-guided biopsy of the largest component recommended for further evaluation.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "70 year old female with right upper quadrant pain. Evaluate gallbladder and liver. LIVER: Increased echogenicity of the liver measuring 16.8 cm in length. Cyst in the right hepatic lobe measures 1.2 cm x 1.2 cm x 1.4 cm which corresponds to the hypodense focus on prior CT's and appears unchanged. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.3 m/sec. common duct measures 4 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.GALLBLADDER, BILIARY TRACT: Multiple shadowing calculi within the gallbladder. No pericholecystic fluid. No gallbladder wall thickening. Sonographic Murphy's sign is negative. Common duct measures 4 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: Not well seen due to overlying bowel gas.RIGHT KIDNEY: Measures 10.5 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 10.5 cm in length. No hydronephrosis or shadowing calculi are noted. Spleen measures 8.5 cm in length and is normal in echogenicity.", "output": "1. Increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesions.2. Cholelithiasis with no evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "38 year old female palpable left axillary abnormality. Patient is 22 weeks pregnant. Family history of breast carcinoma in her maternal grandmother at age 75. On physical examination, there is a dense ridge of tissue along the left axillary ridge. A targeted left axillary ultrasound was performed for the patient\u2019s area of concern. There is no solid or cystic mass identified. Mild increased vascularity is noted, suggesting mild, nonspecific inflammation.", "output": "Mildly increased vascularity in the left axilla, without discrete solid or cystic mass. The findings are suggestive of inflammatory process. No sonographic evidence for malignancy. The patient should return to her primary physician for continued clinical management.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "81-year-old male with leukocytosis, conjugated hyperbilirubinemia LIVER: Increased hepatic echogenicity without discrete focal lesionGALLBLADDER, BILIARY TRACT: Redemonstration of cholelithiasis and biliary sludge, now with mild gallbladder distension. Mild gallbladder wall thickening, but no pericholecystic fluid or sonographic Murphy sign. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.KIDNEY: Not included on this examination. OTHER: No significant abnormalities noted.", "output": "The abnormal appearance of the gallbladder as described above remains nonspecific, but given the persistence of symptoms and sonographic findings, both acute and chronic cholecystitis are differential considerations. If further imaging evaluation is warranted, a nuclear medicine hepatobiliary scan may be considered. "}
{"instruction": "Generate impression based on findings.", "input": "Renal transplant evaluation hydronephrosis after Foley placement Interval decrease in degree of left iliac fossa renal transplant hydronephrosis which is now minimal area possible nonobstructing renal stone. Kidney 13.1 cm in length.OTHER: Mild ascites. Status post Foley placement within bladder", "output": "Interval decrease in degree of hydronephrosis within left iliac fossa renal transplant which is now minimal in degree. Possible nonobstructing renal stone. Mild ascites"}
{"instruction": "Generate impression based on findings.", "input": "Enlarged nontender thyroid on examination RIGHT LOBE MEASUREMENTS: 5.6 x 1.4 x 1.1 cm, normal echotextureLEFT LOBE MEASUREMENTS: 5 x 1.1 x 1.3 cm, normal echotextureISTHMUS MEASUREMENTS: 2 mmRIGHT 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 thyroid gland on ultrasound. No suspicious nodules or lymphadenopathy noted."}
{"instruction": "Generate impression based on findings.", "input": "Hematuria; chronic renal disease RIGHT KIDNEY: Mildly echogenic parenchyma. 1.6 x 1.5 x 1.6 cm echogenic focus arising from the superior pole right kidney. Right kidney 11.6 cm in length. No hydronephrosis or stones.LEFT KIDNEY: Mildly echogenic parenchyma. Multiple renal cysts. No hydronephrosis or stones. Left kidney 10.8 cm in length.OTHER: Bladder nondistended.", "output": "Mildly echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without stones or obstruction. Echogenic focus arising from the superior pole of the right kidney; favor benign etiology such as AML."}
{"instruction": "Generate impression based on findings.", "input": "81-year-old male with new onset renal failure. Evaluate perfusion to kidneys. RIGHT KIDNEY: Status post partial nephrectomy compared to the previous ultrasound examination. Normal cortical echogenicity and corticomedullary differentiation. The longest dimension measures 12.2 cm. No calculus, hydronephrosis, or other evidence of obstruction.Right lower pole hypoechoic lesion measuring 0.9 x 0.7 x 1.0 cm and demonstrates a possible blood vessel coursing at the periphery; this lesion corresponds to a hyperdense cyst measuring 55 Hounsfield units on the CT 6/10/2015 (series 4, image 56).LEFT KIDNEY: Normal cortical echogenicity and corticomedullary differentiation. The longest dimension measures 15.6 cm. There are multiple hypoechoic lesions in the left kidney with the largest measuring 4.1 x 3.1 x 2.8 cm, likely benign cyst.OTHER: No significant abnormalities noted.", "output": "1.No evidence of abnormal perfusion or obstruction as clinically questioned.2.Subcentimeter right lower pole hypoechoic lesion as detailed above is present on the recent CT examination and may represent a proteinaceous cyst; however, close interval follow-up is recommended."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male with a reported history of papillary thyroid carcinoma in 2011, status post thyroidectomy and non-Hodgkin's lymphoma diagnosed in 2013 during lymph node dissection. THYROID: The patient is status post thyroidectomy. RIGHT THYROIDECTOMY BED: Status post thyroidectomy with no evidence of residual or recurrent disease in the right thyroidectomy bed. LEFT THYROIDECTOMY BED: Status post thyroidectomy. Within the inferior left thyroidectomy bed there is a poorly defined 1.4 x 1.3 x 1.3 cm complex hypoechoic focus that is not clearly identified on the prior outside hospital ultrasound images. This may correspond to a cluster of small lymph nodes seen on the outside hospital CT, but this cannot be reliably confirmed given the different modalities. Attention to this area is recommended on subsequent imaging.ISTHMUS BED: Status post thyroidectomy with no evidence of residual or recurrent disease. LYMPH NODES: There are numerous bilateral enlarged cervical lymph nodes at multiple levels. Some of them demonstrate a rounded morphology. No discrete microcalcifications are identified. For future reference, the largest lymph node on the right measures 1.5 x 0.7 x 2.1 cm in superior level II of the neck. One of the regions of the patient's palpable concern is located in the submandibular area and corresponds to a conglomeration of lymph nodes, area measures approximately 2.8 x 1.7 x 2.8 cm.The largest lymph node on the left measures 1.2 x 0.8 x 2.5 cm in mid level III of the neck.", "output": "1. Non-specific hypoechoic focus in the inferior left thyroidectomy bed may represent small lymph nodes, as seen on the outside CT exam, however this is equivocal. Attention to this region on subsequent imaging is recommended.2. Increased size and number of bilateral cervical lymph nodes, some of which demonstrate abnormal rounded morphology. This is increased from the prior comparison ultrasound. Discrete intralesional microcalcifications are not identified; for this reason, lymphoma is favored as the etiology of the bilateral lymphadenopathy given the patient's history. 3. The region of palpable concern on the right side of the neck corresponds to a conglomeration of enlarged lymph nodes."}
{"instruction": "Generate impression based on findings.", "input": "61 years old, Female, Reason: r/o growth of nodule History: h/o Graves'. Treated with RAI. Nowwith clcified thyroid nodule. RIGHT LOBE: Atrophic right thyroid lobe without evidence of nodule.LEFT LOBE: Atrophic left thyroid lobe with hypoechoic nodule with dense peripheral calcification abutting the Isthmus measures 0.7 x 0.6 x 0.6 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level 4 lymph node is unchanged in size measuring 0.6 x 0.5 x 0.5 cm.OTHER: No significant abnormality noted.", "output": "Atrophic thyroid with unchanged left thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "History renal stones RIGHT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. Right kidney 9.6 cm in lengthLEFT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 9.8 cm in length.OTHER: Bladder nondistended", "output": "Normal renal ultrasound without evidence for mass, residual stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old male with right scrotal mass and tender testes. RIGHT TESTIS: Normal in size, contour, architecture and vascularityLEFT TESTIS: Normal in size, contour and vascularity. In the lower pole of the left testicle there is a cluster of calcifications, measuring 3-4 mm in aggregate diameter. There is no definite associated mass. RIGHT EPIDIDYMIS: There is a 1.2 x 1.4 x 1.6 cm cyst arising from the right epididymal head.LEFT EPIDIDYMIS: There is a 3 mm cyst in the left epididymal head as well as a cystic epididymal appendix.OTHER: No significant abnormalities noted.", "output": "1. Palpable abnormality corresponds to right epididymal head cyst.2. Small left epididymal head cyst.3. Cluster of calcifications in the lower pole of the left testes without definite associated mass. If there is no corresponding palpable abnormality, this is likely benign but could be followed up in 6 months"}
{"instruction": "Generate impression based on findings.", "input": "Diabetes with abdominal pain LIVER: Coarse echogenic liver echotexture without mass. Liver length 16.3 cm.GALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.6 cm in lengthOTHER: Left kidney 11.2 cm in length. Spleen 11.9 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. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Elevated bilirubin with jaundice LIVER: Coarse echogenic liver parenchyma without mass. Liver length 20.7 cm. Limited Doppler interrogation the main portal vein demonstrates a patent portal vein with normal directional flow.BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 8.7 cm in lengthRIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 11.7 cm in length OTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. 11.9 cm in length. Trace ascites.", "output": "Coarse echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without mass. Gallbladder sludge without acute inflammation or duct dilatation. Trace ascites.Echogenic renal parenchyma consistent with medical renal disease/parietal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female with a known history of left breast IDC. Presents for evaluation of known left breast masses. A targeted left breast ultrasound was performed for the patient's known left breast masses. Again seen are 2 reference masses in the left breast at the 4:00 position approximately 5 cm from the nipple. The medial mass measures 1.8 x 1.1 x 1.5 cm (TR x AP x CC), previously 1.3 x 1.1 (TR x CC), increased in size. This mass appears more confluent with the second reference left breast mass which is situated immediately lateral to the dominant mass and now measures approximately 1.3 x 1.0 x 1.2 cm (TR x AP x CC), previously 1.0 x 1.1 cm (TR x CC), increased in size. There is associated increased vascularity within both masses on Doppler interrogation.", "output": "Interval increase in size of the patient's reference left breast masses consistent with the patient's known history of IDC with reference measurements provided above. Consultation in the breast surgery clinic is recommended. These findings and recommendation were discussed directly with the patient. The patient reports she has already been seen in the breast surgery clinic and is opting for alternative therapy.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Reason: thyroid nodule on left thyroid lobe seen on CT. RIGHT LOBE MEASUREMENTS: 5.0 x 1.6 x 1.5 cm.LEFT LOBE MEASUREMENTS: 4.4 x 1.3 x 1.5 cm.ISTHMUS MEASUREMENTS: Up to 0.35 cm in thickness.RIGHT LOBE: Normal background parenchymal echotexture without suspicious nodules.LEFT LOBE: Normal background parenchymal echotexture. Inferior pole nodule which appears to be within the thyroid gland measuring 1.5 x 1.3 x 1.3 cm and which is slightly hypoechoic, contains internal vascularity, and has a hypoechoic halo. Overall, this nodule is of intermediate suspicion for neoplasm. Alternatively but less likely, this nodule could be extrathyroidal.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Few mildly prominent benign morphology left cervical lymph nodes, favor reactive.OTHER: No significant abnormality noted.", "output": "Left inferior pole nodule, probably within thyroid, of intermediate suspicion for neoplasm and which would be amenable to fine-needle aspiration. Correlation with patient's clinical history/laboratory values also recommended to exclude possibility of parathyroid adenoma, for which further evaluation with nuclear medicine scintigraphic imaging may be pursued if clinically indicated."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: Non-cirrhotic liver morphology. 20 cm in length. Mildly heterogeneous parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Mildly thickened gallbladder wall, which is nonspecific in the setting of ascites. No cholelithiasis. 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 6.7 cm in length. The left kidney is 7.6 cm in length. The renal parenchyma is echogenic bilaterally. Multiple simple appearing cysts are noted bilaterally. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 6.2 cm in length, without focal lesions evident.OTHER: Mild amount of ascites.", "output": "1. Hepatomegaly with heterogeneous hepatic echogenicity, compatible with parenchymal dysfunction.2. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease.3. Mild ascites"}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male with palpable mass right leg. In the region of palpable abnormality anteriorly in the left leg there is a hypoechoic and complex-appearing well-demarcated region measuring 1.2 x 3.0 x 4.5 cm. This appears to have a increased through transmission consistent with complex fluid. Therefore leading considerations would be subcutaneous hematoma or abscess. There may be slight surrounding increased vascularity. There is diffuse edema in soft tissues, although both legs demonstrate edema diffusely.", "output": "Findings most suggestive of complex fluid collection in the anterior right lower leg. Primary differential consideration is subacute hematoma. Abscess cannot be excluded. By appearance and history, other mass is considered unlikely."}
{"instruction": "Generate impression based on findings.", "input": "History of renal cell cancer in 2008 status post partial right nephrectomy. LIVER: The liver is mildly echogenic. It is normal in size measuring 15 cm in craniocaudal dimension. No focal lesion or biliary ductal dilatation with the common duct measuring 4 mm. Normal hepatopedal portal venous blood flow at 0.3 m/s. BILIARY TRACT: Contracted gallbladder without focal tenderness or shadowing gallstones. No extrahepatic biliary ductal dilatation.PANCREAS: The pancreas is poorly visualized due to overlying bowel gas.SPLEEN: Limited evaluation of the spleen which appears normal in size measuring 9.8 cm.RIGHT KIDNEY: The right kidney measures 9.6 cm in length without hydronephrosis. The renal cortex appears mildly echogenic and lobular. No discrete lesion. OTHER: The left kidney measures 11.7 cm in length without hydronephrosis. A 3.3 cm left renal cyst is noted.", "output": "No specific findings to account for the patient's reported symptoms. Bowel obscures the previously seen splenic lesion. If there is continued clinical concern re-imaging with CT/MR may be considered. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: Check for gallstones History: Pt has upper right quadrant pain, under rib cage, constant, dull pain, c/o a lot of gas.. LIVER: The liver is normal in size, morphology, and echotexture. The liver measures 17 cm in caudal dimension. No focal hepatic lesion.BILIARY TRACT: No cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation. The common hepatic duct measures 2 mm.PANCREAS: The visualized pancreas is within normal limits. The tail is predominantly obscured by overlying bowel gas.SPLEEN: The spleen is normal in size, morphology, and echotexture. The spleen measures 9 cm in craniocaudal dimension.KIDNEY: The right kidney measures 9.7 cm. The left kidney measures 10.9 cm. Corticomedullary differentiation is normal. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Normal examination without findings to account for patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Reason: hep b, screen for hcc LIVER: The liver measures 19.1 cm in length, enlarged. Coarsened, echogenic hepatic parenchyma. The main portal vein is patent with normal directional hepatopedal flow, peak velocity 29.5 m/s. No focal masses.GALLBLADDER, BILIARY TRACT: The gallbladder is contracted, limiting its evaluation. The gallbladder wall measures 0.2 cm. The common bile duct measures 0.4 cm. No definite biliary ductal dilatation.PANCREAS: No significant abnormalities noted.KIDNEYS: The right kidney measures 10.5 cm in length. Left renal upper pole cyst measures 1.8 x 1.5 x 1.6 cm, similar to prior. The left kidney measures 10.9 cm in length. No hydronephrosis or shadowing stones.OTHER: No ascites. The spleen measures 12.5 cm in length, upper limits of normal in size.", "output": "Hepatomegaly and coarse hepatic parenchyma, consistent with chronic liver disease or hepatic dysfunction. No evidence of cirrhosis, ascites, or focal mass."}
{"instruction": "Generate impression based on findings.", "input": "Male 68 years old; Reason: Concern for LVAD drive line infection. Please ultrasound driveline site to assess for fluid collection History: Known pseudomonal skin infection with infected appearing driveline site Surrounding the LVAD drive line within the anterior abdominal wall line is extensive subcutaneous edema with a more discrete complex cystic fluid collection which measures 4.0 x 1.2 x 6.4 cm.", "output": "Complex cystic fluid collection adjacent to the LVAD drive line raises concern for an abscess given the the adjacent postprocedural hyperemia, postprocedural hematoma another differential consideration and correlation with patient's clinical history/laboratory values and physical exam recommended."}
{"instruction": "Generate impression based on findings.", "input": "Male 63 years old Reason: eval cirrhosis and for ascites History: AMS, hx of NASH cirrhosis LIVER: Background liver parenchyma is hyperechogenic compatible with history of cirrhosis, with corresponding morphology. There is a 1.7 x 1.4 x 2.6 cm hypoechoic mass in the right hepatic lobe. In the setting of a cirrhotic liver, this is concerning for HCC. Although the main portal vein appears patent with hepatopedal flow, there is decreased Doppler velocity, and much of the lumen is not opacified with color Doppler. Therefore partial thrombosis cannot be entirely excluded on this exam. Portal vein branches are patent with appropriate flow direction.BILIARY TRACT: Minimally thickened gallbladder wall, which is may be seen in the setting of cirrhosis. Common bile duct measures 4 mm. No intrahepatic biliary ductal dilatation.PANCREAS: The visualized portions of the pancreas are within normal limits.SPLEEN: The spleen is enlarged measuring 15.8 cm. There are perisplenic and splenorenal varices present.KIDNEYS: Right kidney measures 10.3 cm. Left kidney measurement is limited by bowel gas. No shadowing calculi or hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Hypoechoic lesion in a cirrhotic liver suspicious for HCC. Recommend dedicated cross-sectional liver imaging for further evaluation.2.Partial thrombus of the main portal vein cannot be excluded as there is decreased Doppler flow.3.Sequela of portal hypertension including splenomegaly and varices are present."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old female with stage III chronic kidney disease. Ultrasound guidance was provided for biopsy of the right kidney.", "output": "Ultrasound guidance."}
{"instruction": "Generate impression based on findings.", "input": "19-year-old female with history of palpable right breast lesions, subjective increase in size. A targeted right ultrasound was performed for the palpable area of concern. Again seen are multiple benign-appearing lesions in the right breast. At the 11:00 position, there are 2 adjacent, round, isoechoic masses, with circumscribed margins. The more lateral mass measures 15 x 14 x 16 mm, previously 15 x 13 x 17 mm. The more medial mass currently measures 12 x 10 x 16 mm, previously 15 x 12 x 17 mm. There is a similar appearing, isoechoic, circumscribed mass at the 8:00 position measuring 14 x 12 mm, unchanged.", "output": "Stable appearance of 3 circumscribed, benign-appearing masses in the right breast, with imaging features most consistent with benign fibroadenomata. Patient is scheduled to follow up in the surgical clinic today. Continued follow-up with imaging may be considered at 6-12 months or as clinically warranted.BIRADS: 3 - Probably benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B LIVER: Mildly coarse parenchyma again noted without mass. Liver length 12.1 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: Stable cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 8.7 cm in length RIGHT KIDNEY: Echogenic parenchyma again noted without mass, stone, or hydronephrosis. 9 cm in length. OTHER: Echogenic left renal parenchyma again noted without mass, stone, or hydronephrosis. Left kidney 8.4 cm in length. No ascites.", "output": "Coarse liver parenchyma again noted consistent with chronic liver disease without mass. Stable cholelithiasis without acute inflammation or duct dilatation. No ascites.Echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without hydronephrosis or mass."}
{"instruction": "Generate impression based on findings.", "input": "BRCA2 mutation, palpable abnormality in the right upper-outer quadrant for further evaluation A targeted right ultrasound was performed for the patient\u2019s area of concern. On physical examination, no discrete palpable mass noted. Donna Christian had marked with a marking pen the palpable area of concern. Ultrasound of that area demonstrates normal glandular tissue. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy corresponding to the palpable area of concern.Left unilateral diagnostic mammogram is recommended as discussed previously on 4/19/2016, due in October 2016.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Left thyroid nodule RIGHT LOBE MEASUREMENTS: 3 x 0.9 x 0.8 cmLEFT LOBE MEASUREMENTS: 4.4 x 2.1 x 3.3 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Atrophic heterogeneous gland again noted. Stable subcentimeter right thyroid nodules. A representative mid pole solid nodule measures 0.7 x 0.3 x 0.5 cm.LEFT LOBE: No change in dominant mixed cystic and solid left thyroid nodule measuring 4 x 3.1 x 2.3 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable bilateral thyroid nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Measures 17.7 cm. Normal parenchymal echotexture without focal mass. No biliary dilation. The portal vein is patent.GALLBLADDER, BILIARY TRACT: Cholelithiasis without gallbladder wall thickening. There is a small focus of fluid anterior to the gallbladder. The common bile duct is normal diameter.PANCREAS: Not evaluated due to overlying bowel gas.RIGHT KIDNEY: Measures 10.4 cm. No hydronephrosis or mass.OTHER: Left kidney measures 10.5 cm in length. The spleen is atrophic and measures 8.5 cm in length.", "output": "Cholelithiasis without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Renal insufficiency. Transplant kidney. Ultrasound guidance provided for two percutaneous biopsies of the right iliac fossa renal transplant. No postbiopsy hematoma is evident.", "output": "Ultrasound guidance for percutaneous transplant renal biopsy."}
{"instruction": "Generate impression based on findings.", "input": "68 year-old male with a history of cholestasis and TPN. LIVER: The liver parenchyma is mildly coarsened. It is normal in size, measuring 19 cm in craniocaudal dimension. No intrahepatic biliary ductal dilatation or focal hepatic lesion is evident. There is normal hepatopetal portal venous blood flow at 20 cm/sec.BILIARY TRACT: The gallbladder is distended and contains sludge and small gallstones. There is no wall thickening, pericholecystic fluid or focal tenderness. The common bile duct is normal in caliber at the pancreatic head, measuring 4 mm.PANCREAS: The visualized portions of the pancreatic head and body are normal.SPLEEN: The spleen measures 10.6 cm in length without a discrete lesion.RIGHT KIDNEY: The right kidney measures 12.6 cm in length without hydronephrosis or shadowing calculus. There is a lobulated multiseptated lower pole cystic lesion measuring 2.9 x 2.2 x 3.3 cm, as seen on the prior CT, likely a minimally complex cyst. OTHER: The patient is status post left nephrectomy.", "output": "Dilated gallbladder with cholelithiasis and biliary sludge without specific findings of acute cholecystitis."}
{"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. 15 mm gallstone noted in the gallbladder neck, with mild gallbladder distention, wall thickening, and pericholecystic fluid. Positive 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 14.7 cm in length. The left kidney is not well visualized. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 11.2 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No significant abdominal free fluid identified.", "output": "Acute calculous cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. 11.9 cm in lengthLEFT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. 13.6 cm in length.OTHER: Bladder nondistended. Incidental note is made of echogenic liver.", "output": "Negative renal ultrasound. Normal parenchymal echogenicity without mass, stone, or hydronephrosis. Incidental note of echogenic kidney suggestive for fatty infiltration/parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Concern for umbilical hernia. Periumbilical tenderness. Targeted evaluation of the patient's umbilicus shows a 2.3 x 2.1 x 2.2 cm anechoic cystic/fluid collection with echogenic shadowing nonvascular components. No evidence of bowel contents and/or peristalsis. Minimal surrounding subcutaneous fat induration but no drainable fluid collection. No significant change in the collection with Valsalva maneuver.", "output": "Probable small periumbilical hernia containing fluid and herniating fat without evidence of bowel in the hernia sac. If further evaluation is clinically warranted a CT may be obtained."}
{"instruction": "Generate impression based on findings.", "input": "Female 59 years old Reason: any evidence of renal transplant hematoma History: dropped blood count since her kidney transplant biopsy RIGHT ILIAC FOSSA KIDNEY: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. No hematoma as clinically questioned.OTHER: Bladder is nondistended.", "output": "Normal appearance of the right iliac fossa kidney. No hematoma as clinically questioned."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for Nash Limited exam due to large body habitus.LIVER: Liver measures 17.9 cm with heterogenous coarse echotexture. Portal vein demonstrates normal flow directionality and patency. No focal lesions noted. No intrahepatic biliary ductal dilatation noted.BILIARY TRACT: Gallbladder is well-distended with one echogenic focus adhering to the gallbladder wall most likely representing polyp. No evidence of shadowing suggestive of gallstones.Gallbladder wall thickness is within normal limits. Sonographic Murphy sign is negative. No evidence of pericholecystic fluid.PANCREAS: No significant abnormality in the body of the pancreas, head and tail of pancreas is not visualized due to overlying bowel gas.SPLEEN: Spleen measures 12.2 cm without any focal lesions.KIDNEY: Right kidney measures 12.4 and left kidney measures 13.5 cm. Both kidneys demonstrate mild increased echogenicity suggestive of chronic medical renal disease. No hydronephrosis or focal lesion. OTHER: No ascites", "output": "1. Coarse heterogenous echotexture of the liver without any focal lesions.2. Gallbladder polyp without evidence to evidence of cholelithiasis or cholecystitis. Surveillance with ultrasound in 6 months is recommended.3. Mild increased echogenicity of the kidneys consistent with chronic medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Male 73 years old; Reason: assessment for cause of pancreatitis? Gallstones History: pancreatitis LIVER: The liver measures 19.7 cm in length. There is increased echogenicity of the liver parenchyma. No focal hepatic lesions. There is now intrahepatic ductal dilation is seen that was not present on the previous MRI abdomen. The main portal vein is patent with normal hepatopetal flow. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.6 mm at the superficial side, however, the deep wall is shadowed out. No stones are seen, however the WES sign is present suggestive of a gallbladder full of stones. This correlates to the prior MRI. No pericholecystic fluid. The common bile duct measures 0.14 mm in diameter. PANCREAS: Evaluation the pancreas is limited by overlying bowel gas.SPLEEN: The spleen measures 11.1 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 or shadowing calculi. There is a mass seen in the hepatorenal space that is better characterized on the prior MRI.LEFT KIDNEY: The left kidney measures 12.8 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: There are small bilateral pleural effusions.", "output": "1. New mild intrahepatic biliary dilation not present on the prior MRI. This could be further evaluated with an MRCP if clinically warranted. No obvious cause was seen on the prior MRI.2. Cholelithiasis without evidence of acute cholecystitis, although the gallbladder is not fully visualized.3. Mass in the right hepatorenal space better characterized on prior MRI."}
{"instruction": "Generate impression based on findings.", "input": "History of BPH. Rule out hydronephrosis. RIGHT KIDNEY: Right kidney is normal in size measuring 10.6 cm in length. There is normal parenchymal thickness and echotexture. New moderate hydronephrosis. Simple superior pole cyst measuring 8 mm in maximum dimension.LEFT KIDNEY: Left kidney is normal in size measuring 10.2 cm in length there is normal parenchyma thickness and echotexture.New moderate to severe hydronephrosis.URINARY BLADDER: Bladder is moderately distended. The bladder wall is nontrabeculated.OTHER: No significant abnormalities noted.", "output": "New bilateral moderate to severe hydroureteronephrosis.Findings were communicated to Blake Alberts, urology resident on call."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old male with elevated INR. Evaluate for hepatic disease. LIVER: Exam somewhat limited by body habitus. The liver demonstrates irregular increased echogenicity centrally most suggestive of irregular fatty infiltration. No gross, focal mass identified. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Gallbladder is normal without cholelithiasis, 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": "Irregularly echogenic liver, likely due to irregular fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "59 year-old female with hepatitis C. Evaluate for HCC. LIVER: Normal echogenicity of the liver measuring 16.7 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate direction of flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Gallbladder is distended. No pericholecystic fluid. No gallbladder wall thickening. Intra-and extrahepatic biliary ductal dilatation is noted. Common bile duct measures 1.2 cm in caliber. No evidence of choledocholithiasis.PANCREAS: Visualized portions of the pancreas are normal in echogenicity.RIGHT KIDNEY: Normal echogenicity measuring 10.7 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the spleen measuring 10.8 cm in length.Normal echogenicity of the left kidney measuring 9.2 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "Intra-and extrahepatic biliary ductal dilatation suspicious for obstruction in the distal common bile duct. Recommend MRI/MRCP for further evaluation."}
{"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 are multiple cysts 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": "28-year-old female with question of right thyroid enlargement. RIGHT LOBE MEASUREMENTS: 5.9 x 1.9 x 2.7 cmLEFT LOBE MEASUREMENTS: 5.9 x 1.8 x 2.3 cmISTHMUS MEASUREMENTS: 0.4 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 thyroid. No findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with nontoxic multinodular goiter for follow-up. RIGHT LOBE MEASUREMENTS: 4.6 x 1.3 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.1 x 1.8 x 1.9 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Multiple thyroid nodules again identified, all of which are cystic or predominantly cystic, some with comet tail artifact. The largest cystic mass with an echogenic wall focus measures approximately 0.8 x 1.1 x 1.3 cm, slightly decreased when compared to prior exam other nodules appear relatively stable.LEFT LOBE: Multiple thyroid nodules again identified, all of which are cystic or predominantly cystic, some with comet tail artifact, except for the previously measured nodule in the lower pole. This measures 0.9 x 1 x 1.5 cm and is solid with small cystic component, stable or slightly larger than prior examsPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple, bilateral thyroid nodules. The majority of the nodules are benign in appearance. A more solid nodule in the left lobe is stable to slightly increased in size."}
{"instruction": "Generate impression based on findings.", "input": "40 year-old female with history of abdominal pain, vomiting and elevated lipase. Acute pancreatitis. The patient was not tender during exam.LIVER: No biliary dilatation or significant abnormalities noted.BILIARY TRACT: No cholelithiasis, gallbladder wall thickening or significant abnormalities noted.PANCREAS: No fluid collections or significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No hydronephrosis or significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "No significant abnormality to explain the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis LIVER: No change in cirrhotic morphology. Previously noted hypoechoic focus along the left liver capsule no longer visible on current examination. No worrisome mass. Liver length 14 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.9 cm in lengthOTHER: Left kidney 9.9 cm in length. Spleen 13 cm in length. Trace ascites.", "output": "Stable cirrhotic morphology without worrisome mass or ductal dilatation. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female; 34 years old. Reason: assess for causes of elevated LFTs History: rhabdomyolysis, calf pain, LFT elevation (primarily AST/ALT) LIVER: Diffusely coarsened echotexture of the liver, most suggestive of fatty infiltration. Otherwise, significant abnormalities noted.BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted in the pancreatic head. Pancreatic tail obscured by overlying bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Fatty infiltration of the liver."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Unremarkable echogenicity without mass, stone, or hydronephrosis. 14.1 cm in length.LEFT KIDNEY: Unremarkable echogenicity without mass, stone, or hydronephrosis. 14.7 cm in lengthOTHER: Fatty infiltration of the liver. Trace ascites. Bladder nondistended.", "output": "Unremarkable echogenicity without mass, stone, or obstruction. Fatty infiltration of the liver. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female with left breast pain in and around the nipple for the last 3 months. Occasionally entire left breast is sore as well. No personal history of breast cancer. Family history of breast cancer in maternal aunt diagnosed at 60 years of age. DIAGNOSTIC MAMMOGRAM", "output": "Dense parenchymal breast tissue was seen in the left retroareolar region with no cystic or solid lesions identified. Stable bilateral asymmetries and benign calcifications. 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."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old female post cesarean section with question of uterine artery injury. No fluid collections are seen.", "output": "No evidence for intra-abdominal or pelvic fluid."}
{"instruction": "Generate impression based on findings.", "input": "Reason: elevated liver enzymes LIVER: Coarse, echogenic hepatic parenchyma. The liver measures 16.6 cm in length. The portal vein is patent with normal directional hepatopedal portal venous blood flow, 19.5 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: Sludge in the dependent aspect of the gallbladder. No evidence of acute pericholecystic inflammation. The gallbladder wall measures 0.2 cm. The common hepatic duct measures 0.3 cm. No biliary ductal dilatation. Negative sonographic Murphy's sign.PANCREAS: The pancreatic duct measures 0.1 cm.RIGHT KIDNEY: The right kidney measures 9.9 cm in length. No hydronephrosis or shadowing stones.LEFT KIDNEY: The left kidney measures 9.5 cm in length. No hydronephrosis or shadowing stones. Small 0.8 x 0.7 x 0.7 cm anechoic cyst.OTHER: No ascites.", "output": "1. Findings consistent with hepatic steatosis or parenchymal dysfunction.2. Cholelithiasis without acute inflammation or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "86 years old, Female, Reason: rising cr, poor UO RIGHT KIDNEY: Kidney measures 12.5 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. No evidence of hydronephrosis or shadowing calculus.LEFT KIDNEY: Left kidney only partially visualized due to obscuration by gas. Patient is unable to lay in the decubitus position. Kidney measures 9.8 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. No hydronephrosis, shadowing calculus. No mass seen in the visualized portions of the kidney.BLADDER: No significant abnormalities. OTHER: No significant abnormalities noted.", "output": "1.Bilateral increased echogenicity of the kidneys consistent with medical renal disease. No evidence of hydronephrosis or shadowing calculus."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female with right lower quadrant pain and early pregnancy. Evaluate for appendicitis. No abnormally thickened appendix is identified in this examination, or significant, loculated fluid collections. What appears to represent right ovary is enlarged measuring approximately 3.7 x 5.1 x 7.8 cm and contains an approximately 3.6 cm simple-appearing cyst as well as prominent, peripheral ringing follicles. There is a small amount of para-ovarian fluid. Limited color and spectral Doppler does demonstrate some degree of arterial and venous flow within the enlarged ovary. OB ultrasound was not performed but there is fluid within the endometrial canal with presumed fetal pole.", "output": "Enlarged right ovary containing a simple-apparent cyst and a small amount of para ovarian fluid. Despite evidence for flow by Doppler, the findings are highly suggestive of ovarian torsion. This was communicated to the emergency room at the time of the exam.No sonographic evidence for appendicitis.Presumed early pregnancy, but Ob ultrasound was not performed."}
{"instruction": "Generate impression based on findings.", "input": "78-year-old male with sepsis due to strep pneumonia. Lactic acidosis. Acute kidney insufficiency. LIVER:Liver is normal in size. There is no focal hepatic abnormality and echotexture likely within normal limits.GALLBLADDER, BILIARY TRACT: Dependent gallstone within the gallbladder with some associated sludge, but without wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: ThereSPLEEN: Very limited but normal in size.KIDNEYS: The right kidney measures 10.5 cm in length. Echotexture is normal. No hydronephrosis. The left kidney is in adequately visualized due to bowel gas.ABDOMINAL AORTA: Normal in caliber.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Urinary bladder decompressed with Foley catheter.Trace of fluid in the right lower quadrant.", "output": "1. Gallstones without complication.2. Limited exam of the left kidney and spleen."}
{"instruction": "Generate impression based on findings.", "input": "Rule out torsion. History of trauma to the left testicle as per the information relayed by the patient to the technologist. RIGHT TESTIS: Right testes measures 4.1 x 2.5 x 2.7 cm, with normal echotexture. No focal lesion noted.Normal Doppler evaluation of the vasculature noted without evidence of torsion.LEFT TESTIS: Left kidney measures 4 x 2.3 x 3.3 cm with normal echotexture. Irregular hypodense area identified within the testes approximately measuring 1.3 x 1.5 cm which could correspond to an intratesticular hematoma given the history. Few areas of testicular microlithiasis also noted.Normal Doppler evaluation of the vasculature noted without evidence of torsion.Also noted is an irregular hyperechoic collection which is extratesticular, within the scrotal sac measuring 2 x 1.4 cm which is suspicious for a extratesticular hematoma.RIGHT EPIDIDYMIS: Small right epididymal cyst identified measuring 3 x 4 mm. Normal size and morphology of the epididymis noted.LEFT EPIDIDYMIS: Normal size and morphology of the epididymis noted. No focal lesions noted.OTHER: No evidence of right-sided hydrocele. Small left-sided hydrocele", "output": "Findings suspicious for a left scrotal sac hematoma and possibly left intratesticular hematoma. No evidence of torsion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal liver enzymes LIVER: Numerous confluent bilobar metastases again noted. Liver length 21.6 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.4 cm in lengthOTHER: Left kidney 12.6 cm in length. Spleen 17.4 cm in length. Trace ascites. Extensive porta hepatis and peripancreatic metastatic adenopathy again noted.", "output": "Hepatosplenomegaly again noted with extensive bilobar metastatic hepatic lesions again noted. No ductal dilatation. Extensive regional metastatic adenopathy again noted. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female with personal history of left breast lumpectomy for breast cancer in 2011. Follow-up ultrasound from 02/08/16 for left retroareolar focal asymmetry, likely a benign cluster cyst. A targeted left ultrasound was performed for the mammographic area of concern. In the left breast at the 8:00 position approximately 1 cm from the nipple is a subcentimeter benign-appearing cyst which measures 2 x 2 x 3 mm, stable to slightly smaller than on the previous outside study.", "output": "Stable subcentimeter cyst in the left breast at the 8:00 position. No sonographic evidence for malignancy. Recommend annual diagnostic mammogram. Results and recommendations were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female with lateral parotid swelling and left cervical adenopathy. Evaluate for parotitis. There is massive adenopathy involving both sides of the face and neck. The majority of the nodes have normal morphology although largest node on the right has a somewhat rounded appearance. The right parotid gland is enlarged and cystic-appearing. Left parotid gland is less well-visualized although enlarged and cystic-appearing. Both submandibular glands are enlarged and cystic-appearing.No focal fluid collection suggest abscess. Neck vasculature not evaluated.", "output": "Extensive adenopathy within the face and neck.Enlarged parotid and submandibular glands.No evidence for focal abscess."}
{"instruction": "Generate impression based on findings.", "input": "Female 73 years old Reason: eval known liver lesions, pre-biopsy planning History: septic shock, intubated for respiratory failure, uknown/uncontrolled source of infection LIVER: The liver has normal background echogenicity. Mildly hypoechoic, solid-appearing, lesion adjacent to the right portal vein without discrete capsule or internal complexity measures approximately 4.6 cm in diameter. No other focal hepatic masses are identified. No sonographic evidence of cirrhosis.OTHER: No significant abnormalities noted.", "output": "Nonspecific mildly hypoechoic, solid-appearing, lesion adjacent to right portal vein."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules. RIGHT LOBE MEASUREMENTS: 5.4 x 1.8 x 1.7LEFT LOBE MEASUREMENTS: 4.5 x 1.8 x 1.8ISTHMUS MEASUREMENTS: 6 mmRIGHT LOBE: 10 x 8 x 5 mm superior pole hypoechoic well-defined nodule with vascularity and hyperechoic foci is unchanged.Adjacent subcentimeter nodules appear stable.The background thyroid parenchyma is normal in echogenicity.LEFT LOBE: 5 x 3 x 3 mm inferior pole hypoechoic poorly defined nodule is not significantly changed in size.Additional subcentimeter nodules appear stable.The background thyroid parenchyma is normal echogenicity.ISTHMUS: Stable 9 x 9 x 4 mm right inferior isthmus hypoechoic nodule with spongiform appearance.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No significant change in several subcentimeter thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "Targeted ultrasound of the right axillary region is requested. A targeted right ultrasound was performed in the axillary tail and axilla. There is suspicious no solid or cystic mass identified. Two mixed echogenicity areas are identified. One is in the right axillary tail region, and the other more truly in the axilla. It is likely that the axillary finding on this exam correlates with mammography. This measures up to 2.8 x 1.9 cm, similar to prior measurements allowing for differences in positioning and axis of measurement.", "output": "Mixed echogenicity area in the right axilla correlates with mammography. Based on the mixed echogenicity and clear areas of fat within this finding on the mammogram, this is highly compatible with accessory axillary breast tissue or hamartoma. A 6 month follow-up can be considered presuming physical exam is benign.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with elevated LFTs, weight loss. Evaluate for liver lesion. LIVER: Increased hepatic echogenicity without discrete focal lesion.BILIARY TRACT: No cholelithiasis or biliary ductal dilation.PANCREAS: No significant abnormalities noted.SPLEEN: Nonvisualization of the spleen likely due to patient body habitus and bowel gas.KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Increased hepatic echogenicity consistent with hepatic steatosis or chronic parenchymal disease, without discrete hepatic lesion."}
{"instruction": "Generate impression based on findings.", "input": "Female 67 years old; Reason: Nodule size and characterisitics? History: Multindoular goiter, previous benign FNA large left lobe nodule RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.9 x 2.5 x 2.4 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 5.0 x 2.7 x 2.6 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.3 cm.RIGHT LOBE: The right lobe is heterogeneous. There is a dominant nodule in the upper portion of the right lobe with peripheral calcification and a hypoechoic center measuring 0.8 cm x 0.8 cm x 0.7 cm.LEFT LOBE: The left lobe is heterogeneous. There is a dominant nodule in the superior portion that is heterogeneous and isoechoic to hyperechoic compared to the thyroid. This nodule measures 1.8 cm x 1.2 cm x 1.7 cm.ISTHMUS: There is a hyperechoic dominant nodule in the isthmus measuring 0.6 cm x 0.5 cm x 0.5 cm. LYMPH NODES: No suspicious adenopathy noted.", "output": "Multinodular goiter, as above. No suspicious adenopathy. "}
{"instruction": "Generate impression based on findings.", "input": "64 year old woman with multiple breast cysts, screening mammogram. Three standard views of both breasts 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. A round mass in the left upper outer breast at middle depth appears slightly increased in size. Otherwise, small benign-appearing masses are seen bilaterally, unchanged in size from prior examinations and likely cysts. ULTRASOUND", "output": "Cyst in the left breast but no mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "End stage renal disease with elevated creatinine RIGHT KIDNEY: Markedly echogenic renal parenchyma again noted without mass, stone, or hydronephrosis. Right kidney 11.6 cm in length.LEFT KIDNEY: Markedly echogenic renal parenchyma again noted without mass, stone, or hydronephrosis. Left kidney 8.7 cm in length.OTHER: Bladder nondistended.", "output": "Markedly echogenic renal parenchyma again noted consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Kaitlin Stalling is a 22 year old female with bilateral breast reduction in 2012. Biopsy of a left breast fibroadenoma in 2010. Patient stated that her left breast fibroadenoma been removed due to breast reduction in 2012. She presents for a new mass in her left breast. On physical examination, a mobile discrete mass is palpated in the lower inner left breast. A targeted left ultrasound was performed for the palpable area of concern. In the left breast, 8:00 position, 5 cm from the nipple, there is a circumscribed, hypoechoic, lobulated mass with small amount of internal blood flow, which measures 2.3 x 1.1 x 2.3 cm.", "output": "A 2.3 cm circumscribed mass in the left breast, 8:00 position, corresponding to patient's palpable concern, likely represents a fibroadenoma. Patient is scheduled to see the breast surgeon today. Biopsy/FNA can be considered using palpable or image guidance if clinically suspicious. Alternatively, this presumed fibroadenoma can be followed on ultrasound in 6 months to assess the stability. Results and recommendations were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female patient with irregular goiter. History of subacute thyroiditis. Question of nodules. RIGHT LOBE MEASUREMENTS: 6.7 x 2.4 x 2.1 cm.LEFT LOBE MEASUREMENTS: 6.8 x 2.2 x 2.8 cm.ISTHMUS MEASUREMENTS: 7 mm in thickness.RIGHT LOBE: The right thyroid lobe is heterogeneous in echogenicity without dominant thyroid lesion.LEFT LOBE: The left thyroid lobe is heterogeneous in echogenicity and contains a 0.7 x 0.4 x 0.6 cm cystic nodule within the 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": "Heterogeneous, enlarged thyroid gland without dominant thyroid lesion."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury. RIGHT KIDNEY: The right kidney measures 10.3 cm. The cortex is mildly echogenic. There is a right upper pole exophytic lesion measuring 1.0 x 1.0 x 0.8 cm, probable cysts. There is no hydronephrosis, renal calculus, or suspicious mass.LEFT KIDNEY: Left kidney measures 10.7 cm. The cortex is mildly echogenic. There is no renal calculus, hydronephrosis, or suspicious mass.URINARY BLADDER: No significant abnormalities noted.OTHER: Small volume of ascites.", "output": "1.Echogenic kidneys, compatible with medical renal disease. No hydronephrosis, renal calculus or suspicious mass.2.Small volume ascites."}
{"instruction": "Generate impression based on findings.", "input": "Male 48 years old; Reason: Family history of thyroid cancer. Notes USN recommended for all family members. History: As above RIGHT LOBE MEASUREMENTS: 5.5 x 1.6 x 1.5 cm.LEFT LOBE MEASUREMENTS: 4.8 x 1.4 x 1.6 cm.ISTHMUS MEASUREMENT: 0.2 cm.RIGHT LOBE: There is a round approximately 0.6 x 0.5 x 0.4 cm heterogeneous hypoechoic lesion with numerous echogenic foci that could represent microcalcifications. There is a not internal vascularity.LEFT LOBE: Parenchyma is normal and homogenous. There is an approximately 0.4 x 0.3 x 0.2 cm round anechoic lesion consistent with a simple cyst.ISTHMUS: No significant abnormality noted.LYMPH NODES: There are some slightly enlarged lymph nodes, the largest of which is in right level III neck and measures approximately 2.5 x 0.7 x 0.3 cm.OTHER: No significant abnormality noted.", "output": "1.Suspicious thyroid nodule on the right as above is amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury RIGHT KIDNEY: 12.0 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 10.1 cm in length. Increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: No significant abnormality noted.OTHER: Echogenic hepatic parenchyma, compatible with parenchymal dysfunction.", "output": "Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Assess soft tissue region anterior to thyroid History: small growth of mass by thyroid In the subcutaneous tissue anterior to the thyroid there is a well-circumscribed nonvascular echogenic lesion measuring 3.2 x 1.8 x 3.6 cm. The thyroid is uninvolved.", "output": "Soft tissue lesion in the neck which could represent a lipoma, however in this age group ultrasound is relatively nonspecific. If clinically indicated, MRI could be obtained for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Encounter for screening for cardiovascular disorders screen for AAA Proximal aorta measures 2.9 x 3.1 x 2.5 cm, mid aorta measures 2 x 2 x 2 cm, distal aorta measures 1.8 x 1.9 x 1.9 cmRight and left common iliac arteries are well opacified and patent, measuring 1.2 x 1.3 x 1.4 cm and 1 x 1.2 x 1.1 cm respectively. Normal flow directionality and patency is noted in aorta and its branches. No evidence of aneurysmal dilatation. Few areas of atherosclerotic changes identified in the proximal and mid aorta.", "output": "No evidence of AAA. Atherosclerotic changes noted within the aorta. "}
{"instruction": "Generate impression based on findings.", "input": "Patient still palpates a lump in the left breast 6:00 position. Presents for six-month follow-up. Previous mammogram and ultrasound were negative. A targeted left ultrasound was performed for the palpable area of concern at 6:00 position. On physical examination, no discrete mass is palpated. Normal glandular tissue is palpated. There is no solid or cystic mass identified. Ultrasound demonstrates normal glandular tissue.", "output": "No sonographic evidence for malignancy corresponding to the area of concern in the left breast 6:00 position.Annual screening mammogram is recommended, due in 6 months.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIMITED ABDOMENLIVER: Coarse echogenic parenchyma again noted without mass. Liver length 18.6 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 10 cm in length RIGHT KIDNEY: No significant abnormalities noted. 11.1 cm in lengthOTHER: Left kidney 10.5 cm in length. No ascites", "output": "Coarse echogenic liver echotexture again noted consistent with chronic liver disease without mass or ductal dilatation. No ascites. Patent hepatic vessels with normal directional flow."}
{"instruction": "Generate impression based on findings.", "input": "Nausea, vomiting, pancreatitis, rule out CBD dilation LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: Normal gallbladder without stones or sludge. No intrahepatic or extrahepatic biliary ductal dilation. Common bile duct measures 0.4 cm. Gallbladder wall measures 0.10 cm. No pericholecystic fluid.OTHER: No significant abnormalities noted.", "output": "Normal gallbladder without evidence of cholecystitis or biliary ductal dilation."}
{"instruction": "Generate impression based on findings.", "input": "Female 58 years old Reason: Patient complaining of sharp RUQ abdominal pain; Concerning for biliary colic History: Please evaluate for gallstones Exam is somewhat technically limited secondary to patient's inability to change position.LIVER: Portions of the liver are not well visualized. The visualized portions of the liver are normal in appearance without focal hepatic mass.BILIARY TRACT: Gallbladder wall is mildly thickened measuring up to 5 mm. There is gallbladder sludge and possible small stones. Nonshadowing, nonmobile subcentimeter gallbladder density along the gallbladder wall may represent a polyp. Positive sonographic Murphy's sign. No intra or extrahepatic biliary ductal dilatation. Common bile duct measures 4 mm.OTHER: No significant abnormalities noted.", "output": "Mildly thickened gallbladder wall, gallbladder sludge, and a positive sonographic Murphy's sign are suggestive of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B LIVER: Coarse echogenic liver echotexture without mass. Liver length 13.8 cm.GALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.1 cm in lengthOTHER: Left kidney 11.8 cm in length. Spleen 12.1 cm in length. No ascites", "output": "Coarse liver echotexture consistent with chronic liver disease without mass or ductal dilatation. Cholelithiasis without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Bedside ultrasound with stones and wall thickening. LIVER: Non-cirrhotic liver morphology. 19.3 cm in length. Increased parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Multiple subcentimeter gallstones noted. Markedly gallbladder wall thickening, measuring up to 14 mm in thickness. No significant pericholecystic fluid collection is identified. No definite sonographic Murphy's sign was elicited.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 9.7 cm in length. The left kidney is 11.0 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.6 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No significant upper abdominal free fluid is noted.", "output": "1. Cholelithiasis with marked gallbladder wall thickening suspicious for cholecystitis.2. Increased hepatic echogenicity, compatible with parenchymal dysfunction."}
{"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 suspicious lesion identified.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old female with a history of bacteruria and hematuria of unclear cause. Evaluate size of kidneys, for renal cysts or other source. RIGHT KIDNEY: The right kidney measures 9.8 cm in length. The renal parenchyma is normal in echogenicity. There is no hydronephrosis, shadowing renal stone, or worrisome renal mass.LEFT KIDNEY: The left kidney measures 10.4 cm in length. The renal parenchyma is normal echogenicity. There is no hydronephrosis, shadowing renal stone, or worrisome renal mass.OTHER: The bladder is nondistended and incompletely evaluated.", "output": "Normal renal ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old female with thyroid nodule identified on MR imaging of the cervical spine, please evaluate. RIGHT LOBE MEASUREMENTS: 4.1 x 1.7 x 1.3 cmLEFT LOBE MEASUREMENTS: 5.5 x 1.7 x 1.5 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Mixed cystic and solid nodule in the right lower pole measures 0.6 x 0.5 x 0.3 cm.LEFT LOBE: No significant abnormality noted.ISTHMUS: Cystic lesion in the left isthmus measures 0.5 x 0.5 x 0.2 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Subcentimeter thyroid nodules without suspicious features."}
{"instruction": "Generate impression based on findings.", "input": "History of Hashimoto's thyroiditis. RIGHT LOBE MEASUREMENTS: 5.0 x 1.5 x 2.2 cmLEFT LOBE MEASUREMENTS: 4.8 x 1.7 x 1.9 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: The right thyroid lobe is diffusely heterogeneous in echotexture without a discrete dominant nodule. It is mildly hypervascular.LEFT LOBE: The left thyroid lobe is diffusely heterogeneous in echo texture without a discrete dominant nodule. An echogenic 5 x 2 x 5 mm nodule is noted without suspicious sonographic features. Note is made of a 7 x 4 x 5 mm hypoechoic nodule dorsal to the inferior aspect of the left thyroid lobe which may represent a small parathyroid adenoma or exophytic thyroid nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Note is made of a 7 x 4 x 5 mm hypoechoic nodule dorsal to the inferior aspect of the left thyroid lobe which may represent a small parathyroid adenoma or exophytic thyroid nodule.LYMPH NODES: No pathologically enlarged or morphologically suspicious cervical lymph nodes.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous thyroid gland without a discrete dominant nodule measuring greater than 1 cm, compatible with patient's history of Hashimoto's thyroiditis. Note is made of a 7 x 4 x 5 mm hypoechoic nodule dorsal to the inferior aspect of the left thyroid lobe which may represent a small parathyroid adenoma or exophytic thyroid nodule. Alternatively this may represent a small lymph node as there is a questionable fatty hilum on CINE imaging."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old female with history of thyroid cancer status post thyroidectomy. RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Hypoechoic focus in the left thyroid bed measuring 0.7 x 0.5 cm is not significantly changed since 2012. Adjacent 0.4 cm hyperechoic focus is also noted, most likely postoperative scarring.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No specific evidence of recurrent or metastatic disease. Redemonstration of hypoechoic focus in the left thyroid bed without significant interval change since 2012 most likely represents postoperative scarring."}
{"instruction": "Generate impression based on findings.", "input": "Male 72 years old; Reason: abscess in fistula History: worsening left arm swelling Surrounding the AV fistula, there is edema and soft tissue swelling with small pockets of fluid , and no discrete drainable fluid collection.", "output": "1.Soft tissue swelling and edema without any discrete drainable fluid collection. This can be seen in cellulitis."}
{"instruction": "Generate impression based on findings.", "input": "73-year-old female with hepatitis. Evaluate for cirrhosis. LIVER: The liver measures 15.7 cm in length and demonstrates diffusely increased parenchymal echogenicity. No focal hepatic lesions.BILIARY TRACT: Small amount of biliary sludge; no cholelithiasis, gallbladder wall thickening or pericholecystic fluid. Sonographic Murphy's sign is negative. The common duct measures 6 mm in caliber, within normal limits for patient's age.PANCREAS: The distal body and tail of pancreas are obscured by overlying bowel gas. The remaining visualized portions of the pancreatic parenchyma demonstrate no significant abnormality.SPLEEN: The spleen measures 7.2 cm in length and is normal.RIGHT KIDNEY: The right kidney measures 9.5 cm in length and demonstrates normal cortical echogenicity. No hydronephrosis or intrarenal masses or calculi.OTHER: The left kidney measures 9.8 cm in length and demonstrates normal cortical echogenicity. No hydronephrosis or intrarenal masses or calculi.Note is made of a small right pleural effusion partially imaged.", "output": "1. Increased hepatic parenchymal echogenicity suggestive of hepatic steatosis. No findings suggest cirrhosis. No ascites or splenomegaly. 2. Minimal biliary sludge.3. Small right pleural effusion partially imaged. "}
{"instruction": "Generate impression based on findings.", "input": "31 years old, Female, Reason: RUQ US to evaluate gallbladder History: RUQ pain and vomiting LIVER: The liver measures 15 cm in length. Mildly increased hepatic parenchymal echogenicity suggestive of fatty infiltration. 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. 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 9.5 cm in length. RIGHT KIDNEY: Kidney measures 10 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 9.6 cm in length. Normal echotexture. Nohydronephrosis, 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 hepatic parenchymal echogenicity is suggestive of fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old female post islet cell transplant. Evaluate patency of the portal vein. LIVER: Liver is highly and heterogeneously echogenic as seen on the prior exam. There is again noted a wedge shaped area of increased echogenicity in the right lobe measuring approximately 1.1 x 3.2 x 2.3 cm, unchanged from the prior study. This may represent an area of scarring. Foci of shadowing and ring down artifact may be due to pneumobilia. Some of this was present on the prior exam. Please correlate with history. Limited color and spectral Doppler demonstrates patency and appropriate flow direction the main portal vein.BILIARY TRACT: Gallbladder contains small amount of sludge. No shadowing stones, wall thickening or pericholecystic fluid. Possible pneumobilia.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Patent main portal vein.Question pneumobilia within the liver which was present on prior exam.Stable wedged shaped focus of increased echogenicity in the right lobe of the liver."}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine RIGHT KIDNEY: Increased parenchymal echogenicity without worrisome mass, stone, or hydronephrosis. Multiple benign-appearing renal cysts. The largest measures 4.2 x 4.6 x 3.7 cm. Right kidney 10.4 cm in length.LEFT KIDNEY: Increased parenchymal echogenicity without worrisome mass, stone, or hydronephrosis. Multiple benign-appearing cysts. The largest measures 4.1 x 5 x 4.3 cm. Left kidney 10.2 cm in length.OTHER: Enlarged prostate. Bladder nondistended", "output": "Increased parenchymal renal echogenicity suggestive for medical renal disease/parenchymal dysfunction without worrisome mass or stone. No hydronephrosis. Multiple bilateral benign-appearing renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "Female 64 years old; Reason: r/o adenopathy,r ecurrence History: h/o thyroid cancer 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: The thyroid surgically absent without signs of recurrence.LEFT LOBE: The thyroid is surgically absent without signs of recurrence.ISTHMUS: The thyroid is surgically absent without signs of recurrence.LYMPH NODES: No suspicious adenopathy noted. OTHER: No significant abnormality noted.", "output": "1.Surgical changes of thyroidectomy without recurrence of disease."}
{"instruction": "Generate impression based on findings.", "input": "Female 84 years old; Reason: thyroid nodules, solid vs cystic History: asymptomatic. Seen left side on lung CT RIGHT LOBE MEASUREMENTS: 4 x 2.2 x 1.5 cmLEFT LOBE MEASUREMENTS: 5.1 x 3.0 x 2.3 cmISTHMUS MEASUREMENT: 0.4 cmRIGHT LOBE: Small anechoic focus measuring 0.2 x 0.2 x 0.3 cm this is too small to characterize but likely represent a cyst.LEFT LOBE: Complex partially cystic nodule measuring 3.5 x 2.5 x 2.7 cm. Peripheral vascularity is noted. No microcalcifications. ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Complex partially cystic nodule in the left thyroid lobe, which is nonspecific but likely benign."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C; gallbladder polyp LIVER: Coarse echogenic liver parenchyma without mass. Liver length 14.4 cmGALLBLADDER, BILIARY TRACT: Fundal subcentimeter gallbladder polyp again noted and unchanged measuring 0.4 x 0.3 x 0.3 cm. No acute inflammation. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.9 cm in length OTHER: Left kidney 11.3 cm in length. Spleen 8.3 cm in length. No ascites.", "output": "Coarse echogenic liver parenchyma consistent with chronic liver disease without mass or ductal dilatation. Stable subcentimeter gallbladder polyp. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 63 years old Reason: assess for liver lesions History: HCV LIVER: Increased echogenicity of the liver, which is nonspecific but can be seen in the setting of fatty infiltration or diffuse hepatic dysfunction. Unchanged, approximately 1 cm calcification with shadowing most likely representing a granuloma versus scar. No focal hepatic mass. Portal vein is patent with normal directional flow.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Common bile duct measures up to 6 mm. No evidence of acute inflammation of the gallbladder. No gallstones are identified. Ringdown artifact of the gallbladder wall suggests adenomyomatosis.PANCREAS: Pancreas is not well-visualized secondary to overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 8.5 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Left kidney measures 9.0 cm. Right kidney measures 10.5 cm.OTHER: No significant abnormalities noted.", "output": "No focal hepatic mass. Increased echogenicity of the liver is nonspecific but can be seen in the setting of fatty infiltration of diffuse hepatic dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Question of possible parathyroid adenoma versus thyroid nodule seen at outside institution. RIGHT LOBE MEASUREMENTS: 1.9 x 1.8 x 4.5 cm.LEFT LOBE MEASUREMENTS: 1.6 x 1.8 x 3.9 cm.ISTHMUS MEASUREMENTS: 2 mm in AP dimension.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: 5 mm benign-appearing nodule in the inferior pole, similar to prior. The previously described nodular region in the posterior inferior left thyroid gland matches normal thyroid echogenicity on the current examination, with minimal nonsuspicious heterogeneity. No discrete nodule is present.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not identified.LYMPH NODES: No significant abnormality noted.", "output": "No suspicious nodules identified. The previously described lesion on the outside institution study in the posterior left thyroid gland appears to be nonsuspicious minimally heterogeneous thyroid tissue."}
{"instruction": "Generate impression based on findings.", "input": "60 year-old female with history of hepatitis C. Presents for HCC screening. LIVER: Liver is mildly coarsened in echotexture. It is normal in size, measuring 15.2 cm in craniocaudal dimension. No focal hepatic lesion or intrahepatic biliary ductal dilatation. Normal hepatopetal portal venous blood flow at 18 cm/sec.GALLBLADDER, BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 4 mm. Status post cholecystectomy. PANCREAS: Visualized portions of the pancreatic head and body are unremarkable.RIGHT KIDNEY: The right kidney measures 8.7 cm in length with minimal pelviectasis. No focal lesion or shadowing nephrolithiasis.OTHER: The spleen is normal in size, measuring 10 cm. The left kidney is normal in size, measuring 11.2 cm without hydronephrosis or shadowing nephrolithiasis. There is a 2.6 cm inferior pole simple appearing cyst.", "output": "Coarse hepatic echotexture, without discrete lesion or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Female 54 years old; Reason: thyroid nodules on last US, in setting of high TSH, please re-evaluate History: goiter RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 2.1 x 2.1 x 6.2 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 1.6 x 2.0 x 6.4 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.3 cm.RIGHT LOBE: The right lobe appears heterogeneous. There is a hypoechoic spongiform nodule measuring 1.4 cm x 0.6 cm x 1.0 cm seen in the superior right thyroid lobe. This nodule likely corresponds to the right superior nodule seen on the prior ultrasound which was hyperechoic and measured 1.3 cm x 0.8 cm x 0.9 cm.LEFT LOBE: The left lobe is heterogeneous. No dominant nodules are identified.ISTHMUS: No significant abnormality noted. No dominant nodules identified.LYMPH NODES: No suspicious adenopathy noted.", "output": "1.Interval improvement of acute thyroiditis from the prior study. There is a nodule in the right superior lobe favored to be spongiform and likely corresponds with the right superior nodule seen on the prior study. Other thyroid nodules noted on the prior study are no longer well visualized. This may be seen with improvement or burnout of thyroiditis.2.No suspicious regional adenopathy is identified."}
{"instruction": "Generate impression based on findings.", "input": "Renal mass RIGHT KIDNEY: Mild renal atrophy without worrisome mass, stone, or hydronephrosis. Right kidney 11.1 cm in length.LEFT KIDNEY: Limited visualization of the left kidney due to inability of the patient to change position due to back surgery. The previously noted left renal mass seen on CT was not visualized. No hydronephrosis. Left kidney 12.9 cm in length.OTHER: No significant abnormalities noted.", "output": "Mild right renal atrophy without worrisome mass, stone, or hydronephrosis. Limited visualization of left kidney due to the inability for the patient to change position. The previously noted left renal mass seen on CT could not be visualized due to this technical limitation. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "History of thyroid cancer status post surgery. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Status post thyroidectomy.LEFT LOBE: Status post thyroidectomy.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There are small, benign-appearing lymph nodes in the right neck (level 3) and in the left neck (level 3).OTHER: There is a round, hypoechoic structure within the left thyroidectomy bed superiorly which measures 0.6 x 0.4 x 0.7 cm. The structure does not demonstrate significant internal vascularity on Doppler.", "output": "Status post thyroidectomy. Hypoechoic structure in superior left thyroidectomy bed which is nonspecific but could reflect postoperative change, residual thyroid tissue, and/or recurrent neoplasm. Close continued follow-up is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Male; 63 years old. Reason: elevated LFTs and concern for acute hepatitis History: see above LIVER: Hepatomegaly with the right lobe of the liver measuring 25-cm. Echogenic heterogeneous liver parenchyma. No intrahepatic biliary ductal dilation. Portal vein is patent with appropriate flow and velocity.BILIARY TRACT: Single shadowing gallstone measuring 1.5-cm. No gallbladder wall thickening or pericholecystic fluid to suggest acute cholecystitis. Normal common bile duct diameter measuring 5 mm.PANCREAS: Not visualized due to overlying bowel gas.SPLEEN: Spleen measures 13.6-cm in length. No focal splenic lesions.RIGHT KIDNEY: Right kidney measures 10-cm. Cortical thinning of the right kidney. No hydronephrosis. OTHER: Left kidney measures 9.3-cm. Cortical thinning of the left kidney. No hydronephrosis.Small amount of upper abdominal ascites.", "output": "1. Hepatomegaly with nonspecific echogenic, heterogeneous liver parenchyma, which may be due to diffuse fatty infiltration or chronic liver disease.2. Cholelithiasis.3. Ascites."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old female with cirrhosis, assess for hepatocellular carcinoma. LIVER: Measures 16.1 in length. Cirrhotic morphology and increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Gallbladder wall thickening likely represents the sequela of chronic liver disease. 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: Splenomegaly measuring 20.5 cm in length without focal lesion.KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "1.Cirrhotic morphology and increased hepatic echogenicity consistent with chronic liver disease, without discrete lesion.2.Mild ascites and splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for whole breast ultrasound for dense breast screening. Personal history of benign right breast biopsy 1990. 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.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "44 year old female with known right breast cancer, with left tender axillary lymph node, presents for ultrasound evaluation. Focused ultrasound was performed for the left axilla. There are least 4 normal appearing lymph nodes with thin cortices and normal blood flow in the left axilla. No abnormal lymph nodes are seen.", "output": "No abnormal lymph nodes in the left axilla. BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Renal transplant with acute renal insufficiency and pain at transplant site RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality noted. 9.9 cm in length. Limited Doppler interrogation of transplant renal hilar vessels demonstrate patent vessels.COLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: No significant abnormality notedOTHER: No significant abnormality noted", "output": "Unremarkable right iliac fossa renal transplant. No loculated perinephric collection. Unremarkable parenchymal echogenicity without evidence for mass, stone, or hydronephrosis. Limited Doppler interrogation of transplant renal hilar vessels demonstrate patent vessels."}
{"instruction": "Generate impression based on findings.", "input": "History of liver transplant with recurrent hepatitis C, clinical research surveillance examination. LIVER: The liver measures 14.5 cm in length. Mildly increased parenchymal echogenicity is suggestive of fatty infiltration/parenchymal dysfunction. No focal hepatic lesion or mass identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.27 m/s.BILIARY TRACT: Status post cholecystectomy. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 5 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 11.1 cm in length. RIGHT KIDNEY: Kidney measures 10.1 cm in length. Normal echotexture. LEFT KIDNEY: Kidney measures 9.8 cm in length. Normal echotexture. OTHER: No significant abnormalities noted.", "output": "Increased hepatic parenchymal echogenicity suggestive of hepatic steatosis/parenchymal dysfunction without focal hepatic lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "Liver transplant LIMITED ABDOMENLIVER: Coarse echogenic liver echotexture again noted without mass. Liver length 20.7 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: Mild splenomegaly. Spleen length 16.3 cm RIGHT KIDNEY: No significant abnormalities noted. 11.8 cm in lengthOTHER: Left kidney 12.5 cm in length", "output": "Coarse echogenic liver parenchyma again noted consistent with chronic liver disease without mass or ductal dilatation. Hepatosplenomegaly. No significant ascites.Patent hepatic vessels with normal directional flow."}
{"instruction": "Generate impression based on findings.", "input": "Male, 90 years old. Enlarged prostate, acute renal failure. Evaluate for obstruction. RIGHT KIDNEY: The right kidney measures 9.5 cm in length, with increased cortical echogenicity. An upper pole simple cyst measures 1.8 x 1.5 x 1.4 cm. No hydronephrosis.LEFT KIDNEY: The left kidney measures 9.5 cm in length, with increased cortical echogenicity. No focal lesions or hydronephrosis.OTHER: The bladder is decompressed, with Foley catheter.", "output": "1.No hydronephrosis.2.Increased renal cortical echogenicity suggests medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Chronic liver disease LIVER: Coarse liver echotexture without mass. Liver length 14.5 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.BILIARY TRACT: Status post cholecystectomy. No ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 10.4 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. Right kidney 10.7 cm in lengthOTHER: Left kidney 10.6 cm in length. No ascites", "output": "Coarse liver echotexture suggestive for chronic liver disease without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant abdominal pain since oct 2016 LIVER: The liver measures 15.3 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 0.2 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 5.9 cm in length. RIGHT KIDNEY: Kidney measures 11.8 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 11.9 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.No evidence of acute cholecystitis or biliary ductal dilatation.2.Increased hepatic echogenicity raising the possibility of parenchymal dysfunction/fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "74 year old male with history of HCV, evaluate for HCC. LIVER: The liver measures 17 cm in length. Cirrhotic morphology without focal solid lesions. Two small lesions, likely cysts, one in the right lobe measuring 1.5 x 1.4 x 1.1 cm (previously 1.5 x 1.5 x 1.3 cm) and one in the left lobe measuring 0.6 x 0.5 x 0.6 cm (previously 0.5 x 0.7 x 0.5 cm). 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. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common hepatic 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 11.6 cm in length. RIGHT KIDNEY: Kidney measures 10.5 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.1 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No evidence of ascites.", "output": "1. Cirrhotic morphology with two small lesions, likely cysts, not significantly changed. "}
{"instruction": "Generate impression based on findings.", "input": "38 year old female with a history of HBV. Evaluate for HCC. LIVER: The liver parenchymal is mildly coarsened. The liver morphology and capsule are smooth. It is normal in size, measuring 12.9 cm in craniocaudal dimension. No focal hepatic lesion is identified. No intrahepatic biliary ductal dilatation. Normal hepatopetal portal venous blood flow at 40 cm/sec.GALLBLADDER, BILIARY TRACT: Normally distended gallbladder without gallstones, wall thickening or pericholecystic fluid. No extrahepatic biliary ductal dilatation with the common duct measuring 4 mm.PANCREAS: The visualized portions of the pancreatic head and body are normal.RIGHT KIDNEY: The right kidney measures 10.3 cm in length without hydronephrosis, shadowing nephrolithiasis, or focal lesion evident. Color Doppler demonstrates blood flow.OTHER: The left kidney is normal in size, measuring 10.3 cm without hydronephrosis, shadowing nephrolithiasis, or focal lesion evident. Color Doppler demonstrates blood flow.The spleen is normal in size, measuring 8.7 cm without a focal lesion evident.", "output": "Coarse hepatic parenchyma without a discrete lesion or biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "88-year-old female with history of hypothyroidism. RIGHT LOBE MEASUREMENTS: 4.0 x 1.2 x 1.0 cmLEFT LOBE MEASUREMENTS: 2.6 x 1.3 x 1.2 cmISTHMUS MEASUREMENTS: 0.6 cm in AP dimension.RIGHT LOBE: Atrophic with heterogeneous echotexture.LEFT LOBE: Atrophic with heterogeneous echotexture without increased vascularity.ISTHMUS: Atrophic with heterogeneous echotexture without increased vascularity.PARATHYROID GLANDS: No enlarged parathyroid gland identified.LYMPH NODES: No regional lymphadenopathy. OTHER: No significant abnormality noted.", "output": "Atrophic gland with heterogeneous echotexture without increased vascularity suggestive of chronic thyroiditis. No regional lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "34-year-old female with history of right portal vein thrombosis, currently on Coumadin. Evaluate all branches of portal vein for thrombus. Grayscale and color limited abdominal ultrasound through the portal vein and its branches demonstrates a patent main portal vein, right, and left portal vein with appropriate directional flow and expected waveforms, measuring 0.2 m/s.", "output": "Patent portal vasculature."}
{"instruction": "Generate impression based on findings.", "input": "Male 59 years old Reason: 59m w/ AML with worsening transaminitis History: RUQ abdominal discomfort and worsening transaminitis LIVER: Liver measures 20 cm, enlarged. There is small amount of ascites and right-sided pleural effusion.Echogenicity of the liver is unremarkable. Main portal vein is patent.BILIARY TRACT: Gallbladder is contracted, therefore cannot be optimally evaluated. No evidence of intra or extrahepatic biliary dilatation.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. RIGHT KIDNEY: No significant abnormalities noted. OTHER: Small left-sided pleural effusion.", "output": "Bilateral small pleural effusions and ascites. Contracted gallbladder cannot be optimally evaluated. No evidence of intra-axial hepatic biliary dilatation. Hepatomegaly."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female patient with history of thyroid nodule. Follow-up for interval change. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 5.5 x 2.0 x 1.5 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 6.7 x 2.3 x 1.4 cm.ISTHMUS MEASUREMENTS: The isthmus measures 0.6 cm in thickness.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: There is a dominant nodule in the left inferior pole measuring 2.5 x 2.2 x 2.7 cm, previously 2.3 x 2.3 x 1.7 cm. The nodule is relatively well-circumscribed, heterogeneous in echotexture, and contains multiple cystic spaces.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Morphologically normal lymph nodes are noted in the neck bilaterally.OTHER: No significant abnormality noted.", "output": "No significant interval change in a dominant left inferior pole thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis, low platelets, high INR LIVER: Liver measures 18.3 cm with coarse echotexture suggestive of hepatic parenchymal dysfunction/steatosis. No intrahepatic biliary duct dilatation. No focal lesions within the liver.BILIARY TRACT: Gallbladder is well-distended without any gallstones within it. Mild gallbladder wall thickening without pericholecystic fluid. No evidence of gallstones. No intra or extra hepatic delivery ductal dilatation.PANCREAS: Head) visualized appears unremarkable. Body and tail of pancreas is not visualized due to overlying bowel gas.SPLEEN: Spleen measures 7.9 cm without any focal lesions.KIDNEY: Right kidney measures 12.2 cm and left kidney measures 12.9 cm. Bilateral renal sinus cysts, unchanged from prior examination. The cyst in the left kidney measures 2.6 x 2.2 cm, previously measured 2.2 x 2.7 cm and the cyst in the right kidney measures 1.7 x 2.6 cm, previously measured 1.5 x 2.8 cm. No hydronephrosis or focal lesions. OTHER: No ascites", "output": "Mild coarse echotexture of the liver suggestive of hepatic parenchymal dysfunction/chronic liver disease. No focal lesions in the liver.Bilateral renal cysts are stable.Mild gallbladder wall thickening probably due to chronic liver disease.No ascites"}
{"instruction": "Generate impression based on findings.", "input": "History of hepatitis B. Presents for hepatocellular carcinoma screening. LIVER: The liver is coarse in echotexture. It measures 11.9 cm in craniocaudal dimension. No focal suspicious lesion. No intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 0.2 to 0.5 meters per second.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 5 mm. Normally distended gallbladder with sludge and a shadowing gallstone. No gallbladder wall thickening, pericholecystic fluid or focal tenderness.PANCREAS: The partially imaged pancreas is mildly atrophic without a discrete lesion.SPLEEN: The spleen is not visualized due to overlying bowel gas shadowing.RIGHT KIDNEY: The right kidney is atrophic and echogenic measuring 8.4 cm in length without hydronephrosis. OTHER: The left kidney is atrophic and echogenic measuring 8.6 cm in length without hydronephrosis.", "output": "1. Coarse liver echotexture consistent with chronic liver disease without evidence of cirrhosis or focal lesion.2. Cholelithiasis without evidence of cholecystitis.3. Findings of chronic medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "66 years old, Male, Reason: rising creatinine History: rising creatinine ULTRASOUND KIDNEYSRIGHT KIDNEY: No evidence of hydronephrosis or nephrolithiasis.LEFT KIDNEY: No evidence of hydronephrosis or nephrolithiasis.OTHER:No significant abnormalities noted.", "output": "Max velocity in the right renal artery is at the upper limits of normal. The velocity left renal artery is not significantly higher than that of the aorta."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Coarse echogenic liver echotexture without mass. Liver length 13.5 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Mildly echogenic renal parenchyma without mass, stone, or hydronephrosis. 10.3 cm in lengthOTHER: Mildly echogenic left renal parenchyma without mass, stone, or hydronephrosis. 10.8 cm in length. Spleen 13.3 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Cholelithiasis without acute inflammation.Mildly echogenic renal parenchyma raises the possibility of medical renal disease/parenchymal dysfunction without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Evaluation for left popliteal fossa Baker's cyst, history of osteoarthritis The left popliteal fossa was examined without any sonographic evidence of a loculated fluid collection. The popliteal artery and vein appear patent.", "output": "No sonographic evidence of a Baker's cyst in the left popliteal fossa."}
{"instruction": "Generate impression based on findings.", "input": "Hyperthyroidism RIGHT LOBE MEASUREMENTS: 4.4 x 1.9 x 1.5 cmLEFT LOBE MEASUREMENTS: 3.8 x 1.8 x 1.5 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Diffusely heterogeneous gland without discrete mass. Mildly increased vascularityLEFT LOBE: Diffusely heterogeneous gland without discrete mass. Mildly increased vascularityISTHMUS: Diffusely heterogeneous gland without discrete mass. Mildly increased vascularityPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland without discrete mass. Associated with mildly increased vascularity. Findings consistent with thyroiditis."}
{"instruction": "Generate impression based on findings.", "input": "Male 40 years old Reason: assess RUQ for presence of cholelithiasis History: elevated LFTs, elevated lipase LIMITED ABDOMENLIVER: Liver measures 22.2 cm in length. The parenchyma is coarsened and echogenic. Portal venous flow is normal.BILIARY TRACT: Gallbladder sludge without wall thickening or pericholecystic fluid. No intra or extrahepatic biliary ductal dilation.PANCREAS: The pancreas is obscured by overlying bowel gas.KIDNEYS: The right kidney measures 11.1 cm. No hydronephrosis or nephrolithiasis. The left kidney measures 12.7 cm. No hydronephrosis or nephrolithiasis.SPLEEN: The spleen measures 12.7 cm in length.", "output": "1.Gallbladder sludge without wall thickening or pericholecystic fluid.2.Hepatomegaly and coarse liver echotexture."}
{"instruction": "Generate impression based on findings.", "input": "Male; 63 years old. Reason: AKI vs CKD History: uremia RIGHT KIDNEY: The right kidney measures 11.1 cm in length. The renal cortex is highly echogenic and the margins are indistinct. There is no hydronephrosis.LEFT KIDNEY: The left kidney is not well visualized.URINARY BLADDER: The bladder is decompressed by Foley catheter.OTHER: No significant abnormalities noted.", "output": "1.Echogenic right kidney compatible with medical renal disease. No hydronephrosis on the right.2.The left kidney is not well visualized."}
{"instruction": "Generate impression based on findings.", "input": "History of kidney lesion, evaluate change in size or characteristics RIGHT KIDNEY: The right kidney measures 12.2 cm. No hydronephrosis or mass.LEFT KIDNEY: The left kidney measures 12.1 cm. No hydronephrosis or mass.OTHER: The bladder is not visualized.", "output": "No renal mass."}
{"instruction": "Generate impression based on findings.", "input": "65 year-old female with thyromegaly. RIGHT LOBE MEASUREMENTS: 5.1 cm x 1.1 cm x 1.6 cmLEFT LOBE MEASUREMENTS: 4.7 cm x 0.9 cm x 1.7 cmISTHMUS MEASUREMENTS: 2 mm in thicknessRIGHT LOBE: No discrete nodules or masses are identified.LEFT LOBE: No discrete nodules or masses are identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level benign-appearing lymph node measures 0.8 cm x 0.3 cm x 1.1 cm. Right level 4 benign-appearing lymph node measures 6 mm x 2 mm x 7 mm. Left level 3 benign-appearing lymph node measures 0.7 cm x 0.2 cm x 1.0 cm. Left level 4 benign-appearing lymph node measures 0.9 cm x 0.4 cm x 1.3 cm. No pathologic lymphadenopathy. OTHER: Patient's area of neck swelling was evaluated with no discrete nodules or masses identified.", "output": "No discrete nodules or masses were noted. "}
{"instruction": "Generate impression based on findings.", "input": "50 year-old male with history of elevated liver enzymes. LIVER: The liver parenchyma is normal in appearance. The liver measures 17 cm.GALLBLADDER, BILIARY TRACT: The gallbladder wall measures 0.5 cm in thickness. There is no pericholecystic fluid, the gallbladder is not dilated, and no gallstones are seen.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. The right kidney measures 5.7 cm.OTHER: No significant abnormalities noted. The left kidney measures 5.3 cm. The spleen is enlarged, measuring 13 cm. No sonographic Murphy's sign. No significant ascites.", "output": "1.Thickened gallbladder wall, nonspecific but given the patient's relatively benign presentation this would be atypical for cholecystitis. This thickening may be seen with heart failure or hypoproteinemia, among other causes.2.No biliary dilatation, perihepatic fluid collections or other significant liver parenchymal abnormalities."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with hepatitis C, evaluate for HCC. LIVER: Measures 12.8 cm in length. Increased hepatic echogenicity without discrete focal lesion.BILIARY TRACT: No significant abnormalities noted.PANCREAS: Portions of the pancreas are not clearly visualized due to bowel gas. The visualized pancreas is unremarkable.SPLEEN: No significant abnormalities noted.KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Increased hepatic echogenicity consistent with chronic liver disease, without discrete lesion."}
{"instruction": "Generate impression based on findings.", "input": "Reason: transaminitis History: abnormal LFTs Limited exam due to bandages overlying abdomen. LIVER: The liver measures 15.5 cm in length. The liver parenchymal echotexture is course and echogenic. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.26 m/s.BILIARY TRACT: There is no evidence of cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. Repeating linear reflectors at the gallbladder lumen are favored to artifactual, but also could be related to cholecystostomy catheter if one is present; correlate with procedural history. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3.7 mm in diameter.PANCREAS: Not visualized. SPLEEN: Not visualized. RIGHT KIDNEY: Not visualized. LEFT KIDNEY: Not visualized. OTHER: No significant abnormalities noted.", "output": "1.Limited exam. 2.Echogenic liver suggestive of parenchymal dysfunction/fatty infiltration. 3.No sonographic evidence of acute cholecystitis or biliary ductal dilatation. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: enlarged thyroid History: enlarged thyroid RIGHT LOBE MEASUREMENTS: 9.8 x 5.5 x 4.2 cm, previously 9.7 x 5.0 x 2.8 cmLEFT LOBE MEASUREMENTS: 10.3 x 4.5 x 4.2 cm, previously 9.3 x 4.8 x 2.5 cmISTHMUS MEASUREMENTS: 1.8 cm in the AP dimension, previously 1.6 cmRIGHT LOBE: Markedly enlarged right thyroid lobe with extensive heterogeneity and nodularity.Dominant predominantly solid reference nodule in the right lower pole measures approximately 3.2 x 2.3 x 2.8 cm, previously 3.2 x 3.2 x 2.2 cm, however the margins are indistinct and difficult to measure.LEFT LOBE: Markedly enlarged left thyroid lobe with extensive heterogeneity and nodularity. No distinct reference nodules are identified, similar to prior exam.ISTHMUS: Heterogeneous and enlarged gland without interval change.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted. No cervical lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Stable thyromegaly and multinodular goiter without significant interval change."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old female with heterogeneous thyroid gland. RIGHT LOBE MEASUREMENTS: 7.2 x 3.5 x 2.9 cmLEFT LOBE MEASUREMENTS: 9.0 x 4.7 x 3.4 cmISTHMUS MEASUREMENTS: 2.4 cmRIGHT LOBE: Enlarged heterogeneous gland without discrete nodule.LEFT LOBE: Enlarged heterogeneous gland with nodular configuration but no discrete measurable nodule.ISTHMUS: Enlarged heterogeneous gland without discrete nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Enlarged heterogeneous gland without discrete measurable nodule. No significant interval change since the prior study."}
{"instruction": "Generate impression based on findings.", "input": "24-year-old female with right-sided neck pain in the setting of multiple acute on chronic pulmonary emboli. Evaluate for deep venous thrombosis Grayscale and color ultrasound of the neck soft tissues demonstrates no significant abnormalities. No fluid collections are identified. Scattered cervical lymph nodes are normal in size with benign morphologic features. The thyroid gland appears unremarkable.", "output": "No significant abnormalities in the neck soft tissues."}
{"instruction": "Generate impression based on findings.", "input": "Renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 12.5 cm in lengthLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 12.3 cm in lengthOTHER: Bladder nondistended", "output": "Echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or obstruction"}
{"instruction": "Generate impression based on findings.", "input": "Female 75 years old Reason: follow up on multiple nodules RIGHT LOBE MEASUREMENTS: 3.8 x 1.1 x 1.1 cm.LEFT LOBE MEASUREMENTS: 4.5 x 0.9 x 1.5 cm.ISTHMUS MEASUREMENTS: 0.2 cm in thickness.RIGHT LOBE: Heterogeneous multinodular gland with numerous nodules. Several contain echogenic foci possibly calcifications. Several cystic areas in some with areas suggesting ring down consistent with colloid nodules.The baseline purposes nodules are indicated in PACS and measured as nodules #1 through 5 as follows:Nodule #1: 0.7 x 0.3 x 0.6 cmNodule #2: 0.8 x 0.4 x 0.7 cmNodule #3: 0.4 x 0.3 x 0.4 cmNodule #4: 0.9 x 0.4 x 0.6 cmNodule #5: 0.7 x 0.3 x 0.4 cmLEFT LOBE: Heterogeneous nodular glands similar to the right. The baseline purposes 3 nodules measure as follows and annotated in PACS.Nodule #1: 1 x 0.6 x 0.9 cmNodule #2: 1.1 x 0.6 x 0.8 cm (cystic)Nodule #3: 0.9 x 0.4 x 0.6 cm (medial near isthmus)ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Normal blood flow on limited color Doppler imaging. Nodules are relatively hypovascular.", "output": "Numerous nodules bilaterally solid somewhat cystic components some with calcifications. Some with slightly spongiform character and ring down suggestive of colloid nodules. No dominant nodule. Nodules are more numerous compared to the last thyroid study in PACS dated 11/21/2006."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female status post fall on 1/18/16 with trauma to the left anterior chest. Now feels a \"knot\" in the left breast, superior to the nipple. Rule out hematoma. According to the patient today, the palpable area is improving significantly in the past week and was also not present before the fall. On physical exam, a small lump was palpable in the 1:00 position 3 cm from the nipple. A targeted left breast ultrasound was then performed in the palpable area of concern. In the 1:00 position approximately 1 cm from the nipple is a heterogenous, predominantly hyperechoic area measuring 9 x 10 mm without appreciable vascular flow.", "output": "Physical exam and ultrasound findings likely represent a evolving hematoma/fat necrosis in the left breast. However, a three month follow-up is recommended to ensure resolution. These findings and recommendations were discussed with the patient who agreed with the plan.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "Painless 2 cm nodule in the groin area. Targeted evaluation of the patient's left groin palpable abnormality shows a subdermal hypoechoic 8 x 4 x 10 mm lesion without vascularity. No drainable fluid collection is evident.", "output": "Nonspecific subdermal 1 cm hypoechoic oval lesion may represent a sebaceous cyst/epidermal inclusion cyst. No drainable fluid collection or significant adjacent inflammatory changes. If there is persistent clinical concern follow-up to resolution is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Reason: check for thyroid cancer recurrence RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Status post thyroidectomy. No suspicious masses within the thyroidectomy bed.LEFT LOBE: Status post thyroidectomy. No suspicious masses within the thyroidectomy bed.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No suspicious lymphadenopathy.OTHER: No significant abnormality noted.", "output": "No specific evidence of local recurrence or regional lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Female; 48 years old. Reason: goiter History: cough, goiter RIGHT LOBE MEASUREMENTS: 4.7 x 1.8 x 1.5 cmLEFT LOBE MEASUREMENTS: 5.6 x 1.8 x 1.3 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Multiple cystic nodules are seen within the right thyroid lobe. A cyst within the superior pole of the right lobe is spongiform and demonstrates comet tail artifact. This measures 1.1 x 0.6 x 0.8 cm.LEFT LOBE: Multiple cystic nodules are seen within the left thyroid lobe. Within the lower pole is a 0.9 x 0.5 x 0.8 cm cystic nodule.ISTHMUS: At the junction of the isthmus and the left thyroid lobe is a 1.8 x 1.1 x 0.6 cm complex, predominantly cystic lesion mural nodularity and a focus of calcification along the rim. An additional nodule at the junction of the isthmus and the right thyroid lobe has ultrasound characteristics of a colloid nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No suspicious lymph nodes identified.OTHER: No significant abnormality noted.", "output": "Multinodular goiter. No dominant nodule."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old male patient with new ascites fluid. Question of portal vein thrombosis. LIMITED ABDOMENLIVER: The liver measures 14.3 cm in length, is coarsened in echotexture, and nodular in contour. BILIARY TRACT: There is a single shadowing gallstone. The gallbladder wall measures 9 mm in thickness which is nonspecific in the setting of ascites. The common duct measures 4 mm in diameter.PANCREAS: The pancreas is not visualized on this examination.SPLEEN: The spleen measures 12.8 cm in length. RIGHT KIDNEY: The right kidney measures 10.1 cm in length. No evidence of hydronephrosis.OTHER: There is moderate to marked ascites.", "output": "1. Patent main portal vein with poor visualization of the right and left portal veins.2. Patent hepatic arteries and veins.3. Cirrhotic morphology of the liver with moderate to marked ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 45 years old; Reason: s/p total pancreatectomy with auto-islet transplantation, 1 year follow up. Please evaluate flow in liver and complete doppler of poral vein. History: see above LIVER: The liver measures 15.1 cm in length. Diffuse echogenic foci scattered throughout the liver of uncertain etiology which could represent fat although cannot be certain. No focal hepatic lesions. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow measured at 24.0 cm/s. The right portal vein is patent with normal flow measured at 14.7 cm/s. The left portal vein is patent with normal flow measured at 10.3 cm/s.GALLBLADDER/BILIARY TRACT: The gallbladder is been surgically removed. The common hepatic duct measures 2.6 mm in diameter. PANCREAS: Evaluation obscured by bowel gas.SPLEEN: The spleen has been surgically removed.RIGHT KIDNEY: The right kidney measures 10.4 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 12.0 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.", "output": "1. Diffuse echogenic foci scattered throughout the liver of indeterminate etiology. This may represent fat, however if clinically warranted dedicated cross sectional imaging may be indicated.2. Surgical changes of a cholecystectomy and splenectomy."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old male patient with HCV cirrhosis. Evaluate for HCC. LIVER: The liver is echogenic, nodular in contour, and measures 14.2 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder contains sludge. There is no pericholecystic fluid. Minimal non-specific gallbladder wall thickening is noted. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 5 mm in diameter.PANCREAS: The head of the pancreas demonstrates normal echogenicity. The body and tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 13.1 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 13.2 cm in length. No evidence of hydronephrosis.The spleen measures 14.1 cm in length.", "output": "1. Cirrhotic morphology of the liver without focal hepatic lesion.2. Biliary sludge. "}
{"instruction": "Generate impression based on findings.", "input": "Acute pancreatitis LIVER: Echogenic and coarse liver parenchyma without mass. Liver length 23 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10 cm in lengthOTHER: Left kidney 12.5 cm in length. Spleen 10 cm in length. No ascites", "output": "Hepatomegaly with echogenic and coarse liver parenchyma suggestive for chronic parenchymal liver dysfunction/fatty infiltration without mass or ductal dilatation. Unremarkable gallbladder. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "75-year-old male post kidney transplant and Hartman's procedure, now with rising bilirubin and alkaline phosphatase. LIVER: Liver is likely a mildly to moderately echogenic without gross focal abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder is collapsed, containing multiple gallstones. Gallbladder wall is not thickened, and no pericholecystic fluid is seen.. Biliary tract is normal in caliber.PANCREAS: Pancreas appears somewhat pancreas appears somewhat enlarged and hypoechoic when compared to the prior exam no peripancreatic fluid collections RIGHT KIDNEY: Atrophic and echogenic with small cyst OTHER: Left kidney is atrophic and echogenicLimited images of transplant kidney in the right iliac fossa demonstrates patent artery and vein by color Doppler and no hydronephrosis or peritransplant collection. Bladder is collapsed.Bilateral pleural effusions.", "output": "Echogenic liver.Collapsed gallbladder stones.Somewhat enlarged, hypoechoic and heterogeneous pancreas. Patient's lipase is elevated and cannot exclude early pancreatitis. No complication.Echogenic and atrophic kidneys.Bilateral pleural effusions.Limited evaluation of transplant kidney demonstrates no abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Renal stone RIGHT KIDNEY: Normal parenchymal echogenicity. No worrisome mass or hydronephrosis. Stable 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": "Ms. Moog is a 25-year-old with palpable right breast mass which may have slightly increased in size over the past 6 months. Family history of breast cancer in maternal grandmother and maternal aunt. On physical exam, there is a palpable mobile mass in the upper inner quadrant of the right breast.A targeted right breast ultrasound was performed for the palpable area of concern. In the right breast 2:00 position 5 cm from nipple, there is a 1.8 x 1.0 x 2.0 cm circumscribed hypoechoic wider than tall mass with internal vascularity, highly suggestive of a fibroadenoma.", "output": "Benign morphology mass of the right breast, with sonographic features suggestive of a fibroadenoma. Given palpability and history of interval growth, a surgical consultation is recommended for further evaluation. Findings and recommendations were discussed with the patient at time of the exam.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old male with metastatic esophageal carcinoma with severe abdominal pain and abnormal liver function. LIVER: Liver is heterogeneous in echotexture and normal in size. Discrete mass is not seen with certainty. There is now thrombosis of the portal venous system, progressive from the prior CT.GALLBLADDER, BILIARY TRACT: There appears to represent gallbladder is filled with echogenic material. The wall is not easily separated from internal material but is likely mildly thickened which is not specific in the face of ascites. No shadowing gallstones. There is now significant and diffuse biliary tract dilatation with the common duct measuring 1.7 cm in greatest diameter extending to the patient's known mass which infiltrates the porta hepatis.PANCREAS: Not discretely visualized. Large midline mass.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Significant ascites. Pleural effusions.", "output": "Biliary tract dilatation likely due to obstruction in the porta by metastatic disease. Portal venous thrombosis.Gallbladder sludge without shadowing stones.Diffuse, moderate ascites. Pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "54 years old, Female, Reason: eval for liver dz History: RUQ pain, elevated ALT, ALP. Pt has no gallbladder. LIVER: The liver measures 20 cm in length. There is diffusely increased echogenicity of the liver suggestive of diffuse hepatic steatosis. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of .3 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 7.8 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 9.1 cm in length. RIGHT KIDNEY: Kidney measures 12 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 12.6 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "Hepatic steatosis without evidence of biliary ductal dilatation or focal hepatic mass lesion. No evidence of ascites."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma again noted without worrisome mass, stone, or hydronephrosis. Stable right renal cyst. Right kidney 14 cm in lengthLEFT KIDNEY: Echogenic renal parenchyma again noted without mass, stone, or hydronephrosis. Left kidney 14.5 cm in length.OTHER: Bladder nondistended. Mild ascites. Left pleural effusion.", "output": "Echogenic renal parenchyma again noted consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis. Mild ascites. Left pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "Pancreatic mass with right upper carted pain and fever LIVER: Diffusely heterogeneous liver with left lobe gas foci, possibly representing pneumobilia. No discrete mass. Liver length 16.5 cmGALLBLADDER, BILIARY TRACT: Diffuse gallbladder wall thickening with questionable pericholecystic fluid. Associated with cholelithiasis and sludge. Also associated with positive Murphy's sign. Questionable minimal intrahepatic ductal dilatation with mild prominence of the extrahepatic duct.PANCREAS: Not visualized due to overlying gas.RIGHT KIDNEY: No significant abnormalities noted. 8.9 cm in length.OTHER: Left kidney 13.1 cm in length. Spleen 10.9 cm in length. No ascites.", "output": "Diffuse gallbladder wall thickening with questionable pericholecystic fluid with cholelithiasis and sludge. Associated with positive Murphy sign. Findings suspicious for acute cholecystitis. Also associated with questionable minimal intrahepatic ductal dilatation with mild prominence of the extrahepatic duct.Diffusely heterogeneous liver without mass. Left lobe gas foci, possibly representing pneumobilia"}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female recalled from baseline screening mammogram for an ovoid circumscribed mass in the upper outer quadrant of the right rest at mid depth. Family history of breast cancer in the patient's mother. 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. Ovoid asymmetry persists on the spot compression view. The appearance is compared patible with a mass or cyst at the 2:00 position. Ultrasound: Targeted ultrasound performed for the area of mammographic concern at the 2:00 position of the right breast. There is a a 3 mm simple benign cyst at the 9:00 periareolar position at superficial depth.There is a 0.8 x 0.4 x 0.6 cm cyst located approximately 8 cm from the nipple along the 9:00 radian at mid to posterior depth. On transverse imaging, there are internal echoes which cannot be eliminated.", "output": "Highly probable benign cyst at the 9:00 position of the right breast. Ultrasound-guided aspiration and repeat mammogram recommended both to confirm that this is a simple cyst and 2 prove that this explains the asymmetry on the mammogram. The results and recommendations were discussed with the patient at the completion of the exam, and the patient elected to schedule the procedure. She was instructed that our nurse will contact her to set up an appointment.BIRADS: 3 - Probably benign finding.RECOMMENDATION: H - Percutaneus Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "27 year old pregnant patient with 2 cm mass palpated by her obstetrician. The patient reported initially that she does not know where the lump is but also stated later that lump has been there for years. Patient reports physician palpated mass was located in the right upper outer quadrant. A targeted right ultrasound was performed for the palpable area of concern. In the 10 o'clock position 4 cm from the nipple there is an oval circumscribed parallel oriented hypoechoic heterogeneous mass with mild internal vascularity. This mass measures 7 x 4 x 6 mm.", "output": "Benign morphology mass in the right 10 o'clock position likely represents a fibroadenoma. Recommend short term 6 month sonographic follow up to confirm stability. It is also recommended that this result is carefully correlated with physical exam findings as there was difficulty obtaining history from this patient, a specific palpable area of concern from physical exam could not be found in the electronic chart and the referring physician could not be contacted via pager. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "History gallbladder polyps LIVER: Coarse echogenic liver parenchyma again noted without mass. Liver length 18.2 cmGALLBLADDER, BILIARY TRACT: No significant interval change in multiple gallbladder polyps. The largest near the gallbladder neck measures 1 x 0.7 cm.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.8 cm in length.OTHER: Left kidney 10.7 cm in length. Spleen 8.3 cm in length. No ascites.", "output": "No significant interval change in multiple gallbladder polyps. Coarse echogenic liver parenchyma again noted consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Reason: concern for congestive hepatopathy, rule out portal vein thrombosis History: pulmonary hypertension of unclear cause LIVER: The liver measures 18.7 cm in length. The liver parenchymal echotexture is coarse. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating pulsatile hepatopetal flow with a velocity of 0.29 m/s. No filling defects are identified within the main portal vein or visualized branches. The hepatic veins appear somewhat prominent.BILIARY TRACT: No cholelithiasis. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 6 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: Not visualized.RIGHT KIDNEY: Kidney measures 14.9 cm in length. Normal echotexture. No hydronephrosis. Simple cyst.LEFT KIDNEY: Kidney measures 13.7 cm in length. Normal echotexture. No hydronephrosis.OTHER: Right pleural effusion.", "output": "1.Portal vein appears patent without evidence of thrombus.2.Pulsatile portal vein and prominent hepatic veins raise question of right-sided heart failure."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with history of mobile nodule on right jaw line present for at least six years, nonpainful. Grayscale and color ultrasound at the area of the patient's palpable complaint demonstrates a solid mass within the right parotid gland measuring 2.5 x 2.1 cm in maximum diameter with lobulated margins and increased through transmission which is slightly hypoechoic compared to the surrounding gland. Additionally, there is a smaller adjacent lesion along its inferior aspect measuring 1.3 x 0.8 cm, which may represent an exophytic component of the adjacent larger lesion versus a small separate satellite lesion. The remainder of the gland as well as the contralateral parotid are unremarkable.", "output": "Solid mass in the right parotid gland as described above, which is nonspecific by ultrasound. Differential considerations include pleomorphic adenoma as well as other neoplasms. CT or MRI may be considered for further evaluation as warranted clinically."}
{"instruction": "Generate impression based on findings.", "input": "ECMO patient with transaminitis LIVER: Mildly echogenic and coarse liver echotexture again noted without mass. Liver length 15.6 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.5 m in lengthOTHER: Left kidney 12.2 cm in length. Spleen is 18.5 cm in length. Benign echogenic focus within the spleen noted. No ascites.", "output": "Mildly echogenic coarse liver parenchyma again noted suggestive for chronic liver disease/parenchymal dysfunction without mass or ductal dilatation. Mild splenomegaly again noted. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female with history of transaminitis. Evaluate for cirrhosis or portal vein thrombosis. LIVER: Normal hepatic morphology without focal lesion. Mildly coarsened hepatic echotexture. Patent main portal vein with antegrade flow measuring 0.3 m/s.BILIARY TRACT: Status post cholecystectomy. Common bile duct normal in caliber.PANCREAS: No significant abnormalities noted.SPLEEN: Top normal in size measuring 12.1 cm in length without focal lesion. KIDNEYS: 1.2 x 1.0 cm simple right renal cyst. Unremarkable left kidney. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1. Increased hepatic echogenicity may represent diffuse parenchymal disease or fatty infiltration.2. No evidence of cirrhosis or portal vein thrombosis as clinically questioned. "}
{"instruction": "Generate impression based on findings.", "input": "Elevated liver enzymes. Right-sided heart failure. LIVER: Non-cirrhotic liver morphology. Coarsened parenchymal echogenicity. 15 cm in length. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Cholelithiasis. No gallbladder wall thickening, pericholecystic fluid, or 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 9.6 cm in length. The left kidney is 8.3 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 10.9 cm in length, without focal lesions evident.OTHER: Small right pleural effusion is partially imaged.", "output": "1. Heterogeneous hepatic echogenicity, compatible with parenchymal dysfunction.2. Cholelithiasis without specific evidence of cholecystitis.3. Small right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "Reason: right level V cervical lymph node for 1 year, reevaluate Again seen are benign-appearing right preauricular region and right level 5 cervical lymph nodes, measuring 1.0 x 0.3 x 0.5 cm and 1.2 x 0.2 x 0.7 cm respectively without interval change in size.", "output": "Stable nonenlarged benign-appearing cervical lymph nodes."}
{"instruction": "Generate impression based on findings.", "input": "Right groin possible abscess status post cardiac catheterization complicated by hematoma. In the area of concern in the right groin there is a small loculated subcutaneous fluid collection without diffuse vascularity. This is irregularly shaped and measures 3.9 cm x 1.0 cm. There is also diffuse edema of the soft tissue.", "output": "Small loculated non vascular subcutaneous fluid collection in the area of concern of the right groin. Diffuse edema is seen in the surrounding area."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Martin is a 22-year-old woman presenting for short-term follow-up of high probability right breast mass. On physical exam, there is a palpable firm mobile mass in the lateral right breast near the 10:00 position.A targeted right grayscale and color Doppler ultrasound was performed for the palpable area of concern. In the right breast 9:00 position, approximately 3 cm from the nipple, there is redemonstration of a parallel, lobulated well-circumscribed hypoechoic mass measuring 1.9 x 0.6 x 1.4 cm, not significantly changed since the previous exam given differences in technique when it measured 1.9 x 0.6 x 0.9 cm. Internal vascularity is present. Sonographic features favor a benign fibroadenoma.", "output": "Sonographically stable 1.9-cm mass at 9:00 position of the right breast, with features favoring a benign fibroadenoma. Continued clinical management is recommended. Result and recommendations were discussed with the patient at the time of the exam.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "History of cirrhosis. Evaluate for HCC. LIVER: Nodular coarsely echogenic liver compatible with cirrhosis. It measures 17.5 cm in length. No discrete lesion is identified. No intrahepatic biliary ductal dilatation. Patent hepatopedal portal venous blood flow at 29 cm/s.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 1 mm. Normally distended gallbladder without cholelithiasis, gallbladder wall thickening, pericholecystic fluid or focal tenderness.PANCREAS: The visualized portions of the pancreatic head and body are unremarkable. The remainder is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 12 cm in length without a focal lesion.RIGHT KIDNEY: The right kidney measures 12.3 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates color blood flow.OTHER: The left kidney measures 11.3 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates color blood flow.", "output": "Cirrhosis without a discrete liver lesion."}
{"instruction": "Generate impression based on findings.", "input": "Reason: RUQ pain, eval for acute cholecystitis History: RUQ pain LIVER: The liver measures 17.3 cm in length. Cirrhotic liver morphology. The portal vein is patent with normal portal venous hepatopedal blood flow, 28.1 cm/s. GALLBLADDER, BILIARY TRACT: The gallbladder is mildly distended without stones or sludge. The gallbladder wall measures 0.4 cm and the common bile duct measures 0.3 cm. No pericholecystic fluid. No intrahepatic or extrahepatic biliary ductal dilatation. PANCREAS: Obscured by bowel gas.OTHER: No significant abnormalities noted.", "output": "Cirrhotic liver morphology and distended gallbladder without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Female 46 years old Reason: eval for cholelithiasis History: abdominal pain, elevated Tbili and alk phos Exam is limited by patient's inability to change position.LIVER: Coarsened echogenicity of the liver, which can be seen in the setting of fatty infiltration. Liver capsule appears smooth. Liver measures 18.3 cm in length. Main portal vein is patent with normal directional flow and peak velocity of 27.8 cm/s. Hypoechoic area adjacent to the gallbladder may be an area of focal fat sparingBILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. Common bile duct measures up to 2 mm. Gallbladder wall is within normal limits measuring up to 3 mm. No shadowing stones are present in the gallbladder.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: Spleen is within normal limits measuring 9.2 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 10.1 cm. Left kidney measures 9.3 cm. OTHER: No significant abnormalities noted.", "output": "1.No evidence of cholelithiasis or abnormal biliary ductal dilatation.2.Coarsened echogenicity of the liver is nonspecific but can suggest fatty infiltration or be seen in diffuse hepatic dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney failure. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 9.1 cm in length. Cortical echogenicity again may be mildly increased. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures approximately 8.9 cm in length. The upper pole is not well visualized due to position of the kidney. Cortical echogenicity again may be mildly increased. No hydronephrosis, shadowing calculus or mass.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Stable examination. Mildly echogenic kidneys without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old male patient with history of cirrhosis. Evaluate for HCC. LIVER: The liver measures 17.6 cm in length. No focal hepatic lesion is identified. The liver is nodular in contour with coarsened echotexture. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There is cholelithiasis. No pericholecystic fluid is identified. 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 10.7 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.1 cm in length. No evidence of hydronephrosis.The spleen measures 16.3 cm in length.", "output": "1. Cirrhotic morphology of the liver without focal lesion.2. Splenomegaly.3. Cholelithiasis without sonographic evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Female; 45 years old. Reason: history of stage IC3 ovarian cancer, now thyroid nodule seen on recent CT scan History: none RIGHT LOBE MEASUREMENTS: 5.5 x 1.8 x 1.4 cmLEFT LOBE MEASUREMENTS: 4.4 x 1.9 x 1.2 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: Arising from the left aspect of the isthmus is a 4.1 x 3.9 x 2.0 cm nodule. This is predominantly solid with small cystic areas during it is somewhat spongiform appearance. Punctate hyperechoic foci appear to have ring down artifact.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: 1.5 x 0.7 x 0.3 cm right level 3 lymph node has a fatty hilum and benign appearance.OTHER: No significant abnormality noted.", "output": "Predominately solid 4.1 cm isthmus nodule is amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "63 years old, Male, Reason: urinary retention, place intraop SP tube History: urinary retention Ultrasound guidance was performed for intraoperative placement of suprapubic catheter.", "output": "Ultrasound guidance performed for intraoperative placement of suprapubic catheter."}
{"instruction": "Generate impression based on findings.", "input": "Male; 61 years old. Reason: Hepatitis B, eval for HCC History: HBV LIVER: Coarsely echogenic. Measures 14 cm. Right hepatic lobe simple cyst measuring up to 1.2-cm. No suspicious lesion. No intrahepatic biliary ductal dilation. Patent portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: Gallbladder is normally distended. No gallstones/sludge. No pericholecystic fluid or abnormally increased wall thickness. Stable echogenic focus with ringdown artifact in the gallbladder wall, again suggestive of cholesterolosis or adenomyomatosis. Common bile duct measures 3 mm. PANCREAS: Visualized portion of the pancreatic head is unremarkable. Pancreatic tail is obscured by overlying bowel gas.SPLEEN: No significant abnormality. KIDNEYS: Right kidney measures 10.5 cm, left measures 10.3 cm. Echogenicity is within normal limits. No focal lesions, shadowing calculi, or hydronephrosis.OTHER: No ascites.", "output": "1. Coarse echogenic liver, compatible with diffuse fatty alteration or chronic liver disease.2. No suspicious hepatic lesion.3. Gallbladder adenomyomatosis versus cholesterolosis."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Goodman is a 21 year old female presenting with bilateral palpable masses. Patient has had prior FNA of the left breast revealing fibroadenoma in 2013. She currently states that these masses have decreased in size since compared to prior examination. Upon physical exam of the right breast, at least 3 palpable masses are identified, the largest of which is in the right lower inner breast.Targeted right breast ultrasound is performed for the patient's areas of concerns.- 5 o'clock location: 3.0 x 1.6 x 2.4 cm, compared to 3.1 x 1.6 x 2.2 cm.- 9 o'clock location: 1.6 x 1.2 x 1.7 cm, compared to 1.6 x 1 .0 x 1.7 cm.- 10 o'clock location: 0.8 x 0.5 x 0.9 cm, compared to 1.0 by 0.4 x 1.2 cmUpon physical exam of left breast, at least for palpable masses are identified, the largest of which is in the left lower inner breast.Targeted left breast ultrasound is performed for the patient's area of concerns.- 7 o'clock location: 3.4 x 1.5 x 3.4 cm, compared to 3.2 x 1.2 x 3.6 cm.- 3 o'clock location: 1.0 x 0.7 x 1.2, compared to 1.1 x 0.7 x 1.2 cm- 12 o'clock location: 2.4 x 1.6 x 1.5 cm, compared to 0.9 x 0.8 cm.- 12 o'clock location: 1.8 x 1.6 x 1.8 cm, compared to 1.1 x 0.6 cm.", "output": "Interval increase in size of two left breast masses. Multiple additional bilateral masses are relatively unchanged in size, all of which likely represent fibroadenomata. Continued surgical observation is recommended for this patient. All results and recommendations were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Female 58 years old; Reason: Change in nodules History: Multinodular goiter RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.9 x 1.8 x 1.3 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 6.4 x 3.0 x 2.7 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.5 cm.RIGHT LOBE: The right lobe is heterogeneous. There is a dominant nodule in the inferior portion of the right lobe. This appears hypoechoic and heterogeneous to the thyroid. No microcalcifications or internal vascularity are seen. This nodule measures 1.5 cm x 1.4 cm x 0.9 cm and is similar in appearance to prior ultrasound. LEFT LOBE: The left lobe is heterogeneous. A dominant nodule is identified in the inferior portion of the left lobe. This appears heterogeneous and iso to hyperechoic to the thyroid. No internal microcalcifications are seen. This nodule measures 3.6 cm x 2.4 cm x 2.4 cm and is similar in appearance to prior ultrasound.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted.", "output": "Stable thyroid exam from prior ultrasound in 2014. Again noted is a right dominant complex nodule measuring 1.5 cm x 1.4 cm x 0.9 cm and left dominant complex nodule measuring 3.6 cm x 2.4 cm x 2.4 cm that are both stable in size and appearance. No suspicious adenopathy is visualized."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female presents for evaluation of her liver after recent CT examination. LIVER:Measures 18.3 cm. There is markedly increased echogenicity, limiting the penetration of the sound beam through the liver and limiting the sensitivity of the examination. No ascites or intrahepatic biliary dilation. No definite masses. Portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: Gallbladder is poorly visualized given limited penetration of the sound beam through the liver. Appears to be nondistended with an anechoic lumen. No definite stones or sludge. No pericholecystic fluid.PANCREAS: Evaluation the pancreas limited due to overlying bowel gas.SPLEEN: Measures 7.3 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 10.9 cm. Left kidney measures 10.4 cm. Normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "1. Markedly increased echogenicity of the liver consistent with fatty infiltration and chronic liver disease/parenchymal dysfunction. Increased echogenicity limits sensitivity for detection of masses. If a mass is clinically suspected, then dedicated cross sectional imaging is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Reason: elevated creatinine Limited exam due to suboptimal patient positioning and movement.RIGHT KIDNEY: The right kidney measures 11.3 cm in length. Normal renal parenchymal echogenicity. No lesions, masses, or shadowing stones are identified.LEFT KIDNEY: The left kidney measures 12.2 cm in length. Normal renal parenchymal echogenicity. No lesions, masses, or shadowing stones are identified, however the lower pole is not well visualized.OTHER: The bladder is decompressed by a Foley catheter.", "output": "No acute renal abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Goiter. Assess nodules. RIGHT LOBE MEASUREMENTS: 8.0 x 4.7 x 3.6 cm, previously 8.2 x 3.3 x 3.1 cm.LEFT LOBE MEASUREMENTS: 9.4 x 3.5 x 3.1 cm, previously 10.0 x 3.9 x 3.5 cm.ISTHMUS MEASUREMENTS: 0.9 cm in AP dimension.RIGHT LOBE: The heterogeneous nodule in the inferior pole measures 4.9 x 3.1 x 4.0 cm, previously 3.6 x 3.2 x 2.6 cm, with a spongiform appearance. No new or suspicious features.LEFT LOBE: The heterogeneous nodule in the inferior pole measures 4.6 x 2.8 x 4.0 cm, previously 4.9 x 2.7 x 3.4 cm, with a spongiform appearance. No new or suspicious features. A cystic nodule in the midpole measures 1.4 x 1.0 x 1.1 cm, previously 1.2 x 0.8 x 1.2 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualizedLYMPH NODES: No lymphadenopathy identified.", "output": "Multinodular goiter, with slight interval increased size of the nodules since 2012. Some of these nodules are spongiform, compatible with colloid nodules."}
{"instruction": "Generate impression based on findings.", "input": "ATN with high urine output RIGHT KIDNEY: Mildly echogenic kidney without mass, stone, or hydronephrosis. Right kidney 13.1 cm in lengthLEFT KIDNEY: Mildly echogenic kidney without mass, stone, or hydronephrosis. The kidney 12.8 cm in length.OTHER: Bladder collapsed", "output": "Mildly echogenic kidneys consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Male 69 years old Reason: Patient has a AAA, and is a smoker. Please tell me if it's getting bigger History: AAA, asymptomatic ABDOMINAL AORTA: The proximal and mid aorta demonstrate a normal direction of flow without atherosclerotic changes. The distal aorta demonstrates a normal direction of flow. It is aneurysmally dilated (measurements below) with atherosclerotic plaques but stable in size compared to the prior study.Proximal: 2.2 x 3.0 x 2.4 cmMid: 2.3 x 2.6 x 2.3 cmDistal: 2.7 x 2.9 x 2.2 cmRight common iliac artery: 0.8 1.1 x 0.8 cmLeft common iliac artery: 0.9 x 1.1 x 1.0 cmOTHER: Note is made of a fatty liver.", "output": "1.Stable infrarenal abdominal aortic aneurysm."}
{"instruction": "Generate impression based on findings.", "input": "Renal stone RIGHT KIDNEY: Normal parenchymal echogenicity. Renal cyst. No worrisome mass, stone, or hydronephrosis. Right kidney 12.7 cm in lengthLEFT KIDNEY: Normal parenchymal echogenicity. 0.4 x 0.6 x 0.4 cm nonobstructing lower pole stone. No worrisome mass or hydronephrosis. Left kidney 11.2 cm in length.OTHER: Bladder nondistended.", "output": "Subcentimeter nonobstructing left lower pole renal stone. No worrisome mass or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 50-year-old male elevated Cr with unknown baseline, assess for acute vs chronic injury Technically very limited study secondary to patient's body habitus and thus renal parenchymal echogenicity cannot be assessed.RIGHT KIDNEY: The right kidney measures 12.7 cm in length. No significant hydronephrosis.LEFT KIDNEY: The left kidney measures 13.9 cm in length. No significant hydronephrosis.OTHER: The urinary bladder is not visualized.", "output": "Within the limits of a technically limited study renal echogenicity cannot be assessed however there is no evidence of significant hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: History of renal cyst, evaluate for change RIGHT KIDNEY: The right kidney measures 9.6 cm in length. Echogenic renal parenchyma. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.7 cm in length. Echogenic renal parenchyma. Left lower pole anechoic cyst measures 7.2 x 5.1 x 6.9 cm, previously 6.1 x 6.4 x 6.6 cm. Prominent renal column is noted more superiorly. No shadowing stones or hydronephrosis.OTHER: The urinary bladder is nondistended, precluding its evaluation.", "output": "Simple left renal cyst without significant interval change."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female. Metastatic brain mass and mediastinal/retroperitoneal/pelvic lymphadenopathy. Evaluate for a primary breast malignancy. A nodular enhancing focus was seen in the right inferior breast on recent MRI. A whole bilateral breast ultrasound was performed. In the right inferior breast at the 5 o'clock position 7 cm from the nipple, there is a hypoechoic solid mass with internal vascularity, suspicious for malignancy. It measures 1.3 x 1.3 x 1.5 cm. No solid or cystic mass is identified in the left breast.", "output": "Right breast hypoechoic solid mass, suspicious for malignancy and for which ultrasound guided percutaneous biopsy is recommended.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Male; 68 years old. Reason: evaluate liver for portal venous flow and biliary tree patentcy History: transaminitis LIVER: The liver measures 18.3 cm in length. The liver contour is smooth. The parenchyma is increased in echogenicity with coarse echotexture. Within the left lobe of the liver is a 2.5 x 2.5 x 1.9 cm simple cyst. No worrisome masses identified. There is no ascites.The main portal vein is patent with a peak velocity of 0.3 m/sec.BILIARY TRACT: The gallbladder is normal in appearance. The common duct measures 5 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreas is not well visualized due to overlying bowel gas.SPLEEN: The spleen measures 9.5 cm in length.RIGHT KIDNEY: The right kidney measures 13.2 cm in length. The cortex is normal in echogenicity. There is no hydronephrosis, shadowing renal stone, or worrisome mass. OTHER: The left kidney measures 13.4 cm in length. The cortex is normal in echogenicity. No hydronephrosis, shadowing stone, or worrisome mass.Small right pleural effusion.", "output": "1.Mild hepatomegaly. Course and echogenic liver compatible with parenchymal dysfunction.2.Patent main portal vein. No biliary ductal dilatation.3.Simple liver cyst."}
{"instruction": "Generate impression based on findings.", "input": "Reason: BP 200's/100's, Cr 11.3 History: asymptomatic RIGHT KIDNEY: The right kidney measures 10.8 cm in length. Echogenic renal parenchyma. No hydronephrosis, masses, or stones.LEFT KIDNEY: The left kidney measures 11.7 cm in length. Echogenic renal parenchyma. No hydronephrosis, masses, or stones.OTHER: Moderate ascites. The urinary bladder is decompressed, limiting evaluation.", "output": "1. Echogenic renal parenchyma, consistent with medical renal disease/parenchymal dysfunction without mass or obstruction.2. Moderate volume ascites."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old male with history of ascites. There is trace to mild ascites which contains loculations and debris.", "output": "Trace to mild complex ascites."}
{"instruction": "Generate impression based on findings.", "input": "Family history medullary renal cell carcinoma RIGHT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 10.8 cm in length.LEFT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 10.5 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 female with history of coagulopathy, and abnormal LFTs. LIVER: The liver is mildly coarse and increased in echogenicity. There may be mild liver capsule nodularity. No focal hepatic lesion or intrahepatic biliary ductal dilatation is evident. The liver measures 12.7 cm in craniocaudal dimension. Normal hepatopetal portal venous blood flow is present at 30 cm/sec.BILIARY TRACT: A partially distended gallbladder is present with a mildly prominent wall thickness of 3.2 mm, which is likely in part due to underdistention. No pericholecystic fluid, gallstones or focal tenderness. The common bile duct is normal in caliber for the patient's age, measuring up to 7 mm.PANCREAS: Evaluation of the pancreas is limited by overlying bowel gas shadowing.SPLEEN: The spleen measures 7.2 cm in length without a focal lesion evident.RIGHT KIDNEY: The right kidney measures 8.6 cm in length without hydronephrosis. There is decreased corticomedullary differentiation. OTHER: The left kidney is decreased in size, measuring 8.2 cm in length without hydronephrosis or shadowing calculus. There is decreased of corticomedullary differentiation. Small volume ascites.", "output": "1. Mildly coarse and echogenic liver parenchyma may represent diffuse fatty infiltration and/or parenchymal dysfunction. Possibly nodular liver contour raises the possibility of cirrhosis.2. Small volume ascites.3. Findings compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female with generalized abdominal pain. LIVER: Measures 21.0 in length. Hyperechoic focus in the liver thought to represent calcified malignant. Otherwise unremarkable 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. No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "1. Mildly enlarged liver without evidence of focal lesion or biliary obstruction.2. Mild gallbladder sludge versus small stones without evidence of cholecystitis.3. Increased renal echogenicity suggestive of medical renal disease. "}
{"instruction": "Generate impression based on findings.", "input": "37 years old, Female, Reason: History of cholecystitis 2012, now w/ recurrent RUQ pain History: RUQ pain, cramping, nausea/vomiting LIVER: The liver measures 13.6 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 0.2 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 3.2 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 8.4 cm in length. RIGHT KIDNEY: Kidney measures 10 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 11.8 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old female presenting for ultrasound evaluation of a right periareolar palpable lump, first detected approximately 1 month ago. Targeted ultrasound at the area of palpable concern as indicated by the patient, 3:00 position 2 cm from the nipple, reveals no suspicious solid or cystic mass.", "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. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Patient presents with left upper quadrant. LIVER: The liver is mildly coarse measuring 12 cm in length without a focal lesion or biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 17 cm/s. BILIARY TRACT: No extrahepatic biliary ductal dilatation. Cholelithiasis without gallbladder wall thickening, pericholecystic fluid or focal tenderness.PANCREAS: The pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 6.3 cm.RIGHT KIDNEY: The right kidney is atrophic and lobular in contour without hydronephrosis or discrete lesion. It measures 6 cm in length, similar to prior CT. OTHER: The left kidney measures 10.7 cm without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.", "output": "No specific findings to account for the patient's left upper quadrant pain. Chronic findings appearing similar to prior CT."}
{"instruction": "Generate impression based on findings.", "input": "Female, 73 years old. AKI, LE edema, diastolic dysfunction, elevated transaminitis. LIVER: The liver measures 20.8 cm, with homogeneous echotexture. A right hepatic lobe mass measures 9.5 x 11.5 x 12.5 cm, heterogeneous with peripheral vascularity and a somewhat stellate central echotexture.The main portal vein is patent, with normal hepatopetal flow.GALLBLADDER, BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilatation. The common bile duct measures 0.4 cm. Shadowing gallstones are noted. The gallbladder is contracted with normal wall thickness.PANCREAS: The visualized portions of the pancreas are normal.RIGHT KIDNEY: 11.8 cm in length, with increased cortical echogenicity. A solid-appearing lesion in the upper pole measures proximally 2 cm in diameter. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.2 cm in length with increased cortical echogenicity. No shadowing stones or hydronephrosis.SPLEEN: 7.0 cm in length, without focal lesion.ABDOMINAL AORTA: The abdominal aorta is normal in caliber throughout its course with extensive atherosclerotic calcification.INFERIOR VENA CAVA: The IVC is patent with normal directional flow, but is markedly narrowed by the large right hepatic mass.OTHER: No significant abnormality noted.", "output": "1.A large right hepatic lobe mass is indeterminate, and MRI is recommended for further evaluation. Associated displacement/narrowing of the IVC and hepatic veins.2.Solid-appearing right renal lesions are nonspecific and may represent heterogeneous renal parenchyma or a focal lesion, and can be further evaluated on MR imaging.3.Increased renal cortical echogenicity compatible with medical renal disease. No hydronephrosis.4.Cholelithiasis without evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Female; 59 years old. Reason: unexplained left side/flank pain since right chest tube for empyema last monrh. 59F CLL/SLL on clinical trial chemo. high risk for tumor lysis History: deep pain left side/flank Right pleural effusion, partially visualized. No abdominal ascites. Left kidney appears grossly normal. The spleen was not well visualized.", "output": "1. Right pleural effusion, partially visualized.2. No abdominal ascites."}
{"instruction": "Generate impression based on findings.", "input": "80 year old female patient with a thyroid nodule. RIGHT LOBE MEASUREMENTS: 4.6 x 1.9 x 1.5 cm.LEFT LOBE MEASUREMENTS: 3.2 x 1.4 x 1.6 cm. ISTHMUS MEASUREMENTS: 0.2 cm in thickness. RIGHT LOBE: The right thyroid lobe is heterogeneous in echogenicity. There is a 1.1 x 1.0 x 1.0 cm solid right lower pole thyroid nodule with an hypoechoic rim. LEFT LOBE: The left thyroid lobe is heterogeneous in echogenicity. There is a 0.4 x 0.6 x 0.6 cm solid, hyperechoic nodule with irregular borders within the left lower pole.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 nodules which are amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "History of liver abscess LIVER: No significant abnormalities noted. Specifically, no evidence for hepatic mass lesion or abscess. Liver length 16 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: Pancreatic head mass again noted.RIGHT KIDNEY: Large upper pole right renal mass measuring 5 x 4.6 x 5.3 cm again noted. Right kidney 10.3 cm in lengthOTHER: Lower pole left renal mass measuring 1.7 x 1.7 x 2 cm again noted. Left kidney 9.6 cm in length. Spleen 8 cm in length. No ascites.", "output": "No evidence for liver mass or abscess. No ductal dilatation. No ascites. Bilateral renal masses and pancreatic mass again noted."}
{"instruction": "Generate impression based on findings.", "input": "57 year old female with thyroid cancer status post surgery, I-131. Evaluate for masses, abnormal nodes. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: No suspicious nodules or masses noted in the thyroidectomy bed.LEFT LOBE: No suspicious nodules or masses noted in the thyroidectomy bed.ISTHMUS: No suspicious nodules or masses noted in the thyroidectomy bed.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Left neck level 4 benign appearing lymph node measuring 1.4 cm x 0.5 cm x 0.3 cm. OTHER: No significant abnormality noted.", "output": "No residual or recurrent disease in the thyroidectomy bed."}
{"instruction": "Generate impression based on findings.", "input": "Hematuria. RIGHT KIDNEY: The right kidney measures 11.2 cm in length without hydronephrosis, shadowing nephrolithiasis or solid mass. Note is made of a 1.2 cm exophytic inferior pole cyst.LEFT KIDNEY: The left kidney measures 10.9 cm in length without hydronephrosis, shadowing nephrolithiasis or solid mass.URINARY BLADDER: Normal distended urinary bladder.OTHER: Large prostate.", "output": "Prostatomegaly. No hydronephrosis or suspicious liver lesion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "60 year-old female with a history of complex cyst in the inferior pole of the right kidney, seen on recent CT scan in October. Follow-up ultrasound examination recommended in April of 2015. RIGHT KIDNEY: There is a 1.0 x 1.2 x 1.1 cm cyst with posterior acoustic enhancement along the inferior pole of the right kidney, corresponding to the finding seen on recent CT examination. There is no internal vascularity, peripheral nodularity or septation identified. The previously described simple cyst in the superior pole of the right kidney, seen on prior ultrasound examination dated 6/19/2009 is not visualized on today's examination.LEFT KIDNEY: No significant abnormalities noted.OTHER: The bladder is incompletely distended, limiting evaluation.", "output": "Benign appearing cyst in the inferior pole of the right kidney corresponding to the finding on recent CT examination."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with prior thyroidectomy for thyroid cancer. Evaluate for recurrent disease. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: In the right bed there is again noted a small, rounded hypoechoic nodule measuring 0.4 x 0.2 x 0.3 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 examination."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with abnormal liver function. Evaluate for NASH. LIVER: Liver is normal in size but is highly echogenic. Presumably this is due to severe fatty liver, but other causes of hepatic dysfunction cannot be excluded. No obvious hepatic mass although penetration to the depth of the liver is limited.BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliberPANCREAS: The head and body are normal. The tail is obscured by bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Highly echogenic liver, presumably fatty liver."}
{"instruction": "Generate impression based on findings.", "input": "28-year-old male with left pain. Evaluate for Achilles tendon tear. There is perhaps mild thickening of the distal Achilles tendon with a small focus of hypoechogenicity which may represent minimal focal insertional tendinosis. We see no findings to suggest a tear of the Achilles tendon. We see no evidence of a retrocalcaneal bursitis.", "output": "Minimal insertional tendinosis of the left Achilles tendon without evidence of a tear. "}
{"instruction": "Generate impression based on findings.", "input": "Reason: U/S of posterior Thoracic Soft Tissue Mass - Back, Tiny in Size - ? Lipoma Well-defined hypoechoic lesion with internal striations measures 5.2 x 1.6 x 5.7 cm. Several nonspecific nodular hypoechoic components are noted in deep aspect of the lesion. No internal vascularity or microcalcifications.", "output": "Findings suggestive of lipoma with mild heterogeneity. If of clinical concern, follow-up ultrasound can be obtained as indicated."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Coarse echogenic liver parenchyma without mass. Liver length 21 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis with sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.1 cm in length.OTHER: Left kidney 10.7 cm in length. Spleen 13.3 cm in length. No ascites.", "output": "Cholelithiasis with sludge without acute inflammation or ductal dilatation. Hepatomegaly with coarse echogenic liver parenchyma consistent with fatty infiltration/parenchymal dysfunction without mass. 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 77. 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": "61-year-old female patient with history of thyroid nodules on staging CT for colon cancer. Evaluate for quality. RIGHT LOBE MEASUREMENTS: 5.8 x 1.6 x 3.1 cm.LEFT LOBE MEASUREMENTS: 7.1 x 2.7 x 2.4 cm.ISTHMUS MEASUREMENTS: 1.2 cm in thickness.RIGHT LOBE: Multiple nodules are noted within the right thyroid gland, many which have imaging features of colloid nodules. The largest nodule with a spongiform appearance measures 1.7 x 1.4 x 1.4 cm in the right lower pole.LEFT LOBE: The left thyroid gland is heterogeneous containing multiple nodules many which have imaging features of colloid nodules. ISTHMUS: A nondescript, solid, heterogeneous nodule without significant internal vascularity within the isthmus measures 2.7 x 1.8 x 2.9 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Plaque is noted within the left carotid artery near the bifurcation.", "output": "Multinodular goiter as above."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are mammogram dated 12/23/2014, ultrasound dated 12/23/2014 performed at Advocate South Suburban. No comparisons are available. Mammogram: Three standard views of the left breast and two standard views of the right breast were obtained. The breast parenchyma is composed of scattered fibroglandular elements.In the left upper outer breast, there is a large diffuse area of increased density containing pleomorphic calcifications spanning a distance of approximately 10 cm which are highly suspicious. Additionally, there is diffuse skin thickening of the left breast.Ultrasound: A targeted left breast ultrasound was performed. There was diffuse skin thickening measuring up to 1.2 cm. No discrete masses were identified.", "output": "Diffuse increased density in the left upper outer breast spanning a distance of 10 cm with suspicious appearing calcifications and skin thickening. This area is biopsy-proven to represent carcinoma involving dermal lymphatic spaces.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female with palpable left thyroid mass. RIGHT LOBE MEASUREMENTS: 5.6 x 1.6 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.7 x 2.3 x 2.7 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Overall echotexture is homogeneous. There is 0.4 x 0.4 x 0.7 cm spongiform-appearing nodule in the upper pole. Small, benign cystic lesion in the lower pole.LEFT LOBE: Echotexture is homogeneous. There is a 2.3 x 2.7 x 3.7 cm predominantly cystic mass in the left lobe corresponding to the palpable abnormality. There are 2 focal areas of nodular wall thickening, the largest measuring 0.4 burs x 0.8 cm without obvious flow by color Doppler. Wall is otherwise smooth without significant thickening. Slightly cephalad there is a smaller cystic area without definite solid component. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Small, likely colloid nodules right lobe. Dominant complex cystic mass left lobe. Given the large size of the cystic component and small nodular components, this likely represents a complex colloid cyst. Biopsy was not performed due to the high likelihood of a nondiagnostic sample. If aspiration is desired, patient can easily be rescheduled. This was discussed with the patient."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 12 cm in lengthLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis of 11.7 cm in lengthOTHER: Bladder nondistended. Large fibroid uterus again noted", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "26 year old male with rising LFTs, cholestasis, history of Crohn's disease. Evaluate for hepatic clot, portal vein thrombosis, bile duct obstruction. LIMITED ABDOMENLIVER: Mild coarse echogenicity of the liver measuring 18.7 cm in length. No focal hepatic lesions.BILIARY TRACT: Contracted gallbladder making assessment for wall thickening difficult. No pericholecystic fluid. Common bile that measures 3 mm in caliber. No intra-or extrahepatic delayed ductal dilatation.PANCREAS: Distal tail of the pancreas is obscured by overlying bowel gas. The visualized portions are unremarkable.SPLEEN: Measures 14.8 cm in length.RIGHT KIDNEY: Measures 11.9 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 12.5 cm in length. No hydronephrosis or shadowing calculi are noted.Incompletely imaged bilateral pleural effusions.", "output": "1. Mild coarse echogenicity of the liver suggestive of parenchymal dysfunction. Mild hepatosplenomegaly. 2. Patent hepatic vasculature. 3. Incompletely imaged bilateral pleural effusions. "}
{"instruction": "Generate impression based on findings.", "input": "68-year-old female patient with hypertension and persistent hypokalemia. Question of renal artery stenosis. ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures 9.5 cm in length. No evidence of hydronephrosis.LEFT KIDNEY: The left kidney measures 8.6 cm in length. No evidence of hydronephrosis.", "output": "1. Patent renal vasculature without specific evidence of stenosis and intrarenal indices within normal limits.2. No evidence of hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female with acute kidney failure and polycythemia vera with hypertension. Ultrasound guidance was provided for biopsy of the patient's native right kidney.", "output": "Ultrasound guidance"}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female presents with acute kidney injury. Evaluate for hydronephrosis. RIGHT KIDNEY: Measures 10.7 cm. Unremarkable echogenicity. No hydronephrosis or shadowing calculi. Simple cyst measuring 2.7 x 2.2 x 2.6 cm appears unchanged in comparison to the prior study.LEFT KIDNEY: Measures 9.3 cm. Unremarkable echogenicity. No hydronephrosis or shadowing calculi.URINARY BLADDER: The bladder is nondistended.OTHER: No significant abnormalities noted.", "output": "1. Unremarkable study. Benign simple renal cyst as above."}
{"instruction": "Generate impression based on findings.", "input": "Female, 66 years old. Assess for RP bleed after cardiac cath in a woman with hgb drop and abdominal pain. The lower quadrants are suboptimally evaluated by overlying bowel gas. No definite large collection is seen in the lower quadrants. No fluid collection is identified in the upper quadrants.", "output": "No fluid collection is identified in the upper quadrants. The lower quadrants are not well visualized."}
{"instruction": "Generate impression based on findings.", "input": "30-year-old female patient with mild hepatomegaly and mottled appearance of right hepatic lobe of uncertain etiology on outside hospital CT with concern for Budd-Chiari versus hepatic venoocclusive disease. LIMITED ABDOMENLIVER: The liver measures 17.9 cm in length. Hepatic parenchyma echogenicity is mildly increased. No focal hepatic lesion is identified.BILIARY TRACT: No gallstones, pericholecystic fluid, or gallbladder wall thickening is identified. There is no intra or extrahepatic biliary ductal dilatation. The common duct measures 3 mm in diameter.PANCREAS: The head of the pancreas has normal echogenicity. The body and tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 8.5 cm in length. RIGHT KIDNEY: The right kidney measures 9.3 cm and the left kidney measures 10.4 cm in length. No evidence of hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Patent hepatic vasculature."}
{"instruction": "Generate impression based on findings.", "input": "Left upper quadrant pain LIVER: Mildly coarse echogenic liver echotexture again noted without mass. Liver length 19 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 9 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 11.8 cm in lengthOTHER: Left kidney 10.6 cm in length. No ascites.", "output": "Mildly coarse echogenic liver echotexture associated with mild hepatomegaly consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "65 year old male with diminished urine output. Transplant kidney. Evaluate for obstruction. RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: Transplanted kidney measures 12.2 cm in length. No parenchymal abnormality.COLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: Poorly distendedOTHER: No significant abnormality noted", "output": "No hydronephrosis. No change from prior exam."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules RIGHT LOBE MEASUREMENTS: 7.7 x 4.6 x 3.6 cmLEFT LOBE MEASUREMENTS: 6.2 x 1.7 x 1.6 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Diffusely heterogeneous gland again noted and unchanged.LEFT LOBE: Stable discrete mixed cystic and solid nodules. Upper pole nodule measures 1.8 x 0.8 x 1.3 cm. Mid pole nodule measures 1 x 0.9 x 0.7 cm. More medially located mid pole nodule measures 0.9 x 0.8 x 0.9 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable thyroid nodules and heterogeneous thyroid gland. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old male with history of hepatitis C. LIVER: Increased hepatic echogenicity without discrete focal lesion.BILIARY TRACT: Cholelithiasis with stones in the gallbladder neck. No gallbladder wall thickening, sonographic Murphy's sign, or pericholecystic fluid. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.KIDNEY: Echogenic atrophic kidneys without hydronephrosis. 2.2 cm left renal cyst without septation or suspicious nodular component.OTHER: No significant abnormalities noted.", "output": "1. Increased hepatic echogenicity consistent with hepatic steatosis or diffuse parenchymal disease. 2. Cholelithiasis. 3. Atrophic echogenic kidneys consistent with medical renal disease. "}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine RIGHT KIDNEY: Echogenic renal parenchyma without stone or hydronephrosis. Multiple cystic foci some demonstrating internal increased echogenicity and complexity. Right kidney 10.2 cm in length.LEFT KIDNEY: Echogenic renal parenchyma without stone, worrisome mass, or hydronephrosis. Left kidney 7.9 cm in length.OTHER: Bladder nondistended", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without stone or obstruction. Multiple cystic foci involving the right kidney some with increased internal echogenicity and complexity. Would pay special attention to these lesions on future surveillance scans as clinically relevant."}
{"instruction": "Generate impression based on findings.", "input": "Male 26 years old; Reason: 26 yo M with hx of L epididymal cyst and enlarging R epididymal cyst History: Right posterior testicular cyst RIGHT TESTIS: Right testes measures 2.7 x 4.1 x 1.9 cm. Normal color Doppler flow. No focal intratesticular lesion.LEFT TESTIS: Left testes measures 2.7 x 2.7 x 1.9 cm. Normal color Doppler flow. No focal intratesticular lesion.RIGHT EPIDIDYMIS: Right epididymis measures 0.9 x 1.2 x 1.0 cm.LEFT EPIDIDYMIS: Left epididymis measures 1.0 x 1.0 x 1.5 cm. A small anechoic cyst within the epididymis measures 8 x 6 mm representing a small epididymal head cyst. This previously measured 8 x 6 mm and is unchanged.OTHER: No hydrocele.", "output": "No evident right epididymal head cyst.Stable 8 mm left epididymal head cyst.No evident intratesticular mass."}
{"instruction": "Generate impression based on findings.", "input": "23 year-old female with a history of hypothyroidism. RIGHT LOBE MEASUREMENTS: 1.7 x 1.3 x 5 cmLEFT LOBE MEASUREMENTS: 1.7 x 1.3 x 4.9 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: The thyroid lobe parenchyma is heterogeneous compatible with history of hypothyroidism. No discrete suspicious nodule is evident.LEFT LOBE: The left thyroid lobe parenchyma is heterogeneous in echotexture compatible with history of hypothyroidism. No discrete suspicious nodule is evident.ISTHMUS: Heterogeneous echotexture, without discrete suspicious nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: There is a 5 x 5 x 6 mm hypoechoic nodule inferior to the left thyroid lobe, which may reflect a small lymph node or parathyroid adenoma.", "output": "Heterogeneous thyroid parenchyma compatible with history of hypothyroidism without a discrete suspicious nodule evident. 6-mm hypoechoic nodule inferior to the left thyroid lobe may reflect a small lymph node or parathyroid adenoma; correlate with PTH/calcium."}
{"instruction": "Generate impression based on findings.", "input": "62 year old female presents for follow-up and possible aspiration of a right lower axillary cyst. Personal history of left lumpectomy in 1997 for DCIS. No current breast complaints. A targeted right axillary ultrasound was performed for the imaging area of concern. Within the right mid to lower axilla there is redemonstration of a oval, parallel, anechoic lesion which is smaller than on prior examination, today measuring 0.6 x 0.1 x 0.3 cm, suggesting resorbing cyst.", "output": "High probability benign right axillary cyst. Given the interval decrease in size and the benign appearance, follow-up right axillary ultrasound is recommended in 6 months to further assess stability. Additionally, right breast mammogram should also be performed at this time to assess stability of high probability benign calcifications in the right breast, as recommended on prior study dated March 25, 2015. Results and recommendations were discussed with the patient the time of her examination.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain. Loose screening stool. LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. An 8 mm hyperechoic focus in the right hepatic lobe, favoring benign etiology such as an hemangioma. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Normal appearance of the gallbladderPANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney is 10.7 cm in length, with a 2.5 cm simple appearing cyst. The renal parenchymal echogenicity is increased. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: Not visualized.OTHER: Ectatic aorta noted.", "output": "1. No specific findings 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": "60 year-old male with alcohol withdrawal and abnormal liver function. LIVER: Liver is highly echogenic which may be due to fatty infiltration or other parenchymal disease. Mildly nodular contour but appearance is not grossly cirrhotic. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal veinBILIARY TRACT: Gallbladder appears normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: Relatively small and echogenicSPLEEN: Mild splenomegaly without focal abnormalityRIGHT KIDNEY: No significant abnormalities noted. OTHER: No ascites", "output": "Echogenic and mildly nodular liver.Splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "14-year-old female patient with history of fibroadenoma removal of the left breast presents with bilateral irregular breast tissue and pain. A targeted bilateral breast ultrasound was performed for the patient\u2019s area of concern. Normal appearing dense breast tissue was seen in the right breast at the 10 and 9 o'clock positions as well as in the left breast at the 2 o'clock position. There is no solid or cystic mass identified.", "output": "Normal appearing dense breast tissue in the area of patient's pain in right breast 9 and position and left breast two o'clock position. Recommend continued clinical management.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Status post liver transplant with portal vein stenosis status post stent placement LIMITED ABDOMENLIVER: Status post left hepatic lobe liver transplant. No mass. Liver length 15.2 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: Splenomegaly again noted. Spleen length 18.9 cm RIGHT KIDNEY: No significant abnormalities noted. 9.7 cm in lengthOTHER: Stable left renal cyst. Left kidney 11.4 cm in length.", "output": "Status post left lobe hepatic transplant. Patent hepatic vessels with normal directional flow. Portal venous stent again noted and unchanged. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "74 year old female who was recalled from screening mammogram for a developing mass in the left breast at anterior upper outer aspect. Mammogram: An ML view 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, unchanged in pattern and distribution. Spiculated 10-mm mass persist on spot compression views. No associated calcifications within the mass. Few loosely scattered calcifications posterior to the mass are mostly unchanged dating back to 2007.Ultrasound: Targeted left upper outer quadrant Ultrasound is performed. Irregular hypoechoic mass with blood flow measures 1.1 x 0.6 x 0.8 cm corresponding to the mammographic abnormality at 2 to 2:30 o'clock position. Located 2 cm posterior and slightly superior is a second taller than wide hypoechoic small lesion with micro-lobulations that measures 4 x 3 mm which probably corresponds to a oval asymmetry, slightly superior and posterior to the spiculated mass in the ML full-field view.", "output": "Two suspicious masses in the left breast two o'clock position, need further evaluation with ultrasound guided core biopsy. Findings and recommendations were discussed with the patient in detail.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Left flank pain and dysuria RIGHT KIDNEY: Normal parenchymal echogenicity without mass, stone or hydronephrosis. No perinephric collection. 14.2 cm in length.LEFT KIDNEY: Normal parenchymal echogenicity without mass, stone, or hydronephrosis. No perinephric collection. 12.9 cm in length.OTHER: Debris within bladder. Bladder nondistended.", "output": "Debris within bladder. Normal renal parenchymal echogenicity without mass, stone, hydronephrosis, or perinephric collection."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old male with history of nausea and vomiting. LIVER: No hepatic lesions identified. Mild increased echogenicity of the hepatic parenchyma. The liver measures 17.9 cm in length. The main portal vein demonstrates normal hepatopedal flow.BILIARY TRACT: No evidence for gallstones or wall thickening. The common bile duct measures 3 mm in diameter.PANCREAS: Normal echogenicity of the pancreatic head and body. The tail is obscured due to overlying bowel gas.SPLEEN: The spleen measures 8.6 cm in length.RIGHT KIDNEY: The right kidney measures 10.9 cm in length. No hydronephrosis. OTHER: The left kidney measures 10.1 cm in length. No hydronephrosis. There is a 1.8 x 1.9 x 2.2 cm parapelvic cyst of the left upper renal pole.", "output": "1. No acute abnormality of the right upper quadrant.2. Mild increased echogenicity of the hepatic parenchyma. Consider fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female with thyroid nodules. Please evaluate for changes. RIGHT LOBE MEASUREMENTS: 4.0 x 1.3 x 1.9 cm.LEFT LOBE MEASUREMENTS: 2.5 x 4.1 x 2.1 cm.ISTHMUS MEASUREMENTS: 0.4 cm in thickness.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: Hyperechoic nodule of the left mid thyroid measuring 1.8 x 2.3 x 1.8 cm (prior 1.8 x 2.4 x 1.5 cm). Additional hyperechoic nodule of the anterior lower pole and measures 0.8 x 0.8 x 0.8 cm (prior 0.9 x 0.9 x 1.2 cm).ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable left-sided hyperechoic nodules."}
{"instruction": "Generate impression based on findings.", "input": "Altered mental status with hyperbilirubinemia LIVER: Coarse echogenic liver parenchyma without mass. Liver length 15.8 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. 10.6 cm in length OTHER: Left kidney 9.3 cm in length. Spleen 7.3 cm in length. Moderate ascites.", "output": "Coarse echogenic liver parenchyma consistent with fatty liver/parenchymal dysfunction without mass or ductal dilatation. Moderate ascites. Limited Doppler interrogation of the main portal vein demonstrates a patent portal vein with normal directional flow."}
{"instruction": "Generate impression based on findings.", "input": "male presenting with right breast mass, evaluate for cyst versus abscess Adjacent to the area of the right nipple, there is an approximately 2.2 cm subcutaneous area of hypoechogenicity likely representing edema, without definite evidence of collection or abscess formation.", "output": "Subcutaneous area of hypoechogenicity adjacent to the nipple, likely representing edema without definite evidence of abscess formation. Follow-up ultrasound can be performed as clinically indicated to ensure resolution."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old female patient with left-sided nodule. Prior surgery. RIGHT LOBE MEASUREMENTS: Status post partial right thyroidectomy. Remaining thyroid tissue measures approximately 1.7 x 1.0 x 1.2 cm.LEFT LOBE MEASUREMENTS: 4.8 x 2.7 x 2.3 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: The residual right thyroid lobe tissue is heterogeneous in echogenicity.LEFT LOBE: Left thyroid lobe is predominantly replaced by 2.6 x 1.9 x 4.2 cm cystic and solid thyroid nodule which contains colloid.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology lymph nodes are noted within the right level two and left level three lymph node stations.OTHER: No significant abnormality noted.", "output": "1. Status post partial right thyroidectomy.2. Dominant left thyroid nodule which is likely benign in etiology."}
{"instruction": "Generate impression based on findings.", "input": "Male 50 years old Reason: please assess bladder and kidney History: poor urine output RIGHT KIDNEY: 14.3 cm in length. Normal echogenicity. No hydronephrosis or hydroureter.LEFT KIDNEY: 14.4 cm in length. No hydronephrosis or hydroureter.OTHER: Collapsed urinary bladder.Limited color Doppler shows blood flow to both kidneys.", "output": "Normal exam."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis LIVER: Stable cirrhotic morphology. Benign right hepatic cyst unchanged. No worrisome mass lesion. Liver length 11.6 cm. Limited Doppler interrogation of main portal vein demonstrates a patent portal vein with normal directional flow. Main portal vein velocity 14 cm second.GALLBLADDER, BILIARY TRACT: Mildly prominent, bile duct with maximal diameter of 0.7 cm unchanged. Stable cholelithiasis without acute inflammation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.6 cm in length.OTHER: Left kidney 10.2 cm in length. Spleen is 18 cm in length. No ascites.", "output": "Stable cirrhotic morphology without worrisome mass or worsening ductal dilatation. Stable cholelithiasis without acute inflammation. No ascites. Stable moderate spinal megaly."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old male with history of abdominal aortic aneurysm. Evaluate No significant change in the tortuous and aneurysmal abdominal aorta. Maximal mid aortic AP dimension measures 2.8 cm, previously measuring 2.8 cm. Stable mid aneurysmal dilatation of both common iliac arteries with maximal AP diameter of 1.1 on the right and 1.2 on the left. The abdominal aorta is patent with normal arterial waveform.", "output": "Stable abdominal aortic aneurysm and mid aneurysmal dilation of the common iliac arteries bilaterally."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female patient with mildly elevated LFTs. Patient is mildly overweight and also on Lipitor. Serologies negative. LIVER: The liver measures 14.3 cm in length. Hepatic parenchymal echogenicity is increased. There is a region of hypoechogenicity adjacent to the gallbladder fossa which is in the typical location of fatty sparing. 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 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 10.2 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 10.3 cm in length. No evidence of hydronephrosis.The spleen measures 7.5 cm in length.", "output": "Hepatic steatosis with focal fatty sparing. "}
{"instruction": "Generate impression based on findings.", "input": "60 year-old female with history of thyroid cancer. Follow-up. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: There is again noted a hyperechoic focus in the right thyroid bed which appears stable measuring 0.5 x 0.5 x 0.8 cm.LEFT LOBE: There is again noted in the left thyroidectomy bed an ovoid hypoechoic focus measuring 0.3 x 0.3 x 0.6 cm which may represent lymph nodeISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable ultrasound of the thyroid."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules RIGHT LOBE MEASUREMENTS: 4.5 x 1.6 x 1.6 cmLEFT LOBE MEASUREMENTS: 3 x 1.4 x 1.6 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Stable solid right lobe nodule measuring 1.3 x 0.8 x 1.1 cmLEFT LOBE: Slight interval decrease in size of predominantly solid left thyroid nodule measuring 0.8 x 0.7 x 1.1 cm; this is comparison to 1.3 x 1.1 x 0.9 cm on 10/23/2012. This smaller nodule now demonstrates coarse, probably dystrophic internal calcificationsISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable dominant right thyroid nodule. Slight interval decrease in size of left thyroid nodule. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "82-year-old female with history of thyroid cyst on remote ultrasound. RIGHT LOBE MEASUREMENTS: 1.4 x 1.3 x 3.8 cmLEFT LOBE MEASUREMENTS: 1.3 x 1 x 4 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Echotexture is normal. Posterior to the right lobe is a rounded, hypoechoic 0.3 x 0.4 x 0.4 cm nodule which appears likely to be extrathyroidal. No other mass identified.LEFT LOBE: Echotexture is normal without mass.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: See above. Cannot exclude right parathyroid adenoma posterior to the midportion of the gland.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Small extrathyroidal mass on the right. Differential considerations would include parathyroid adenoma or atypical small lymph node. This does not appear to be intrathyroidal in nature."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female with history of thrombosis of a right mid lateral quadrant superficial vein, now with recurrent symptoms. Right-sided abdominal pain. Grayscale and color ultrasound of the right upper quadrant subcutaneous soft tissues in the area of the patient's complaint demonstrates no significant abnormalities. No abnormal blood vessels are identified. There are no fluid collections or inflammatory changes in this location.", "output": "No evidence of thrombosed superficial vessel or other findings to account for the patient's symptoms. "}
{"instruction": "Generate impression based on findings.", "input": "Male; 71 years old. Reason: 71 yo with bladder cancer and AKI - on anti PD-1 agent and steady rise in creatinine since then - creatinine baseline of 1.4 in November and now 4.8 needs kidney biopsy Ultrasound guidance and technical assistance was provided for a right native kidney biopsy by the nephrology service. Images demonstrate moderate hydronephrosis.", "output": "Biopsy of right native kidney by nephrology service.Hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "59 years old, Female, Reason: Acute kidney injury, unclear etiology History: Increased creatinine RIGHT KIDNEY: Patient is status post right nephrectomy.LEFT KIDNEY: Kidney measures 12.8 cm in length. Normal echotexture. No hydronephrosis or shadowing calculus. Small left renal cyst in the inferior pole measuring 1.3 x 1.5 cm.Bladder: The bladder is collapsed and not well-visualized.", "output": "No evidence of hydronephrosis or shadowing calculus."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old female with enlarged left thyroid seen on CT, possible cause of dysphagia. RIGHT LOBE MEASUREMENTS: 5.3 x 2.2 x 2.0 cmLEFT LOBE MEASUREMENTS: 7.9 x 5.1 x 4.0 cmISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: 0.7 x 0.6 x 0.5 cm mixed cystic and solid nodule in the right upper pole and 0.9 x 0.9 x 0.6 cm nodule in the right lower pole, favor benign.LEFT LOBE: Dominant large primarily solid nodule in the left thyroid with coarse calcifications and small cystic spaces measures 5.5 x 3.5 x 3.4 cm. A superior adjacent hypoechoic nodule with somewhat ill-defined margins as well as both micro and macro calcifications measures 1.7 x 1.4 x 1.6 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multinodular thyroid as described above. The smaller more superior hypoechoic nodule on the left in particular is amenable to biopsy as warranted clinically. "}
{"instruction": "Generate impression based on findings.", "input": "20-year-old female patient with papillary thyroid cancer at age 16. Left posterior high cervical lymph node, soft palpated. RIGHT LOBE: Status post thyroidectomy without residual tissue identified.LEFT LOBE: Status post thyroidectomy without residual tissue identified.ISTHMUS: Status post thyroidectomy without residual tissue identified. A 0.3 x 0.4 cm benign morphology lymph node is noted within the thyroidectomy bed.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is a right level 3 benign morphology lymph node. In the left posterior auricular region corresponding to the patient's palpable abnormality, there are two prominent benign morphology lymph nodes with fatty hila measuring up to 1.3 cm in the largest dimension. OTHER: No significant abnormality noted.", "output": "1. No specific evidence of disease recurrence.2. Left posterior auricular prominent lymph nodes with benign morphology are likely reactive in etiology. "}
{"instruction": "Generate impression based on findings.", "input": "Hypertension RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality noted. 9.2 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 vessel. Patent renal vasculature without evidence for inflow or outflow compromise.OTHER: No significant abnormality noted", "output": "Unremarkable right iliac fossa renal transplant without evidence for abnormal mass or hydronephrosis. Patent inflow and outflow vasculature."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old male with prior left thyroidectomy. Evaluate for recurrent neoplasm. RIGHT LOBE MEASUREMENTS: 4.8 x 1.4 x 2 cmLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: No massesLEFT LOBE: No mass in the thyroidectomy bedISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No evidence recurrent mass post left lobectomy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: HBV, on entecavir, evaluate for HCC History: HBV LIVER: Heterogeneous, echogenic liver parenchyma. The liver measures 15.2 cm in length. The portal vein is patent with normal directional hepatopedal portal venous blood flow, peak velocity is 17.1 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. The gallbladder wall measures 0.2 cm. The common hepatic duct measures 0.2 cm. No biliary ductal dilatation. Negative sonographic Murphy's sign.PANCREAS: Pancreatic duct measures 0.3 cm.RIGHT KIDNEY: The right kidney measures 10.4 cm in length. No hydronephrosis, masses, or shadowing stones.LEFT KIDNEY: The left kidney measures 11.5 cm in length. No hydronephrosis, masses, or shadowing stones.OTHER: No ascites.", "output": "Heterogeneous, echogenic liver parenchyma, consistent with hepatic parenchymal dysfunction, hepatic steatosis, or chronic liver disease."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Coarse echogenic liver echotexture again noted without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 14.8 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 7.7 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 11.2 cm in lengthOTHER: Left kidney 12.4 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture again noted consistent with fatty infiltration without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old male with SIRS. There is clinical concern for acute cholecystitis. LIVER:The liver measures approximately 14.2 cm. Hepatic parenchyma has normal echotexture. There is a hyperechoic lobulated well-defined focus in the left liver that respects the anterior aspect liver capsule measuring approximately 5.7 x 1.7 x 2.3 cm. No calcifications or internal vascularity. No intrahepatic biliary dilation or ascites. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended. No stone or sludge. Negative sonographic Murphy's sign. No pericholecystic fluid. Gallbladder wall measures 4.5 mm. The common bile duct measures approximately 3.7 mm.PANCREAS: Pancreas is obscured by overlying bowel gas.SPLEEN: The spleen measures approximately 8.6 cm without specific radiographic abnormality.KIDNEYS: The right kidney measures approximately 12.8 cm. The left kidney measures approximately 11.8 cm. There is a shadowing hyperechoic focus in the pelvis of the left kidney measuring approximately 1.1 x 0.9 x 1.3 cm, consistent with a renal stone. It is nonobstructing. Mild hydronephrosis on the right without shadowing calculi. OTHER: No significant abnormality noted.", "output": "1. No evidence of acute cholecystitis.2. Echogenic focus in the left lobe of the liver may represent a hemangioma however dedicated CT or MRI would be helpful for better characterization of this lesion.3. Mild hydronephrosis of the right kidney.4. Nonobstructive nephrolithiasis of the left kidney. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Congestive heart failure with abnormal LFTs LIMITED ABDOMENLIVER: No significant abnormalities noted. Liver length is 15.6 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 7.6 cm in length. RIGHT KIDNEY: No significant abnormalities noted. 8.5 cm in length.OTHER: Left kidney 8.3 cm in length.", "output": "No obvious hepatobiliary abnormality. Patent hepatic vessels with normal directional flow. "}
{"instruction": "Generate impression based on findings.", "input": "Alcohol cirrhosis LIMITED ABDOMENLIVER: Cirrhotic morphology without mass. Liver length 18.1 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. Spleen length 14.9 cm RIGHT KIDNEY: No significant abnormalities noted. 10.9 cm in lengthOTHER: Left kidney 11.4 cm in length. Moderately severe ascites.", "output": "Cirrhotic morphology without mass or duct dilatation. Moderately severe ascites. Patent portal vessels with normal directional flow."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C. Evaluate for hepatocellular carcinoma. LIVER: Non-cirrhotic liver morphology. Coarsened parenchymal echogenicity. 15 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 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 9.3 cm in length. The left kidney is 10.0 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.6 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites.", "output": "Coarsened hepatic echogenicity compatible with parenchymal dysfunction, without suspicious hepatic lesion identified."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male with worsening proteinuria. Ultrasound guidance provided for biopsy of transplanted kidney. Biopsy needle is seen traversing the renal parenchyma.", "output": "Ultrasound guidance provided for biopsy of transplanted kidney which was performed by the nephrology team."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old with history of left mastectomy. Routine right mammogram was normal earlier today. A palpable area of concern was felt in the right outer breast at posterior depth. Targeted ultrasound was performed for the palpable area which was marked by the clinical service. No suspicious solid or cystic mass is apparent. A few prominent fat lobules were noted.", "output": "No sonographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Clinical correlation is recommended for the palpable area of concern as further workup may be warranted if the area is highly suspicious on physical exam. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old male with history of thyroid nodule. RIGHT LOBE MEASUREMENTS: 5.4 x 1.8 x 2.4 cmLEFT LOBE MEASUREMENTS: 4.9 x 1.6 x 2.1 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Diffusely and heterogeneously echogenic with associated linear foci of decreased attenuation as seen with thyroiditis. No dominant mass.LEFT LOBE: Diffusely and heterogeneously echogenic with associated linear foci of decreased attenuation as seen with thyroiditis. No dominant mass.ISTHMUS: Diffusely and heterogeneously echogenic with associated linear foci of decreased attenuation as seen with thyroiditis. No dominant mass.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Heterogeneous, echogenic gland consistent with thyroiditis. No dominant mass."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old male patient with mononucleosis infection with hepatitis and thrombocytopenia. Evaluate for splenomegaly. The liver measures 18.3 cm in length. The spleen measures 20.6 cm in length. There is a 2.3 x 2.2 x 2.1 cm ill-defined hypoechoic. solid lesion within the lateral spleen.", "output": "1. Splenomegaly.2. Single hypoechoic lesion within the spleen is likely benign in etiology, but non-specific; this may be re-imaged with ultrasound in 6 months to confirm stability. "}
{"instruction": "Generate impression based on findings.", "input": "67 year old male patient with transaminitis. Question of liver disease. LIVER: The liver measures 16.5 cm in length. 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 2 mm in diameter.PANCREAS: The pancreas is poorly visualized on this examination.RIGHT KIDNEY: The right kidney measures 9.2 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 9.7 cm in length. No evidence of hydronephrosis.The spleen measures 8.6 cm in length.Trace right pleural effusion.", "output": "1. No specific findings to account for the patient's symptoms.2. Trace right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "History of cirrhosis. Evaluate for HCC. LIVER: Heterogeneously coarse liver parenchyma with nodular contour compatible with cirrhosis. No focal lesion is evident. Normal hepatopedal portal venous blood flow at 30 cm/s.BILIARY TRACT: Large gallstone within a normally distended gallbladder without pericholecystic fluid or focal tenderness. The gallbladder wall measures 4 mm which is nonspecific.No intra or extra hepatic biliary ductal dilatation with the common duct measuring 3 to 4 mm.PANCREAS: The visualized pancreatic body is unremarkable. The remainder is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 17 cm in length without a focal lesion.RIGHT KIDNEY: The right kidney measures 11.7 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. OTHER: The left kidney measures 13.5 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion.", "output": "Cirrhotic liver without a focal lesion or biliary ductal dilatation. Borderline splenomegaly.Cholelithiasis without cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "70-year-old female with history of left breast cancer, with prior imaging performed at outside hospital. Bilateral Mammogram: Spot compression views of the right upper outer breast and spot magnification views of the left upper outer breast, as well as standard bilateral ML 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. Within the right upper outer breast there is a well circumscribed 8mm focal asymmetry, probably representing a normal lymph node. An additional focal asymmetry within the right upper outer breast did not persist on spot compression views. Benign calcifications, including arterial calcifications, are present.Within the left breast there is a group of amorphous calcifications spanning 3 mm. Additional scattered benign-appearing calcifications, including arterial calcifications, are present. A lock clip is identified within the left upper outer breast at site of biopsy-proven breast cancer.Left breast ultrasound: A targeted left ultrasound was performed at site of calcifications within the left breast 12:00 location, 5cm from the nipple. There is no solid or cystic mass identified.", "output": "Grouped calcifications within the left breast 12:00, approximately 5 cm from the nipple. Given known left breast cancer, further evaluation is recommended with stereotactic biopsy. Results were discussed with Dr. Bao.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female presents for 6 month follow-up of high probability benign right breast asymmetries. Personal history of endometrial carcinoma. No family history of breast cancer. MAMMOGRAM: Three standard views of the right breast, additional right CC view, and multiple 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, unchanged in pattern and distribution. Multiple circumscribed masses are again noted in the lower inner right breast, unchanged. A focal asymmetry is present within the upper outer right breast, posterior depth, which persists on spot compression imaging. ULTRASOUND: On physical examination, no palpable abnormality is identified. Targeted right ultrasound was performed for the mammographic area of concern. A 0.7 x 0.5 x 0.5 cm circumscribed, hypoechoic lesion is present at the 11:00 position of the right breast, 10 cm from the nipple, without increased vascularity. This is felt to represent a cyst.", "output": "High probability benign cyst at the 11 o'clock position of the right breast. Follow up mammogram and ultrasound is recommended in 6 months to assess stability. The patient will be due for annual bilateral mammogram at this time. Results 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": "89-year-old male with acute renal failure. Evaluate RIGHT KIDNEY: The right kidney is normal in echotexture and measures 9.1 cm in length. No evidence of hydronephrosis.LEFT KIDNEY: The left kidney is normal in echotexture and measures 9.5 cm in length. Mild hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Mild left hydronephrosis.Findings relayed to Dr. Nikhil Narang over the phone at approximately 10:35 AM"}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male with elevated liver function tests, evaluate for liver pathology. LIVER: Unremarkable echogenicity without discrete focal lesion.BILIARY TRACT: No cholelithiasis or evidence of cholecystitis. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.KIDNEY: Nephrolithiasis without hydronephrosis. The identified renal stones measure 3-4 mm.OTHER: No significant abnormalities noted.", "output": "1. No specific findings to account for the patient's elevated liver enzymes. 2. Nephrolithiasis without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Dominguez is a 48-year-old female with a personal history of left nipple sparing mastectomy in 2011 for DCIS. She presents for whole breast ultrasound for dense breast screening. 3-D whole breast ultrasound was performed for the right breast and images were reviewed on an independent workstation. Multiple simple cysts were identified in the right breast. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy.BIRADS: 2 - BenignRECOMMENDATION: ND - Routine Diagnostic Mammogram. "}
{"instruction": "Generate impression based on findings.", "input": "Male 61 years old; Reason: history of NASH, reassess liver, surveillance for HCC History: none LIVER: The liver measures 16 cm in length. There is irregular in course echogenicity of the liver parenchyma. There is a nodular contour to the liver. No intrahepatic ductal dilation is seen. The main portal vein is patent with normal hepatopetal flow. No ascites or masses seen.GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 3 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 5.6 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 12.1 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.7 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones. There is a 1.8 x 1.9 cm hyperechoic round circular mass seen in left kidney.OTHER: No significant abnormality noted.", "output": "1. Liver echotexture consistent with history of cirrhosis. No ascites or liver masses.2. Left kidney lesion concerning for renal cell carcinoma. Per patient, aware of lesion with plans for partial nephrectomy in the near future."}
{"instruction": "Generate impression based on findings.", "input": "Liver cirrhosis in septic shock LIMITED ABDOMENLIVER: Cirrhotic morphology without mass or ductal dilatation. Liver length 16.9 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: Not visualized due to overlying gasSPLEEN: Not visualized due to overlying gas RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. Right kidney 8.9 cm in lengthOTHER: Mild ascites. Left kidney not visualized due to overlying gas", "output": "Thrombosed main portal vein with no measurable flow observed. Cirrhotic morphology without mass or duct dilatation. Mild ascites.Echogenic right renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without obstruction.Dr. Scholettler notified of findings 7/1/2015; 15:00."}
{"instruction": "Generate impression based on findings.", "input": "39 years old, Female, Reason: 39 yo with hx of repaired ventral hernia in 2000; please do ultrasound exam to evaluate for hernia History: abdominal pain No evidence of hernia at rest or with Valsalva maneuver.", "output": "No evidence of ventral abdominal hernia."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for renal recurrence history of renal cell carcinoma status post partial nephrectomy RIGHT KIDNEY: Right kidney measures 13.1 cm with normal echo texture. No hydronephrosis. No focal lesions.LEFT KIDNEY: Left kidney measures 9.3 cm with postsurgical changes of the lower pole of the left kidney. No focal lesions noted. No hydronephrosis.OTHER: Partially distended bladder is incompletely evaluated.", "output": "Normal echotexture of the kidneys. No new sites of disease."}
{"instruction": "Generate impression based on findings.", "input": "Female 50 years old Reason: RUQ abdominal pain please evaluate for mass in abdominal wall or intraabdominal mass. Possible LAM syndrome History: RUQ abdominal pain LIMITED ABDOMENLIVER: Measures 16.7 cm. Normal parenchymal echotexture. Hyperechoic focus in the inferior right hepatic lobe measures up to 1.1 cm. The portal vein is patent with normal directional flow.BILIARY TRACT: Common bile duct measures 5 mm. No cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No intra or extra hepatic biliary ductal dilation.PANCREAS: No significant abnormality noted.KIDNEYS: The right kidney measures 10.2 cm. The left kidney measures 9.4 cm. No hydronephrosis or mass.SPLEEN: The spleen is not visualized. OTHER: No significant abnormalities noted.", "output": "Hyperechoic focus in the inferior right hepatic lobe, statistically is most likely a hemangioma, but is best considered indeterminate. Correlate with CT."}
{"instruction": "Generate impression based on findings.", "input": "3 month follow-up ultrasound of the left breast to evaluate interval decrease in left breast mass and intramammary lymph node. A targeted left ultrasound was performed for the patient\u2019s area of concern. Interval decrease in size of intramammary lymph node, now measures 5 x 4 x 10 mm with normal morphology. Interval resolution of mass identified in the left breast 2:00 position previously thought to be abscess versus complicated cyst. A cyst with milk of calcium identified at that location measuring 4 x 2 mm. Simple cysts identified also identified in the left retroareolar region, largest measuring 8 x 9 mm.", "output": "Interval decrease in size of intramammary lymph node, with normal morphology.Interval resolution of mass in the left breast 2:00 position, previously, it to be abscess versus, located cyst.Multiple simple cysts identified in the left breast.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "24 year old with self palpated masses in the left breast. Areas for ultrasound are marked by the clinical service. A targeted left ultrasound was performed for the patient\u2019s areas of concern. There is no solid or cystic mass identified. Dense fibroglandular elements are seen, as is the patient's left breast implant.", "output": "No sonographic evidence for malignancy. Clinical follow-up is recommended. The patient will be seeing Dr. Jaskowiak today.BIRADS: 1 - Negative.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old male. Assess change in left lower pole complex cyst. GFR 37. Contrast relatively contraindicated. RIGHT KIDNEY: The right kidney measures 9.8 cm in length. No hydronephrosis. Increased echogenicity of the renal parenchyma. Multiple renal cysts are again seen. The largest cyst on the right measures 6 x 6.5 x 7.3 cm (prior 6.1 x 6.3 x 6.1 cm). LEFT KIDNEY: The left kidney measures 12.1 cm in length. No hydronephrosis. Increased echogenicity of the renal parenchyma. Left lower pole heterogenous lesion measuring 1.3 x 1.2 x 1.3 cm (prior 1.5 x 1.3 x 1.4 cm).URINARY BLADDER: The urinary bladder is collapsed and incompletely evaluated.OTHER: No significant abnormalities noted.", "output": "Stable appearance of the left lower pole heterogenous lesion. Further evaluation with dedicated CT or MRI is recommended (half dose contrast administration is available for GFR between 30 and 60)."}
{"instruction": "Generate impression based on findings.", "input": "Female 24 years old Reason: history of gallstones, presenting with nausea/vomiting. Looking for evidence of cholecystitis History: nausea, vomiting LIVER:There is normal echogenicity and measures 16.0 cm in length. No focal hepatic mass. Main portal vein is patent with normal directional flow and a peak velocity of 29.0 cm/s. GALLBLADDER, BILIARY TRACT: Multiple shadowing gallstones are present within the gallbladder. The gallbladder wall is upper limits of normal measuring 3 mm, likely contracted. No pericholecystic fluid. Negative Murphy's sign. No intra or extrahepatic biliary ductal dilatation. Common bile duct is not well-visualized.PANCREAS: Pancreas is obscured by overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 7.9 cm.KIDNEYS: Moderate right hydronephrosis. Mildly increased echogenicity of the right renal cortex. Left kidney is normal in appearance measuring 10.5 cm. No left hydronephrosis. Normal left cortical echogenicity.OTHER: No significant abnormality noted.", "output": "1.Cholelithiasis without evidence of acute cholecystitis.2.Moderate right hydronephrosis, which is nonspecific and can be physiologic in a pregnant patient. "}
{"instruction": "Generate impression based on findings.", "input": "Follow-up thyroid nodules RIGHT LOBE MEASUREMENTS: 4.2 x 1.6 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.3 x 1.7 x 1.7 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: No change in heterogeneous gland. Stable subcentimeter hypoechoic nodules. Mid pole reference nodule measures 0.4 x 0.5 x 0.2 cm. Inferior reference nodule measures 0.6 x 0.4 x 0.3 cm.LEFT LOBE: No change in heterogeneous gland. Stable left thyroid nodules. Reference superior pole nodule measures 0.6 x 0.8 x 0.5 cm. Reference midpole nodule measures 0.5 x 0.5 x 0.5 cm. Reference lower pole nodule measures 1.7 x 1.9 x 1.2 cm.ISTHMUS: No change in heterogeneous glandPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable examination. Stable heterogeneous thyroid gland with stable bilateral thyroid nodules. No regional adenopathy."}
{"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. Of note, interpretation of mammographic and ultrasound studies are 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. Otherwise, patient is due for a screening mammogram now. BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Female 83 years old; Reason: r/o CBD obstruction History: jaundice LIVER: The liver measures 18.4 cm in length. There is increased echogenicity of the liver parenchyma. No focal hepatic lesions. The main portal vein is patent with normal hepatopetal flow measured at 52.2 cm/s. GALLBLADDER/BILIARY TRACT: There is intrahepatic as well as extrahepatic ductal dilation. The gallbladder wall measures 2.1 mm and the gallbladder is distended. No stones or sludge are seen. No pericholecystic fluid. The common bile duct measures 14.6 mm in diameter. PANCREAS: The majority of the pancreas is obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 11.8 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 9.7 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 9.5 cm in length. The cortex has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. Mild hepatomegaly with increased echogenicity of the liver parenchyma compatible with fatty infiltration/hepatocellular dysfunction. No worrisome masses seen.2. Intrahepatic as well as extrahepatic ductal dilation; the distal common bile duct is not visualized due to overlying gas and a distal obstructing lesion including mass cannot be excluded. The gallbladder is also distended. Recommend further cross-sectional imaging to evaluate a potential source of obstruction.3. Bilaterally the kidneys have increased echogenicity compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Total anomalous pulmonary venous connection. Evaluate for renal abnormality. RENAL AND BLADDER ULTRASOUND:BLADDER  Wall Thickness: Normal  Contents: Distended and normal. Distal Ureter -- SFU Grade**  Right: 0  Left: 0   Ureteral Jets Right: Not observed  Left: Present.KIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 4.4 cm Left: 4.7 cm   Mean for age: 4.5 cm  Range for age: 4.0 - 5.7 cmADDITIONAL OBSERVATIONS: None.", "output": "Normal examination.*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": "Cirrhosis with TIPS: Assess patency and portal vein LIMITED ABDOMENLIVER: Cirrhotic morphology again noted. No mass. Liver length 13.4 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 10 cm in length RIGHT KIDNEY: No significant abnormalities noted. 12.6 cm in lengthOTHER: Left kidney 13 cm in length. No ascites", "output": "Stable cirrhotic morphology without mass or ductal dilatation. No ascites. Patent hepatic vasculature with normal directional flow. Patent TIPS catheter with expected reversal of flow within undivided left portal vein."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Salazar is a 46 year old female presenting 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. In the right upper outer breast (3/120), there is a 0.6 cm oval hypoechoic lesion identified. In the left lower inner breast (3/159), there is a 0.9 cm oval hypoechoic lesion identified.", "output": "Bilateral hypoechoic lesions that are incompletely characterized. Additional imaging, including bilateral targeted ultrasound, is recommended for further evaluation. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required. "}
{"instruction": "Generate impression based on findings.", "input": "68 years old, Male, Reason: pt with elevated liver enzymes new from 2 wks ago; please eval for acute obstruction/pathology LIVER: The liver measures 17 cm in length. Increased echogenicity of the liver consistent with fatty infiltration. 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: Patient is status post cholecystectomy. 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 12.4 cm in length. RIGHT KIDNEY: Kidney measures 13.6 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The patient is status post left nephrectomy.OTHER: No significant abnormalities noted.", "output": "1.Diffuse fatty infiltration of the liver. No hepatic mass2.No intrahepatic or extra hepatic biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs, left flank pain, suprapubic pain. LIVER: The liver measures 19.7 cm in length, this is mildly enlarged. There is some mild increase in echogenicity within the liver. Adjacent to the gallbladder there is an area of decreased echogenicity which may represent focal fatty sparing. This measures 2 cm x 1.3 cm x 1.7 cm. No worrisome masses are noted within the liver, and there is no intrahepatic ductal dilation seen. The portal vein is patent with hepatopetal flow measuring 27.1 cm/s. No ascites is seen. BILIARY TRACT: There is a nonmobile subcentimeter polyp seen along the gallbladder wall that measures 0.4 cm x 0.2 cm x 0.5 cm. There is another smaller subcentimeter nonmobile polyp is seen along the gallbladder wall. No stones are seen and very minimal sludge. The gallbladder wall measures 0.1 cm, which is normal. Negative sonographic Murphy sign. The common bile duct measures 0.2 cm.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen measures 8.7 cm in length. No significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 12.1 cm in length. The cortex is normal in echogenicity. There is no hydronephrosis seen, and no stones. No worrisome masses are seen within the right kidney. LEFT KIDNEY: The left kidney measures 11.7 cm in length. The renal cortex is normal echogenicity. No hydronephrosis, stones, or worrisome masses are noted within the left kidney.", "output": "1. The liver is mildly enlarged with a slight increase in echogenicity compatible with fatty liver/parenchymal dysfunction. No worrisome masses or intrahepatic ductal dilation are seen. No ascites. However there is a hypoechoic area adjacent to the gallbladder that probably represents focal fatty sparing.2. Two nonmobile subcentimeter polyps are visualized along the gallbladder wall. No evidence of cholelithiasis or acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "76-year-old female with worsening renal function. RIGHT KIDNEY: Right renal size is difficult to assess due to patient motion. Cortex is mildly echogenic as seen on the prior exam. Large, simple cyst is again identified measuring approximately 8.7 cm in greatest diameter. No hydronephrosis or shadowing calculus.LEFT KIDNEY: The left kidney measures approximately 9 cm in length. There is again noted a 4 cm cyst arising from the lower pole which appears simple with a smaller cyst arising from the lower pole that may have a single septation. The cortex is mildly echogenic as seen on the prior exam. No hydronephrosis or shadowing calculus.URINARY BLADDER: Decompressed. Patient is Foley catheter.OTHER: No significant abnormalities noted.", "output": "No significant interval change. Echogenic kidneys with large, bilateral cysts."}
{"instruction": "Generate impression based on findings.", "input": "New right upper quadrant pain, evaluate for cholecystitis LIVER: Liver measures 17.1 cm with normal echotexture. No focal lesions noted. No intrahepatic biliary ductal dilatation. Portal vein demonstrates normal flow directionality and patency.BILIARY TRACT: Gallbladder is distended with multiple gallstones within it. Gallbladder wall appears thickened, measures up to 8 mm. Minimal pericholecystic fluid noted. Sonographic Murphy sign is negative as per the technologist. Common bile duct measures up to 5 mm within normal limits. No stones or debris noted within the common bowel duct.PANCREAS: Normal echotexture of the pancreas without any focal lesions. Peripancreatic enlarged lymph node most likely reactive measures 1.6 x 1.2 cm.SPLEEN: No significant abnormalities noted. Spleen measures 10.2 cm.RIGHT KIDNEY: Right kidney measures 12.4 cm left kidney measures 11.4 cm. No hydronephrosis, normal architecture. OTHER: No significant abnormalities noted.", "output": "Distended gallbladder with multiple gallstones with gall bladder wall thickening and minimal pericholecystic fluid suspicious for acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Male, 56 years old. AKI with Cr of 10.0. Hx of BPH s/p suprapubic cath. Decreased urine output. RIGHT KIDNEY: The right kidney measures 13.4 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 14.1 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The urinary bladder is decompressed, with balloon catheter in place. Increased liver echogenicity.", "output": "1.Increased renal cortical echogenicity compatible with medical renal disease or parenchymal dysfunction. No hydronephrosis.2.Increased hepatic echogenicity, compatible with fatty infiltration or parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "History left AML and renal cysts RIGHT KIDNEY: Unremarkable echogenicity. No worrisome mass, stone, or hydronephrosis. Multiple right renal cysts. The largest cyst located within the upper pole measures 3.9 x 5 cm. Right kidney 11.2 cm in length.LEFT KIDNEY: Unremarkable echogenicity. No worrisome mass, stone, or hydronephrosis. Inferior pole cyst measures 1.8 x 1.7 cm. Left kidney 10.3 cm in length.OTHER: Bladder nondistended", "output": "Bilateral benign-appearing renal cysts. No worrisome mass, stone, or obstruction. AML not identified."}
{"instruction": "Generate impression based on findings.", "input": " Trace perihepatic ascites is present. No free fluid is seen in the left upper, left lower, or right lower quadrants. Heterogenous liver echotexture again noted.Bilateral pleural effusions are present.", "output": "1.Only trace ascites. 2.Bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Ms.AMERICA M BARRERA is a 50 years old female recalled for a new focal asymmetry in the left lower outer breast. MAMMOGRAM: An ML view 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 heterogeneously dense, which may obscure small masses(BiRads Density Category C), unchanged in pattern and distribution. The focal asymmetry in the left lower outer breast, posterior depth, persists on the spot compression views.ULTRASOUND:On physical examination, no discrete mass is palpated.A targeted left ultrasound was performed for the mammographic area of concern at 5 to 6:00 position. There is no solid or cystic mass identified.", "output": "Screen detected focal asymmetry in the posterior left breast without a sonographic correlate is most likely benign. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended in 6 months. Results and recommendation 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": "62 years old, Male, Reason: concern for cirrhosis History: anasarca LIVER: The liver measures 15.4 cm in length. Liver parenchyma is within normal limits. No surface nodularity 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: The gallbladder is sludge-filled without evidence of 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 11.6 cm in length. RIGHT NATIVE KIDNEY: Kidney measures 8.7 cm in length. Increased echogenicity consistent with known medical renal disease.TRANSPLANTED KIDNEY: Transplanted kidney in the right iliac fossa has normal echogenicity without evidence of significant hydronephrosis.LEFT KIDNEY: Kidney measures 9.5 cm in length. Increased echogenicity of the kidneys consistent with known medical renal disease.", "output": "1.No sonographic evidence of hepatic cirrhosis. 2.Echogenic native kidneys, compatible with medical renal disease. Visualized transplanted kidney in right iliac fossa unremarkable. "}
{"instruction": "Generate impression based on findings.", "input": "Female 54 years old Reason: assess for steatosis, any e/o cirrhosis History: high output cardiac failure with unknown etiology, h/o hepatic steatosis in the past LIVER: Markedly coarse and echogenic liver consistent with fatty infiltration. No focal masses. Liver capsule appears smooth. Main portal vein is patent with peak velocity of 30.8 cm/s.BILIARY TRACT: Patient status post cholecystectomy. No intra or extrahepatic biliary ductal dilatation. Common bile duct measures 5.4 mm.PANCREAS: Pancreas is not well-visualized.SPLEEN: Spleen is normal echogenicity measuring 13.8 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Left kidney measures 11.7 cm. Right kidney measures 11.8 cm.OTHER: No significant abnormalities noted.", "output": "Marked hepatic steatosis without sonographic evidence of cirrhosis. No focal mass is identified, however with this degree of hepatic steatosis, ultrasound ability to detect small masses is diminished. If there is high clinical suspicion for hepatic mass, CT is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Palpable thyroid enlargement RIGHT LOBE MEASUREMENTS: The right lobe measures 4.8 cm x 2.1 cm x 1.8 cm.LEFT LOBE MEASUREMENTS: The left thyroid measures 5 cm x 1.6 cm x 1.8 cm.ISTHMUS MEASUREMENTS: The isthmus measures 0.3 cm.RIGHT LOBE: Multiple solid nodules in the right lobe with similar character, all homogeneously isoechoic with the gland without any cystic components, calcifications or ring down and all demonstrating a hypoechoic rim. They were hypovascular on color Doppler imaging.The first is located in the superior portion and measures 1.4 cm x 1.1 cm x 0.9 cm.The second is located in the middle portion and measures 1.3 x 1 cm x 1.0 cm.The third nodule is located inferiorly and measures1.3 cm x 0.8 cm x 1.2 cm.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: None visualized on this study.LYMPH NODES: Several small superficial benign-appearing lymph nodes. No suspicious adenopathy.", "output": "Three solid nodules are redemonstrated in the right thyroid lobe appear to be slightly enlarged from prior ultrasound. No suspicious adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Patient is a 47-year-old female who presents for a ultrasound examination of the enlarged lymph nodes in the right axilla found on the recent screening mammogram. She reports recent history of cold and she started on the dietary pill recently. A right axillary ultrasound was performed . The left axillary ultrasound was performed for comparison. Multiple prominent right axillary lymph nodes with some mild cortical thickening are noted and measure up to 18 x 7 cm in diameter. There is no hilar replacement. Central hilar flows are present. Benign-looking lymph nodes are also noted in the left axilla.", "output": "Prominent lymph node in the right axilla, likely reactive in nature given patient's recent history of infection. Follow-up ultrasound of the right axilla in 6 months is recommended. 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": "Ms. Toy is a 46-year-old female who presents for short-term follow-up of mass in upper outer quadrant of left breast. A targeted left ultrasound was performed at the site of the previously described mass.In the left breast 1:00 location, approximately 4 cm the nipple, there is a circumscribed, lobulated hypoechoic mass most likely representing a benign fibroadenoma measuring 1.2 x 0.7 x 1.0 cm, previously 1.2 x 0.6 x 1.0 cm.", "output": "High probability benign mass of the left breast, likely representing a fibroadenoma. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram and possible left breast ultrasound is recommended in 6 months in order to ensure stability of these findings. All results and recommendation 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": "49-year-old female presents for evaluation of a possible thyroid nodule. RIGHT LOBE MEASUREMENTS: 1.3 x 1.4 x 4.2 cm.LEFT LOBE MEASUREMENTS: 4.0 x 1.6 x 1.4 cm.ISTHMUS MEASUREMENTS: 0.2 cm.RIGHT LOBE: The right-sided thyroid parenchyma appears homogenous without concerning mass or other abnormality.LEFT LOBE: The left-sided thyroid parenchyma appears homogenous without concerning mass or other abnormality.ISTHMUS: The isthmic parenchyma appears homogenous without concerning mass or abnormality.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional adenopathy.OTHER: No significant abnormality noted.", "output": "1. Normal ultrasound of the thyroid."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Pt with Chromophobe RCC cancer s/p adrenal sparing nephrectomy and modified RPLND for a 23cm renal mass, 12/31/05. Segment 2 hepatic lesion with atypical features suspicious for cystic metastasis. Limited images of the liver for biopsy planning demonstrate a cystic lesion within segment 2 measuring 0.6 x 1.0 x 1.0 cm, decreased in size from 1.6 x 1.4 cm on recent MRI. The lesion is immediately adjacent to the diaphragm and heart.", "output": "Decrease in size of cystic segment 2 lesion which may be related to treatment effect. Biopsy canceled after discussion with Dr. Roggin regarding risks and benefits of biopsy. Continued follow-up is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Abuali is a 58 year old female recalled from screening mammogram for two partially obscured masses in the left upper outer breast on screening mammography (9/26/2016). An ML view and four 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 (BiRads Density Category C), unchanged in pattern and distribution.There are two partially obscured masses in the left upper outer quadrant, which persist on spot compression views. ULTRASOUND", "output": "High probability benign lesions of the left breast, likely representing complicated cysts. As long as the patient's physical examination remains normal, unilateral left breast diagnostic mammogram and ultrasound is recommended in 6 months in order to ensure stability of these findings, due in March 2017. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months).I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old female with elevated creatinine. Evaluate kidney size and echogenicity. Exam is limited due to overlying bowel gas.RIGHT KIDNEY: The right kidney measures 10 cm in length. No hydronephrosis. Hyperechoic renal parenchyma.LEFT KIDNEY: The left kidney measures 10.1 cm in length. No hydronephrosis. Hyperechoic renal parenchyma.URINARY BLADDER: The urinary bladder shows no acute abnormality.OTHER: No significant abnormalities noted.", "output": "Hyperechoic renal parenchyma suggestive of chronic medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Female 35 years old; Reason: thyroid nodule. RIGHT LOBE MEASUREMENTS: 5.2 x 2.0 x 1.8 cmLEFT LOBE MEASUREMENTS: 5.0 x 2.4 x 1.2 cmISTHMUS MEASUREMENT: 0.3 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted. The previously noted predominantly cystic nodule in the left lobe is no longer visualized.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No significant abnormalities noted. The previously noted predominantly cystic nodule in the left lobe is no longer visualized."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Acute abdominal pain; assess for cholecystitis. Examination limited by motion and difficulty positioning patient.LIVER: The liver measures 16.9 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 0.28 m/s.BILIARY TRACT: No cholelithiasis or significant gallbladder wall thickening. The sonographic Murphy's sign is not well assessed. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4.6 mm in diameter.PANCREAS: Not visualized due to bowel gas.SPLEEN: No significant abnormalities noted. The spleen measures 12.3 cm in length. RIGHT KIDNEY: Atrophic, echogenic kidney measuring 9.8 cm in length. No hydronephrosis.LEFT KIDNEY: Atrophic, echogenic kidney measuring 9.2 cm in length. No hydronephrosis.OTHER: Mild upper abdominal ascites.", "output": "1.No sonographic evidence of acute cholelithiasis or biliary ductal dilatation.2.Atrophic echogenic native kidneys compatible with medical renal disease.3.Increased hepatic echogenicity suggestive of parenchymal dysfunction/fatty infiltration.4.Mild upper abdominal ascites."}
{"instruction": "Generate impression based on findings.", "input": "79-year-old male with history of acute kidney injury. Evaluate for hydronephrosis. RIGHT KIDNEY: Slightly hyperechoic renal parenchyma, which may represent medical renal disease. Small, approximately 1 cm right superior pole renal cyst. No hydronephrosis or hydroureter.LEFT KIDNEY: Slightly hyperechoic renal parenchyma, which may represent medical renal disease. No hydronephrosis or hydroureter.OTHER: Bladder is within normal limits, and there is a Foley catheter in place.", "output": "Slightly hyperechoic renal parenchyma, which may represent medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "77-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": "Stable exam without evidence for recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "63-year-old male with history of gastric cancer with recent biliary drain placement, abdominal pain with concern for cholecystitis on CT. LIVER: Mild increased echogenicity of the liver measuring 20.6 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: There is gallbladder wall thickening measuring 8 mm in thickness. No stones are visualized within the gallbladder. No pericholecystic fluid. Sonographic Murphy's sign is negative. A drain is noted within the biliary tract limiting evaluation for common bile duct caliber, however there is no intrahepatic biliary duct dilatation. PANCREAS: Obscured by overlying bowel gas.RIGHT KIDNEY: Measures 12.0 cm in length and is normal in echogenicity. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 11.6 cm in length and is normal in echogenicity. There is mild pelvicaliceal dilatation of the inferior pole. No shadowing calculi are noted.Normal echogenicity of the spleen measuring 10.3 cm in length.", "output": "1. Gallbladder wall thickening is noted with no evidence of cholelithiasis. Given that these findings are new based on prior CT scans, this is suspicious for acute acalculous cholecystitis.2. Mild increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. 3. Mild left sided pelvicaliceal dilatation. "}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for hepatic vein thrombosis. Decompensated cirrhosis status post wide resection. History of pulmonary embolus. Exam is limited due to patient positioning and movement. LIMITED ABDOMENLIVER: The liver measures 17.3 cm in length. No intrahepatic biliary ductal dilatation. Liver is mildly coarse in echotexture compatible to history of cirrhosis. Gallstones.BILIARY TRACT: Common duct measured 2 mm which is within normal limitsPANCREAS: Obscured by overlying bowel gasSPLEEN: Spleen measures 11.7 cm in length. No focal lesions identified RIGHT KIDNEY: No hydronephrosis of either kidney. Both kidneys measure 10 cm in length. Probable cyst at the lower pole left kidney.OTHER: Trace ascites", "output": "Patent hepatic vasculature. Gallstones. Cirrhotic appearing liver. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "60 years old, Female, Reason: Assess size of nodule. Cystic vs solid? Any microcalcifications? Evaluate for adenopathy History: Left inferior nodule at least since 7/12 (1.2cm- mostly cystic, but with calcifications). Most recent US 7/14 (1.4 cm). This is 6 month follow up study, first study at UC RIGHT LOBE MEASUREMENTS: 4.3 x 1.1 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.2 x 1.5 cmISTHMUS MEASUREMENTS: 0.1 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Left lower pole thyroid nodule with peripheral coarse calcifications and internal hypoechogenicity measures 1.3 x 1.0 x 1.0 cm.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.", "output": "Left lower pole thyroid nodule with peripheral coarse calcifications. Please correlate with outside imaging and pathology results."}
{"instruction": "Generate impression based on findings.", "input": "67 years old, Female, Reason: status of MNG History: \"food gets stuck occasionally\" RIGHT LOBE MEASUREMENTS: History of right thyroidectomy.LEFT LOBE MEASUREMENTS: 5.3 x 1.9 x 1.8 cm.ISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Status post right thyroidectomy.LEFT LOBE: Multiple left thyroid nodules. The largest left thyroid nodule has a spongiform appearance and is slightly increased size from prior study measuring 2.9 x 2.3 x 2.0 cm. A second smaller cystic nodule measures 1.4 x 0.6 x 0.9 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple left thyroid nodules of varying appearance the largest of which measures slightly increased in size and is amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "77-year-old female with history of renal cell carcinoma. RIGHT KIDNEY: Measures 11.9 cm in length. Mildly prominent right renal pelvis is more conspicuous compared to the prior study, with borderline mild hydronephrosis. No suspicious masses.LEFT KIDNEY: Status post left nephrectomy.URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: Stable left adrenal adenoma.", "output": "1. Mildly prominent right renal pelvis is more conspicuous compared to the prior study, with borderline mild hydronephrosis. No suspicious right renal mass identified.2. Status post left nephrectomy.3. Stable left adrenal adenoma."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B LIVER: Coarse liver echotexture without worrisome mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 17.1 cmBILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: Obscured by overlying gasSPLEEN: AbsentRIGHT KIDNEY: No significant abnormalities noted. 11.1 cm in lengthOTHER: Left kidney 13.2 cm in length. No ascites", "output": "Coarse liver echotexture consistent with chronic liver disease without worrisome mass or ductal dilatation. No ascites. Cholelithiasis without acute inflammation."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male patient with cirrhosis status post OLT 9/2010 for HCV. Evaluate for lesions, assess hepatic vessel patency. LIMITED ABDOMENLIVER: The transplant liver measures 13.8 cm in length and demonstrates coarsened hepatic echotexture. A left hepatic cyst measures 0.9 x 0.6 x 0.8 cm, similar to the prior study. The main portal vein stent is present.BILIARY TRACT: There is no intra or extrahepatic biliary ductal dilatation. The common duct measures 5 mm in diameter.PANCREAS: An approximately 1.3 x 1.0 cm area of hypoechogenicity is noted within the body of the pancreas.SPLEEN: The spleen measures 12.2 cm in length. RIGHT KIDNEY: The right kidney measures 9.0 cm in length and demonstrates renal cortical thinning. No evidence of hydronephrosis.OTHER: The left kidney measures 10.6 cm in length. No evidence of hydronephrosis.", "output": "1. Patent transplant hepatic vasculature.2. Coarsened hepatic echotexture which can be seen with hepatic parenchymal dysfunction.3. Region of hypoechogenicity in the pancreas; MRI/MRCP is recommended for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Hypotension, renal dysfunction, assess for cholecystitis/cholethiasis or hydronephrosis History: hypotension Exam limited due to bowel gas/patient positioning.LIVER:Increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures 16.4 cm. The main portal vein is patent with normal hepatopetal flow with a velocity of 35 cm/s. No intrahepatic biliary ductal dilatation.GALLBLADDER, BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 2 mm in diameter. The common bile duct measures 3 mm in diameter. No choledocholithiasis. No intra or extrahepatic biliary ductal dilatation identified.PANCREAS: Limited evaluation of pancreas due to overlying bowel gas.SPLEEN: The spleen measures 12.2 cm and has a normal echotexture.KIDNEYS: The right kidney measures 12 cm in length and demonstrates normal echogenicity with no hydronephrosis or shadowing calculi. The left kidney measures 12.2 cm and demonstrates normal echogenicity with no hydronephrosis or shadowing calculi. ABDOMINAL AORTA: Abdominal aorta measures 1.5 cm approximately, 1.4 cm mid aorta, and the distal aorta is not well visualized.INFERIOR VENA CAVA: Inferior vena cava is and not well visualized.OTHER: Trace left pleural effusion is noted.", "output": "1.Mild increase in echogenicity and coarsened echotexture of the hepatic parenchyma, suggestive of fatty infiltration/hepatic parenchymal dysfunction with no focal mass or ductal dilatation.2.No evidence of cholelithiasis or acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C LIVER: Coarse echogenic liver echotexture again noted without mass. Liver length 15.4 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.4 cm in length OTHER: Left kidney 9.9 cm in length. Spleen 8.2 cm in length. No ascites.", "output": "Stable coarse echogenic liver parenchyma consistent with chronic liver disease without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female with known right breast mass, and clinical palpable findings within the right retroareolar region and right axilla presents for ultrasound examination. A targeted right ultrasound was performed for the palpable areas of concern. At the area of palpable concern at the 12 o'clock position of the right areolar border, there is a circumscribed anechoic cyst measuring 1.1 x 0.6 x 1.3 cm.Within the right axilla, for normal morphology lymph nodes are present in with normal fatty hila. The largest lymph node identified measures 1.2 cm and demonstrates thin cortex with normal fatty hilum and vascularity.", "output": "1. Simple cyst at the 12 o'clock position of the right breast, corresponding to area of palpable concern. 2. Normal right axillary lymph nodes.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess for intra-renal etiology for acute kidney injury RIGHT KIDNEY: The right kidney measures 10.7 cm in length. Normal renal parenchymal echogenicity. Mid pole cyst measures 2.4 x 1.4 x 1.8 cm and is cystic with a small septation or solid component. No hydronephrosis or shadowing stones.LEFT KIDNEY: The left kidney measures 10.1 cm in length. Normal renal parenchymal echogenicity. No hydronephrosis or shadowing stones.OTHER: The urinary bladder is poorly distended, limiting its evaluation. Small amount of free pelvic fluid. Ureteral jets not visualized.", "output": "1. No acute renal abnormality.2. Minimally complex right midpole cyst as described above."}
{"instruction": "Generate impression based on findings.", "input": "Female 55 years old; Reason: Assess if Left mid lobe 2.8cm mass is a nodule vs Parathyroid adenoma. She has Primary HPT. History: Assess if Left mid lobe 2.8cm mass is a nodule vs Parathyroid adenoma. She has Primary HPT. RIGHT LOBE MEASUREMENTS: 5.0 x 1.4 x 1.2 cm.LEFT LOBE MEASUREMENTS: 6.4 x 2.6 x 2.9 cm.ISTHMUS MEASUREMENT: 0.1 cm.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: There is a mixed solid-cystic but predominately solid heterogenous nodule measuring approximately 3.5 x 2.1 x 2.4 cm lesion in the left thyroid. No microcalcifications. There is some internal vascularity. This lesion was subsequently biopsied.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted. OTHER: No significant abnormality noted.", "output": "1.Thyroid nodule as above. Was subsequently biopsied after this study was performed."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female patient with history of thyroid cancer. One year follow-up study. Evaluate for adenopathy, recurrence. RIGHT LOBE: Status post thyroidectomy without residual or recurrent tissue identified.LEFT LOBE: Status post thyroidectomy without residual or recurrent tissue identified.ISTHMUS: Status post thyroidectomy without residual or recurrent tissue identified.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology lymph nodes are noted bilaterally.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy without evidence of recurrence or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Patient presents for evaluation of previously noted ill-defined mass in the inferior medial right breast at posterior depth seen on study from 1/23/2015. RIGHT BREAST DIGITAL MAMMOGRAPHY: Three standard views 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 composed of scattered fibroglandular density, unchanged in pattern and distribution. Again identified is a subcentimeter ill-defined mass in the inferior medial right breast at the posterior depth.TARGETED RIGHT BREAST ULTRASOUND: Targeted right breast ultrasound demonstrates a hypoechoic mass with peripheral echogenicity at 4:00 position, 3 cm from the nipple measuring 5 x 5 x 5 mm with associated vascularity.", "output": "Right breast 4:00 position subcentimeter mass as above. Further evaluation with percutaneous biopsy is recommended. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Left testicular pain RIGHT TESTIS: 4.6 x 2.8 x 2 .0 centimeters. No intratesticular mass. Bilaterally symmetric Doppler flow characteristicsLEFT TESTIS: 0.6 x 3.1 x 2.1 cm. No intratesticular mass. Bilaterally symmetric Doppler flow characteristicsRIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Negative scrotal ultrasound. No evidence for intratesticular mass, acute inflammation, or torsion."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old female recalled from screening mammogram for bilateral breast masses. No family history of breast cancer. Bilateral ML views and 3 right spot compression views and 2 left spot compression views of bilateral breast masses 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. Within the right upper outer breast there is a well-circumscribed 8 mm mass within the right upper outer quadrant. There is a focal asymmetry within the right breast 6:00, which persists on spot compression images.Within the left breast 12:00, posterior depth, the previously identified focal asymmetry does not persist on spot compression views.A targeted ultrasound was performed of the right breast at 10:00 and 6:00. Within the right breast at 10:00, 5 cm from the nipple, there is a cluster of cysts measuring 0.9 x 0.6 x 0.7 cm. Within the right breast at 7:00, 5cm from the nipple, there is an additional cluster of cysts measuring 0.7 x 0.4 x 0.9 cm. A targeted ultrasound of the left breast at 12:00 identified few simple cysts, the largest measuring 0.6 x 0.4 x 0.4 cm. No suspicious mass is identified.", "output": "There are clustered cysts within the right breast at 10:00 and 6:00, for which unilateral ultrasound is recommended in 6 months. No mammographic or sonographic evidence of malignancy within the left breast. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months). 3"}
{"instruction": "Generate impression based on findings.", "input": "50-year-old male with history of kidney stone. RIGHT KIDNEY: Measures 12.6 cm in length. Enlarged right renal pelvis with at most minimal hydronephrosis is not significantly changed compared with the prior CT examination. No discrete stones are identified on the right. There is a 1.7 cm right renal cyst without septation or solid component. There is chronic right renal cortical scarring. Interval removal of the previously seen right renal stent.LEFT KIDNEY: Atrophic echogenic left kidney measures 9.2 cm in length with dystrophic calcifications.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "1. No evidence of nephrolithiasis. 2. Interval removal of right collecting system stent since the prior study. Chronic parenchymal abnormalities as detailed above without significant interval change since the prior CT study. "}
{"instruction": "Generate impression based on findings.", "input": "33 years old, Male, Reason: baseline exam as part of evaluation for heart/kidney transplant History: none LIVER: Mildly heterogeneous liver measuring 13.7 cm. No evidence of focal hepatic mass. The portal vein is patent with hepatic pedal flow at 0.2 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is normal in appearance without evidence of cholelithiasis. No pericholecystic fluid or gallbladder wall thickening.PANCREAS: No significant abnormality noted.SPLEEN: The spleen measures 9.2 centers. No significant abnormality noted.KIDNEYS: The right kidney measures 9.6 cm. Increased echogenicity the right kidney is consistent medical renal disease. No evidence of shadowing calculus or hydronephrosis.The left kidney measures approximately 8.6 cm in length. Increased echogenicity of the normal portions of the left kidney is consistent medical renal disease. There is a hypoechoic at least partially exophytic lobulated mass in the mid to inferior portion of the left kidney measuring approximately 6.5 x 3.6 x 4.5 cm, similar to prior exam dated 1/19/15. No gross shadowing calculus or hydronephrosis.ABDOMINAL AORTA: Proximal aorta measures up to 2.2 cm in diameter. The mid abdominal aorta measures up to 1.9 cm in diameter. The distal abdominal aorta measures 1.6 m in diameter. No focal aneurysmal dilation is identified.INFERIOR VENA CAVA: The inferior vena cava is not well-visualized on this exam.OTHER: No significant abnormality noted.", "output": "1. Echogenic renal cortices compatible with medical renal disease.2. Hypoechoic partially exophytic lobulated soft tissue mass in the mid to lower pole of the left kidney appearing similar to prior exam and is concerning for neoplasm."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid thyroid carcinoma status post resection. History of right adrenal metastasis RIGHT LOBE: Status post thyroidectomy. 0.9 x 0.7 x 0.9 cm hypoechoic focus within the inferior aspect of the right central compartment/level 6. This lesion demonstrates internal heterogeneity and possible internal microcalcifications.LEFT 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. Hypoechoic focus within the inferior aspect of the right central compartment/level 6. This lesion demonstrates internal heterogeneity and possible internal microcalcifications. While this may represent a scar, a metastatic thyroid carcinoma focus cannot be excluded. This lesion is amenable to ultrasound-guided percutaneous biopsy. If biopsy is not contemplated, would pay special attention to this focus on future surveillance scans."}
{"instruction": "Generate impression based on findings.", "input": "Female 23 years old Reason: r/o cholecystitis or ab source, fever unknown origin History: as above LIVER: Liver is enlarged measuring 18.7 cm. Hepatic veins and IVC are dilated. No focal liver lesions.BILIARY TRACT: No evidence of intra or extrahepatic biliary dilatation. No evidence of gallstones. Gallbladder is unremarkable.PANCREAS: Not well visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 8.8 cm.RIGHT KIDNEY: Bilateral slightly echogenic kidneys. Right kidney measures 11.8 cm. Left kidney measures 11.8 cm. No evidence of hydronephrosis. OTHER: No significant abnormalities noted.", "output": "Mild hepatomegaly likely secondary to heart failure. Otherwise unremarkable study."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Is there an aneurysm? History: Reported history of AAA LIVER: The liver measures 18.9 cm in length. The hepatic parenchymal echotexture and echogenicity is coarse. There is a mildly nodular hepatic contour, concerning for a cirrhotic liver morphology. There are no focal masses. The main portal vein is patent with normal directional hepatopedal flow, maximum systolic velocity 19.4 cm/s.GALLBLADDER, BILIARY TRACT: The common hepatic duct measures 2 mm in diameter. The gallbladder is moderately distended. There is a small echogenic focus in the dependent portion of the gallbladder with posterior acoustic shadowing, consistent with a small stone. There is no pericholecystic fluid. The gallbladder wall measures 2 mm. There is no biliary ductal dilatation. Murphy's sign was negative.PANCREAS: Obscured by bowel gas.SPLEEN: The spleen measures 16.9 cm in length.KIDNEYS: The left kidney measures 11.8 cm in length. The right kidney measures 11.9 cm in length. No hydronephrosis. ABDOMINAL AORTA: The abdominal aorta is obscured by bowel gas distally. The abdominal aorta measures 3.2 cm proximally and 2.9 cm more distally in the AP diameter. The distal abdominal aorta was nonvisualized. The arterial waveform is pulsatile, consistent with reported history of intra-aortic balloon pump.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Left pleural effusion. No free intraperitoneal fluid.", "output": "1. Echogenic coarse hepatic parenchyma with nodular contour, concerning for cirrhosis.2. Cholelithiasis without evidence of cholecystitis.3. Limited evaluation of the abdominal aorta without evidence of abdominal aortic aneurysm."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old male with history of chronic kidney disease. RIGHT KIDNEY: Measures 10.4 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 10.5 cm in length. 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. "}
{"instruction": "Generate impression based on findings.", "input": "55 years old, Male, Reason: 55 y/o male hx of AML with worsening right-sided and radiating abdominal pain x 5 days, question of gallstones History: Right sided and radiating abdominal pain upon palpation and with movement Suboptimal ultrasound evaluation to patient's body habitus.LIVER: The liver is mildly increased in size measuring 19.1 cm in length. Increased parenchymal echogenicity suggestive of fatty infiltration. The main 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. Per the ultrasound technologist, 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: Pancreas is not well visualized on the study.SPLEEN: No significant abnormalities noted. The spleen measures 14.8 cm in length. RIGHT KIDNEY: Kidney measures 13.7 cm in length. No evidence of hydronephrosis.LEFT KIDNEY: Kidney measures 15.2 cm in length. No evidence of hydronephrosis.", "output": "1.Limited examination due to body habitus. Increased echogenicity of the hepatic parenchyma suggestive of fatty infiltration. 2.Normal gallbladder and biliary tract with no evidence of cholelithiasis or acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "50-year-old female patient with elevated LFTs. LIVER: The liver measures 21.5 cm in length. There is diffuse increased hepatic parenchymal echogenicity which decreases the sensitivity to detect subtle lesions. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 4 mm in diameter.PANCREAS: The head of the pancreas demonstrates normal echogenicity. The body and tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 11.5 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 12 cm in length. No evidence of hydronephrosis.The spleen measures 6.7 cm in length.Small amount of ascites is noted.", "output": "1. Hepatic steatosis and hepatomegaly.2. Trace ascites. "}
{"instruction": "Generate impression based on findings.", "input": "66 years old, Female, Reason: evaluate for residual thyroid cancer RIGHT LOBE MEASUREMENTS: Status post thyroidectomy. No definite soft tissue echogenicity seen to suggest tumor recurrence.LEFT LOBE MEASUREMENTS: Status post thyroidectomy. No definite soft tissue echogenicity seen to suggest tumor recurrence.ISTHMUS MEASUREMENTS: Status post thyroidectomy. No definite soft tissue echogenicity seen to suggest tumor recurrence.LYMPH NODES: Single subcentimeter benign-appearing level 2 lymph node on the left, with a fatty hilum.", "output": "No evidence of recurrent disease or lymphadenopathy."}
{"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 a hypoechoic mass at 9:30 position, 9 cm from nipple, in the right breast. There is no solid or cystic mass identified in the left breast.", "output": "A hypoechoic mass at 9:30 position, 9 cm from nipple, in the right breast for which hand-held ultrasound study is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "Elevated liver enzymes. Evaluate for cholecystitis or biliary process. LIVER: 14.3 cm in length. Non-cirrhotic liver morphology. Increased parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Biliary sludge and several subcentimeter gallstones noted, without evidence of cholecystitis. 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 12.4 cm in length. No suspicious renal lesions are evident. No right-sided hydronephrosis is seen.The left kidney is 11.6 cm in length. Mild left-sided hydronephrosis, with stent in place.SPLEEN: 12.0 cm in length, without focal lesions evident.OTHER: Small right pleural effusion.", "output": "1. Increased hepatic echogenicity, compatible with proximal dysfunction.2. Biliary sludge and cholelithiasis, without evidence of cholecystitis.3. Mild left-sided hydronephrosis, with stent in place.4. Small right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "Rising creatinine. Evaluate for stenosis or obstruction. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: No significant abnormality noted.KIDNEY: 11.1 cm in length. The renal parenchymal echogenicity is mildly increased. COLLECTING SYSTEM/URETER: There is new mild caliectasis, with no obstructing stone identified.URINARY BLADDER: No significant abnormality notedVASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels.The renal vein is patent with appropriate directional flow.Iliac artery: PSV 136 cm/s, RI 0.88Anastomosis: PSV 142 cm/sRenal segmental arteries PSV in cm/s are as follows: Upper: 59; Mid: 49 ; Lower 29Renal segmental arteries resistive indices are as follows: Upper: 0.75; Mid: 0.79; Lower 0.68 Renal arcuate arteries PSV in cm/s are as follows: Upper: 67; Mid: 38 ; Lower 32Renal arcuate arteries resistive indices are as follows: Upper: 0.70; Mid: 0.72; Lower 0.77", "output": "1.Echogenic transplant renal parenchyma and mildly elevated resistive indices, compatible with medical renal disease. 2.Mild caliectasis, with no obstructing lesion identified.3.Vasculature is patent."}
{"instruction": "Generate impression based on findings.", "input": "43 year-old female with right-sided submandibular gland tenderness and swelling. Right submandibular gland appears normal and relatively symmetrical with the left. No shadowing calculus or ductal dilatation. The posterior auricular region on the right was also evaluated due to patient discomfort without mass or collection.", "output": "No submandibular gland stone or ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Alcoholic cirrhosis LIMITED ABDOMENLIVER: Cirrhotic morphology. 1.5 x 1.5 x 1.3 cm hypoechoic focus within segment 2 of the left lobe of the liver. Liver length 15 cmBILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 12.6 cm in length RIGHT KIDNEY: Right renal cyst. Right kidney 13.4 cm in length.OTHER: Left kidney 13.2 cm in length. Nonobstructing left renal stone again noted. Spleen length 12.6 cm Moderate ascites.", "output": "Cirrhotic morphology. Hypoechoic lesion segment 2 left lobe of the liver; a neoplastic process including malignancy cannot be excluded. Strongly recommend correlation with contrast cross sectional imaging. Cholelithiasis without ductal dilatation. Moderate ascites.Patent hepatic vessels with normal directional flow."}
{"instruction": "Generate impression based on findings.", "input": "Mr. Jones is a 22-year-old female presenting with a superficial lesion in the left breast. Per patient, this lesion became an open wound with bleeding approximately 4 days ago. She denies any discrete mass or nipple discharge. Upon physical exam at the patient's area of concern, there is an open wound with serous drainage in the left lower inner breast. No discrete mass is appreciated at this site.A targeted left breast ultrasound was performed for the patient\u2019s area of concern. In the left breast 8:00 location, approximately 6 cm from the nipple, there is a superficially located, hypoechoic lesion identified measuring 1.2 x 0.1 x 1.0 cm. Minimal associated vascularity is present. Sonographic findings are compatible with an epidermal inclusion cyst.", "output": "Benign epidermal inclusion cyst of the left breast. No sonographic evidence for malignancy. Patient should keep the wound dry and covered, use bacitracin daily, and warm compresses. The patient should follow up with her primary care physician as clinically warranted for this area, presuming these results are concordant with the physical exam findings. 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": "Reason: to rule out hcc per protocol LIVER: The liver measures 16.5 cm in length. Coarse, heterogeneous hepatic echotexture. No focal lesions or masses. The portal vein is patent with normal directional hepatopedal portal venous blood flow, peak velocity is 16.7 cm/s.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. The gallbladder wall measures 0.1 cm. The common bile duct measures 0.3 cm. No biliary ductal dilatation.PANCREAS: Obscured by bowel gas.RIGHT KIDNEY: The right kidney measures 11.1 cm in length. No hydronephrosis, masses, or shadowing stones.LEFT KIDNEY: The left kidney measures 11.6 cm in length. No hydronephrosis, masses, or shadowing stones.OTHER: No ascites. The spleen measures 12.0 cm in length.", "output": "Coarse, heterogeneous hepatic echotexture, consistent with chronic liver disease or parenchymal dysfunction. No focal masses."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: Coarse echogenic liver echotexture without mass. Liver length 17.7 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Benign-appearing cyst. Possible subcentimeter punctate nonobstructing renal stones. Right kidney 11.9 cm in lengthOTHER: Left kidney 11.5 cm in length. Spleen 11.4 cm in length. No ascites.", "output": "Echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites. Possible nonobstructing punctate right nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male with pain and edema. Evaluate for Baker cyst. Grayscale and color ultrasound of the posterior left knee soft tissues demonstrate no evidence of Baker's cyst or other findings to account for the patient's symptoms.", "output": "No evidence of Baker's cyst."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with cirrhosis presents with concern for ascites. LIVER:The liver measures 23.1cm. There is an approximately 1.6 x 1.6 x 1.4 cm round anechoic area with minimal complexity consistent with a minimally complex hepatic cyst. The parenchyma has increased, coarse echogenicity. No worrisome masses, intrahepatic biliary dilation, or ascites. 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 0.3 cm. No pericholecystic fluid. The common duct measures 0.6 cm.PANCREAS: Evaluation the pancreas is limited due to overlying bowel gas.SPLEEN: The spleen measures 8.6 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 12.7 cm. The left kidney measures 13.2 cm. The cortices have normal echogenicity. No shadowing calculi, hydronephrosis, or solid mass. There is an approximately 3.3 x 2.8 x 2.8 round well-defined anechoic area with posterior acoustic shadowing consistent with a simple renal cyst in the right kidney. OTHER: No significant abnormality noted.", "output": "1. Increased, coarse echogenicity of liver consistent with chronic liver disease/parenchymal dysfunction. With comparison to a prior CT dated July 1, 2016, the increased echogenicity is consistent with fatty liver. No worrisome mass or ascites.2. Hepatomegaly."}
{"instruction": "Generate impression based on findings.", "input": "History: RUQ pain LIVER: The liver measures 14.7 cm in length. Mildly echogenic hepatic parenchyma. The portal vein is patent with normal directional hepatopedal flow, peak velocity 20.5 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: The gallbladder is mildly distended, however there is no evidence of pericholecystic inflammation or fluid. No stones or sludge are identified. The gallbladder wall measures 0.2 cm. The common hepatic duct measures 0.2 cm. No biliary ductal dilatation. Negative sonographic Murphy's sign.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 12.4 cm in length. Unremarkable renal parenchymal echogenicity. No hydronephrosis or shadowing renal calculi.The left kidney measures 11.4 cm in length. Unremarkable renal parenchymal echogenicity. No hydronephrosis or shadowing renal calculi.OTHER: The spleen measures 10.2 cm in length. No ascites.", "output": "1. Mildly distended gallbladder without cholelithiasis, sludge, or evidence of acute inflammation.2. Mildly echogenic liver, consistent with hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: No significant abnormalities noted. Liver length 19.1 cmGALLBLADDER, BILIARY TRACT: Mildly prominent extra hepatic duct without obvious distal obstructing lesion. Unremarkable gallbladder.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Increased parenchymal echogenicity. Mild interval enlargement of benign-appearing renal cysts. Right kidney 10.6 cm in lengthOTHER: Left kidney 11.8 cm in length. Increased left renal parenchymal echogenicity. Mild interval increase in benign-appearing left renal cysts. Spleen 10.4 cm in length. No ascites.", "output": "Mildly prominent extra hepatic duct without obvious distal obstructing lesion. Unremarkable gallbladder without evidence for acute inflammation. Mild hepatomegaly. No ascites.Echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Ware is a 74-year-old female recalled from screening exam of 08/31/16 for new focal asymmetry in the left central breast. She has a family history of breast cancer in her sister. An ML view and 3 spot magnification 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. Again seen is a 4 mm mass in the left central breast with partially obscured margins. A subsequent targeted left breast ultrasound was performed.ULTRASOUND", "output": "Simple cyst in the left breast at the 11:00 position correlating to focal asymmetry seen 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": "History of chronic cholecystitis. Examination is extremely limited by patient body habitus.LIVER: Non-cirrhotic liver morphology. Increased parenchymal echogenicity suggestive of parenchymal dysfunction. No focal hepatic lesions. Normal portal venous blood flow direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Layering small gallstones noted, without specific evidence of cholecystitis.PANCREAS: The pancreas is obscured by bowel gas.KIDNEYS: The right kidney is 13.7 cm in length. The left kidney is 13.5 cm in length. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 11.7 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.", "output": "1. Limited examination due to patient's body habitus.2. Cholelithiasis without specific evidence of cholecystitis.3. Increased hepatic echogenicity suggestive of parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "18-year-old female with history of bilateral biopsy-proven fibroadenomas. A targeted bilateral breast ultrasound was performed at the site of patient's known fibroadenomas. At 10:00 in the right breast 5 cm from the nipple there is a well-defined, hypoechoic mass measuring 25 x 16 x 29 mm (previously 23 x 15 x 27 mm), compatible with the patient's biopsy-proven fibroadenoma.At 1:00 in the left breast 6 cm from nipple there is a 33 x 25 x 31 (previously 28 x 19 x 29 mm) hypoechoic circumscribed mass, slightly increased in size from the prior exam, compatible with the patient's known fibroadenoma.", "output": "Slight increase in size of the patient's left breast biopsy proven fibroadenoma. Stable right breast fibroadenoma. No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "19-year-old with palpable lump for 5 months in the left breast With physical exam, small mobile lump is present at left 7:00 position near the nipple. With focused ultrasound, there is a circumscribed hypoechoic mass measuring 11 x 8 mm with peripheral blood flow, most likely a fibroadenoma.", "output": "High probability benign mass in the left breast. Short-term ultrasound follow-up in 6 months is recommended.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": "Female 64 years old; Reason: Eval gallstones, ?cholecystitis History: RUQ pain This portable exam is limited due to patient's body habitus, bowel gas, and immobility.LIVER: Evaluation of liver is limited in this study. There is a low volume ascites seen superior to the liver.GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 3 mm and appears contracted. Small echogenic foci are seen within the gallbladder. No pericholecystic fluid. The common bile duct measures 2 mm in diameter.", "output": "1. Cholelithiasis without overt evidence of acute cholecystitis.2. Small volume of ascites is present."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old female with left flank pain. RIGHT KIDNEY: Measures 11.7 cm in length. No renal stones, suspicious masses, or hydronephrosis.LEFT KIDNEY: Measures 11.5 cm in length. Left renal cyst measures 1.7 x 1.2 x 1.2 cm without septation or suspicious nodular component. No renal stones or hydronephrosis.OTHER: No significant abnormalities noted.", "output": "No nephrolithiasis, hydronephrosis, or suspicious mass lesions."}
{"instruction": "Generate impression based on findings.", "input": "Female 55 years old Reason: please rule out abscess on the back of head History: patient with indurated lesion on back of scalp unclear if abscess In the area of the palpable lump there is a small hypoechoic area ill-defined measuring 0.4 x 0.4 x 0.2 cm of uncertain significance. Does not have increased through transmission to suggest a fluid collection. Possibly lymph node. Abscess cannot be excluded but is unlikely.", "output": "Small nonspecific irregular hypoechoic focus in the palpable region."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal LFTs LIVER: Mildly echogenic liver echotexture without mass. Liver length 13.8 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.3 cm in lengthOTHER: Left kidney 11.6 cm in length. Spleen 10 cm in length. No ascites.", "output": "Mildly echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male undergoing renal biopsy. Ultrasound guidance was provided for nephrology service to perform a renal biopsy. 4 passes were performed.", "output": "1. Ultrasound guidance was provided for nephrology service to perform a renal biopsy."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old male with acute kidney failure. Evaluate for hydronephrosis. Abnormal liver function. LIVER:There is hepatomegaly with the liver measuring at least 20 cm in length. The hepatic parenchyma is echogenic which is nonspecific. No focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: The head is normal. The body and tail are less well seen due to bowel gas.SPLEEN: Splenomegaly with the spleen measuring at least 15 cm in length.KIDNEYS: Right kidney measures 15.7 cm in length and is likely mildly echogenic consistent with parenchymal disease. No hydronephrosis, shadowing calculus or mass. Left kidney measures approximately 15.2 cm in length and is likely mildly echogenic consistent with parenchymal disease. No hydronephrosis, shadowing calculus or mass.ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No ascites.", "output": "Hepatosplenomegaly with echogenic liver.No evidence for hydronephrosis. Kidneys may be mildly echogenic."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female with history of left lumpectomy 2009 presents as a call back from screening mammography for right breast asymmetries. No current breast complaints. Three standard views of the right breast and additional 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. Focal asymmetries in the right upper outer breast and the right inferior inner breast persist with spot compression. Scattered benign calcifications are again visualized. Ultrasound was performed for further evaluation.ULTRASOUND", "output": "Benign cysts in the right upper outer and lower inner breast correlating with the 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": "Papillary thyroid carcinoma status post resection with history of regional metastatic adenopathy. PET-positive focus right supraclavicular region. 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: Stable left level 1B and 2 lymph nodes. A representative level 2 lymph node measures 1.3 x 0.6 x 0.3 cm. No change in hypoechoic left level 5 lymph node measuring 0.4 x 0.3 x 0.5 cm.Examination of the right supraclavicular area does not demonstrate any mass corresponding to the PET-positive focus.OTHER: No significant abnormality noted.", "output": "Stable examination. Status post thyroidectomy without worrisome mass. Stable left cervical lymph nodes, including indeterminate left level 5 lymph node.Examination of the right supraclavicular area does not demonstrate any mass corresponding to the PET-positive focus; as a result, no biopsy was performed. Continued surveillance ultrasound examination is recommended."}
{"instruction": "Generate impression based on findings.", "input": "HCV, cirrhosis, evaluate for HCC LIVER: Liver measures 18 cm, with increased echogenicity. No intrahepatic biliary ductal dilatation. Normal capsule of the liver. No focal lesions within the liver.BILIARY TRACT: Gallbladder is well-distended with multiple gallstones within it measuring approximately 7 mm. No evidence of gallbladder wall thickening. Common duct measures within normal limits up to 3 mm. No pericholecystic fluid noted.PANCREAS: Head of the pancreas appears unremarkable. Body and tail of pancreas is not visualized and appears unremarkable.SPLEEN: Spleen measures 10.6 cm, normal echotexture.KIDNEY: Right kidney measures 14.4 cm left kidney measures 14.8 cm. Normal collection noted. No hydronephrosis or hydroureter. No focal lesions noted. OTHER: No ascites.", "output": "Increased hepatic echogenicity suggestive of hepatic steatosis/chronic liver disease without any focal lesions.Cholelithiasis without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Veneris is a 35 year old female returning for a short-term follow-up for high probability benign area of fat necrosis in the left breast. Dr. Jaskowiak did an in-office FNA which was non-diagnostic. Per patient, she can no longer feel this area. A targeted left breast ultrasound was performed for the palpable area of concern. In the left breast 8:00 location, approximately 6 cm from the nipple, there is revisualization of a mixed echogenic lesion measuring 0.3 x 0.5 cm, compared to 0.7 x 0.9 cm. There is no new suspicious solid or cystic mass identified.", "output": "Interval decrease in size of fat necrosis in the left breast. No sonographic evidence for malignancy. The patient should follow up with Dr. Jaskowiak as clinically warranted.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old male with right upper quadrant pain. LIVER: Liver 17 cm in length. No focal hepatic lesions. No intrahepatic biliary ductal dilation. Main portal vein is patent with normal directional flow and peak systolic velocity of 0.3 m/s.GALLBLADDER, BILIARY TRACT: No cholelithiasis. No gallbladder wall thickening or pericholecystic fluid. Negative sonographic Murphy's sign. Normal caliber of the common duct measuring up to 4 mm.PANCREAS: No focal pancreatic lesions in the pancreatic head. The remainder of the pancreas is poorly visualized due to overlying bowel gas.RIGHT KIDNEY: Right kidney is 12.7 cm in length. Left kidney is 12.4 cm in length. Increased nonspecific cortical echogenicity of both kidneys. Moderate left hydronephrosis and bilateral perinephric free fluid, similar to CT from yesterday.OTHER: No significant abnormalities noted.", "output": "1. No cholelithiasis or acute cholecystitis.2. Left hydronephrosis, similar to CT from yesterday.3. Increased nonspecific cortical echogenicity of both kidneys, which may be related to medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "35 years old, Female, Reason: UTI, left sided flank and abdominal pain History: left sided pain, history of uti RIGHT KIDNEY: Kidney measures 9.4 cm in length. Normal echotexture. Mild pelvicaliectasis on the right. No evidence of shadowing calculus or mass.LEFT KIDNEY: Kidney measures 9.6 cm in length. Normal echotexture. Mild pelvic caliectasis on the left without evidence of shadowing calculus or mass.BLADDER: No significant abnormality pre-and postvoid. OTHER: No significant abnormalities noted.", "output": "1.Bilateral mild pelvicaliectasis without evidence of shadowing calculus or mass."}
{"instruction": "Generate impression based on findings.", "input": "75 year old female with incidental thyroid nodule noted on MRI neck. RIGHT LOBE MEASUREMENTS: 1.5 cm x 1.2 cm x 2.9 cm.LEFT LOBE MEASUREMENTS: 1.2 cm x 1.6 cm x 2.8 cm.ISTHMUS MEASUREMENTS: 3 mm in thicknessRIGHT LOBE: Heterogeneous echotexture. Multiple subcentimeter nodules are noted, the largest of which is hypoechoic and measures 6 mm x 4 mm x 5 mm. LEFT LOBE: Multiple subcentimeter nodules are noted, the largest of which measures 7 mm x 7 mm x 8 mm and is cystic in appearance. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Multiple bilateral lymph nodes are noted in the neck, the majority of which appear benign with a prominent fatty hilum. However, prominent left neck level 3 lymph node measures 1.3 cm x 0.5 cm x 0.8 cm is noted with suggestion of a fatty hilum. OTHER: No significant abnormality noted.", "output": "1. Prominent left neck level 3 lymph node with suggestion of a fatty hilum. While presence of fatty hilum suggests benignity and node may merely be reactive in etiology, the node is prominent and has an abnormal rounded configuration, correlation with patient's clinical history and follow up is recommended to exclude a neoplastic process. 2. Heterogeneous thyroid gland with bilateral subcentimeter nodule, largest on the left lobe which is predominantly cystic and likely represents a benign colloid nodule. "}
{"instruction": "Generate impression based on findings.", "input": "Male 67 years old; Reason: evaluate thyroid nodule found on CT scan. RIGHT LOBE MEASUREMENTS: 5.1 x 1.9 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.0 x 1.4 x 1.6 cmISTHMUS MEASUREMENT: 0.4 cmRIGHT LOBE: Mixed cystic and solid nodule measuring 2.0 x 1.7 x 1.2 cm is noted in the right lobe of the thyroid. An additional adjacent vascular hypoechoic solid nodule measures 0.8 x 0.6 x 0.6 cm.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.LYMPH NODES: Benign-appearing left neck lymph node measures 1.7 x 5.9 x 0.5 cm.OTHER: No significant abnormality noted.", "output": "Dominant cystic and solid nodule in the right prior lobe with an adjacent smaller solid nodule. The dominant nodule is amenable to fine-needle aspiration biopsy."}
{"instruction": "Generate impression based on findings.", "input": "18-year-old female with history of thyroid cancer status post thyroidectomy. Evaluate for recurrence. RIGHT LOBE MEASUREMENTS: Surgically absentLEFT LOBE MEASUREMENTS: Surgically absentISTHMUS MEASUREMENTS: Surgically absentRIGHT LOBE: Echogenic focus in the right thyroid bed unchanged compared with prior studies, favored to represent postsurgical scarring.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered cervical lymph nodes with benign morphologic features, without significant interval change.OTHER: No significant abnormality noted.", "output": "No evidence of recurrent or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Reason: renal cyst RIGHT KIDNEY: Kidney measures 8.4 cm in length. Increased cortical echogenicity. No hydronephrosis or shadowing calculus. Lower pole subcentimeter cyst, not definitively visualized on the prior examination.LEFT KIDNEY: Kidney measures 10.1 cm in length. Increased cortical echogenicity. No hydronephrosis or shadowing calculus. Midpole exophytic cyst measuring 1.2 x 1.1 x 1.0 cm, not significantly changed. Lower pole exophytic cyst measuring 1.5 x 1.7 x 1.5 cm, not significant changed.OTHER: No significant abnormalities noted.", "output": "1.Renal cysts, as described above and not significantly changed.2.Increased renal echogenicity suggestive of medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Female 66 years old; Reason: thyroid nodules please evaluate History: as above RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.5 x 2.0 x 1.9 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.3 x 1.8 x 1.5 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.4 cm.RIGHT LOBE: The right lobe is heterogeneous. In the superior portion of the right lobe there is a subcentimeter nodule isoechoic to the thyroid. This measures 0.8 cm x 0.4 cm x 0.6 cm. This appears spongiform and no internal microcalcifications are seen. As the lower portion of the right lobe there is a round subcentimeter hypoechoic nodule measuring 1 cm x 0.6 cm x 0.7 cm. No internal microcalcifications are seen.LEFT LOBE: The left lobe is heterogeneous. No dominant nodules are identified on the left.ISTHMUS: No significant abnormality noted.LYMPH NODES: There is a right level 4 lymph node visualized on prior ultrasound measuring 1.1 cm x 0.9 cm x 1.6 cm. This node has a fatty hilum and is previously measured to be 0.9 cm x 0.7 cm x 0.9 cm. On the left at level 4 there is a lymph node revisualized measuring 1.5 cm x 0.5 cm x 0.8 cm. This node is increased fatty hilum from prior ultrasound and previously measured 0.6 cm x 0.3 cm x 0.9 cm.", "output": "1. Heterogeneous thyroid gland with two subcentimeter nodules located in the right thyroid lobe. One is located superiorly with benign appearance and the other inferiorly, which is indeterminant. No prior thyroid ultrasounds are available for comparison. 2. Right and left level 4 lymph nodes are revisualized from prior ultrasound both slightly increased in size. These lymph nodes still demonstrate benign appearing morphology. No new suspicious adenopathy is visualized."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old male with neuro muscular dysfunction of bladder. RIGHT KIDNEY: The right kidney is difficult to visualize due to severe scoliosis, an accurate length cannot be assessed. However, no hydronephrosis or gross shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 9.3 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.URINARY BLADDER: No significant abnormalities noted. Bilateral ureteral jets identified.OTHER: No significant abnormalities noted.", "output": "Stable appearance the kidneys and bladder. No hydronephrosis or bladder wall thickening."}
{"instruction": "Generate impression based on findings.", "input": "80 years old, Female, Reason: AKI History: As above RIGHT KIDNEY: Kidney measures 9.6 cm in length. Minimally hyperechoic. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 9.0 cm in length. Minimally hyperechoic kidney. Nohydronephrosis, shadowing calculus or mass.OTHER: A significant amount of ascites is present consistent with findings on recent CT scan.", "output": "1.Generalized abdominal ascites.2.Kidneys are minimally hyperechoic consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female with palpable subcutaneous nodule in the right upper quadrant. Grayscale and color ultrasound performed in the area of the patient's palpable complaint in the right upper quadrant and additionally on the left side for comparison demonstrate mildly asymmetric partially circumscribed adipose tissue on the right measuring 2.0 x 2.4 x 1.4 cm with thin linear areas of increased echogenicity which most likely represents a lipoma or asymmetrical lobulated subcutaneous fat. No suspicious solid lesions or areas of increased vascularity are present.", "output": "Findings as described above most likely represent a lipoma or asymmetric lobulated adipose tissue."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Patient with bilious emesis and RUQ pain, assess liver and biliary system LIVER: The liver measures 16.9 cm in length. The hepatic parenchymal echotexture and echogenicity is normal. There are no focal masses. There is no biliary ductal dilatation. The main portal vein is patent with normal directional hepatopedal flow and waveform, peak velocity 29.3 cm/s.BILIARY TRACT: The gallbladder appears normal. There is no cholelithiasis. The common bile duct measures 5 mm. The common hepatic duct measures 3 mm. The gallbladder wall measures 2 mm.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen measures 9.6 cm in length.RIGHT KIDNEY: The right kidney measures 10.3 cm in length. No hydronephrosis, shadowing stones, or focal masses.LEFT KIDNEY: The left kidney measures 10.3 cm in length. No hydronephrosis, shadowing stones, or focal masses. OTHER: No significant abnormalities noted.", "output": "Negative exam."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs. History stem cell transplant LIMITED ABDOMENLIVER: Coarse echogenic parenchyma again noted without mass. Liver length 18.9 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 12.1 cm in length RIGHT KIDNEY: No significant abnormalities noted. Right kidney 10.9 cm in lengthOTHER: Left kidney 11.9 cm in length. No ascites.", "output": "Echogenic coarse liver echotexture again noted consistent with fatty infiltration/parenchymal dysfunction. Mild hepatomegaly. No worrisome mass lesion or ductal dilatation. Hepatic vessels patent with normal directional flow. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Primary hyperparathyroidism with high PTH and calcium RIGHT KIDNEY: Mildly echogenic parenchyma echogenicity without worrisome mass. Multifocal parenchymal based echogenic foci somewhat more conspicuous on the current study. Benign renal cyst. No hydronephrosis or renal stones. Right kidney 11.7 cm in lengthLEFT KIDNEY: Mildly echogenic parenchymal echogenicity without worrisome mass. Multifocal parenchymal base echogenic foci somewhat more conspicuous on the current study. No hydronephrosis or renal stones. Left kidney 11.1 cm in length.OTHER: Bladder nondistended", "output": "Interval appearance of mildly increased parenchymal echogenicity with more conspicuous multifocal parenchymal base echogenic foci. Findings raise the possibility of parenchymal dysfunction with nephrocalcinosis without nephrolithiasis or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules RIGHT LOBE MEASUREMENTS: 5.8 x 3.7 x 3.0 cmLEFT LOBE MEASUREMENTS: 6.6 x 2.6 x 2.5 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Spongiform nodules again noted. Dominant nodule slightly increased in size measuring 3.5 x 2.7 x 3.6 cm.; this is in comparison to 3.2 x 2.9 x 2.1 cm on 3/19/2013.LEFT LOBE: Spongiform nodules again noted. Dominant left nodule measures 3.9 x 2.4 x 2.5 cm.; This is in comparison to 3.3 x 1.9 x 1.7 cm on 3/19/2013. This dominant left thyroid nodule now demonstrates a focus of coarse calcification.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Slight interval increase in size of bilateral dominant thyroid nodules. Although there has been slight interval increase in size of these nodules, the overall appearance of these nodules still favor colloid nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "81-year-old male with right upper quadrant pain, evaluate for liver or gallbladder pathology. LIVER: Increased hepatic echogenicity without discrete focal lesion.GALLBLADDER, BILIARY TRACT: Cholelithiasis and biliary sludge. No gallbladder wall thickening, pericholecystic fluid, or sonographic Murphy sign. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.KIDNEY: Increased renal echogenicity.OTHER: No significant abnormalities noted.", "output": "1. Cholelithiasis without specific evidence of cholecystitis. 2. Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease. 3. Increased renal echogenicity consistent with medical renal disease. "}
{"instruction": "Generate impression based on findings.", "input": "Abnormal liver enzymes. History of renal cell carcinoma. Elevated creatinine. LIVER: Non-cirrhotic liver morphology. Coarsened parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. The gallbladder is distended with biliary sludge. There is mild gallbladder wall thickening and minimal pericholecystic fluid. No sonographic Murphy's sign is elicited.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 10.2 cm in length. The renal parenchyma is echogenic bilaterally. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 6.2 cm in length, without focal lesions evident.ABDOMINAL AORTA: Patent. 2.8 cm in maximal diameter, without aneurysm.INFERIOR VENA CAVA: Patent.OTHER: Prostatomegaly. Bilateral pleural effusions, partially imaged.", "output": "1. Increased hepatic echogenicity compatible with parenchymal dysfunction, without biliary ductal dilation.2. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease.3. Gallbladder distention, biliary sludge, and mild wall thickening suggestive of cholecystitis in the appropriate clinical setting."}
{"instruction": "Generate impression based on findings.", "input": "Male 66 years old Reason: eval for thyroid nodules, lymphadenopathy History: hyperthyroidism, L sided nodule on thyroid bed on exam RIGHT LOBE MEASUREMENTS: 8.1 x 3 x 4.8 cmLEFT LOBE MEASUREMENTS: 2 x 2.7 x 2.4 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: There are multiple subcentimeter nodules in the right lobe of the thyroid. Most of them looks sponges. Some of them have nonspecific ultrasound appearance. An index nodule in the upper lobe measures 9 x 6 x 10 mm. LEFT LOBE: There are multiple subcentimeter nodules in the right lobe of the thyroid. Most of them looks sponges. Some of them have nonspecific ultrasound appearance. An index nodule in the upper lobe measures 15 x 6 x 11 mmISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multinodular goiter. Most of the nodules are small and appear benign."}
{"instruction": "Generate impression based on findings.", "input": "History of thyroid nodules, assess for changes. RIGHT LOBE MEASUREMENTS: 4.5 x 1.4 x 1.7 cm.LEFT LOBE MEASUREMENTS: 3.5 x 1.3 x 1.4 cm.ISTHMUS MEASUREMENTS: 0.4 cm.RIGHT LOBE: Normal background parenchymal echotexture. Lower pole partially cystic partially solid nodule without internal vascularity or calcifications measures 1.9 x 1.5 x 1.6 cm, previously 2.1 x 1.7 x 1.7 cm and is of low suspicion for malignancy.LEFT LOBE: Normal background parenchymal echotexture. Upper pole partially cystic nodule without internal vascularity measures 0.6 x 0.3 x 0.4 cm, previously 0.4 x 0.4 x 0.2 cm and remains very low suspicion for malignancy.ISTHMUS: Benign cyst in the isthmus measures 0.9 x 0.8 x 0.9 cm, previously 0.6 x 0.9 x 0.4 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A few benign morphology lymph nodes are noted.OTHER: No significant abnormality noted.", "output": "Right lower pole partially cystic partially solid nodule, low suspicion for malignancy based on ATA guidelines, slightly decreased in size."}
{"instruction": "Generate impression based on findings.", "input": "Female, 57 years old. Acute renal failure RIGHT KIDNEY: The right kidney measures 10.5 cm in length, with increased cortical echogenicity. An upper pole simple cyst measures 1.4 x 1.1 x 1.0 cm, unchanged. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.6 cm in length, with increased cortical echogenicity. An upper pole cyst measures 1.1 x 0.7 x 0.8 cm, unchanged. A lower pole nonobstructing stone measures 0.8 x 0.8 x 0.4 cm, unchanged. No hydronephrosis.OTHER: The bladder is incompletely distended.", "output": "1.Increased renal cortical echogenicity, compatible with medical renal disease. No hydronephrosis.2.Nonobstructing 8 mm left renal stone. Small bilateral renal cysts, unchanged."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male presents with transaminitis. Evaluate for hepatic pathology. LIVER:Liver measures 15.9 cm. There is increased, coarse echogenicity. No focal mass, ascites, or intrahepatic biliary dilation. The portal vein is patent with hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. The common duct measures 0.5 cm.PANCREAS: Evaluation of the pancreas is limited due to overlying bowel gas.SPLEEN: Measures 8.1 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 11.8 cm. Left kidney measures 12.5 cm. Unremarkable echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "1. Increased, coarse echogenicity of liver consistent with chronic liver disease/parenchymal dysfunction. No mass or ascites.2. Surgical changes of prior cholecystectomy."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female with history of thyroid cancer. Evaluate nodule seen in right thyroid bed on prior ultrasound. RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: Redemonstration of two hypoechoic nodules in the right thyroid bed, the larger measuring 0.6 x 0.4 x 0.2, and the smaller measuring 0.5 x 0.3 x 0.2 cm. These do not appear significantly changed compared to prior studies.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 significant interval change in subcentimeter nodules in the right thyroid bed."}
{"instruction": "Generate impression based on findings.", "input": "79-year-old male with history of lung cancer, concern for metastasis. Grayscale and color thyroid ultrasound of the left antecubital soft tissues again demonstrates a heterogeneous hypoechoic mass measuring 3.4 x 2.9 x 2.8 cm along the medial aspect, increased in size compared with the prior study. Additionally, there is an adjacent 1.2 x 1.2 x 1.4 cm hypoechoic nodule immediately inferiorly which has not been seen on prior studies.", "output": "Interval increase in size of left antecubital mass and development of a new adjacent smaller lesion."}
{"instruction": "Generate impression based on findings.", "input": "Reason: graves disease History: high T4, tachycardia RIGHT LOBE MEASUREMENTS: 6.3 x 2.9 x 2.4 cm.LEFT LOBE MEASUREMENTS: 6.1 x 2.9 x 2.5 cm.ISTHMUS MEASUREMENTS: Up to 0.4 cm in thickness.RIGHT LOBE: Heterogeneous parenchymal echotexture and increased vascularity. No discrete nodules.LEFT LOBE: Heterogeneous parenchymal echotexture and increased vascularity. No discrete nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Few nonspecific mildly prominent right cervical lymph nodes, may be reactive.OTHER: No significant abnormality noted.", "output": "Heterogeneous, enlarged thyroid gland with increased vascularity suggestive of thyroiditis."}
{"instruction": "Generate impression based on findings.", "input": "69-year-old male with jaundice, abnormal overlying. Evaluate hepatic and portal vein. LIMITED ABDOMENLIVER: Increased echogenicity of the liver measuring 17.3 cm in length. No focal hepatic lesions.BILIARY TRACT: Normal echogenicity of 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.SPLEEN: Enlarged measuring 16.4 cm in length and is normal echogenicity.RIGHT KIDNEY: Measures 11.8 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Left kidney measures 10.8 cm in length. No hydronephrosis or shadowing calculi are noted. Moderate ascites.", "output": "1. Hepatosplenomegaly with increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. Patent hepatic inflow and outflow vasculature.2. Moderate ascites. "}
{"instruction": "Generate impression based on findings.", "input": "69-year-old with personal history of breast cancer presenting with enlarged right supraclavicular lymph nodes. Ultrasound is requested. Targeted ultrasound is performed for the right supraclavicular region and right neck. There are numerous abnormal enlarged lymph nodes in this region. The largest and most superficial node measures 1.8 x 1.5 cm. Adjacent to the right jugular vein, at least two abnormal morphology are also seen, measuring about 9 mm each.", "output": "Multiple abnormal right supraclavicular and jugular lymph nodes. Surgical consultation is recommended, and the patient will be seeing Dr. Jaskowiak today.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male patient with tertiary hyperparathyroidism status post two parathyroidectomies with persistent HPT. Sestamibi scan shows left inferior uptake. Evaluate for thyroid nodule size and location and parathyroid adenomas. RIGHT LOBE MEASUREMENTS: 4.7 x 3.1 x 3.4 cm.LEFT LOBE MEASUREMENTS: 4.2 x 1.9 x 2.6 cm.ISTHMUS MEASUREMENTS: 7 mm in thickness.RIGHT LOBE: The right thyroid lobe is heterogeneous in echogenicity and contains a 0.8 x 0.6 x 0.6 cm hypoechoic nodule within the left inferior pole.LEFT LOBE: The left thyroid lobe is heterogeneous in echogenicity without dominant thyroid lesion.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: There is a 0.5 x 0.5 x 9 mm hypoechoic nodule inferior to the left inferior pole, which may correlate to a parathyroid adenoma.LYMPH NODES: A right level three lymph node measures 1.4 x 0.7 x 1.1 cm.OTHER: No significant abnormality noted.", "output": "1. No dominant thyroid lesion identified.2. Possible parathyroid adenoma correlate inferior to the left thyroid lobe."}
{"instruction": "Generate impression based on findings.", "input": "2-year-old female patient with history of MEN2A presents for presurgery evaluation. Evaluate for suspicious nodules or lymph nodes. RIGHT LOBE MEASUREMENTS: 0.9 x 0.9 x 2.0 cm.LEFT LOBE MEASUREMENTS: 0.9 x 0.6 x 2.2 cm.ISTHMUS MEASUREMENTS: 0.1 cm.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No definitive parathyroid glands are observed.LYMPH NODES: Multiple enlarged lymph nodes are noted bilaterally. A right level III lymph node measures 0.8 x 0.3 x 1.1 cm. A left level II lymph node measures 0.9 x 0.9 x 1.8 cm.OTHER: No significant abnormality noted.", "output": "Normal-appearing thyroid gland with multiple enlarged bilateral lymph nodes in the neck."}
{"instruction": "Generate impression based on findings.", "input": "Female 55 years old Reason: eval liver morphology, r/o thrombosis History: decompensated cirrhosis vs acute liver failure LIMITED ABDOMENLIVER: Nodular and cirrhotic contour of the liver. No focal masses identified. Liver measures 16.8 cm in length.BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. No evidence of acute gallbladder inflammation. Bile duct is normal measuring 5 mm. Gallstone is present within the gallbladder measuring 2.8 x 2.8 x 2.9 cm.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: Spleen is not well-visualized. KIDNEYS: Kidneys are not well-visualized secondary to body habitus and ascites. Left kidney measures 10.7 cm. Right kidney has normal echogenicity measuring 9.8 cm.OTHER: Mild to moderate ascites", "output": "1.Cirrhotic liver morphology without mass. Portal vein is patent with hepatopetal flow, however the flow is sluggish and the caliber is small, which can be seen when a significant portosystemic shunt is present . Mild/moderate ascites2.Cholelithiasis."}
{"instruction": "Generate impression based on findings.", "input": "Renal transplant with decreased urine output RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: Small perinephric fluid collectionKIDNEY: No worrisome mass or stone. 10.4 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 inflow or outflow compromise.OTHER: No significant abnormality noted", "output": "Unremarkable right iliac fossa renal transplant. Patent vasculature without inflow or outflow compromise."}
{"instruction": "Generate impression based on findings.", "input": "Male 63 years old; Reason: Cirrhosis, eval for HCC History: Cirrhosis LIVER: The liver measures 15.3 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 20.8 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.5 mm. No stones are seen. Redemonstrated gallbladder polyp is visualized measuring 0.6 cm x 0.3 cm x 0.6 cm. No pericholecystic fluid. The common bile duct measures 4.7 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 7.8 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.8 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.5 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. Coarse echogenic liver compatible with history of cirrhosis. No new worrisome masses seen.2. Redemonstration of small gallbladder polyp, stable stable in appearance but slightly larger than prior exam."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old male with known liver mass and abnormal liver function. LIVER: There is again noted a mildly heterogeneous, lobulated and echogenic mass or masses in the right hepatic lobe measuring approximately 7.6 x 10.8 x 10.4 cm, unchanged from prior exam. In the left hepatic lobe there is a similar-appearing 2.1 x 2.6 x 2.1 cm mass not definitely visualized on prior exams. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein. However, main portal vein velocity is low at 9 cm/s which may be related to portal hypertension.GALLBLADDER, BILIARY TRACT: Gallbladder is adequately visualized and contains dependent sludge. There are several small echogenic foci within the sludge which may represent very small gallstones.The wall is mildly thickened but this is nonspecific in the face of ascites. No diffuse biliary tract dilatation. PANCREAS: Not visualized due to bowel gas.RIGHT KIDNEY: Limited without hydronephrosis.OTHER: Mild ascites not seen on prior exams.", "output": "Large right lobe hepatic masses again identified as well as a smaller left lobe mass.Dependent sludge in gallbladder with possible small stones. Gallbladder wall thickening is seen but nonspecific in face of ascites."}
{"instruction": "Generate impression based on findings.", "input": "29-year-old female with abdominal pain. Evaluate for gallstones. LIVER: Normal hepatic echogenicity and morphology. No focal lesions.BILIARY TRACT: No cholelithiasis, gallbladder wall thickening, or pericholecystic fluid. No sonographic Murphy sign. No biliary ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "No cholelithiasis or other findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old male with erythema, pain in left groin. Evaluate for abscess. There is infiltrating fluid and edema of the subcutaneous soft tissues in the left groin compatible with cellulitis. There is a slightly more focal hypoechoic collection measuring 4 mm x 5 mm which could represent a small amount of complex fluid with apparent tract extending to the skin.", "output": "Left groin cellulitis with what may represent a small complex fluid collection with apparent tract extending to the skin. "}
{"instruction": "Generate impression based on findings.", "input": "Male; 52 years old. Reason: please evaluate for malignancy or worsening portal HTN (ascites) History: 52 yo M with Hereditary hemochromatosis associated cirrhosis LIVER: The liver measures 20.0 cm in length. The liver is nodular in contour, the parenchyma is echogenic and very coarsened in echotexture. Within this limitation, no focal lesion is identified.The main portal vein is patent with hepatopetal flow and a peak velocity of 0.27 m/sec.BILIARY TRACT: Status post cholecystectomy. The common duct measures 8 mm in diameter. There is no intrahepatic biliary duct dilatation.PANCREAS: The the body of the pancreas are unremarkable. The pancreatic tail is not well-visualized due to overlying bowel gas.SPLEEN: The spleen measures 15.4 cm in length.KIDNEYS: Right kidney measures 13.2 cm in length. The left kidney measures 13.7 cm in length. A 2.5 x 1.5 x 2.2 cm simple cyst is seen in the upper pole of left kidney. There is no hydronephrosis, shadowing renal stone, or worrisome renal mass identified in either kidney. OTHER: A 3.5 x 3.8 x 5.3 cm lymph node is again seen in the region of the pancreatic head.", "output": "1.Cirrhotic liver morphology. Within this limitation no focal lesion is identified.2.5.3-cm lymph node again seen near the pancreatic head, stable. "}
{"instruction": "Generate impression based on findings.", "input": "Nontoxic multinodular goiter. Colloid nodules noted on prior thyroid biopsy. RIGHT LOBE MEASUREMENTS: 4.4 x 1.6 x 1.4 cmLEFT LOBE MEASUREMENTS: 5.5 x 1.5 x 1.0 cmISTHMUS MEASUREMENTS: 0.3 cm in AP dimensionRIGHT LOBE: Unchanged spongiform nodule measuring 10 x 6 x 8 mm.LEFT LOBE: Unchanged heterogeneous nodule measuring 15 x 10 x 12 mm, without suspicious features.ISTHMUS: Unchanged nodule measuring 10 x 13 x 8 mm, without suspicious features.PARATHYROID GLANDS: Not identified.LYMPH NODES: Benign appearance of the identified cervical lymph nodes.OTHER: No significant abnormality noted.", "output": "Stable thyroid nodules and cervical lymph nodes."}
{"instruction": "Generate impression based on findings.", "input": "Nontoxic multinodular goiter, history of Hashimoto's RIGHT LOBE MEASUREMENTS: 5.2 x 2 x 2.4 cm, mostly unchanged from prior study, heterogenousLEFT LOBE MEASUREMENTS: 5 x 1.8 x 2 cm, mostly unchanged from prior study, heterogenousISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: Heterogenous right lobe nodule predominantly involving the mid portion measures 2.2 x 1.7 x 1.5 cm, unchanged from prior study when it measured 2 x 1.5 x 2.2 cm.LEFT LOBE: Heterogenous left thyroid gland with a small hypoechoic nodule which was not seen on prior study measuring 0.5 x 0.4 x 0.6 cm.ISTHMUS: Heterogenous nodule in the isthmus measures 1.2 x 0.4 x 1.2 cm, mostly unchanged from prior study when it measured 1.1 x 0.4 x 0.8 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Level 1 and level 3 lymph nodes identified in the right lateral aspect of the neck, largest measuring 1 x 0.5 x 1.7 cm, with normal morphology. In the left neck, level 3 lymph node measures 1.4 x 0.3 x 1.3 cm which demonstrates normal morphology.OTHER: No significant abnormality noted.", "output": "1. Heterogenous echotexture of the thyroid gland consistent with known history of Hashimoto's thyroiditis2. Stable right thyroid nodule. A small new subcentimeter left thyroid nodule noted. Follow-up ultrasound can be performed to confirm stability.3. Normal morphology bilateral level 2 and 3 neck lymph nodes noted"}
{"instruction": "Generate impression based on findings.", "input": "Acute acute kidney injury. Limited evaluation due to poor penetration.RIGHT KIDNEY: Right kidney measures 9.8 cm. No suspicious lesion, hydronephrosis or renal calculus identified.LEFT KIDNEY: Left kidney measures 10.1 cm. No suspicious lesion, hydronephrosis or renal calculus identified.URINARY BLADDER: Incompletely distended.OTHER: No significant abnormalities noted.", "output": "Limited evaluation due to poor penetration. However, no worrisome hydronephrosis or renal calculi identified."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with history of elevated creatinine. RIGHT KIDNEY: Measures 11 cm in length. Mild prominence of the right collecting system is not significantly changed compared with prior studies. Increased renal echogenicity without nephrolithiasis or frank hydronephrosis. LEFT KIDNEY: Measures 10.9 cm in length. Increased renal echogenicity without hydronephrosis or nephrolithiasis.OTHER: Mild ascites.", "output": "Increased renal echogenicity consistent with medical renal disease. "}
{"instruction": "Generate impression based on findings.", "input": "Hyperparathyroidism, please evaluate for thyroid nodules, size and location and any abnormal lymph nodesBilateral parathyroid nodules and right upper pole thyroid nodule which is previously not been biopsied needs FNA RIGHT LOBE MEASUREMENTS: 5.4 x 1.4 x 1.7 cm, normal echotextureLEFT LOBE MEASUREMENTS: 4.5 x 1 x 1.5 cm, normal echotextureISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: Within the right lobe upper pole there is a solid hypoechoic nodule with a halo around it that measures 1.2 x 0.7 x 0.7 cm with peripheral blood flow.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Small parathyroid nodules bilaterally, on the right measuring 0.7 x 0.3 x 0.3 cm and on the left measuring 1.4 x 0.3 x 0.4 cm.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. 1.2 cm hypoechoic right upper lobe thyroid nodule which is previously not been FNA, is amenable to FNA.2. Bilateral parathyroid nodules left more than right"}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodule RIGHT LOBE MEASUREMENTS: 4 x 1.3 x 1.6 cmLEFT LOBE MEASUREMENTS: No significant abnormality noted.ISTHMUS MEASUREMENTS: No significant abnormality noted.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 significant abnormality noted.OTHER: No significant abnormality noted.", "output": "US THYROID, 4/6/2015 9:03 AMCLINICAL INFORMATION:Thyroid noduleCOMPARISON: 7/12/2013 TECHNIQUE: Thyroid ultrasoundFINDINGS:RIGHT LOBE MEASUREMENTS: 4 x 1.3 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.4 x 1.4 x 1.1 cmISTHMUS MEASUREMENTS: Zero .1 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Little significant change in the dominant solid left thyroid nodule now measuring 1.6 x 0.8 x 1 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted."}
{"instruction": "Generate impression based on findings.", "input": "Reason: please eval retroperitoneal and abdominal fluid History: decreasing hgb LIVER: Coarse hepatic parenchymal echotexture and echogenicity, consistent with hepatic steatosis. No biliary ductal dilatation.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.RIGHT KIDNEY: Mildly echogenic renal parenchyma. There is no hydronephrosis.OTHER: The left kidney is not visualized due to overlying bowel gas. The spleen appears unremarkable.Extremely limited exam due to suboptimal patient positioning and overlying material external to the patient. There is trace perihepatic ascites. Large left pleural effusion.", "output": "1. Extremely limited exam. Trace ascites. No definite retroperitoneal hematoma.2. Large left pleural effusion.3. Echogenic hepatic parenchyma, consistent with hepatic steatosis.3. Echogenic right renal parenchyma, consistent with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "90-year-old male with acute kidney failure and urinary tract infection. Evaluate for anatomic abnormalities, hydronephrosis, urinary retention. RIGHT KIDNEY: The right kidney measures approximately 9.5 cm in length. There is a complex cyst arising from the upper pole with a single thin to moderate septation. This was present on the prior study but is slightly larger, measuring 3.1 x 3.4 x 3.1 cm on today's exam. No obvious solid component. 2 other smaller cortical cysts are identified.Echotexture likely slightly increased. No hydronephrosis or shadowing calculus.LEFT KIDNEY: Left kidney is difficult to visualize due to positioning and a large lobulated cyst. The major component of this measures 7.3 x 9.8 x 9.9 cm, significantly increased in size when compared to the prior exam. This may also have a septation or adjacent smaller cyst. Limited visualization of the left kidney demonstrates no gross hydronephrosis.OTHER: Urinary bladder is collapsed with Foley catheter.", "output": "Limited exam with mild increase in renal echogenicity. Bilateral cysts with complex cyst upper pole right kidney and very large exophytic cyst arising from the left kidney."}
{"instruction": "Generate impression based on findings.", "input": "Female 53 years old Reason: Post prandial epigastric pain, exclude pancreaticobiliary process History: Post prandial epigastric pain, exclude pancreaticobiliary process LIVER: The liver measures 16.7 cm in length. The liver is homogeneously mildly echogenic consistent with fatty infiltration. No focal hepatic masses. Main portal vein is patent and has a peak velocity of 26.1 cm/s.BILIARY TRACT: Patient status post cholecystectomy. No intra or extra hepatic biliary ductal dilatation. The common bile duct measures 4.9 mm, within normal limits.PANCREAS: The tail of the pancreas is obscured by overlying bowel gas. The head of the pancreas is normal in appearance.SPLEEN: The spleen measures 11.5 cm and is normal in echogenicity.RIGHT KIDNEY: The right kidney measures 12.5 cm and has normal echogenicity. No hydronephrosis. No shadowing calculi. No mass.LEFT KIDNEY: The left kidney measures 12.7 cm and has normal echogenicity. No hydronephrosis. No shadowing calculi. No mass.OTHER: No significant abnormalities noted.", "output": "1.No intra or extrahepatic biliary ductal dilatation. Head of the pancreas is within normal limits.2.Fatty infiltration of the liver."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are:Right breast ultrasound with postprocedure mammogram dated 9/28/16 performed at Lynn Sage breast CenterBilateral screening mammogram dated 2/29/2016 with tomo synthesis is available for comparison. Also available are prior mammograms dated 3/11/2015 and 3/10/2014 and 2/18/2013. Right breast ultrasound with postprocedure mammogram dated 9/28/16: Patient presented with a new palpable mass in the right breast.Ultrasound evaluation demonstrated 2 adjacent contiguous masses in the right outer breast for which ultrasound-guided biopsy was recommended.8 mm mass and the adjacent lobulated 17 mm mass at the 9:30 o'clock position of the right breast were targeted under ultrasound. A twirl clip was deployed at the biopsy site. Postprocedure mammogram demonstrates the clip at the site of the mass in the right outer breast.Pathology report revealed right breast 18 mm mass 9:30 o'clock position 3 cm from the nipple, IDC grade 3, largest tumor fragment measures 0.7 cm, microcalcifications overlying blood vessels. This is concordant.As per the report right unilateral diagnostic mammogram with ultrasound was performed on 9/28/2016 before performing the biopsy which have not been submitted.", "output": "Biopsy-proven multifocal cancer in the right breast 9:30 o'clock position. Given the dense breast, breast MRI is recommended for staging.Right unilateral diagnostic mammogram and ultrasound performed before biopsy should be submitted for review.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Precardiac transplant LIVER:Mildly heterogeneous liver echotexture without mass. Liver length 14.4 cmGALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatationPANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. 10.6 cm in lengthKIDNEYS: No significant abnormality noted. Right kidney 11.5 cm in length; left kidney 10.8 cm in lengthABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted. No ascites", "output": "Mildly heterogeneous liver echotexture suggestive for chronic liver disease without mass or ductal dilatation. Gallbladder sludge without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Polycystic disease RIGHT KIDNEY: Numerous cysts of varying sizes. No worrisome complexity within a cyst appreciated. The largest cyst measures 7.6 x 9.8 x 6.8 cm. No worrisome mass, stone, or hydronephrosis. Right kidney 24.3 cm in lengthLEFT KIDNEY: Numerous cysts of varying sizes. No worrisome complexity within the cyst appreciated. The largest cyst measures 7.6 x 4.7 x 6.6 cm. No worrisome mass or hydronephrosis. Possible subcentimeter nonobstructing left renal calculi. Left kidney 24.1 cm in length.OTHER: Bladder nondistended.", "output": "Numerous bilateral renal cysts consistent with known polycystic disease. No worrisome cyst complexity or mass. Possible subcentimeter nonobstructing left renal calculi. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Female, 77 years old. Left renal mass seen on CT RIGHT KIDNEY: The right kidney measures 8.4 cm in length, with increased cortical echogenicity. A mid to upper pole simple cyst measures 1.0 x 1.2 x 1.2 cm. No hydronephrosis.LEFT KIDNEY: The left kidney measures 12.1 cm in length, with normal echotexture. A 2.2 x 2.3 x 1.9 cm lower pole hypoechoic structure appear cystic. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1. The structure seen in the left lower renal pole on recent CT imaging corresponds with a simple cyst.2. Increased renal cortical echogenicity suggests medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female with history of ulcerative colitis, new onset pruritis, elevated alkaline phosphatase. LIVER: The liver measures 16 cm in length. Patchy increased hepatic echogenicity without discrete focal lesion or intrahepatic biliary ductal dilation.BILIARY TRACT: No cholelithiasis or evidence of cholecystitis. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "1. Patchy increased hepatic echogenicity consistent with hepatic steatosis.2. No superimposed focal hepatic lesion or biliary ductal dilation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male with primary hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 5.6 x 2 x 2.2 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.9 x 1.7 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Homogeneous without evidence for mass.LEFT LOBE: Homogeneous without evidence for mass.ISTHMUS: Homogeneous without evidence for mass.PARATHYROID GLANDS: No extrathyroidal masses are identified.LYMPH NODES: No abnormal lymph nodes are identified.OTHER: No significant abnormality noted.", "output": "Normal exam without evidence for parathyroid adenoma."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male patient with advanced heart failure secondary to ICM, thrombocytopenia. Also with history of ulcerative colitis. Evaluation for heart transplant and exploration of thrombocytopenia. LIVER:The liver measures 17.6 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/s.GALLBLADDER, BILIARY TRACT: No gallstones, gallbladder wall thickening, or pericholecystic fluid is identified. The common duct measures 4 mm in diameter.PANCREAS: The pancreas is poorly visualized examination.SPLEEN: The spleen measures 12.3 cm in length.KIDNEYS: The right kidney measures 9.9 cm and the left kidney measures 10.7 cm in length. No evidence of hydronephrosis. ABDOMINAL AORTA: The proximal abdominal aorta measures 1.8 x 1.7 cm and the distal aorta measures 1.7 x 1.5 cm. The midportion of the abdominal aorta is obscured by overlying bowel gas.INFERIOR VENA CAVA: The IVC is patent.OTHER: No significant abnormality noted.", "output": "1. No acute sonographic abnormality within the abdomen.2. Poor visualization of the mid-abdominal aorta."}
{"instruction": "Generate impression based on findings.", "input": "Female 33 years old follow-up right renal mass (1.3 cm), stable on MRI. RIGHT KIDNEY: The right kidney measures 10.5 cm in length. There is a 1.6 x 1.6 x 1.4 cm hypoechoic lesion in the midpole of the right kidney with low-level internal echoes and no vascularity. The superior pole of the right kidney appears heterogeneous which may be due to a prominent medullary pyramid. No lesion was present at this location on the prior MRI. No shadowing renal stone hydronephrosis.LEFT KIDNEY: The left kidney measures 11.4 cm in length. There is no suspicious renal mass, shadowing renal stone or hydronephrosis.OTHER: The bladder was mildly distended and unremarkable in appearance.A 2.4 x 1.5 x 1.9 cm well marginated hyperechoic subcapsular hepatic segment 7 lesion which correlates with a hemangioma seen on the previous MRI.", "output": "1. Right midpole renal lesion is likely unchanged in size from the prior MRI after allowing for differences in technique.2. The superior pole of the right kidney appears heterogeneous which is nonspecific and may be due to a prominent medullary pyramid. No lesion was present at this location on the prior MRI. "}
{"instruction": "Generate impression based on findings.", "input": "60-year-old male with history of renal transplant presents with AKI. RENAL TRANSPLANT: Measures approximately 11.9 cm. There is a heterogenous echotexture of the parenchyma with poor corticomedullary differentiation.LOCATION: Left iliac fossa.PERITRANSPLANT TISSUES: Small amount of perinephric fluid measuring approximately 5.8 x 1.4 x 1.9 cm.COLLECTING SYSTEM/URETER: No significant abnormality notedURINARY BLADDER: The bladder is nondistended.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels The left renal artery anastomosis area has a peak systolic flow of 93.2 cm/s and resistive index of 0.84.The mid renal artery had a peak systolic flow 102 cm/s and a resistive index of 0.88.The hilum had a peak systolic flow of 65 cm/s with a resistive index of 0.94.The mid segmental artery had a peak systolic flow 110 cm/s the resistive index of 1.0The mid arcuate artery has a peak systolic flow 35 cm/s resistive index of 1.0.The renal vein is patent without evidence of thrombus.OTHER: No significant abnormality noted", "output": "1. Heterogenous echotexture parenchyma and increased resistive indices of the arcuate and segmental arteries most consistent with parenchymal dysfunction. Consider acute tubular necrosis or rejection. Renal vein thrombosis less likely given the renal vein is patent.Findings were discussed with Dr. Wright @ 2250 on 08/21/16 by the on call radiology resident."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female post resection of mediastinal thyroid and left lobe, with papillary thyroid microcarcinoma. RIGHT LOBE MEASUREMENTS: 4.6 x 1.7 x 1.7 cm. No change in 5 mm cyst.LEFT LOBE MEASUREMENTS: Post thyroidectomy. ISTHMUS MEASUREMENTS: Not measurable on today's examRIGHT LOBE: No change in 5 mm cyst.LEFT LOBE: No massesISTHMUS: Not visible on today's study.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is again noted an enlarged subclavicular lymph node on the left measuring 1 x 1.4 by 2 cm, not significantly changed.OTHER: No significant abnormality noted.", "output": "Stable examination with resolution of thickened isthmus. Stable left subclavicular lymph node."}
{"instruction": "Generate impression based on findings.", "input": "Pulsatile nodule in the right thyroid, needs follow-up RIGHT LOBE MEASUREMENTS: 3.7 x 1.2 x 1.5 cm heterogenous echotexture, atrophicLEFT LOBE MEASUREMENTS: 4.3 x 1.2 x 1.1 cm, heterogenous echotexture, atrophicISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: Right mid pole there is a heterogenous hypoechoic nodule that measures 0.6 x 0.3 x 0.5 cm, unchanged from prior examination.LEFT LOBE: Heterogenous and atrophic glandISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Stable right mid thyroid lobe subcentimeter nodule2. Atrophic and heterogenous thyroid gland seen in the setting of thyroiditis."}
{"instruction": "Generate impression based on findings.", "input": "42-year-old female with history of follicular thyroid cancer post thyroidectomy. RIGHT LOBE MEASUREMENTS: AppendectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: Previously noted nodular density in the right bed no longer identified.LEFT LOBE: Small hypoechoic nodular density in the left bed is again identified measuring 0.2 x 0.3 x 0.5 cm, unchanged in size. This may contain a single calcification. Cranial to this there is a 0.3 x 0.4 x 0.5 cm hypoechoic nodule with dense calcification. There is a suggestion that this was present on the prior exam although incompletely visualized.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing lymph nodes on the right. There is again noted at level 3 on the left a 0.4 x 0.7 x 0.5 cm node with dense calcification which is unchanged in size and appearance when compared to prior exam.OTHER: No significant abnormality noted.", "output": "1. No change in small hypoechoic left bed nodule. Right bed nodule not identified.2. Left bed nodule with calcification, which may have been present on prior exam.3. Stable left neck lymph node with calcification."}
{"instruction": "Generate impression based on findings.", "input": "Viral hepatitis C and right renal cyst LIVER: Mildly coarse liver echotexture without worrisome mass. Liver length 14.9 cm. Benign-appearing right lobe hepatic cyst unchanged.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Stable minimally complex right renal cyst measuring 2.6 x 3 x 2.7 cm. Right kidney 12.8 cm in length.OTHER: Left kidney 11.7 cm in length. Spleen 8.7 cm in length. No ascites.", "output": "Mildly coarse liver echotexture suggestive for chronic liver disease without worrisome mass or ductal dilatation. No ascites. Stable minimally complex right renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Evaluate for biliary pathology History: epigastric pain LIVER: Mild hepatomegaly with coarse echotexture. The liver measures 19 cm in length. The portal vein is patent. Normal hepatopedal portal venous blood flow, 21.6 cm/s.GALLBLADDER, BILIARY TRACT: Layering intraluminal sludge in the dependent portion of the gallbladder. No pericholecystic fluid, stones, or biliary ductal dilation. The gallbladder wall measures 2 mm. The common hepatic duct measures 4 mm.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 12.0 cm.LEFT KIDNEY: The left kidney measures 11.2 cm. 3.0 x 3.9 cm x 3.7 anechoic cyst in the inferior pole of the left kidney.SPLEEN: The spleen measures 9.0 cm.OTHER: Small left pleural effusion.", "output": "Mild hepatomegaly and gallbladder sludge without other acute biliary pathology."}
{"instruction": "Generate impression based on findings.", "input": "Pyelonephritis. UTI. RIGHT KIDNEY: 9.4 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis. No perinephric fluid collections.LEFT KIDNEY: 10.5 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis. No perinephric fluid collections.BLADDER: Debris is noted within the bladderOTHER: No significant abnormality noted.", "output": "No sonographic evidence of pyelonephritis or renal abscess. Nonspecific debris or clot noted within the bladder, correlation with patient's clinical history/urinalysis recommended."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female with history of left breast DCIS status post lumpectomy, followed by radiation and tamoxifen presents for six-month follow-up of probably benign right breast mass. A targeted right ultrasound was performed for the previously described area of concern.In the right breast, 5:00, 8 cm from the nipple, there is a 1.1 x 0.5 x 1.1 cm oval circumscribed hypoechoic mass, previously 1 x 0.5 x 1 cm. This mass demonstrates no internal vascularity.", "output": "No significant interval change in a right breast mass at the 5:00 position, which is probably benign given morphology and stability over time. Six-month follow-up right breast ultrasound is recommended to evaluate for stability. Patient will be due for bilateral mammogram at that time.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "67 years old, Female, Reason: Eval for cirrhotic morphology of liver History: Low VItamin K LIVER: The liver measures 14.4 cm in length. The liver is echogenic consistent with a fatty infiltration. Multiple focal hepatic lesions are indeterminate on this ultrasound exam. Largest hypoechoic lesion in the right hepatic lobe measures 1.2 x 1.1 x 0.9cm. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.3 m/s.BILIARY TRACT: The gallbladder is nondistended. 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: The spleen is not well-visualized on this exam.RIGHT KIDNEY: Kidney measures 9.0 cm in length. Normal echotexture. No hydronephrosis. Shadowing catheter was present within the right kidney.LEFT KIDNEY: Kidney measures 9.0 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1. The liver is echogenic consistent with fatty infiltration.2. No nodularity to suggest cirrhosis.3. Multiple hypoechoic lesions within the liver which are indeterminate on this exam. Dedicated liver follow-up imaging is recommended.Findings discussed with Dr. Minic at time of dictation."}
{"instruction": "Generate impression based on findings.", "input": "Obstruction of bile duct, malignant neoplasm of the pancreas. Evaluate for jaundice On call after hours exam performed.LIVER: The liver measures 16.1 cm in length. No focal liver lesions. Presumed pneumobilia is noted making evaluation of the intrahepatic bile ducts somewhat limited. These appear to be mildly dilated. Portal vein is patent with flow towards the liver on color Doppler imaging.GALLBLADDER, BILIARY TRACT: Gallbladder sludge and wall thickening. Patient did not have a sonographic Murphy sign. The common duct measured 5 mm in diameter; metal stent noted.PANCREAS: There is a mass in head of the pancreas measuring approximately 3.8 cm in diameter. Pancreatic duct appears dilated Correlation with cross-sectional imaging is advised.RIGHT KIDNEY: No hydronephrosis of either kidney.OTHER: Right pleural effusion.", "output": "Pancreatic mass with mild intrahepatic and pancreatic ductal dilatation. Correlation with CT or MRI is advised. Right pleural effusion. Gallbladder sludge."}
{"instruction": "Generate impression based on findings.", "input": "32 year-old female with hyperthyroidism. RIGHT LOBE MEASUREMENTS: 3.2-cm x 6.4 cm x 2.5 cmLEFT LOBE MEASUREMENTS: 2.9 cm x 5.8 cm x 2.5 cmISTHMUS MEASUREMENTS: 1.0-cm in thickness.RIGHT LOBE: Markedly heterogeneous in echotexture and hypervascular. No discrete nodules are identified. LEFT LOBE: Markedly heterogeneous in echotexture and hypervascular. No discrete nodules are identified.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Multiple bilateral benign-appearing lymph nodes likely reactive.OTHER: No significant abnormality noted.", "output": "Enlarged, heterogeneous and hypervascular thyroid gland, appearance consistent with thyroiditis. Multiple likely reactive lymph nodes in the neck."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old male with a history of scrotal pain. RIGHT TESTIS: The right testis is normal in morphology, echogenicity, and size, measuring 3.2 x 2.4 x 4.6 cm. Spectral Doppler evaluation demonstrates arterial blood flow. There is a small 2 mm cyst.LEFT TESTIS: The left testis is normal in morphology, echogenicity and size measuring 3.2 x 2.0 x 4.8 cm. Spectral Doppler demonstrates arterial blood flow.RIGHT EPIDIDYMIS: Normal in size and appearance and contains a 2.2-cm head cyst. 4-mm epididymal body cyst. 1.5-cm epididymal tail cyst. Coarse calcification adjacent to the epididymal tail.LEFT EPIDIDYMIS: Normal in morphology, echogenicity, and size without hypervascularity.OTHER: Bilateral varicoceles and small hydroceles.", "output": "Bilateral varicoceles and small hydroceles. No acute epididymal or testicular abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Neck discomfort RIGHT LOBE MEASUREMENTS: 6.1 x 2.3 x 3.4 cmLEFT LOBE MEASUREMENTS: 5 x 2.3 x 2.5 cmISTHMUS MEASUREMENTS: 1.7 cmRIGHT LOBE: Diffusely heterogeneous and enlarged right thyroid gland with increased vascularity. No convincing discrete nodule could be appreciated.LEFT LOBE: Diffusely heterogeneous enlarged left thyroid gland with increased vascularity. No convincing discrete nodule could be appreciatedISTHMUS: Diffusely heterogeneous enlarged isthmus with increased vascularity without convincing discrete nodulePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous enlarged thyroid gland with increased vascularity. Findings suggestive for thyroiditis or Graves. No convincing discrete nodule. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "The patient submitted outside mammogram dated 12/18/12, 12/14/11. Submitted outside study was compared to the current mammogram dated 2/16/15. A 1.0 cm mass in the left upper outer breast is new when compared to the prior studies. Recommend ultrasound guided needle biopsy for this mass.", "output": "A 1.0 cm mass in the left upper outer breast is new when compared to the prior studies. Recommend ultrasound guided needle biopsy for this mass.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "30 years Female with left flank pain and dysuria, evaluate for pyelonephritis. RIGHT KIDNEY: Kidney measures 13.4 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 14 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.BLADDER: No significant abnormalities. OTHER: No significant abnormalities.", "output": "Normal examination. "}
{"instruction": "Generate impression based on findings.", "input": "44-year-old female with thyroid enlargement. RIGHT LOBE MEASUREMENTS: 5.9 x 1.6 x 2.1 cmLEFT LOBE MEASUREMENTS: 5.4 x 1.6 x 2 cmISTHMUS MEASUREMENTS: No significant abnormality noted.RIGHT LOBE: In the inferior right lobe of the thyroid there is a complex nodule with small cystic spaces measuring 1.3 x 0.7 x 0.9 cm most suggestive of colloid nodule.LEFT LOBE: In the inferior left lobe of the thyroid there is a complex nodule with small cystic spaces measuring 0.6 x 0.4 x 0.7 cm most suggestive of colloid noduleISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Small, bilateral thyroid nodules likely colloid nodules."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain with history of chronic viral hepatitis and hepatocellular carcinoma LIVER: Coarse echogenic liver echotexture again noted. Known hepatic mass lesion not well demonstrated on ultrasound. Porta hepatis infiltrative tumor and adenopathy again noted. Thrombosed undivided left portal vein again noted. Liver length 18.8 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.4 cm in lengthOTHER: Left kidney 11.6 cm in length. Spleen 14 cm in length. No ascites", "output": "Coarse echogenic liver parenchyma again noted consistent with chronic liver disease. Known hepatic mass lesion is not well appreciated on today's ultrasound. Porta hepatis infiltrative tumor and adenopathy unchanged. Thrombosed undivided left portal vein again noted. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 64 years old; Reason: history of thyroid nodules, please evaluate for interval changes History: none RIGHT LOBE MEASUREMENTS: 5.0 x 1.7 x 1.8 cm.LEFT LOBE MEASUREMENTS: 4.6 x 1.2 x 1.4 cm.ISTHMUS MEASUREMENT: 0.5 cm.RIGHT LOBE: Again seen is a hypoechoic nodule in the right lobe of the thyroid measuring approximately 0.9 x 0.4 x 0.4 and it appears unchanged from the prior study. No significant vascularity or microcalcifications. Additionally, there is a 0.5 cm cyst that appears similar to the prior study.LEFT LOBE: Mildly heterogenous without discrete nodule.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted. OTHER: No significant abnormality noted.", "output": "1.Grossly stable right thyroid nodule and cyst."}
{"instruction": "Generate impression based on findings.", "input": "Targeted ultrasound of the right upper breast at 1:00 and 11:00 is requested by the clinical service. Personal history of known right breast cancer. A targeted right ultrasound was performed for the areas requested at 1:00 and 11:00. Multiple masses are seen in the right upper breast. Two adjacent masses in the right breast near the 1:00 position measure 9 x 7 and 9 x 8 mm. Overall extent of these 2 masses near 1:00 is 2.4 cm, a slightly larger extent than can be measured on the prior study. An additional possible superficially located mass near the right 1:00 scar measures 7 mm. Additionally, an area of hypodensity and shadowing near the right breast 11:00 scarring is nonspecific, though similar to the prior study.", "output": "Multiple right upper breast masses as described above compatible with known malignancy. Treatment recommendations have been made by the breast surgery team.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Female 54 years old Reason: evaluate for left buttock abscess History: left buttock pain, lesion, swelling There is diffuse edema of the subcutaneous fat and thickening of the skin in the region of the left buttock lesion where it's tender. No evidence of abscess.", "output": "Ultrasound findings compatible with cellulitis without evidence of abscess."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old male with HBV, NASH, evaluate for HCC. LIVER: Measures 16.2 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: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease, without discrete focal lesion. "}
{"instruction": "Generate impression based on findings.", "input": "Male, 79 years old. Elevated creatinine RIGHT KIDNEY: The right kidney measures 11.7 cm in length, with increased cortical echogenicity. An upper pole exophytic simple cyst measures 2.1 x 1.9 x 1.9 cm. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 12.8 cm in length, with increased cortical echogenicity. An exophytic lower pole simple cyst measures 3.4 x 2.6 x 3.4 cm. No shadowing stones or hydronephrosis.OTHER: The bladder is incompletely distended.", "output": "1.Increased renal cortical echogenicity compatible with medical renal disease.2.Bilateral renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "71-year-old male with biopsy demonstrating \"suspicious for follicular neoplasm\" in the right lobe of the thyroid. Evaluate thyroid preoperatively. RIGHT LOBE MEASUREMENTS: 2.3 x 2.5 x 4.7 cmLEFT LOBE MEASUREMENTS: 1.5 x 1.8 x 5.5 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Within the right lobe of the thyroid posteriorly there is an unusually shaped and well-demarcated heterogeneous but hypoechoic mass with several small bright reflectors which could represent calcification. It is difficult to determine whether this is predominantly intra or extra thyroidal, and the mass corresponds to the outside biopsy.LEFT LOBE: No significant abnormality noted.ISTHMUS: In the left isthmus there is dense, shadowing calcification. No obvious mass although a mass posterior to the shadowing can't be excluded.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Mass involving the right lobe of the thyroid although this could be arising from an extrathyroidal location.Dense calcification without obvious mass involving the left isthmus.No mass identified within the left lobe and no adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old female with right breast cancer. Evaluate right axilla. A targeted right ultrasound was performed of the right axilla. Few short axis subcentimeter lymph nodes are present, with normal morphology. No suspicious lymph node or mass identified.", "output": "No abnormal lymph node or mass identified within the right axilla. Known right breast cancer not evaluated. BIRADS: 1 - Negative.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "70 year-old male with acute kidney injury and possible urinary tract infection. RIGHT KIDNEY: The right kidney measures 12.6 cm in length. There is moderate hydronephrosis and moderate proximal hydroureter. The middle and distal ureter is not visualized. No shadowing calculus or focal renal lesion is evident. Color Doppler demonstrates hilar blood flow.LEFT KIDNEY: The left kidney measures 11.8 cm in length without hydronephrosis, shadowing calculus or discrete lesion. Color Doppler demonstrates hilar blood flow.URINARY BLADDER: The urinary bladder is partially distended with anechoic urine. Ureteral jetsOTHER: No significant abnormalities noted.", "output": "Moderate right hydroureteronephrosis of uncertain chronicity and etiology.Findings were relayed to primary service (Anderson @ pager 6918) at 1415 on 01/07/2015."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male patient with right upper quadrant pain, hepatic dysfunction, and hepatitis C. Altered mental status, LFT abnormalities. LIVER: The liver measures 20.5 cm in length and demonstrates increased hepatic parenchymal echogenicity. There are regions of relatively well-demarcated hypoechogenicity within the right hepatic lobe. The largest measures approximately 5.7 x 3.7 cm. Additional smaller ill-defined areas are noted. Main portal vein flow is hepatopetal and measures 0.6 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder wall is diffusely thickened with obliteration of the lumen. No shadowing gallstone is identified. Sonographic Murphy's sign is negative. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 8 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 9.7 cm in length. No evidence of hydronephrosis.The spleen measures 11.6 cm in length.There is mild ascites.", "output": "1. Increased hepatic parenchymal echogenicity consistent with hepatic steatosis with regions of hypoechogenicity which may represent focal fatty sparing, however, are incompletely evaluated on this examination. MRI is recommended for further evaluation.2. Diffusely thickened gallbladder wall of uncertain etiology; MRI is recommended for further evaluation. 3. Mild ascites. "}
{"instruction": "Generate impression based on findings.", "input": "51-year-old female complains of recurrent abdominal pain. Evaluate biliary system. LIVER:The liver measures 15.3 cm. Mildly increased echogenicity of the parenchyma. No focal masses, intrahepatic biliary dilation, or ascites. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is absent. The common bile duct measures 6.7 mm.PANCREAS: Evaluation the pancreas limited due to overlying bowel gas.SPLEEN: Measures 9.3 cm without sonographic abnormalities.KIDNEYS: Right kidney measures 10.7 cm. Left kidney measures 11.4 cm. Normal echogenicity. No shadowing calculi, hydronephrosis, or focal masses. OTHER: No significant abnormality noted.", "output": "1. Mildly increased echotexture of liver consistent with chronic liver disease/parenchymal dysfunction.2. Surgical changes of a prior cholecystectomy."}
{"instruction": "Generate impression based on findings.", "input": "45 years old, Female, Reason: eval for medical renal disease History: rising Cr, hematuria, protenuria RIGHT KIDNEY: Kidney measures 12.1 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. Mild pelvicaliectasis is present.LEFT KIDNEY: Kidney measures 11.2 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. No hydronephrosis, shadowing calculus or mass.BLADDER: The bladder is incompletely distended. OTHER: Note is made of a mildly increased echogenicity to the liver which is consistent with fatty infiltration.", "output": "1.Increased echogenicity of the kidneys consistent with medical renal disease. 2.Mild pelvicaliectasis on the right.3.Increased echogenicity of the liver is consistent with fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "49 year-old male with transaminase elevation and history of alcohol abuse. Evaluate for biliary distention or liver abnormality. LIVER: Increased echogenicity of the liver, suggestive of hepatic steatosis. The portal vein flow is hepatopetal. The liver contour is smooth.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. The common duct measures 4 mm in diameter. No gallstones or common duct stones are seen.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Increased echogenicity of the liver, suggestive of hepatic steatosis/parenchymal dysfunction. Otherwise, unremarkable ultrasound examination of the right upper quadrant."}
{"instruction": "Generate impression based on findings.", "input": "57 year-old female with a history of gradual increase in abdominal appearance. Rule out ascites. LIVER: Mild hepatomegaly. Increased echogenicity if the liver is nonspecific but can be seen in hepatic steatosis. The liver measures 17.4 cm in length. The liver contour is smooth. Portal vein flow is hepatopetal.BILIARY TRACT: Note is made of a 1.4 cm dependent gallstone in the body of the gallbladder without evidence of acute cholecystitis.PANCREAS: The pancreas is partially obscured by overlying bowel gas.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: Note is made of a 4.9 x 4.8 x 4.2 cm cyst in the superior pole of the left kidney, with associated septation and peripheral nodularity. There is no internal vascularity.OTHER: No significant abnormalities noted.", "output": "1. No evidence of ascites, as clinically questioned.2. Complex cyst in the left kidney with peripheral nodularity and septation. Further evaluation with a dedicated renal CT protocol is recommended.3. Mild hepatomegaly. Increased echogenicity if the liver is nonspecific but can be seen in hepatic steatosis. 4. Gallstones without evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Female 50 years old Reason: eval for causes of abdominal pain including pancreatitis History: lipase elev, abd pain LIVER: Intrahepatic biliary ductal dilatation is present. The liver has normal echogenicity. There is a large simple appearing central cyst measuring 3.7 x 3.7 x 3.5 cm, not significant changed in size. Liver measures 19.3 cm. Main portal vein is patent with a peak velocity of 19.1 cm/s.BILIARY TRACT: Patient is status post cholecystectomy. The common bile duct is 4 mm. Intrahepatic biliary ductal dilatation. No choledocholithiasis is identified.PANCREAS: Small cyst in the head of the pancreas measuring 0.7 x 0.9 x 0.8 cm is not significant changed. There is a new cyst is identified in the tail the pancreas measuring 1.7 x 2.6 x 1.7 cm.SPLEEN: The spleen measures 9.9 cm and is normal in echogenicity.KIDNEYS: Right kidney measures 10.9 cm. Small hyperechoic lesion measuring 0.5 x 0.5 x 0.5 cm likely representing an angiomyolipoma in the right kidney. Right exophytic renal cyst is not significant change in size measuring 1.2 x 1.0 x 1.1 cm. No hydronephrosis or shadowing calculi bilaterally.Left kidney measures 10.6 cm. No hydronephrosis, shadowing calculi, or mass.OTHER: Trace ascites.", "output": "1.Unchanged liver cysts and intrahepatic biliary duct dilatation.2.Multiple cysts in the pancreas, one of which is new from the prior study. Recommend CT which would further characterize the cysts in the pancreas as well as more likely characterize the renal lesions.3.Renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "Reason: On CT of neck/chest, 1.9cm lesion just inferior to midline of thyroid History: Above RIGHT LOBE MEASUREMENTS: 4.1 x 1.3 x 1.8 cm.LEFT LOBE MEASUREMENTS: 4.4 x 1.0 x 1.4 cm.ISTHMUS MEASUREMENTS: 0.5 cm.RIGHT LOBE: Heterogeneous thyroid echotexture without discrete nodules or masses.LEFT LOBE: Heterogeneous thyroid echotexture without discrete nodules or masses.ISTHMUS: Heterogeneous thyroid echotexture without discrete nodules or masses.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No cervical adenopathy.OTHER: 1.9 cm lesion inferior to the thyroid seen on CT is not visualized on this ultrasound examination.", "output": "Heterogeneous thyroid echotexture. 1.9 cm lesion inferior to the thyroid seen on CT is not visualized on this ultrasound examination."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old who presents for stability assessment of the left breast cyst. A targeted left ultrasound was performed for the area of concern. The previously identified cysts in the left breast 12:00 position are again seen. The smaller of these is located 3 cm from the nipple and measures 3 x 3 mm. The larger of these is located 2 cm from the nipple and measures 9 x 8 mm. There is no solid mass identified.", "output": "No sonographic evidence for malignancy. Left breast cysts. Based on the patient's mammographic density, she would qualify for automated whole breast ultrasound if clinically desired. Annual screening mammography is due in March 2016. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Left breast mass consistent with fibroadenoma on ultrasound December 2015. Follow-up. A targeted left ultrasound was performed for the patient\u2019s area of concern. A circumscribed, hypoechoic, oval mass is identified within the left breast at 6:00 location, 2 cm from the nipple, and measures 2.4 x 1.8 x 1.8 cm, not significantly changed. There is no internal vascularity or posterior shadowing.", "output": "No significant change in the circumscribed mass in the left breast, which is probably a fibroadenoma. The patient will see Dr. Jaskowiak for clinical follow up today.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Elevated INR, evaluate for cirrhosis. LIVER: The liver is enlarged and measures 20.2 cm in length. The liver parenchymal echotexture is coarse. 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. The sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 4 mm in diameterPANCREAS: Poorly visualized due to overlying bowel gas.SPLEEN: The spleen measures 14.6 cm in length and is heterogeneous in echotexture. Peripheral areas of low attenuation on the 11/17/2015 CT are nonspecific but raise the possibility of splenic infarcts.RIGHT KIDNEY: Kidney measures 13.8 cm in length. Normal echotexture. No hydronephrosis or mass. Two simple cysts are present in the right kidney the largest of which measures up to 3.9 cm.LEFT KIDNEY: Kidney measures 14.0 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: Bilateral pleural effusions.", "output": "1.Hepatomegaly and coarsened hepatic echotexture suggesting liver disease without specific morphologic features of cirrhosis.2.Heterogeneous splenic echotexture nonspecific but raising possibility of splenic infarcts.3.Bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Suprapubic pain for one year ABDOMINAL WALL: No significant abnormalities are noted. No hernia is seen. No intra-abdominal fluid is seen.BLADDER: The bladder is visualized without abnormality. The prostate appears enlarged.", "output": "Negative bladder and suprapubic ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old male with history of right upper quadrant pain. LIVER: Increased hepatic echogenicity without discrete focal lesion.GALLBLADDER, BILIARY TRACT: Cholelithiasis without gallbladder wall thickening, pericholecystic fluid, or sonographic Murphy sign. No biliary ductal dilation.PANCREAS: Pancreas is obscured by bowel gas and not clearly visualized.KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "1.Cholelithiasis without specific evidence of acute cholecystitis.2.Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "71 year old female with a personal history of right breast DCIS/IDC status post mastectomy in 2005 with adjuvant Arimidex therapy. She had a recent US-guided biopsy of right axillary mass on 5/28/2015 complicated by hematoma formation. Evaluate for axillary lymph nodes and hematoma. Upon physical exam, the right axillary region appeared normal without discoloration or swelling. Targeted ultrasound of the right axilla demonstrated near interval resolution of previously demonstrated hematoma now measuring 0.4 x 0.4 cm, previously 3.6 x 2.3 x 1.5 cm. There is no overlying skin thickening or parenchymal edema. There is no appreciable lymph nodes. Note that no biopsy clip was placed at the time of axillary biopsy.", "output": "Near interval resolution of right axillary hematoma without evidence of lymph nodes."}
{"instruction": "Generate impression based on findings.", "input": "76 are old female with ovarian carcinoma and abnormal liver function. LIVER: Liver is normal in size. There is marked parenchymal heterogeneity in the right lobe, with superficial complex cystic masses consistent with implants, as well as poorly defined, hyperechoic parenchymal lesions in the right lobe . Findings are consistent with progressive metastatic disease to liver.GALLBLADDER, BILIARY TRACT: Gall bladder contains sludge without gross wall thickening or pericholecystic fluid. Mild, focal biliary tract dilatation associated with mass. Biliary tract otherwise normal in caliberPANCREAS: Limited due to bowel gas.RIGHT KIDNEY: Parapelvic cysts and mild calyectasis without change.OTHER: Left kidney with parapelvic cysts and mild calyectasis without change.", "output": "Progressive surface and parenchymal disease involving the liver.Gallbladder sludge without complication segmental biliary tract dilatation associated with hepatic metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "40 year-old female complains of ongoing soft lesion in her left lower back. Evaluated with ultrasound. There is an approximately 4.8 x 0.9 x 3.0 cm is elongated isoechoic mass in the subcutaneous tissue of the left lower back was not present on the contralateral side. No calcifications. No internal vascularity.", "output": "1. Soft tissue mass is described above."}
{"instruction": "Generate impression based on findings.", "input": "History of 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: The hypoechoic focus in the left thyroid bed measures 9 x 4 x 4 mm, previously 8 x 4 x 4 mm when measured similarly and accounting for differences in technique.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not identified.LYMPH NODES: Benign appearing cervical lymph nodes bilaterally.OTHER: No significant abnormality noted.", "output": "Unchanged nonspecific subcentimeter hypoechoic focus in left thyroid bed. No specific evidence of disease recurrence."}
{"instruction": "Generate impression based on findings.", "input": "History papillary thyroid carcinoma RIGHT LOBE MEASUREMENTS: 4 x 1.4 x 1.9 cmLEFT LOBE MEASUREMENTS: 4.3 x 1.4 x 1.9 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: 1.6 x 0.6 x 1.4 cm intermediate echogenicity solid nodule mid pole right thyroid glandLEFT LOBE: 1.2 x 0.9 x 0.6 cm predominantly hypoechoic nodule within the mid pole of the left thyroid gland with internal echogenic foci worrisome for coarse calcifications. 1.4 x 0.8 x 0.9 cm intermediate echogenicity solid nodule lower pole 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 thyroid nodules. A mid pole left thyroid gland nodule demonstrates hypoechogenicity with internal possible calcifications; this nodule may represent the clinically known papillary thyroid carcinoma focus.No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Flank pain. RIGHT KIDNEY: No significant abnormalities noted.LEFT KIDNEY: There is hydronephrosis of left kidney without visualized obstruction. There is prominence of the renal pyramids.OTHER: Mild ascites and a left pleural effusion are noted. There is sludge in the gallbladder. The bladder is partially distended.", "output": "1. Mild left-sided hydronephrosis without evidence of obstruction."}
{"instruction": "Generate impression based on findings.", "input": "RUQ pain. LIVER: Non-cirrhotic liver morphology. 17.6 cm in length. Mildly heterogeneous hepatic echogenicity. Unchanged hepatic cyst. No suspicious hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Biliary sludge and subcentimeter gallstones, without specific evidence of 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 12.1 cm in length. The left kidney is 11.6 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.", "output": "1. Cholelithiasis without cholecystitis.2. Hepatomegaly with echogenicity suggestive of steatosis."}
{"instruction": "Generate impression based on findings.", "input": "82-year-old male with unexplained weight loss and transaminitis. LIVER:The liver measures approximately 13.5 cm. Increased echogenicity of the parenchyma. No intrahepatic biliary dilation. Mild ascites is noted. Portal vein is patent with pulsatile hepatopedal flow. There is prominence of the intrahepatic veins and inferior vena cava.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. There is an approximately 1.9 x 1.7 cm well-defined hyperechoic lesion within the lumen of the gallbladder that cast a shadow, consistent with choledocholithiasis or a sludge ball. Does not appear to be impacted. The gallbladder wall measures 1.3 cm. No pericholecystic fluid. Common duct measures 0.3 centimeters.PANCREAS: Unable to evaluate the pancreas due to overlying bowel gas.SPLEEN: Measures 9.5 cm. No sonographic abnormalities.KIDNEYS: Right kidney measures 10.0 cm. Left kidney measures 12.3 cm. Unremarkable and echogenicity. No shadowing calculi or hydronephrosis.There are three large simple renal cysts around the left kidney, the largest measuring 4.9 x 4.4 x 3.5 cm. OTHER: No significant abnormality noted.", "output": "1. Increased echogenicity of the liver parenchyma consistent with fatty infiltration and chronic liver disease/parenchymal dysfunction.2. Mild ascites. 3. Gallbladder wall thickening which is nonspecific in the context of ascites. No other secondary signs of acute cholecystitis.4. Pulsatile portal vein and prominence of intrahepatic veins and inferior vena cava consistent with a congestive heart failure.5. Multiple left-sided simple renal cyst as described above."}
{"instruction": "Generate impression based on findings.", "input": "57 year old female who was recalled from screening mammogram for right breast mass. No family history of breast cancer. Right Breast Diagnostic 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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Within the medial slightly upper right breast, there is redemonstration of a circumscribed mass measuring approximately 0.4 cm which persists on spot compression imaging.Right Breast Ultrasound: On physical examination, no palpable abnormality is identified.A targeted right ultrasound was performed for the mammographic area of concern. At the two o'clock radian of the right breast, 4 cm from the nipple, there is a clustered cyst measuring 0.5 x 0.4 x 0.9 cm, corresponding to the mass visualized on mammogram.", "output": "Clustered cyst at the two o'clock position in the right breast, corresponding to the mass visualized on prior mammogram. Left unilateral diagnostic mammogram and ultrasound is recommended in 6 months to assess stability. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old female with left upper quadrant fullness and pain. LIVER: Measures 13.2 in length. Unremarkable 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, measures 10.5 cm in length. KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "No findings to account for the patient's left upper quadrant pain. "}
{"instruction": "Generate impression based on findings.", "input": "80-year-old female with history of NASH. Evaluate for hepatocellular carcinoma. LIVER:Liver measures 12.5 cm. There is coarse and increased echogenicity of the parenchyma. No concerning mass or ascites. Again seen is a round anechoic 1.0 x 0.8 x 0.9 cm lesion with posterior acoustic enhancement consistent with a simple cyst. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended. The gallbladder wall measures 2.0 mm. No stones, sludge, or pericholecystic fluid.PANCREAS: Examination the pancreas is limited by overlying bowel gas. The visualized portions appear normal.SPLEEN: The spleen was unable to visualized.KIDNEYS: The right kidney measures 10.4 cm. The cortex has normal echogenicity. No shadowing calculi or hydronephrosis. The left kidney measures 9.2 cm. The cortex has normal echogenicity. No shadowing calculi or hydronephrosis. OTHER: No significant abnormality noted.", "output": "1. Coarse, echogenic liver consistent with chronic liver disease/parenchymal dysfunction. No concerning mass or ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 66 years old; Reason: r/o adenopathy, increased size of nodules, concerning features. Are nodes concerning and should be biopsied? History: h/o thyroid nodules, s/p lobectomy. Has nodes that are felt to be indeterminate. This is 9 month follow up study; please compare to prior ultrasounds. LEFT LOBE MEASUREMENTS: 5.1 x 2.3 x 1.9 cmISTHMUS MEASUREMENT: 0.4 cmRIGHT LOBE: Patient is status post right thyroidectomy.LEFT LOBE: There are multiple hyperechoic nodules, the largest of which measures 0.9 x 0.9 x 0.8 cm and the inferior pole and is stable.ISTHMUS: Nodule measuring 0.7 x 0.5 x 0.3 cm is stable.LYMPH NODES: Normal lymph nodes seen.OTHER: No significant abnormality noted.", "output": "No significant change in thyroid nodules and lymph nodes without suspicious features."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodule RIGHT LOBE MEASUREMENTS: 5.5 x 2.2 x 1.1 cm. Normal in size with unchanged mildly heterogeneous background architecture.LEFT LOBE MEASUREMENTS: 4.1 x 1.5 x 1.1 cm. Normal in size with unchanged mildly heterogeneous background echotexture.ISTHMUS MEASUREMENTS: 4 mm in AP dimension.RIGHT LOBE: The upper pole hypoechoic nodule is unchanged in appearance, measuring 7 mm, previously 6 mm. The lower pole hypoechoic nodule is unchanged in appearance, measuring 3 mm, previously 5 mm.LEFT LOBE: The mid pole hypoechoic nodule is unchanged in appearance and size at 4 mm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "1. Stable subcentimeter thyroid nodules.2. Unchanged heterogeneous background thyroid gland, which may be seen with chronic thyroiditis."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female. Follow-up of colloid nodule. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 5 x 1.4 x 1.5 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.7 x 1.4 x 1.3 cm.ISTHMUS MEASUREMENTS: The thyroid isthmus measures 0.1 cm in thickness.RIGHT LOBE: Heterogenous echotexture of the right thyroid lobe. In the right lower pole, there is a stable spongiform nodule measuring 0.7 x 0.5 x 0.6 cm (prior 0.6 x 0.5 x 0.5 cm). Mild increased vascularity of the right thyroid lobe.LEFT LOBE: In the left upper/mid pole, there is a spongiform nodule measuring 0.7 x 0.7 x 0.7 cm that has decreased in size (prior 1.1 x 1 x 0.6 cm). Mild increased vascularity of the left thyroid lobe.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Decreased size of the spongiform nodule of the left upper/mid pole.2. Stable subcentimeter spongiform nodule of the right lower pole.3. Nonspecific increased vascularity of the thyroid parenchyma, which may be seen in the setting of thyroiditis; clinical correlation suggested."}
{"instruction": "Generate impression based on findings.", "input": "Papillary thyroid cancer. Assess for abnormal lymph nodes. RIGHT LOBE MEASUREMENTS: 5.1 x 1.6 x 1.9 cm. Normal in size with normal background echotexture and vascularity.LEFT LOBE MEASUREMENTS: 5.2 x 0.8 x 1.2 cm. Normal in size with normal background echotexture and vascularity.ISTHMUS MEASUREMENTS: 2 mm in AP dimension.RIGHT LOBE: A heterogeneous 2.5 cm solid nodule with calcification is identified, compatible with the given history of thyroid cancer.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "Right thyroid nodule compatible with the given history of thyroid cancer. Benign-appearing cervical lymph nodes identified."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with history of thyroid cancer with nodules in right thyroid bed. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: In the inferior right bed there are again noted to hypoechoic nodular densities, measuring 0.4 x 0.4 x 0.6 cm and 0.4 x 0.6 x 0.4 cm. These measurements are unchanged from the prior study.LEFT LOBE: No massesISTHMUS: No massesPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No morphologically normal lymph nodes.OTHER: No significant abnormality noted.", "output": "Stable soft tissue nodules right thyroid bed."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old female patient status post resection of left thyroid lobe. Enlarging right-sided goiter. RIGHT LOBE MEASUREMENTS: 6.7 x 4.3 x 4.1 cm, previously 6.9 x 4.1 x 3.3 cm.LEFT LOBE MEASUREMENTS: Status post left lobectomy.ISTHMUS MEASUREMENTS: 3 mm in thickness.RIGHT LOBE: The right thyroid lobe is diffusely heterogeneous with mixed cystic and solid components, appearing similar to the prior study.LEFT LOBE: Status post left lobectomy.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Diffusely enlarged, heterogeneous right thyroid lobe, appearing similar to the prior study.2. Status post left lobectomy. "}
{"instruction": "Generate impression based on findings.", "input": "52-year-old male with renal transplant and liver lesions on prior CT. LIVER: Echotexture may be mildly coarsened. Within the lateral segment left lobe one of the nodules identified and CT represents a simple cyst measuring 8-9 mm in diameter. The dome lesions cannot be adequately visualized.GALLBLADDER, BILIARY TRACT: Very limited views the gallbladder demonstrate no gross abnormality. The visualized biliary tract is normal in caliber.PANCREAS: Not evaluatedRIGHT KIDNEY: Not evaluated.OTHER: Perihepatic ascites.", "output": "1. Only one of the liver lesions noted on prior CT is identified and represents a simple cyst.2. Ascites."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C. Evaluate for hepatocellular carcinoma. LIVER: Cirrhotic liver morphology. Increased parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Minimally thickened gallbladder wall, which may be seen in the setting of ascites. Otherwise unremarkable appearance of the gallbladderPANCREAS: Obscured by bowel gas.KIDNEYS: The right kidney is 10.1 cm in length. The renal parenchyma is echogenic. No suspicious renal lesions are evident. No hydronephrosis is present. The left kidney is not well visualized due to inability to reposition the patient. SPLEEN: 10.8 cm in length, without focal lesions evident.OTHER: Moderate amount of ascites present.", "output": "1. Cirrhotic liver morphology without suspicious hepatic lesion identified.2. Moderate amount of ascites.3. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female with prior thyroidectomy for papillary carcinoma. Possible residual thyroid tissue on nuclear medicine exam from 10/2/2015. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massLEFT LOBE: No massISTHMUS: No massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No abnormal lymph nodesOTHER: No significant abnormality noted.", "output": "No ultrasound evidence for recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "History renal cell carcinoma RIGHT KIDNEY: Echogenic renal parenchyma. Numerous renal cysts again noted. None of these cysts exhibit worrisome characteristics at this time. No stone or hydronephrosis. Right kidney 12.2 cm in lengthLEFT KIDNEY: AbsentOTHER: Bladder nondistended", "output": "Echogenic right renal parenchyma consistent with medical renal disease/parenchymal dysfunction without obstruction. Stable numerous right renal cysts; none of the cysts exhibit worrisome characteristics at this time."}
{"instruction": "Generate impression based on findings.", "input": "Female 62 years old; Reason: Thyroid nodules RIGHT LOBE MEASUREMENTS: 4.7 x 1.7 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.1 x 1.3 x 1.6 cmISTHMUS MEASUREMENT: 0.24 cmRIGHT LOBE: Two small nodules are seen within the inferior aspect of the right thyroid lobe. The first is solid, heterogeneous but predominantly hyperechoic and measures 0.8 x 0.7 x 0.8 cm and has no increased vascularity. The second nodule is solid and hypoechoic and measures 0.9 x 0.6 x 0.8 cm.LEFT LOBE: The left lobe contains a poorly defined, heterogeneous, hypoechoic nodule with no increased vascularity which measures 3.2 x 1.1 x 1.4 cm.ISTHMUS: No significant abnormality noted.LYMPH NODES: Multiple prominent bilateral cervical nodes with fatty hila.", "output": "1.Heterogeneous, ill defined 3.2-cm left thyroid nodule and reactive cervical lymphadenopathy may be seen with thyroiditis and correlation with clinical signs/labs is recommended. If clinically warranted, this nodule is amenable to ultrasound guided biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Female 76 years old Reason: looking for subQ abscess related to tunneled catheter History: peri-catheter erythema and tenderness, purulence Ultrasound attention to the area of previous catheter insertion showed 1.7 x 0.5 x 0.7 cm hypoechoic area, just under the skin, without blood flow on color Doppler imaging that may represent irregular small collection. It might be fluid with debris is this some suggestion of posterior enhancement.", "output": "Small hypoechoic possibly fluid collection is measured above. Infected fluid collection cannot be excluded."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules. Hypothyroidism. RIGHT LOBE MEASUREMENTS: 6.0 x 1.6 x 2.4 cm, similar to prior.LEFT LOBE MEASUREMENTS: 4.9 x 1.4 x 1.7 cm, similar to prior.ISTHMUS MEASUREMENTS: 2 mm in AP dimension, similar to prior.RIGHT LOBE: The dominant solid nodule is unchanged in size at 2.4 x 2.2 x 1.5 cm, with minimal cystic change.LEFT LOBE: The poorly circumscribed hypoechoic nodule is unchanged measuring 0.7 x 0.8 x 0.8 cm.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Unchanged 15 mm hypoechoic nodule posterior to the left inferior thyroid pole. Not seen on earlier exam 8 mm hypoechoic nodule posterior to the right superior thyroid pole.", "output": "1. Multinodular goiter, with unchanged dominant nodules.2. Two hypoechoic nodules posterior to the left and right thyroid lobes, one of which on the right was not seen previously. These may represent parathyroid adenoma/hyperplasia or exophytic thyroid nodules. Correlation with parathyroid function tests may be helpful. "}
{"instruction": "Generate impression based on findings.", "input": "Female 31 years old Reason: Elevated liver tests History: Elevated liver tests LIVER: Normal echotexture of the liver. Liver measures 16 cm. No focal lesions.BILIARY TRACT: Gallbladder is unremarkable. No evidence of intra or extrahepatic biliary dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. Right kidney measures 11.1 cm. No focal lesions are hydronephrosis. Left kidney is unremarkable.OTHER: No significant abnormalities noted.", "output": "Unremarkable study."}
{"instruction": "Generate impression based on findings.", "input": "60 years old, Male, Reason: HCV screen for HCC and assess liver contour History: HCV LIVER: The liver measures 15.6 cm in length. There is coarsened echogenicity of the liver. There is a nodular contour of the liver consistent with cirrhosis. 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 two mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 10.9 cm in length. RIGHT KIDNEY: Kidney measures 12.9 cm in length. Severe hydronephrosis with thinned cortex may be chronic in etiology. No evidence of shadowing calculus. LEFT KIDNEY: Kidney measures 11.0 cm in length. Normal echotexture. No evidence of hydronephrosis. Anechoic minimally complex cyst with a septation measures 1.9 x 1.8 x 1.5 cm. Another smaller anechoic lesion favored to represent a cyst near the lower pole of the left kidney measures 1.0 x 1.0 x 1.0 cm.OTHER: No significant abnormalities noted.", "output": "1.Nodular contour of the liver is consistent with cirrhosis.2.Severe hydronephrosis in the right kidney with thin cortex may be chronic in etiology. No visualized obstructing calculus or mass."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female, evaluate for residual thyroid cancer. RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: Hypoechoic nodule in the right thyroidectomy bed measures 3 mm x 3 mm x 3 mm, previously 4 mm x 3 mm x 4 mm.LEFT LOBE: Hypoechoic nodule in the left thyroidectomy bed measures 1.0 cm x 0.4 cm x 0.2 cm, previously 0.4 cm x 0.8 cm x 0.3 cm. Additional hypoechoic nodule measures 0.9 cm x 0.3 cm x 0.3 cm, previously 1.1 cm x 0.2 cm x 0.5 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Stable right IB lymph node measuring 6 mm x 2 mm x 6 mm, previously 9 mm x 4 mm x 7 mm.OTHER: No significant abnormality noted.", "output": "Stable bilateral hypoechoic foci in the bilateral thyroidectomy beds. Stable right level IB neck lymph node. "}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney failure, on chronic kidney disease stage IV. Worsening creatinine. RIGHT KIDNEY: The right kidney measures 11 cm. The renal parenchyma is echogenic and atrophic. There are multiple subcentimeter hypodense lesions, probable simple cysts. No suspicious lesion is identified. There is no hydronephrosis or renal calculus.LEFT KIDNEY: The left kidney measures 11.1 cm. The renal parenchyma is echogenic and atrophic. There are multiple simple cysts. There is no hydronephrosis or renal calculi.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Echogenic, atrophic renal parenchyma, compatible with medical renal disease/parenchymal dysfunction. No worrisome mass, hydronephrosis or renal calculus."}
{"instruction": "Generate impression based on findings.", "input": "Alcoholic cirrhosis LIVER: Coarse echogenic liver parenchyma without mass. Liver length 14.8 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic renal parenchyma without worrisome mass, stone, or hydronephrosis. Right renal cyst. Right kidney 11.3 cm in lengthOTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. Left kidney 9.6 cm in length. Spleen 10.2 cm in length. No ascites. Bilateral pleural effusions.", "output": "Coarse echogenic liver parenchyma consistent with chronic liver disease without mass or ductal dilatation. Cholelithiasis without acute inflammation. No ascites.Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "59 year old with newly diagnosed right IDC grade 3. Recent CT demonstrated abnormal lymph node in the right axilla. History of left lumpectomy and sentinel lymph node biopsy in 2011 for IDC and DCIS. She completed radiation and chemotherapy and is currently on Arimidex. History of right lumpectomy for carcinoma in 1997. Ultrasound of the right axilla is performed. There are multiple abnormally enlarged lymph nodes with effaced hila in the level 1 of right axilla. The largest one measures 22 x 11 mm, locating upper part of the right axilla.", "output": "Multiple suspicious lymph nodes in the right axilla, level 1BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old female with goiter RIGHT LOBE MEASUREMENTS: 6.0 cm x 2.4 cm x 1.4 cm. LEFT LOBE MEASUREMENTS: 5.5 cm x 2.5 cm x 1.6 cm ISTHMUS MEASUREMENTS: 2 mm in thicknessRIGHT LOBE: Predominantly cystic nodule at the upper pole measures 7 mm x 7 mm x 4 mm. Spongiform appearing nodule at the lower pole measures 1.9 cm x 1.4 cm x 1.0 cm. LEFT LOBE: Spongiform appearing nodule at the upper pole measures 1.1 cm x 0.7 cm x 0.5 cm. Additional spongiform appearing nodule at the lower pole measures 1.7 cm x 1.2 cm x 1.1 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 thyroid nodules, majority of which are spongiform in appearance and the other is predominantly cystic. Continued surveillance is recommended. "}
{"instruction": "Generate impression based on findings.", "input": "Prekidney transplant RIGHT KIDNEY: Markedly echogenic renal parenchyma without worrisome mass, stone or hydronephrosis. 2.2 x 1.7 x 1.9 cm lower pole cyst. Right kidney 10 cm in lengthLEFT KIDNEY: Markedly echogenic renal parenchyma without worrisome mass, stone, or hydronephrosis. 1.9 x 1.8 x 1.5 cm upper pole cyst. Left kidney 10.1 cm in lengthOTHER: Bladder nondistended", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis. Uncomplicated bilateral benign renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "Male 82 years old Reason: supratube placement Ultrasound guidance and technical assistance was provided for a suprapubic catheter placement. The procedure was successfully completed.", "output": "Successful ultrasound guided suprapubic catheter placement."}
{"instruction": "Generate impression based on findings.", "input": "Epigastric and right upper quadrant pain LIVER: No significant abnormalities noted. 15.5 cm in length GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.6 cm in lengthOTHER: Left kidney 9.9 cm in length. Spleen 9.9 cm in length. No ascites", "output": "Negative right upper quadrant ultrasound. No hepatobiliary abnormality."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old female complains of right upper quadrant pain. GALLBLADDER, BILIARY TRACT: There are several dependent shadowing echogenic foci within the lumen of the gallbladder consistent with cholelithiasis. Negative sonographic Murphy's sign. No pericholecystic fluid. The gallbladder wall measures 0.1 cm. The common hepatic duct measures 0.2 cm. The common bile duct measures 0.2 cm.OTHER: No significant abnormality noted.", "output": "1. Cholelithiasis without signs of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Acute on chronic renal insufficiency RIGHT KIDNEY: Increased parenchymal echogenicity. Renal cyst. Mid pole 1.2 x 1 x 1.4 cm indeterminate focus. No hydronephrosis. Right kidney 10.5 cm in lengthLEFT KIDNEY: Increased parenchymal echogenicity. Renal cyst. No hydronephrosis. Left kidney 10 cm in lengthOTHER: Bladder nondistended.", "output": "Increased parenchymal echogenicity consistent with medical renal disease/parenchymal dysfunction without hydronephrosis. Right midpole indeterminate focus that does not fill the criteria for a simple cyst. If further characterization is desired, dedicated renal CT would be helpful."}
{"instruction": "Generate impression based on findings.", "input": "Renal stones RIGHT KIDNEY: Normal parenchymal echogenicity without mass or hydronephrosis. Right kidney 12.6 cm in length. Multiple nonobstructing stones. The largest within the lower pole measures 1.5 x 0.6 x 0.9 cm.LEFT KIDNEY: Normal parenchymal echogenicity without mass or hydronephrosis. Left kidney 12.6 cm in length. Multiple nonobstructing renal stones. The largest within the upper pole measures 0.5 x 0.5 x 0.3 cm.OTHER: Bladder nondistended.", "output": "Bilateral nonobstructing renal stones. Normal parenchymal echogenicity without mass or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Status post bilateral nephrostomy tube placement RIGHT KIDNEY: Near-complete resolution of previously noted hydronephrosis status post nephrostomy tube placement. Right kidney 11.2 cm in length.LEFT KIDNEY: Near-complete resolution of previously noted hydronephrosis status post nephrostomy tube placement. Left kidney 11.9 cm in length.OTHER: Bladder collapsed", "output": "Near-complete resolution of bilateral hydronephrosis status post bilateral nephrostomy tube placement."}
{"instruction": "Generate impression based on findings.", "input": "Female 52 years old; Reason: r/o gallstones; abdominal inflammation History: right sided sided swelling and pain LIVER: The liver measures 20.0 cm in length. There is 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 20.0 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.5 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 2.4 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 10.5 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. Hepatomegaly with increased liver echogenicity, compatible with fatty infiltration/hepatocellular dysfunction. No focal hepatic masses are seen.2. No evidence of cholelithiasis or acute cholecystitis are seen. No intra or extrahepatic ductal dilation."}
{"instruction": "Generate impression based on findings.", "input": "Hyperparathyroidism RIGHT LOBE MEASUREMENTS: 1.7 x 1.5 x 4.8 cmLEFT LOBE MEASUREMENTS: 1.9 x 1.4 x 4.3 cmISTHMUS MEASUREMENTS: 0.1 cmRIGHT LOBE: 0.7 x 0.6 x 0.7 cm predominantly solid nodule lower pole right thyroid glandLEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: 1.4 x 1.5 x 0.5 cm hypoechoic extrathyroidal focus projecting inferior to the left thyroid glandLYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Hypoechoic extrathyroidal focus projecting inferior to the left thyroid gland consistent with clinically suspected parathyroid adenoma.Subcentimeter predominantly solid lower pole right thyroid nodule. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "45 year old female with history of hepatitis B virus. Evaluate for HCC. LIVER: The liver measures 15 cm, and is normal in echotexture. No focal masses are identified. Small left liver cyst, unchanged from prior, measures 1.8 x 1.5 x 2 cm.GALLBLADDER, BILIARY TRACT: The gallbladder is within normal limits. No biliary dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. The right kidney measures 10.60 m.OTHER: No significant abnormalities noted. The left kidney is within normal limits, measuring 11.4 cm.", "output": "No focal mass or biliary dilatation to suggest tumor."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain with elevated LFTs LIVER: Mildly echogenic parenchyma without mass. Liver length 19.2 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation. Moderately dilated common bile duct with maximal diameter 1.1 cm. No intrahepatic ductal dilatation. Distal common bile duct obscured due to overlying bowel gas.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.5 cm in lengthOTHER: Left kidney 12.1 cm in length. Spleen 11.7 cm in length. No ascites.", "output": "Mildly echogenic liver parenchyma with mild hepatomegaly suggestive for fatty infiltration/parenchymal dysfunction without worrisome mass. Cholelithiasis without acute inflammation. Moderately dilated common bile duct; distal common bile duct obscured due to overlying gas. No intrahepatic ductal dilatation. Suggest correlation with CT or MRCP if a distal obstructing lesion is clinically suspected."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old female with thyroid mass and neck adenopathy and prior CT. RIGHT LOBE MEASUREMENTS: 4.1 x 1.8 x 1.6 cmLEFT LOBE MEASUREMENTS: 1.8 x 1.8 x 5.1 cmISTHMUS MEASUREMENTS: 0.2-cmRIGHT LOBE: Heterogeneous in echotexture. Cystic nodule with comet tail artifact consistent with colloid measuring 0.5 x 0.5 x 0.5 cm. Very small, hypoechoic nodules present as well.LEFT LOBE: Heterogeneous in echo architecture. Spongiform appearing lower pole nodule measuring 0.8 x 0.7 x 1 cm likely with comet tail artifact consistent with colloid nodule. Posterior solid nodule with internal dense rim calcification measuring 1.4 x 1.3 x 2.3 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Abnormal lymph nodes identified in the left neck including a round cystic -- appearing level 3 node measuring 0.5 x 0.5 x 0.7 cm a round solid 0. 5 x 0.5 x 0.8 cm level 3 node and a predominantly cystic level floor/supraclavicular cystic node measuring 0.9 x 0.9 x 0.9 cm. OTHER: No significant abnormality noted.", "output": "Solid left thyroid nodule with smaller nodules most suggestive of colloid nodules.Necrotic -- appearing left neck lymph nodes.US GUIDED FNA; 3/6/2015 12:46 PMCLINICAL INFORMATION AND PRE-OPERATIVE DIAGNOSIS: Thyroid mass, neck adenopathyPOST-OPERATIVE DIAGNOSIS : SameCOMPARISON: Same-day ultrasound, CT neck from 2/19/15OPERATORS: Doctors paushter; The attending physician, Dr. paushter, performed the procedure. TECHNIQUE: Following a discussion of the procedure with the patient, including its risks, benefits, alternatives and steps to prevent infection, an informed written consent was obtained and documented in the patient's chart. The time-out form was completed to confirm patient identity and side/type of procedure.Localizing US demonstrated large solid left thyroid mass and necrotic -- appearing left supraclavicular lymph node. The skin over the target area was cleansed with chlorhexidine. Transducer was sterilely sheathed. Local anesthesia was obtained using 1% lidocaine, superficially and at depth. Using aseptic technique, and continuous ultrasound guidance, the thyroid lesion was sampled using 25 gauge needles. Two fine needle aspirations were performed. The left supraclavicular lymph node was sampled using 25-gauge needles. Four fine needle aspirations were performed.Cytology was present to confirm specimen adequacy. Specimen was handed to cytology. The patient tolerated the procedure well without immediate complications. Routine post procedure instructions were communicated to the patient.COMPLICATIONS: NoneESTIMATED BLOOD LOSS: Less than 5 cc. An adhesive bandage was placed on the patient\u2019s skin."}
{"instruction": "Generate impression based on findings.", "input": "Cardiac patient; evaluate hepatic vasculature LIMITED ABDOMENLIVER: Mildly coarse and echogenic liver echotexture without mass. Liver length 19.8 cm.BILIARY TRACT: Gallbladder contracted. No ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 10.4 cm in length. RIGHT KIDNEY: Echogenic renal parenchyma without mass or stone. Mild hydronephrosis. Right kidney 11 cm in lengthOTHER: Left kidney demonstrates echogenic renal parenchyma without mass or stone. Mild left hydronephrosis. Left kidney 11.5 cm in length. Mild ascites.", "output": "Mild hepatomegaly associated with coarse echogenic liver parenchyma consistent with chronic liver disease without mass or ductal dilatation. Gallbladder collapsed. Mild ascites.Patent hepatic vessels with normal directional flow.Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction with mild bilateral hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "70 year-old male with history of kidney injury. Evaluate for hydronephrosis. RIGHT KIDNEY: No hydronephrosis or perinephric fluid collections. The right kidney measures 9.5 cm. Mild hyperechoic renal parenchyma, raising the suspicion of medical renal disease.LEFT KIDNEY: No hydronephrosis or perinephric fluid collections. The left kidney measures 10.9 cm. Mild hyperechoic renal parenchyma, raising the suspicion of medical renal disease.OTHER: The bladder is decompressed, with Foley in place.", "output": "No hydronephrosis or findings of obstruction. Mild hyperechoic renal parenchyma, raising the suspicion of medical renal disease. "}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis with distended abdomen and acute renal insufficiency LIVER:Cirrhotic morphology without mass. Liver length 20 cmGALLBLADDER, BILIARY TRACT: Collapsed gallbladder with thickened wall trace pericholecystic fluid. Cholelithiasis without Murphy's sign.PANCREAS: No significant abnormality noted.SPLEEN: Moderate splenomegaly. Spleen length 17.3 cmKIDNEYS: No significant abnormality noted. Right kidney 10.5 cm in length; left kidney 9.9 cm in length.ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Trace perihepatic ascites.", "output": "Cirrhotic morphology without mass or ductal dilatation. Trace ascites. Moderate splenomegaly. Cholelithiasis without acute inflammation or ductal dilatation.Unremarkable renal echogenicity without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "87-year-old female patient with right upper quadrant pain. Evaluate for gallstones. LIVER: The liver measures 13.7 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There is echogenic material with shadowing in the gallbladder fossa which likely represents the gallbladder with stones. 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: There is a 3.0 x 3.3 x 4 cm right renal cyst. No evidence of hydronephrosis. OTHER: The left kidney measures 10.2 cm in length. No evidence of hydronephrosis. There is a 1.7 x 1.4 cm lower pole renal cyst.The spleen measures 5.1 cm in length.There is a right pleural effusion.", "output": "1. Echogenic material and shadowing within the gallbladder fossa which likely represents cholelithiasis.2. Bilateral renal cysts. 3. Right pleural effusion."}
{"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, nonenlarged and benign morphology lymph nodes are identified. There is no solid or cystic masses identified.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "75 year old female with history of thyroidectomy for papillary carcinoma with metastatic disease to lung and positive PET scan in right paratracheal region. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massesLEFT LOBE: No massesISTHMUS: No massesPARATHYROID GLANDS: Not identifiedLYMPH NODES: There are scattered, small and morphologically normal -- appearing lymph nodes involving levels two through 4 bilaterally. There are no enlarged or morphologically abnormal lymph nodes identifiedOTHER: A mass corresponding to focal area of increased activity on the PET scan in the right paratracheal region is not identified.", "output": "No mass or abnormal lymph node.Results were discussed with the patient and her daughter."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodule seen incidentally on recent MR RIGHT LOBE MEASUREMENTS: 4.6 x 1.7 x 2.1 cmLEFT LOBE MEASUREMENTS: 5.4 x 2 x 2.3 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Heterogeneous gland with multiple benign-appearing mixed cystic and solid as well as spongiform nodules. A representative inferior mixed cystic and solid nodule measures 1.1 x 0.5 x 0.8 cm.LEFT LOBE: Heterogeneous gland with dominant predominantly solid mid pole nodule measuring 1.7 x 1.3 x 2 cm.ISTHMUS: Heterogeneous gland.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral thyroid nodules. Dominant predominantly solid mid pole left thyroid nodule amenable to ultrasound-guided biopsy. No regional adenopathy.Heterogeneous somewhat small thyroid gland without increased vascularity. Finding raises the possibility of chronic thyroiditis. Correlation with thyroid function tests suggested."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old male with hepatitis C and known liver mass for follow-up. LIVER: Liver parenchyma is mildly coarsened without significant change. Hepatic size is within normal limits. There is again noted a rounded, echogenic and minimally heterogeneous right lobe mass measuring approximately 1.4 x 1.4 x 1.6 cm without significant change from prior exams. Prior pathology of biopsy of this nodule demonstrated regenerative nodule. No other mass is identified. GALLBLADDER, BILIARY TRACT: The gallbladder is well-visualized and appears normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Highly echogenic consistent with parenchymal disease. No hydronephrosis.OTHER: Left kidney is highly echogenic consistent with parenchymal disease. No hydronephrosis. Splenic size normal.", "output": "Coarsely echogenic liver with stable, echogenic mass. No new mass identified."}
{"instruction": "Generate impression based on findings.", "input": "63 years old, Female, Reason: 63 yo female with abnmormlity seen on neck CT History: abnormal neck CT RIGHT LOBE MEASUREMENTS: 6.4 x 1.9 x 2.3 centimetersLEFT LOBE MEASUREMENTS: 6.2 x 1.6 x 2.2 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Right thyroid lobe at least two nodules in the more superior of which is partially solid and cystic measuring 1.3 x 0.9 x 1.4 cm. A more inferior right thyroid nodule contains calcifications and measures approximately 0.8 x 1.3 x 0.4 cm and is amenable biopsy. LEFT LOBE: Two subcentimeter hypoechoic nodules with a spongiform appearance on the left. Another hyperechoic nodule measures 0.6 x 0.5 x 0.9 cm.ISTHMUS: Large midline Isthmus nodule has a mixed solid cystic appearance with questionable microcalcifications and measures 2.1 x 1.1 x 2.6 centimeters and is amenable to biopsy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Multiple thyroid nodules bilaterally, some of which are mixed solid-cystic in appearance containing calcifications and are amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "38-year-old male patient with heart failure. Evaluate possible liver pathology. LIVER: The liver is coarsened in echotexture. There is hepatopetal blood flow with peak velocity of 37 cm/s in the main portal vein.BILIARY TRACT: The gallbladder wall is thickened, which is not abnormal in the setting of intra-abdominal ascites. No cholelithiasis. There is no intra or extrahepatic biliary ductal dilatation.PANCREAS: The pancreas is largely obscured by overlying bowel gas.SPLEEN: Splenomegaly, measuring up to 12.9 cm in length.RIGHT KIDNEY: The right kidney measures 10.7 cm in length. There is no hydronephrosis or shadowing renal calculi.OTHER: There is a moderately large amount of mildly complex ascites.The left kidney measures 10.4 cm in length. No hydronephrosis or shadowing renal calculi.", "output": "1.Coarsened liver echotexture is compatible with nonspecific parenchymal dysfunction/fatty infiltration.2.Splenomegaly.3.Moderately large intra-abdominal ascites, which is minimally complex."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain with worsening LFTs; history breast cancer LIVER: Widespread bilobar confluent metastatic lesions again noted within the liver. Liver length 17.8 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11 cm in length OTHER: Left kidney 10.5 cm in length. Spleen 10.4 cm in length. Trace ascites. Bilateral pleural effusions.", "output": "Widespread bilobar confluent metastatic hepatic lesions again noted without ductal dilatation. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old male with prior lipoma resection left, now with sensation of mass. Ultrasound evaluation adjacent to the scar medial to the left scapula demonstrates no underlying mass.", "output": "No mass identified by ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "72-year-old male with increased creatinine. RIGHT KIDNEY: The right kidney measures 10.6 cm in length. Echotexture within normal limits. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Left kidney measures 11.2 cm in length. Echotexture within normal limits. No hydronephrosis, shadowing calculus or mass.OTHER: Bladder incompletely distended.", "output": "No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "History of abnormal mammogram. LIVER: The liver measures 17.7 cm in length. The liver demonstrates increased parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions or masses are identified. BILIARY TRACT: Cholelithiasis. The largest stone measures 1.6 cm. The gallbladder wall appears mildly thickened. Echogenic foci within the gallbladder wall suggest cholesterolosis. The sonographic Murphy's sign is negative per outside report. 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.OTHER: No significant abnormalities noted.", "output": "1.Increased hepatic echogenicity suggestive of fatty infiltration/parenchymal dysfunction.2.Cholelithiasis with gallbladder wall thickening raising the possibility of acute cholecystitis. No biliary ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "Cholelithiasis with abdominal pain LIVER: No significant abnormalities noted. Liver length 12.7 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.3 cm in length OTHER: Left kidney 10.2 cm in length. Spleen 9.9 cm in length. No ascites", "output": "Cholelithiasis without acute inflammation or ductal dilatation. No ascites."}
{"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. Unfortunately, data obtained from portions of the right lateral breast were not saved. In addition, in the right upper inner breast, note is made of a circumscribed hypoechoic mass measuring approximately 1.2 cm.", "output": "Technical repeat required. Hand-held right breast ultrasound should be performed, with particular attention to the right lateral breast (where data was not saved) and right upper inner breast (at site of 1.2 cm hypoechoic mass).BIRADS: 0 - Incomplete.RECOMMENDATION: E - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "Female 62 years old Reason: eval for PCKD History: family history of PCKD RIGHT KIDNEY: Right kidney measures 11.6 cm. No hydronephrosis. No shadowing calculi. No cysts as clinically questioned. Cortical echogenicity is normal.LEFT KIDNEY: Left kidney measures 11.8 cm. No hydronephrosis. No shadowing calculi. No cysts as clinically questioned. Cortical echogenicity is normal.BLADDER: No significant abnormalities noted.", "output": "No renal cysts as clinically questioned. No other abnormality noted."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female patient with thyroid nodules. RIGHT LOBE MEASUREMENTS: 5.1 x 2.1 x 2.0 cm.LEFT LOBE MEASUREMENTS: 5.0 x 1.4 x 1.2 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: The right thyroid lobe contains a mixed solid and cystic nodule measuring approximately 1.9 x 1.4 x 2.8 cm within the mid to lower pole. The nodule is slightly smaller in size in the longitudinal dimension, though with interval decrease in size of an inferiorly located cystic component.LEFT LOBE: A 0.2 x 0.1 x 0.3 cm hypoechoic, nondescript nodule in the left midpole is unchanged in size or appearance compared to the prior study.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology lymph nodes are noted in the left neck.OTHER: No significant abnormality noted.", "output": "Dominant complex right thyroid nodule, which was subsequently biopsied per service request."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C. Evaluate for hepatocellular carcinoma. LIVER: Non-cirrhotic liver morphology. Normal parenchymal echogenicity. No suspicious hepatic lesions. A 9 mm hyperechoic focus in the right hepatic lobe statistically likely represents an hemangioma. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Cholelithiasis. Otherwise unremarkable appearance of the gallbladder. 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 10.2 cm in length. The left kidney is 10.9 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 11.0 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No ascites.", "output": "1. 9 mm hyperechoic focus in the right hepatic lobe statistically likely represents an hemangioma. Follow-up ultrasound in 6-12 months is recommended. No suspicious hepatic lesions identified otherwise.2. Cholelithiasis without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old female patient with thyroid nodules. RIGHT LOBE MEASUREMENTS: 5.4 x 1.5 x 1.3 cm.LEFT LOBE MEASUREMENTS: 6.8 x 2.4 x 2.1 cm.ISTHMUS MEASUREMENTS: 3 mm thickness.RIGHT LOBE: The right thyroid lobe is homogeneous in echogenicity without focal lesion.LEFT LOBE: There is a predominantly solid nodule with cystic components within the left lower pole measuring 3.6 x 2.0 x 2.3 cm, previously 3.5 x 1.8 cm. The cystic component of the nodule is increased in size with a fluid-fluid level. The nodule has internal vascularity. No internal calcifications are identified. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: An enlarged right level two lymph node with a fatty hilum measures 3.1 x 1.3 x 0.6 cm. A left level two lymph node with a fatty hilum measures 1.1 x 1.8 x 0.7 cm.OTHER: No significant abnormality noted.", "output": "Slight interval increase in size of a predominantly solid left lower pole nodule."}
{"instruction": "Generate impression based on findings.", "input": "Status post thyroidectomy for papillary thyroid carcinoma 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": "Stable examination. Status post thyroidectomy without worrisome mass or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid carcinoma RIGHT LOBE: Status post thyroidectomy without worrisome massLEFT LOBE: Status post thyroidectomy without worrisome massISTHMUS: Status post thyroidectomy without worrisome 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": "History of hepatomegaly on CT in 2011 now with right lower quadrant and flank pain. LIVER: The liver measures 15.1 cm in length. The liver parenchymal echotexture is normal. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating pulsatile 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 3 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas.SPLEEN: The spleen is not visualized likely related to close approximation to the diaphragm as seen on 2011 CT.RIGHT KIDNEY: Kidney measures 10.8 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 12.8 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.No evidence of acute cholecystitis, hydronephrosis, or other specific findings to account for patient's symptoms.2.Pulsatile blood flow in the portal vein raising the possibility of elevated right heart pressures."}
{"instruction": "Generate impression based on findings.", "input": "Chronic renal disease RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 11.17 m in lengthLEFT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Left kidney 10.9 cm in length. Minimally complex benign-appearing renal cyst.OTHER: 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": "Reason: assess liver parenchyma for evidence of cirrhosis; assess for portal vein thrombosis History: liver failure Study mildly limited due to dilated bowel loops.LIVER: The liver measures 15.1 cm in length. Mildly increased parenchymal echogenicity. Left hepatic cyst as seen on prior CT examinations. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.32 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 3 mm in diameter.PANCREAS: No significant abnormalities noted within the visualized portions of the head and body of the pancreas.SPLEEN: No significant abnormalities noted. The spleen measures 6.6 cm in length. RIGHT KIDNEY: Kidney measures 7.9 cm in length. Increased parenchymal echogenicity. No hydronephrosis.LEFT KIDNEY: Kidney measures 8.0 cm in length. Increased parenchymal echogenicity. No hydronephrosis.OTHER: Right pleural effusion and ascites.", "output": "1.Mildly increased hepatic echogenicity raising the possibility of fatty infiltration/parenchymal dysfunction without additional morphologic evidence of cirrhosis.2.Patent portal vein.3.Atrophic, echogenic kidneys suggestive of medical renal disease.4.Right pleural effusion and ascites."}
{"instruction": "Generate impression based on findings.", "input": "Reason: follow-up MNG History: multi-nodular goiter RIGHT LOBE MEASUREMENTS: 6.5 x 1.9 x 2.2 cmLEFT LOBE MEASUREMENTS: 6.0 x 1.6 x 2.0 cmISTHMUS MEASUREMENTS: 0.8 cmRIGHT LOBE: Right midpole nodule without internal vascularity measures 1.2 x 1.0 x 1.6 cm, previously 1.3 x 0.9 x 1.7 cm and contains small comet tail artifacts, likely representing colloid. More inferiorly within the right lower pole, a calcified nodule without internal vascularity measures 0.7 x 0.7 x 1.4 cm, previously 0.8 x 0.8 x 1.3 cm, previously nondiagnostic on FNA.LEFT LOBE: A hypoechoic left superior pole nodule measures 0.7 x 0.7 x 0.8 cm, previously 0.9 x 0.7 x 0.9 cm. An additional isoechoic mid thyroid nodule measures 0.5 x 0.5 x 0.8 cm, previously 0.5 x 0.5 x 0.8 cm.ISTHMUS: A nodule within the isthmus measures 1.9 x 2.3 x 2.1 cm, previously 2.1 x 1.1 x 2.6 cm, colloid nodule on prior FNA.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral thyroid nodules are not significantly changed."}
{"instruction": "Generate impression based on findings.", "input": "Male; 66 years old. Reason: left lower pole cystic lesion and left midpole solid lesion; interval exam/see CT 1/2014 for comparison History: known solid midpole and cystic lower pole left renal mass, survey RIGHT KIDNEY: Right kidney measures 12.6 cm in length. The renal parenchyma is normal in echogenicity. There is no hydronephrosis or shadowing renal stone. No suspicious renal mass is identified.LEFT KIDNEY: The left kidney measures 12.7 cm in length. The renal parenchyma is normal in echogenicity. There is no hydronephrosis or shadowing renal stone. Within the lower pole of the kidney is a 2.1 x 1.9 x 1.8 cm lesion (previously 2.3 x 1.5 x 2.0 cm) which demonstrates posterior acoustic enhancement. There is no wall nodularity and no internal vascularity. There is a thin septation. Within the mid pole of the kidney is a 1.3 x 1.0 x 1.2 cm cyst with a thin septation, no wall nodularity, and no internal vascularity. No additional renal lesion identified.OTHER: The bladder is nondistended.", "output": "Stable appearance of minimally complex left lower and mid pole renal cysts."}
{"instruction": "Generate impression based on findings.", "input": "Reason: History of liver cyst. Needs monitoring LIVER: The liver measures 12.7 cm in length. Hyperechoic, homogenous hepatic parenchyma. The portal vein is patent with normal directional hepatopetal flow, peak velocity 20.1 cm/s. No focal mass. No cystic lesions are identified.GALLBLADDER, BILIARY TRACT: The gallbladder is distended and folded upon itself. No shadowing stones. No biliary ductal dilatation. Negative sonographic Murphy's sign.PANCREAS: The pancreatic duct measures 0.2 cm.RIGHT KIDNEY: The right kidney measures 8.9 cm in length. The left kidney measures 9.0 cm in length. No shadowing stones or hydronephrosis.OTHER: The spleen is heterogeneous, which is nonspecific on ultrasound but may be consistent with prior granulomatous disease.", "output": "1. Findings consistent with hepatic steatosis or parenchymal dysfunction. No focal cystic lesions or masses are identified.2. Heterogeneous appearing spleen which is nonspecific on ultrasound but may be consistent with prior granulomatous disease."}
{"instruction": "Generate impression based on findings.", "input": "65 years old, Female, Reason: RUQ US for ?cholelithiasis History: RUQ pain LIVER: The liver measures 17.3 cm in length. Increased echogenicity of the liver is consistent with fatty infiltration. 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 5 mm in diameter.PANCREAS: Pancreas is not well visualized in this examination due to overlying bowel gas. 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 11.6 cm in length. Normal echotexture. Nohydronephrosis or shadowing calculusLEFT KIDNEY: Kidney measures 12.6 cm in length. Normal echotexture. Nohydronephrosis or shadowing calculusOTHER: No significant abnormalities noted.", "output": "1.Normal gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis.2.Increased echogenicity of the hepatic parenchyma compatible with fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "Female 51 years old Reason: multiple thyroid nodules History: multiple thyroid nodules RIGHT LOBE MEASUREMENTS: 11.1 x 4.1 x 6.5 cmLEFT LOBE MEASUREMENTS: 5.3 x 2.9 x 3.1 cmISTHMUS MEASUREMENTS: 1.1 cmRIGHT LOBE: The right thyroid lobe is nearly completely replaced by a predominantly solid nodules. Heterogeneous solid right thyroid nodule measures 4.8 x 3.3 x 4.9 cm. A second heterogeneous solid thyroid nodule measures 4.1 x 4.8 x 6.2 cm.LEFT LOBE: Left thyroid lobe is also nearly completely replaced by a large heterogeneous nodule measuring 3.0 x 2.6 x 2.6 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No regional lymphadenopathyOTHER: No significant abnormality noted.", "output": "Enlarged thyroid is nearly completely replaced by predominantly solid heterogeneous thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "47 years old, Female, Reason: possible thyromegaly on exam History: weight gain, HTN RIGHT LOBE MEASUREMENTS: 5.5 x 1.7 by 1.5 cm.LEFT LOBE MEASUREMENTS: 5.1 x 1.3 by 2.2 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: No significant abnormality noted. Thyroid lobe parenchyma is slightly heterogeneous. There are no nodules identified.LEFT LOBE: No significant abnormality noted. Thyroid lobe parenchyma slightly heterogeneous. There are no 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": "1.No evidence of thyromegaly or thyroid nodules.2.Heterogeneous thyroid echotexture can be consistent with chronic thyroiditis in the correct clinical setting."}
{"instruction": "Generate impression based on findings.", "input": "Ascites. Evaluate for cirrhosis. LIVER: Mildly echogenic and coarse liver parenchyma. The liver contour is micronodular suspicious for chronic liver disease. Increasing perihepatic ascites. The liver is slightly shrunken measuring 14 cm in craniocaudal dimension. No focal lesion or biliary ductal dilatation. Maintained hepatopedal portal venous blood flow at 0.3 cm/s.BILIARY TRACT: No extrahepatic biliary ductal dilatation.Normally distended gallbladder with sludge, small gallstones and mild wall thickening which is nonspecific in the setting of ascites.PANCREAS: The pancreas is obscured by overlying bowel gas.SPLEEN: The spleen measures 13 cm in length without focal lesion.RIGHT KIDNEY: The right kidney measures 11.3 cm without hydronephrosis.OTHER: The left kidney measures 10.8 cm without hydronephrosis. Small pleural effusions.", "output": "1. Coarse echogenic and micronodular liver contour suspicious for chronic liver disease/cirrhosis.2. Increasing perihepatic ascites. Small pleural effusions.3. Cholelithiasis. "}
{"instruction": "Generate impression based on findings.", "input": "Male 34 years old Reason: eval of neoscrotum History: swelling s/p phalloplasty Soft tissue of the neoscrotum has some vascularity which would be expected. Tissues appear somewhat indurated and heterogenous, but there are no loculated fluid collections to suggest abscess. Continued follow-up advised with this study serving as a baseline.", "output": "No definite abscess collection."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old male with metastatic pancreatic carcinoma with persistent right upper quadrant pain. LIVER: Diffusely heterogeneous with multiple masses consistent with metastatic disease. Hepatomegaly.GALLBLADDER, BILIARY TRACT: Gallbladder is noted to be thick-walled which is non--- septic in the face of ascites. No shadowing gallstones. Trace of pericholecystic fluid is also nonspecific. Patient was not tender over the gallbladder during the exam.PANCREAS: Limited with mass in or adjacent to the pancreatic head.RIGHT KIDNEY: Echogenic without hydronephrosisOTHER: Splenomegaly. Left kidney echogenic without hydronephrosis.Ascites.", "output": "Nonspecific gallbladder wall thickening with moderate ascites.Hepatosplenomegaly.Echogenic kidneys."}
{"instruction": "Generate impression based on findings.", "input": "82-year-old female patient with thyroid nodules. RIGHT LOBE MEASUREMENTS: 3.9 x 1.7 x 1.6 cm, previously 3.9 x 1.4 x 1.5 cm.LEFT LOBE MEASUREMENTS: 5.2 x 2.6 x 1.6 cm, previously 4.5 x 2.2 x 2.3 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness. RIGHT LOBE: Multiple nodules are noted within the right thyroid lobe, many which have imaging features consistent with colloid nodules. A mixed echogenicity nodule with colloid within the right lower pole measures 1.2 x 0.9 x 1.1 cm, previously 1.2 x 0.8 x 1.2 cm. An additional predominantly cystic nodule in the right midpole measures 0.6 x 0.4 x 0.5 cm, previously 0.6 x 0.4 x 0.6 cm.LEFT LOBE: Multiple nodules are noted within the left thyroid lobe, many which have imaging features consistent with colloid nodules. A mixed echogenicity nodule in the left lower pole measures 2.2 x 1.6 x 1.8 cm, appearing similar in size to the prior study when measured similarly. An additional complex cystic nodule within the inferior lower pole measures 1.0 x 0.8 x 0.6 cm, previous 1.0 x 0.5 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": "Bilateral complex thyroid nodules, many of which with imaging features of colloid nodules, appearing similar in size to the prior study."}
{"instruction": "Generate impression based on findings.", "input": "68 year old female with history of thyroid nodules. RIGHT LOBE MEASUREMENTS: 4.1 cm x 1.7 cm x 1.8 cmLEFT LOBE MEASUREMENTS: 4.6 cm x 1.5 cm x 1.8 cmISTHMUS MEASUREMENTS: 4 mm in thickness. RIGHT LOBE: Heterogeneous echotexture. Two hypoechoic nodules are again seen, one of which measures 3 mm x 4 mm x 2 mm at the midpole (previously 4 mm x 3 mm x 2 mm) and the other at the inferior pole measures 7 mm x 4 mm x 4 mm (previously 6 mm x 4 mm). LEFT LOBE: Heterogeneous echotexture. Three solid hypoechoic nodules are again noted. Largest at the inferior pole measures 1.4 cm x 1.6 cm x 1.2 cm, previously 1.4 cm x 1.7 cm x 1.2 cm. The remaining smaller predominantly solid nodules are not significantly changed, one of which measures 6 mm x 7 mm x 5 mm (previously 5 mm x 5 mm x 4 mm), and the other measures 5 mm x 6 mm x 6 mm (previously 4 mm x 6 mm x 3 mm). ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Heterogeneous thyroid gland with bilateral thyroid nodules unchanged. "}
{"instruction": "Generate impression based on findings.", "input": "71-year-old male with HCV cirrhosis. Evaluate for hepatocellular carcinoma. LIVER: Liver is very mildly and coarsely echogenic. No focal hepatic mass is identified. Overall hepatic size is within normal limits. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein although the flow is low velocity.BILIARY TRACT: Gallbladder appears unremarkable without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: The pancreatic head and body are normal. The tail is less well-visualized due to bowel gas.SPLEEN: In the midportion noRIGHT KIDNEY: Right renal cyst again identified. OTHER: No significant abnormalities noted.", "output": "Stable examination without liver mass."}
{"instruction": "Generate impression based on findings.", "input": "Male 89 years old Reason: bilateral groin History: groin swelling Complex heterogeneous collections in the subcutaneous tissues of the left and right lower quadrant, near the incisions, which do not appear to connect in the midline. The right lower quadrant collection measures 9.9 x 2.8 x 4.0 cm. Left lower quadrant collection measures 5.3 x 3.6 x 5.1 cm.", "output": "Two subcutaneous nonspecific complex fluid collections near incision sites in right and left lower quadrants."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female with history of thyroid nodule. RIGHT LOBE MEASUREMENTS: 2.5 x 2.6 x 6.5 cmLEFT LOBE MEASUREMENTS: No significant abnormality noted.ISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: A primarily solid nodule in the mid right lobe measures 1.6 x 1.5 cm. Portions of the solid component have increased echogenicity, and there is a crescentic peripheral cystic component along its anterior margin.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered cervical lymph nodes without specific suspicious featuresOTHER: No significant abnormality noted.", "output": "Right thyroid nodule as described above is amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "77 years old, Female, Reason: left hand and wrist swelling, concern for splinter ( foreign body) History: pain and swelling No echogenic foreign body identified. No significant abnormality.", "output": "No echogenic foreign body identified. "}
{"instruction": "Generate impression based on findings.", "input": "Male; 61 years old. Reason: 61 y/o M with elevated ALT, RUQ u/s requested to rule out fatty liver disease LIVER: The liver measures 15.2 cm in length. The liver contour is smooth. The parenchyma is markedly increased in echogenicity with a coarsened echotexture. There is a geographic area of sparing adjacent to gallbladder fossa. These findings limit sensitivity for identification of focal hepatic masses.The main portal vein is patent with hepatopetal flow and a peak velocity of 0.2 m/sec.BILIARY TRACT: A small amount of debris is seen layering within the dependent portions of the gallbladder. There is no gallbladder wall thickening or pericholecystic fluid. The common duct measures 0.3 cm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 9 .0 cm in length.KIDNEYS: The right kidney measures 11.1 cm in length, the left kidney measures 11.4 cm in length. There is no hydronephrosis or shadowing renal stone bilaterally.", "output": "Echogenic and coarse liver parenchyma compatible with hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for hydronephrosis. Acute kidney injury. RIGHT KIDNEY: The right kidney measures 11.2 cm in length. No evidence of hydronephrosis. The kidney Is mildly echogenic compatible with medical renal disease.LEFT KIDNEY: The left kidney measures 11.3 cm in length. No evidence of hydronephrosis. The kidney Is mildly echogenic compatible with medical renal disease.URINARY BLADDER: Bladder is collapsed around a Foley catheterOTHER: Moderate abdominal ascites which is new compared to prior. Liver appears nodular compatible with cirrhosis.", "output": "Medical renal disease; no evidence of hydronephrosis. Moderate 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": "Multinodular goiter, evaluate for change in nodules. RIGHT LOBE MEASUREMENTS: 5.9 x 2.2 x 1.9 cm.LEFT LOBE MEASUREMENTS: 6.3 x 3.3 x 4.3 cm.ISTHMUS MEASUREMENTS: Up to 8 millimeters.RIGHT LOBE: Multiple nodules. Dominant lower pole solid nodule with heterogeneous echotexture, no definite calcifications, and mild internal vascularity measures 2.9 x 1.8 x 2.1 cm, previously 2.7 x 1.5 x 1.7 cm and grossly stable since 2008.LEFT LOBE: Dominant nodule occupying nearly entire left lobe with heterogeneous echotexture, no definite calcifications, mild internal vascularity, and large complex cystic component overall measures 6.2 x 3.3 x 4.3 cm, previously 7.1 x 4.6 x 3.0 cm and grossly stable since 2008.ISTHMUS: No discrete nodules identified.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A few benign morphology cervical lymph nodes are noted.OTHER: No significant abnormality noted.", "output": "Multinodular goiter. Dominant nodules are stable in size."}
{"instruction": "Generate impression based on findings.", "input": "Enlarged thyroid with choking symptoms at night RIGHT LOBE MEASUREMENTS: 2.4 x 1.9 x 6.5 cmLEFT LOBE MEASUREMENTS: 2.4 x 2.4 x 6.5 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: Diffusely heterogeneous gland without mass or increased vascularity.LEFT LOBE: Diffusely heterogenous gland without mass or increased vascularityISTHMUS: Diffusely heterogeneous gland without mass or increased vascularityPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland without mass or increased vascularity. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Female 57 years old Reason: right upper quadrant pain with previous possible hemangioma but dye allergy History: right upper quadrant pain LIVER: Liver has normal homogeneous echogenicity. There is a hyperechoic lesion in the liver compatible with hemangioma, previously seen on CT measuring 1.2 x 1.2 x 1.4 cm. Main portal vein is patent with normal directional flow and a with a peak velocity of 24.7 cm/s. No evidence of hemorrhage or perihepatic fluid.BILIARY TRACT: No intra or extravascular dilatation. The gallbladder wall is normal. No pericholecystic fluid. Negative Murphy's sign.PANCREAS: The visualized portions of the pancreas are normal.SPLEEN: Spleen is normal in appearance measuring 7.1 cm.KIDNEYS: Right kidney measures 9.47 m. Kidney measures 10.1 cm. No shadowing calculus or hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.No evidence of cholelithiasis or cholecystitis.2.Unchanged hemangioma in the liver without evidence of complication."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain and elevated lipase LIVER: No significant abnormalities noted. 14.3 cm in lengthGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Minimally complex upper pole right renal cyst measuring 1.7 x 1.8 x 1.3 cm. No stone or hydronephrosis. Right kidney 10.3 cm in length.OTHER: Left kidney cyst. Left kidney 10.4 cm in length. Spleen 8.4 cm in length. No ascites.", "output": "Negative for acute, inflammatory, or neoplastic process. No evidence for sonographically obvious complication of patient's known pancreatitis."}
{"instruction": "Generate impression based on findings.", "input": "Male 62 years old Reason: Evaluate soft tissue mass on midline back of neck (C5-8) History: Painless, soft lump on neck for over a year High and medium frequency grayscale and color Doppler ultrasound the region of the lump the back of the neck fails to reveal discrete measurable mass. Soft tissues and muscle planes appear normal.", "output": "No mass visible by ultrasound. Consider re-evaluation of MRI of the head and neck of 2/28/15 in light of this clinical finding."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal 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. Normal appearance of the gallbladder. No sonographic Murphy's sign.OTHER: No perihepatic free fluid identified.", "output": "Normal appearing gallbladder and biliary ducts."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old male with concern for abdominal aortic aneurysm ABDOMINAL AORTA: Abdominal artery is patent with appropriate directional flow.Proximal: 2.7 cm in AP dimensionMid: 2.0 cm in AP dimensionDistal: 2.0 cm AP dimensionRIGHT ILIAC ARTERY: Measures 1.3 cm AP dimension.LEFT ILIAC ARTERY: Measures 1.2 cm AP dimension.", "output": "Mild abdominal aortic ectasia. No aneurysmal dilatation of the abdominal aorta or right and left iliac arteries are seen."}
{"instruction": "Generate impression based on findings.", "input": "24-year-old female, right upper quadrant pain LIVER:The liver measures 16.5 cm in length. The portal vein is patent with hepatopetal flow measured at 25.9 cm/s. The liver is coarsely echogenic. No mass.GALLBLADDER, BILIARY TRACT: Several gallstones are noted within the gallbladder. There is no pericholecystic fluid. The gallbladder wall measures 4.2 mm, which is at the upper limits of normal. There was a negative sonographic Murphy sign. Common bile duct measures 8.7 mm, which is enlarged, however no stones are seen within the bile duct on this study.PANCREAS: The pancreas is not well visualized, No significant abnormality is noted.SPLEEN: The spleen measures 11.9 cm in length.KIDNEYS: The right kidney measures 12.7 cm. No mass, hydronephrosis, or stones are noted within the right kidney. The left kidney is not well-visualized on this study", "output": "1. Coarse liver echotexture consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. 2. Cholelithiasis, without evidence of acute cholecystitis. "}
{"instruction": "Generate impression based on findings.", "input": "Female 49 years old Reason: eval for gallbladder/liver etiology History: severe RUQ tenderness, elevated LFTs, fevers LIVER: Partially visualized liver is normal in appearance.BILIARY TRACT: No evidence of acute inflammation of the gallbladder. No gallstones. Gallbladder wall is within normal limits measuring 2 mm. No pericholecystic fluid. Common bile duct is normal measuring 4 mm. Negative sonographic Murphy's sign. OTHER: No significant abnormalities noted.", "output": "No evidence of acute cholecystitis, cholelithiasis, or specific findings to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid cancer s/p resection and I-131 RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: The previously described hyperechoic focus in the right thyroidectomy bed is unchanged, likely representing scar tissue or residual thyroid tissue.LEFT LOBE: 5 x 4 x 3 mm hypoechoic nodule in the left thyroidectomy bed which is stable to minimally increased in size, accounting for differences in technique, previously measuring 4 x 3 x 2 mm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not identified.LYMPH NODES: Benign-appearing cervical lymph nodes. The largest of these measures 21 x 4 x 6 mm.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy with stable postsurgical changes in the right thyroidectomy bed and hypoechoic nodule in the left thyroidectomy bed."}
{"instruction": "Generate impression based on findings.", "input": "Rising creatinine RIGHT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. 8.2 cm in length.LEFT KIDNEY: Echogenic renal parenchyma again noted without worrisome mass, stone, or hydronephrosis. Benign renal cyst. Left kidney 9.7 cm in lengthOTHER: Bladder collapsed", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Female 85 years old Reason: Evaluate for thyroid nodules and left inferior parathyroid adenoma prior to parathyroidectomy. Sestamibi localized to left inferior pole of thyroid. RIGHT LOBE MEASUREMENTS: 4.5 x 1.6 x 1.2 cmLEFT LOBE MEASUREMENTS: 4.8 x 1.3 x 1.4 cm.ISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Mildly heterogeneous background right thyroid lobe. A small hypoechoic nodule in the inferior right thyroid lobe measures 0.7 x 0.6 x 0.5 cm, with a nonspecific appearance.LEFT LOBE: Left thyroid lobe has a heterogeneous background. Small heterogeneous nodule in the inferior left thyroid lobe measures 0.9 x 0.7 x 0.9 cm. No hypoechoic extrathyroid nodule is identified to indicate a parathyroid adenoma.ISTHMUS: Isthmus has a heterogeneous appearance.PARATHYROID GLANDS: No parathyroid adenomas identified on this exam.LYMPH NODES: No suspicious lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Heterogeneous background thyroid with subcentimeter nonspecific nodules bilaterally. No hypoechoic extrathyroid nodule is identified to suggest a parathyroid adenoma."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old female presents with a three day history of a breast lump in the 11:00 position. No known trauma history, no additional symptoms. A targeted left breast ultrasound was performed in the area of the patient's palpable concern. At the 11:00 position 5 cm from the nipple near the area of palpable concern is a circumscribed predominantly hyperechoic mixed echogenicity lesion measuring 1.5 x 2.0 x 0.8 cm, most likely representing either fat necrosis or a hematoma.", "output": "Mixed echogenicity lesion in the area of palpable concern is consistent with either fat necrosis or hematoma. A three month follow-up examination is recommended to confirm stability or resolution.These findings were discussed with the patient and Dr. Checkett at the time of this dictation. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "Male, 37 years old. CKD s/p renal transplant, with hx of hydroureter The transplant kidney in the right iliac fossa measures 13.1 cm in length, with normal echotexture. No perinephric collection. A midpole simple cyst measures 0.8 x 0.9 x 0.7 cm. Extrarenal pelvis. No significant hydronephrosis. No shadowing stones. OTHER: The bladder is incompletely distended.", "output": "No significant hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Patti Tyc is a 53 years old female with a personal history of palpable lump in the left breast of 2 weeks duration. History of cysts. MAMMOGRAM: Three standard views of both breasts and 2 additional 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(BiRads Density Category C), unchanged in pattern and distribution. A triangular marker is placed at 12 o'clock position of left breast, indicating the area of palpable concern. A multilobular mass or multiple adjacent masses are noted in the 12:00 position of the left breast, corresponding to the palpable concern. Another smaller focal asymmetry is noted in the 6:00 position of the left breast. In the right breast upper outer quadrant, there is a focal asymmetry noted in the posterior depth, likely an additional cyst given her history of cysts. Elsewhere, stable benign masses scattered in each breast are noted. ULTRASOUND:On physical examination, a mass is palpated in the left breast 12:00 position.A targeted left ultrasound was performed for the palpable and new mammographic areas of concern. In the left breast, 12:00 position, 3 cm from the nipple, there is redemonstration of the clustered cyst, now measuring 2.5 x 2.0 x 2.7 cm (previously 1.8 x 1.7 x 1.2 cm), corresponding to the palpable and mammographic concern. In the left breast, 6:00 position 3 cm from the nipple, there is a 0.8 x 0.6 x 0.8 cm cyst, corresponding to the mammographic finding.A targeted right ultrasound was performed for the new mammographic area of concern. In the right breast, 10:00 position, 5 cm from the nipple, there is a 0.8 x 1.1 cm cyst, corresponding to the mammographic finding.", "output": "No mammographic evidence of malignancy. Multiple cysts in both breasts. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic 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": "46 year old female with history of left breast benign core biopsy (fibroadenoma) with increasing size of right-sided breast mass and focal asymmetry in the left upper outer breast. Patient is currently asymptomatic. No personal or family history of breast cancer. DIAGNOSTIC MAMMOGRAM", "output": "Circumscribed mass in the right breast 10 o'clock position is compatible with a benign cyst. Normal breast parenchyma in the left upper outer breast. No 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": "Acute kidney injury. Oliguria. RIGHT KIDNEY: 11.9 cm in length. Mildly increased renal parenchymal echogenicity. Lobulated contours, similar to the prior CT. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 11.4 cm in length. Mildly increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: No significant abnormality noted.OTHER: Small amount of ascites identified.", "output": "Mildly echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male with abnormal LFTs. LIVER: Measures 11.5 in length. Unremarkable 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": "No abnormalities to account for the patient's symptoms."}
{"instruction": "Generate impression based on findings.", "input": "15 year old female with personal history of three excisional biopsies of the right breast (November 2015) compatible with biopsy proven juvenile fibroadenomas. She presents today with follow-up. A targeted right ultrasound was performed in the area of known masses. Three lobulated circumscribed masses were again noted in the right upper outer breast.The largest mass (#1) at the 10:00 position 5 cm from the nipple measured 3.6 x 2.0 x 4.7 cm, increased from prior 2.7 x 1.8 x 3.7 cm.The more superomedial mass (#2) at the 12:00 position 5 cm from the nipple measured 0.9 x 0.8 x 1.1 cm, increased from prior 0.7 x 0.7 x 0.9 cm.The inferolateral mass (#3) at the 10:00 position 5 cm from the nipple measured 1.4 x 0.9 x 2.3 cm, increased from prior 1.3 x 0.9 x 2.1 cm.", "output": "Interval increase in size of three right breast masses likely fibroadenomas. Patient is scheduled to follow-up with Dr. Jaskowiak. Results were discussed with patient and her mother. BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: No significant abnormalities noted. 17.3 cm in lengthBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 10 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 11.7 cm in lengthOTHER: Left kidney 11.1 cm in length. No ascites", "output": "Negative limited right upper quadrant ultrasound. No hepatobiliary abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Sepsis and abdominal pain LIVER: No significant abnormalities noted. Right kidney 14.8 cm in length.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic renal parenchyma without obstruction. 10.8 cm in lengthOTHER: Echogenic left renal parenchymal without obstruction. Left kidney 9.7 cm in length. Spleen is 13.8 cm in length. Mild ascites.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction. Mild ascites."}
{"instruction": "Generate impression based on findings.", "input": "53 year old woman with history of left breast cancer, enhancing lesion seen in right breast on pre-treatment MRI. A targeted right ultrasound was performed for the MR/mammographic area of concern. There is a hypoechoic, circumscribed oval mass measuring 1.1 x 1.0 x 0.6 cm in the 9:00 position of the right breast 7 cm from the nipple, corresponding to the MR/mammographic findings. Mild peripheral flow is noted. The lesion is consistent with fibroadenoma. No additional or suspicious findings noted.", "output": "Right breast fibroadenoma for which a biopsy is not needed. Recommend follow-up with Breast Surgery, results discussed with patient.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Male; 52 years old. 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 recurrenceLEFT LOBE: No evidence of recurrenceISTHMUS: No evidence of recurrencePARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: 2.0 x 0.4 x 0.6 cm left level 2 lymph node has a fatty hilum and normal ultrasound appearance and is likely reactive.OTHER: No significant abnormality noted.", "output": "Stable exam. No evidence for disease recurrence."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain. Opacity seen on recent KUB. RIGHT KIDNEY: 14.0 cm in length. There is a 6.2 cm benign appearing cyst at the inferior pole, corresponding to the opacity seen on the recent abdominal radiograph. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 10.1 cm in length. Unremarkable renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "6.2 cm benign-appearing cyst at the right inferior renal pole, corresponding to the opacity seen on the recent abdominal radiograph."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules. RIGHT LOBE MEASUREMENTS: 5.1 x 1.9 x 1.4 cm.LEFT LOBE MEASUREMENTS: 4.8 x 1.5 x 1.5 cm.ISTHMUS MEASUREMENTS: 0.3 cm.RIGHT LOBE: Right inferior pole mixed solid and cystic nodule measures 0.9 x 0.6 x 0.8 cm, stable from the prior exam. There is and adjacent cystic right inferior pole thyroid nodule, measuring 1.0 x 1.0 x 0.7 cm, new or increased from the previous exam. Other subcentimeter nodules are stable.LEFT LOBE: Superior left thyroid lobe mixed solid and cystic nodule measures 0.5 x 0.3 x 0.6 cm, stable from the prior exam. Other subcentimeter nodules are also stable.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Right inferior pole nodule is new or increased in size, but favored benign given its cystic morphology.2. Other bilateral subcentimeter nodules are stable. "}
{"instruction": "Generate impression based on findings.", "input": "Female 69 years old; Reason: Primary HPT. Assess Sternal Notch location as this may be where the Parathyroid adenoma is located History: Primary HPT. Assess Sternal Notch location as this may be where the Parathyroid adenoma is located RIGHT LOBE MEASUREMENTS: Status post surgical removal.LEFT LOBE MEASUREMENTS: Status post surgical removalISTHMUS MEASUREMENT: Status post surgical removal.ISTHMUS: No significant abnormality noted.LYMPH NODES: A right level I lymph node measures 1.0 x 0.6 x 2.7 cm. An additional left level II lymph node measures 0.9 x 0.5 x 2.4 cm.OTHER: No evidence of a parathyroid adenoma, including adjacent to the sternal notch", "output": "1.No evidence of a parathyroid adenoma, including adjacent to the sternal notch."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid cancer monitoring RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: Multiple hypoechoic nodules in the right thyroid bed are stable compared to prior. The largest of these measures 6 mm and is unchanged, accounting for differences in measurement technique.LEFT LOBE: Multiple hypoechoic nodules in the left thyroid bed are stable compared to prior. The largest of these measures 6 mm and is unchanged, accounting for differences in measurement technique.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Enlarged right cervical lymph nodes. A slowly enlarging right level 2 lymph node measures 1.5 x 0.9 x 1.9 cm, previously 0.9 x 0.5 x 1.5 cm on 3/5/2012. A slowly enlarging right level 4 lymph node measures 1.5 x 1.7 x 2.3 cm, previously 1.1 x 0.9 x 1.1 cm on 3/5/2012. Slightly decreased size of the left submandibular nodule, now 1.7 cm, previously 2.3 cm on 3/5/2012.OTHER: No significant abnormality noted.", "output": "Enlarging abnormal right level 2 and level 4 lymph nodes. These are amenable to percutaneous biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Female 59 years old Reason: evaluate renal lesion seen on CT History: renal lesion on CT/ abd pain RIGHT KIDNEY: Right kidney measures 10.6 in meters. There is a multicystic lesion in the right kidney with a central calcification measuring approximately 2.7 x 1.1 x 1.1 cm. Corresponding to lesion seen on recent noncontrast CT. No hydronephrosis. Renal cortical echogenicity is normal.LEFT KIDNEY: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Left mid renal cyst measures 1.4 x 1.2 x 1.5 cm.OTHER: No significant abnormalities noted.", "output": "Complex cystic lesion in the right mid kidney, with calcification, is incompletely evaluated on this renal ultrasound. Recommend dedicated renal CT with and without contrast for full evaluation.Discussed with ordering physician, Dr. Yang."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old female with worsening renal function, hematuria RIGHT KIDNEY: Measures 10.2 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. Stent visualized in the renal pelvis.LEFT KIDNEY: Measures 10.2 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. Stent visualized in the renal pelvis.URINARY BLADDER: Incompletely distended without focal abnormality. Bilateral distal stent catheters visualized in the bladder lumen.OTHER: No significant abnormalities noted.", "output": "1. Increased renal echogenicity consistent with medical renal disease. 2. Renal stents in place without hydronephrosis. "}
{"instruction": "Generate impression based on findings.", "input": "History of pancreatitis with abdominal pain nausea and vomiting CT performed 5/ LIVER: Coarse echogenic liver without mass. Liver length 18.9 cmGALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No ductal dilatationPANCREAS: Abnormal heterogeneous pancreas with multiple calcifications again noted consistent with chronic pancreatitis.RIGHT KIDNEY: No significant abnormalities noted. 12 cm in length.OTHER: Left kidney 12.9 cm in length. Spleen 13.8 cm in length. No ascites.", "output": "Echogenic liver parenchyma again noted consistent with chronic liver disease/fatty infiltration without mass or ductal dilatation. Mild hepatomegaly. Status post cholecystectomy. No ascites.Abnormal heterogeneous pancreas with multiple calcifications again noted consistent with chronic pancreatitis; cannot assess for presence of acute pancreatitis"}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain. Recently diagnosed with celiac disease. LIVER: The liver parenchyma is mildly coarse and echogenic. No focal suspicious lesion or intrahepatic biliary ductal dilatation. Normal hepatopedal portal venous blood flow at 49 cm/s.BILIARY TRACT: No extrahepatic biliary ductal dilatation with the common duct measuring 4 mm.Normally distended gallbladder without gallbladder wall thickening, pericholecystic fluid, gallstones or focal tenderness.PANCREAS: The visualized portions of the pancreatic head and body are unremarkable. The remainder of the pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The spleen is normal in size measuring 7.8 cm in length.RIGHT KIDNEY: The right kidney measures 9.7 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar flow flow. OTHER: The left kidney measures 10.5 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar flow flow.", "output": "No specific findings to account for the patient's right upper quadrant pain. Mildly coarse and echogenic liver parenchyma most commonly seen in fatty infiltration of the liver."}
{"instruction": "Generate impression based on findings.", "input": "58 years old, Female, Reason: papillary thyroid cancer History: thyroid cancer RIGHT LOBE MEASUREMENTS: 4.9 x 1.9 by 1.9 cmLEFT LOBE MEASUREMENTS: Patient status post left thyroidectomyISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Spongiform appearing nodule in the inferior pole the right thyroid lobe measures 0.9 x 1.1 x 1.0 cm, previously measuring 0.8 x 0.9 x 1.0 cm. Multiple sub-centimeter hypoechoic right thyroid nodules are identified, similar to prior exam.LEFT LOBE: Patient status post left thyroidectomyISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Right inferior pole spongiform nodule is not significantly changed from prior exam."}
{"instruction": "Generate impression based on findings.", "input": "Suppressed TSH; thyrotoxicosis RIGHT LOBE MEASUREMENTS: 5.8 x 0.9 x 1.6 cm.LEFT LOBE MEASUREMENTS: 5 x 0.9 x 1.4 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: Diffusely heterogeneous gland without discrete mass. No increased vascularity.LEFT LOBE: Diffusely heterogeneous gland without discrete mass. No increased vascularityISTHMUS: 2 x 0.9 x 2.8 cm predominantly solid isthmic nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland without increased vascularity suggestive for chronic thyroiditis. Dominant solid isthmic nodule; this nodule is amenable to percutaneous ultrasound-guided biopsy. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Right-sided thyroid fullness RIGHT LOBE MEASUREMENTS: 4.7 x 1.2 x 1.6 cm, normal echotexture and vascularityLEFT LOBE MEASUREMENTS: 4.2 x 1.4 x 1.5 cm, normal vasculature and echotextureISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal morphology left level 1 right neck lymph node measures 0.8 x 1 x 0.3 cm. Normal morphology left lateral neck lymph node measures 3.2 x 1 x 0.4 cmOTHER: No significant abnormality noted.", "output": "Normal morphology thyroid gland without any focal lesions."}
{"instruction": "Generate impression based on findings.", "input": "Male, 63 years old. Reason: Evaluate kidneys and liver in setting of AKI and possible liver dysfunction (elevated bili, INR), concern for cirrhosis LIVER: The liver measures 14.5 cm, with mildly increased echogenicity, and no focal lesion. Visualized liver contour within normal limits. The main portal vein is patent, with normal hepatopetal flow.GALLBLADDER, BILIARY TRACT: No intrahepatic or extrahepatic biliary ductal dilatation. The common bile duct measures 0.3 cm. The gallbladder is contracted with normal wall thickness. No stones.PANCREAS: The visualized portions of the pancreas are normal.RIGHT KIDNEY: 10.1 cm in length, with normal echotexture. No hydronephrosis, perinephric fluid, or echogenic stones.LEFT KIDNEY: 10.1 cm in length, with normal echotexture. No hydronephrosis, perinephric fluid, or echogenic stones.SPLEEN: Suboptimally visualized due to patient positioning and habitus. 7.0 cm in length, without focal lesion.ABDOMINAL AORTA: Patent and normal in caliber throughout its course.INFERIOR VENA CAVA: Visualized portions patent, with normal flow.OTHER: No significant abnormality noted.", "output": "1. Mildly increased hepatic parenchymal echogenicity, may reflect underlying hepatic steatosis/parenchymal dysfunction.2. No hydronephrosis, perinephric fluid, or shadowing renal stone."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Bruce submitted outside mammograms dated 1/8/2015 and 3/8/2016, from Mercy Hospital. Submitted outside studies were compared to the current mammogram/ultrasound dated 11/4/2016. The breast parenchyma is composed of scattered fibroglandular density (BiRads Density Category B), unchanged in pattern and distribution. Previously identified mass in the right lateral breast (2:30 location) and left upper outer breast (1:00 location) are stable when compared to prior mammograms dating back to 2015.There is no significant change between these studies.", "output": "Bilateral stable benign morphology masses. 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: NSB - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Multinodular goiter RIGHT LOBE MEASUREMENTS: 6.9 x 3.7 x 3.3 cmLEFT LOBE MEASUREMENTS: 5.8 x 1.4 x 2 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Interval increase in size of large spongiform nodule occupying much of the lower aspect of the right thyroid gland measuring 4.4 x 3 x 5.1 cm; this is in comparison to 2.2 x 2.7 x 1.5 cm in 2013.LEFT LOBE: No significant change in multiple benign-appearing left thyroid nodules the largest measuring 2.1 x 1 x 1.8 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Interval increase in size of right spongiform nodule. Left thyroid nodule stable. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal levels of other serum enzymes LIVER: The liver measures 13.4 cm in length. Normal hepatic parenchymal echogenicity and echotexture. Patent portal vein with normal directional hepatopetal blood flow, peak velocity 17.0 cm/s. Previously seen 2 cm segment II lesion on CT is homogeneously echogenic, consistent with hemangioma, measuring 2.4 cm in maximum diameter, without change.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. Status post cholecystectomy. The common hepatic duct measures 0.5 cm. No biliary ductal dilatation.PANCREAS: No significant abnormalities noted. The pancreatic duct measures 0.4 cm.RIGHT KIDNEY: The right kidney measures 9.7 cm. No hydronephrosis or shadowing stones.LEFT KIDNEY: The left kidney measures 10.5 cm in length. No hydronephrosis or shadowing stones.OTHER: The spleen measures 9.0 cm in length. No ascites.", "output": "No acute hepatobiliary findings.Stable hepatic hemangioma."}
{"instruction": "Generate impression based on findings.", "input": "10-year-old female, with history of enuresis and bladder dysfunction, evaluate. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. Distal Ureter -- SFU Grade**  Right: 0  Left: 0   Ureteral Jets Right: Right ureteral jet observed.  Left: Not observedKIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 0  Length*** Right: 8 cm Left: 7.7 cm   Mean for age: 9 cm  Range for age: 7.5 - 10.8 cmADDITIONAL OBSERVATIONS: No significant abnormalities.", "output": "Normal appearance of bilateral kidneys and the bladder.*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": "Female 70 years old; history of thyroid cancer at isthmus, evaluate for further nodules, and lymph nodes History: History of papillary thyroid cancer RIGHT LOBE MEASUREMENTS: 4.5 x 1.3 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.4 x 1.5 x 1.3 cmISTHMUS MEASUREMENT: 0.6 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Circumscribed hypoechoic lesion measuring 2.3 x 2.0 x 1.0 cm, previously 1.0 x 0.7 x 0.8 cm, slightly increased in size compared to prior exam.ISTHMUS: Primary solid hypovascular hypoechoic nodule measures 1.2 x 1.0 x 0.7 cm compared to 1.0 x 0.7 x 0.8 cm, not significantly changed compared to prior exam. This lesion was demonstrated to be a papillary thyroid cancer on biopsy.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Primary solid hypovascular hypoechoic nodule in the isthmus, not significantly changed in size as compared to prior exam. This nodule was found to be papillary thyroid cancer on biopsy.2.Circumscribed hypoechoic lesion in the left thyroid lobe, slightly increased in size as compared to prior exam. Given the history of known thyroid cancer, this may represent additional focus of thyroid cancer."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female. History of right inner breast mass that was biopsied on 10/7/2014 to be spindle cell proliferation and focal usual ductal hyperplasia. Patient presents for short interval follow-up mammogram of her right breast. Right breast diagnostic mammogram: Three standard 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. The right breast mass containing a biopsy clip at the 3 o'clock position appears slightly larger; ultrasound was done for further evaluation. Right breast ultrasound: Targeted ultrasound for the right breast 3 o'clock position 2 cm from the nipple again showed a mixed echogenicity predominately hypoechoic mildly vascular mass that measures 2.3 x 1.2 x 1.8 cm, previously 1.5 x 1.1 x 1.3 cm. A few cystic components within this mass are again noted. The biopsy clip is at its inferior margin.", "output": "Mild increase in size of the right breast complex mass. Recommend surgical consultation regarding its management.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "72 years old, Female, Reason: R/o gallstones or Ulcer History: abdominal pain LIVER: The liver is slightly enlarged measuring 18 cm in length. The liver parenchyma is normal in appearance. 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 5 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 10 cm in length. RIGHT KIDNEY: Kidney measures 11.4 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 11.9 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Normal appearing gallbladder and biliary tract with no evidence of cholelithiasis or cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Advanced CKD History: advanced CKD RIGHT KIDNEY: The right kidney measures 12.5 cm in length. Unremarkable renal parenchymal echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 11.7 cm in length. Unremarkable renal parenchymal echogenicity. No shadowing stones or hydronephrosis.OTHER: Renal jets visualized bilaterally. Unremarkable urinary bladder.", "output": "No acute renal abnormality."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Cowden is a 44-year-old female with recently diagnosed left breast cancer and prominent left axillary lymph nodes. She presents today for repeat ultrasound evaluation of these lymph nodes. A targeted left axillary ultrasound was performed. Two lymph nodes are identified in the left axilla. -The first lymph node measures approximately 1.5 x 0.6 cm with uniform cortical thickness measuring up to 0.3 cm and preserved fatty hilum. There is normal hilar vascular flow identified.-The second adjacent lymph node measures 0.9 x 0.6 cm with uniform cortical thickness measuring up to 0.3 cm and preserved fatty hilum. There is normal hilar vascular flow identified.", "output": "Two mildly prominent left axillary lymph nodes, which are not typically suspicious in appearance. These are likely reactive given the sonographic appearance and recent history of multiple biopsies. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old male with cirrhosis. Screen for HCC. Limited evaluation, particularly of the liver at the dome, due to technical factors including poor patient breath holding and bowel gas. Within this limitation, the following observations are made.LIVER: Cirrhotic liver morphology. No definite focal hepatic lesion. Liver measures 13 cm in length. Main portal vein is patent with normal directional flow. Patent TIPS visualized. No intrahepatic biliary ductal dilation.GALLBLADDER, BILIARY TRACT: Normal appearance of the gallbladder. Common bile duct measures 2 mm.PANCREAS: Poorly visualized due to overlying bowel gas.RIGHT KIDNEY: Right kidney is 9.9 cm in length. No hydronephrosis.OTHER: Left kidney is 11.7 cm in length. No hydronephrosis.Spleen is 15.3 cm in length. No focal splenic lesions.No ascites.", "output": "Limited examination without evidence of focal liver lesion."}
{"instruction": "Generate impression based on findings.", "input": "Reason: s/p LVAD, drive line infection, please assess fluid collection around drive line site History: pain and drainage at site Within the superficial soft tissues of the right lower quadrant anterior abdominal wall, there is a 2.8 x 2.6 x 1.2 cm complex fluid collection medial to the LVAD drive line with increased vascularity in the surrounding soft tissues.", "output": "Findings concerning for superinfected fluid collection or abscess measuring up to 2.8 cm around and adjacent to the drive line.Findings were communicated to the emergency department staff via the stat consult system and acknowledged by Dr. Shah. "}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain LIVER: Coarse echogenic liver parenchyma. No mass lesion. Liver length 22 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11 cm in length.OTHER: Left kidney 11.7 cm in length. Spleen 10 cm in length. No ascites.", "output": "Hepatomegaly with coarse echogenic liver parenchyma suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with history of goiter seen on chest x-ray. RIGHT LOBE MEASUREMENTS: 5.8 x 1.4 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.7 x 2.8 x 2.1 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Subcentimeter partially cystic nodule in the right lobe measures 0.5 x 0.5 x 0.5 cm. Mildly heterogeneous background gland. LEFT LOBE: Dominant left thyroid lobe nodule which is solid with a central cystic component measures 2.2 x 1.6 x 2.7 cm. A more posteriorly located smaller nodule with spongiform features measures 1.2 x 1.2 x 1.6 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered cervical lymph nodes with benign morphologic features.OTHER: Incidental note of calcification and atherosclerotic plaque with stenosis of both carotid arteries at the bifurcations.", "output": "1. Thyroid nodules greater on the left as detailed above. 2. Incidental note of calcification and atherosclerotic plaque with stenosis of both carotid arteries at the bifurcations. Recommend a dedicated carotid vascular ultrasound examination for further evaluation. "}
{"instruction": "Generate impression based on findings.", "input": "Status post left breast lumpectomy followed by radiation now with increasing pain and swelling. No discrete mass noted. Patient presents for ultrasound. A targeted left ultrasound was performed for the patient\u2019s area of pain. Patient indicates area of pain in the left breast 9:00, 8:00 10:00 and 4:00 position around the nipple. Breast edema with skin thickening noted consistent with post surgical change. Scar noted at 9 to 10:00 position periareolar. Scar tissue identified at that location with a small seroma cavity measuring 1.8 x 0.9 x 0.9 cm. No suspicious solid mass noted.", "output": "No sonographic evidence for malignancy corresponding to patient's area of pain at 9, 10, 8 and 4:00 position of the left breast.Postsurgical changes identified in the left breast.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female recalled for asymmetry in the lateral aspect of the right breast seen on screening mammogram One standard ML mammographic view of the right breast was performed followed by 2 right CC spot compression views and medial and lateral rolled CC views. Targeted grayscale and color Doppler ultrasound was subsequently performed and a BB was placed on the skin. Mammograms were then obtained with tangential and LMO views.The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. The asymmetry in the lateral breast that triggered this exam was not evident on spot compression views. Medial rolled CC views demonstrated lateral displacement of the 5 mm asymmetry, which has the appearance of a circumscribed cyst as subsequently demonstrated by ultrasound.Targeted ultrasound of the right lower quadrant showed an anechoic, unilocular cyst with no internal flow measuring 3 x 3 x 3 mm located 8 cm from the nipple along the 8:00 radian. A BB was placed on the cyst. Tangential and LMO views of the right breast confirm that the cyst corresponds to the asymmetry that triggered this exam.", "output": "Asymmetry identified on the screening mammogram corresponds to a simple benign cyst. No further evaluation is necessary. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, annual bilateral screening mammography is recommended. The results and recommendations were discussed with the patient at the completion of the exam.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female patient with HCV infection. LIVER: The liver measures 17 cm in length. Mildly coarsened liver echotexture but no discrete lesion. Main portal vein flow is hepatopetal and measures 0.2 m/s.BILIARY TRACT: There is no intra or extrahepatic biliary ductal dilatation. The common bile duct measures 3 mm in diameter. The gallbladder has been surgically removed.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen is poorly visualized but measures approximately 7.4 cm in length.RIGHT KIDNEY: The right kidney measures 10.4 cm in length. No evidence of hydronephrosis. OTHER: Left kidney measures 10.1 cm in length. No evidence of hydronephrosis.", "output": "Mildly coarsened liver echotexture but no discrete lesion."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male with worsening renal failure. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney is markedly echogenic and measures 8.9 cm in length. No evidence of hydronephrosis.LEFT KIDNEY: Nonvisualization of the left kidney.OTHER: No significant abnormalities noted.", "output": "1.Markedly echogenic right kidney compatible with medical renal disease without evidence of hydronephrosis. 2.Nonvisualization of left kidney."}
{"instruction": "Generate impression based on findings.", "input": "History of Hurthle cell cancer status post thyroidectomy. RIGHT LOBE: Status post thyroidectomy.Morphologically benign-appearing lymph noted in the inferior aspect of the inferior thyroidectomy bed measures 8 x 3 x 5 mm compared to 7 x 2 x 4 mm previously. The more superior homogeneously echogenic nodule measures 6 x 4 x 5 mm compared to 5 x 3 x 5 mm previously.LEFT LOBE: Status post thyroidectomy.Morphologically benign-appearing lymph nodes in the thyroidectomy bed are noted.The superior bed lymph node measures 7 x 3 x 6 mm compared to 7 x 2 x 4 mm.The mid/inferior bed lymph node measures 5 x 5 x 3 mm. It was not visible on the prior studies but is unchanged from 2012.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No new sites of disease. Stable bilateral thyroidectomy bed lymph nodes and stable nonspecific homogeneous echogenic nodule in the right inferior thyroidectomy bed."}
{"instruction": "Generate impression based on findings.", "input": "Reason: nausea and vomiting, assess for gallstones LIVER: The liver measures 14.4 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 0.24 m/s.BILIARY TRACT: Cholelithiasis, shadowing from which obscures the posterior aspect of the gallbladder. No gallbladder wall thickening or pericholecystic fluid is visualized. 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 10.0 cm in length. RIGHT KIDNEY: Kidney measures 11.1 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 11.4 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Cholelithiasis without sonographic evidence of acute cholecystitis or biliary ductal dilatation.2.Increased hepatic echogenicity raising the possibility of parenchymal dysfunction/fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "84-year-old female with left neck mass Redemonstrated is a vascular tumor deep and medial to the left internal jugular vein inserting mass effect and measuring 3.8 x 2.8 x 4.3 cm. The tumor is isoechoic to muscle and mildly heterogeneous in echogenicity. No significant lymphadenopathy is present.", "output": "Left neck mass compatible with paraganglioma as described above."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodule suspicious for carcinoma. Assess cervical lymph nodes RIGHT LOBE MEASUREMENTS: 5.2 x 1.5 x 1.5 cmLEFT LOBE MEASUREMENTS: 5.2 x 1.5 x 1.5 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: 1.3 x 0.8 x 1 cm hypoechoic nodule with worrisome internal echogenic foci within the upper pole. 0.4 x 0.4 x 0.4 cm hypoechoic midpole nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Worrisome hypoechoic nodule upper pole left thyroid gland with possible internal microcalcifications; this lesion is suspicious for a malignant focus.No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Male 67 years old with hepatitis C, evaluate for HCC History: HCV LIVER: Mild increase in hepatic parenchymal echogenicity with coarsened echotexture. No focal hepatic lesions. Hepatic length measures up to 18.3 cm in craniocaudal dimension. No intrahepatic biliary ductal dilatation. The main portal vein is patent with normal hepatopedal flow directed towards the liver with a velocity of 26.5 cm/s. GALLBLADDER, BILIARY TRACT: The gallbladder is normal in echotexture with the wall measuring 4 mm. The common bile duct measures 5 mm in diameter. No choledocholithiasis. No extrahepatic biliary ductal dilatation.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 8.9 cm and has a normal echotexture.KIDNEYS: The kidneys have normal corticomedullary differentiation. Thr right kidney measures 12.0 cm and has normal vascular flow. The left kidney measures 11.5 cm and has normal vascular flow. OTHER: No significant abnormality noted.", "output": "Mild increase in hepatic parenchymal echogenicity with coarsened echotexture consistent with fatty liver/hepatic parenchymal dysfunction. No hepatic mass or ductal dilatation identified."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female with history of hepatitis C, evaluate for HCC. LIVER: Measures 21.3 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: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "Hepatomegaly and increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease, without discrete focal lesion. "}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with palpable abnormality at mandibular angle Right submandibular gland is generally homogeneous in echotexture without diffuse slialectasis. There is a 1.3 cm lymph node within the substance of the gland. Cranial to this there is a complex cystic mass which is superficial within the gland and corresponds to the palpable abnormality. This measures 0.6 x 0.8 x 0.9 cm and contains multiple shadowing calcifications. On several images, it appears at this may communicate with a segment of duct. No definite thrombosed vasculature is identified..", "output": "Complex cystic mass in the right submandibular gland with calcification. Differential considerations would include Sialic cyst/sialocele, there does not appear to be significant vascularity or soft tissue mass to suggest mucoepidermoid carcinoma or papillary carcinoma, and therefore this may be postinflammatory."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old female with abdominal pain, right flank pain. Choledocholithiasis on CT, evaluate for acute cholecystitis. LIVER: Coarse echotexture 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 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Stones within the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. Sonographic Murphy's sign is negative. Common duct measures 5 mm in caliber. No intra-or extrahepatic biliary ductal dilatation. No evidence of choledochal lithiasis within the visualized portions of the common bile duct.PANCREAS: Distal body and tail of the pancreas are obscured by overlying bowel gas. The remaining visualized portions are unremarkable.RIGHT KIDNEY: Measures 11.2 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Spleen measures 10.2 cm in length.Left kidney measures 12.9-cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "1. Cholelithiasis with no evidence of cholecystitis. No choledocholithiasis within the visualized common bile duct. 2. Coarse echotexture of the liver suggestive of parenchymal dysfunction/fatty infiltration. No focal hepatic lesions. "}
{"instruction": "Generate impression based on findings.", "input": "88 year old female patient with right upper and lower quadrant abdominal pain. LIVER: The liver measures 14.2 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 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 8.6 cm in length. No evidence of hydronephrosis. There is a subcentimeter midpole renal sinus cyst.OTHER: The left kidney measures 8.6 cm in length. No evidence of hydronephrosis. There is a 1.6 x 2.1 x 1.4 cm superior pole renal cyst.The spleen measures 7.5 cm in length.", "output": "1. No acute sonographic findings to account for the patient's symptoms.2. Left upper pole renal cyst. "}
{"instruction": "Generate impression based on findings.", "input": "Male 65 years old Reason: eval for lesions, assess hepatic vessel patency History: s/p OLT for HBV in October 2004, recurrent HBV LIVER: Liver measures 11.7 cm. Small liver cyst is present measuring 1.0 x 0.7 x 1.0 cm. No suspicious hepatic mass identified.BILIARY TRACT: Patient is status post cholecystectomy. No intra or extra hepatic biliary ductal dilatation. Common bile duct measures 0.7 cm.PANCREAS: Head of the pancreas is normal in appearance without pancreatic ductal dilatation. Body and tail of the pancreas are obscured by overlying bowel gas.SPLEEN: Spleen is normal in appearance measuring 12.5 cm.KIDNEYS: Cortical echogenicity is increased bilaterally which can be seen in the setting of medical renal disease. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 9.0 cm. Within the right kidney there is a small anechoic cyst measuring 1.3 x 1.3 x 1.1 cm. Left kidney measures 10.9 cm. Within the left kidney there is a small anechoic cyst measuring 2.7 x 2.6 x 3.6 cm.OTHER: No significant abnormalities noted.", "output": "1.Echotexture of the liver within normal limits. Unchanged small hepatic cyst. Patent hepatic vessels with normal directional flow.2.Echogenic renal parenchyma is again noted, which can be seen in the setting of medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "38 year old female with right upper quadrant pain, history of breast cancer. Evaluate for cholelithiasis or other etiology of abdominal pain. LIVER: Increased echogenicity of the liver measuring 16.0 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: Normal echogenicity of the gallbladder. No pericholecystic fluid. No gallbladder wall thickening. Common bile duct measures 3 mm in caliber. No intra-or extrahepatic biliary ductal dilatation. PANCREAS: Normal echogenicity of the visualized pancreas.RIGHT KIDNEY: Normal echogenicity measuring 10.3 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the left kidney measuring 11.7 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "Increased echogenicity of the liver compatible with fatty infiltration. No sonographic evidence of cholelithiasis."}
{"instruction": "Generate impression based on findings.", "input": "History of pulsatile abdominal pain, evaluate for abdominal aortic aneurysm. ABDOMINAL AORTA: The abdominal aorta is normal in caliber without evidence of aneurysm. The proximal aorta measures 2.4 x 2.3 cm. The middle aorta measures 1.9 x 2.0 cm. The distal aorta measures 2.0 x 2.2 cm. OTHER: The right iliac artery measures approximately 1.5 x 1.6 cm. The left iliac artery measures approximately 1.5 x 1.6 cm.", "output": "No sonographic evidence of abdominal aortic aneurysm."}
{"instruction": "Generate impression based on findings.", "input": "Prerenal transplant evaluation RIGHT KIDNEY: Atrophic echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Stable right renal cysts Right kidney 9.1 cm in length. LEFT KIDNEY: Atrophic echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Left kidney 7.4 cm in length Complex fluid collection within the inferior left perinephric space measuring 5.2 x 4.1 x 7.7 cm consistent with evolution of previously noted hematoma.OTHER: Bladder nondistended. Moderate ascites with dialysis catheter noted.", "output": "Atrophic echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis. Interval decrease in size of loculated complex inferior left perinephric space cystic/fluid collection consistent with resolution of previously noted hematoma."}
{"instruction": "Generate impression based on findings.", "input": "Male 74 years old; Reason: R/O HCC History: HCV, advanced liver fibrosis LIVER: The liver measures 13.8 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 12.1 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder is hardly visualized due to shadowing from overlying bowel gas. The common bile duct measures 6.0 mm in diameter. PANCREAS: The majority of the pancreas is obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 6.3 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.2 cm in length. The cortex possibly has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 9.8 cm in length. The cortex possibly has increased echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. The liver has coarse increased echogenicity compatible with fatty infiltration/hepatocellular dysfunction. No worrisome masses or intrahepatic ductal dilation are seen.2. Bilaterally the kidneys may have increased echogenicity which would be compatible with medical renal disease. The exam is partially limited due to overlying bowel gas and the patient's breathing."}
{"instruction": "Generate impression based on findings.", "input": "32-year-old male with likely right varicocele RIGHT TESTIS: Measures 4.1 cm x 2.4 cm x 1.8 cm. Microcalcifications are again seen within the testicle. Arterial and venous flow are demonstrated in the right testis upon Doppler exam. LEFT TESTIS: Measures 3.6 cm x 3.0 cm x 1.7 cm. Microcalcifications are again seen within the testicle. Arterial and venous flow are demonstrated in the left testis upon Doppler exam. RIGHT EPIDIDYMIS: Measures 2.9 cm x 1.0 cm x 0.9 cm. Epididymal cyst is again noted measuring 4 mm x 3 mm x 4-mm.LEFT EPIDIDYMIS: Measures 3.2 cm x 1.6 cm x 0.8 cm. OTHER: Bilateral varicoceles, left greater than right however improved from prior study. Bilateral trace hydroceles.", "output": "1. Bilateral varicoceles, left greater than right however improved from prior study. 2. Bilateral testicular microcalcifications are again noted. "}
{"instruction": "Generate impression based on findings.", "input": "Female, 64 years old. Elevated Cr RIGHT KIDNEY: The right kidney measures 9.8 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 8.3 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The bladder is decompressed.", "output": "Increased renal cortical echogenicity, compatible with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Male 55 years old Reason: assess for HCC History: Hx of HCV and cirrhosis LIVER: Cirrhotic appearance of liver, consistent with given history. No focal hepatic mass is identified. Main portal vein is patent with normal directional flow and uptake velocity of 13.8 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. No gallstones. Unchanged gallbladder polyp measuring 0.3 x 0.3 x 0.4 cm. Negative Murphy's sign. Common bile duct is within normal limits measuring 4 mm.PANCREAS: Visualized portions of the pancreas are within normal limits.SPLEEN: Spleen is normal in appearance measuring 14.0 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 13.5 cm. Left kidney measures 14.1 cm. OTHER: No significant abnormalities noted.", "output": "1.Cirrhotic liver morphology consistent with given history, without focal mass.2.Unchanged gallbladder polyp. Recommend continued attention to this polyp on regular follow-up exams."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with history of cervical cancer, elevated alkaline phosphatase. Evaluate for liver pathology. Limited examination, particularly of the liver, due to pneumothorax, pulmonary opacities, and patient body habitus. LIVER: Increased hepatic echogenicity. Allowing for the limitations detailed above, no discrete hepatic lesions are identified. BILIARY TRACT: Very limited examination, however there is suggestion of dilation of the common bile duct and gallbladder distention. However, the gallbladder is not clearly visualized sonographically and incompletely characterized. PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.KIDNEY: Mild to moderate bilateral hydronephrosis. Increased renal echogenicity. OTHER: No significant abnormalities noted.", "output": "1. Very limited examination as detailed above. Suggestion of common bile duct dilation and gallbladder distension, though neither can be clearly imaged or completely characterized on this limited exam. A short term follow up examination or a nuclear medicine hepatobiliary study may be considered for further evaluation as warranted clinically. 3. Mild to moderate bilateral hydronephrosis. Findings were discussed with Dr. Haman by phone at 1045 on 9/2/15. "}
{"instruction": "Generate impression based on findings.", "input": "68-year-old female with acute kidney injury RIGHT KIDNEY: Measures 10.9 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 10.8 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. URINARY BLADDER: Incompletely distended without focal abnormality. OTHER: Bilateral renal stents in place.", "output": "1.Increased renal echogenicity consistent with medical renal disease.2.Renal stents in place without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "UTI; overactive bladder RIGHT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 9.7 cm in lengthLEFT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 9.3 cm in lengthOTHER: Bladder nondistended", "output": "Negative renal ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female with 2 sites of fat necrosis/coil cyst in the left reconstructed breast presents for follow-up study. Focused ultrasound is performed for the palpable lumps at left 9:00 position and left axillary tail.At left 9:00 position, again seen is a hypoechoic lesion measuring 5 x 3 x 5 mm with an internal hyperechoic clip, consistent with fat necrosis. There is no significant change in size or shape of this lesion.At left axillary tail, there is a similar hypoechoic lesion measuring 5 x 3 x 7 mm with an internal hyperechoic clip, consistent with fat necrosis. Size of this lesion is somewhat smaller than the prior study.", "output": "Benign fat necrosis at 9:00 position and axillary tail in the left breast.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Shortness of breath and ascites Trace ascites within the left lower quadrant.", "output": "Trace ascites within the left lower quadrant."}
{"instruction": "Generate impression based on findings.", "input": "Colicky epigastric pain LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.", "output": "Negative for acute hepatobiliary abnormality. Specifically, unremarkable gallbladder. No ductal dilatation."}
{"instruction": "Generate impression based on findings.", "input": "History renal stones RIGHT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 10.6 cm in lengthLEFT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 11.3 cm in lengthOTHER: Bladder nondistended", "output": "Negative renal ultrasound. No evidence for worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Question of cholestasis or gallstone, right upper quadrant pain LIVER: Liver measures 14.2 cm with normal echo texture. No focal lesions within the liver. No intrahepatic biliary ductal dilatation. Portal vein demonstrates normal flow directionality and patency.GALLBLADDER, BILIARY TRACT: Distended gallbladder with normal gallbladder wall thickness measuring up to 2 mm. Hyperechoic lesion within the gallbladder which is mobile, without definite shadowing that measures 6 x 5 x 9 mm most likely a gallstone bladder polyp.PANCREAS: Not well visualized due to overlying bowel gasKIDNEY: Right kidney measures 11.3 cm with a simple cyst in the upper pole measuring 1.5 x 1.7 x 1.7 cm. No hydronephrosis or other focal lesions. Normal echotexture noted.Left kidney measures 11 cm without any hydronephrosis or focal lesionOTHER: Spleen measures 7.3 cm with normal echotexture.", "output": "Gallbladder polyp measuring up to 9 mm noted. Follow-up ultrasound can be performed if clinically warranted to confirm stability of the polyp.Right simple renal cyst"}
{"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 carcinoma in mother and ovarian carcinoma in sister 3-D whole breast ultrasound was performed for both breasts and images were reviewed on an independent workstation. No suspicious solid or cystic mass is identified.", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Reason: r/o adenopathy, recurrence History: h/o thyroid cancer RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Isoechoic nodule in the thyroid bed is unchanged in size measuring and 0.3 x 0.3 x 0.5 cm, previously 0.3 x 0.3 x 0.4 cm. LEFT LOBE: Status post thyroidectomy.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."}
{"instruction": "Generate impression based on findings.", "input": "Female; 43 years old. Reason: elevated transaminases; +HepBsag LIVER: The liver measures 13.7 cm in length. The surface is smooth. The parenchyma is increased in echogenicity with a coarsened echotexture. The main portal vein is patent and demonstrates pedal flow with peak velocity of 0.2 m/sec. No worrisome masses identified. There is no ascites.BILIARY TRACT: The gallbladder is normal in appearance. There is no shadowing stone or gallbladder wall thickening. The common duct measures 4 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The body of the pancreas are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 8.7 cm in length.RIGHT KIDNEY: The right kidney measures 10.3 cm in length. The cortex is normal echogenicity. There is no shadowing stone, hydronephrosis, or worrisome mass identified. OTHER: The left kidney measures 10.3 cm in length and is partially visualized.", "output": "1.Echogenic and coarse liver parenchyma suggestive of chronic liver disease/fatty infiltration. 2.No worrisome hepatic lesion."}
{"instruction": "Generate impression based on findings.", "input": "Renal transplant with rising creatinine and hypertension RENAL TRANSPLANT: LOCATION: Left iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: No significant abnormality noted. Multiple cysts again noted. 11.1 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 Interval development of slightly delayed systolic upstroke with slight increase in velocities of the mid distal renal artery.Interval development of 7 mm abnormal mixed arterial venous Doppler focus within the midportion of the kidney corresponding to the location of the 1/13/2015 biopsy site.OTHER: No significant abnormality noted", "output": "Interval development of slightly delayed systolic upstroke with slight increase in velocities of the mid distal renal artery; findings raise the possibility of mild inflow compromise/stenosis.Interval development of 7 mm abnormal mixed arterial venous Doppler focus within the midportion of the kidney corresponding to the location of the 1/13/2015 biopsy site. Findings consistent with AV fistula."}
{"instruction": "Generate impression based on findings.", "input": "History of hepatitis C. Presents for HCC screening. LIVER: Diffusely coarse and mildly echogenic liver parenchymal echotexture compatible with chronic liver disease. The capsule is relatively smooth. The liver measures 13 cm in craniocaudal dimension.Noted again is a 7 mm mildly hyperechoic lesion adjacent to a hepatic vein, unchanged from prior ultrasound. Stable echogenic shadowing 4 mm probable calcified granuloma in the right lobe of the liver.Normal hepatopedal portal venous blood flow at 18 cm/second. BILIARY TRACT: Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid or focal tenderness. The common bile duct measures 5 mm.PANCREAS: The visualized portions of the pancreatic head and body are unremarkable. The remainder is obscured by overlying bowel gas shadowing.SPLEEN: The spleen measures 9 cm without a focal lesion.RIGHT KIDNEY: The right kidney measures 9.3 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 8.7 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.", "output": "1. Stable examination from prior ultrasound including the stable 7 mm mildly hyperechoic lesion adjacent to the hepatic vein which was not visualized on intervening MRI. 2. Findings compatible with chronic liver disease."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. Technical repeat study. 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": "Female; 56 years old. Reason: History of multinodular goiter with tenderness to left palpable nodularity. RIGHT LOBE MEASUREMENTS: 5.1 x 1.7 x 1.4 cmLEFT LOBE MEASUREMENTS: 5.5 x 1.8 x 1.2 cmISTHMUS MEASUREMENTS: 0.5 cmRIGHT LOBE: The right lobe is heterogeneous. In the lower pole is a mildly hypoechoic, heterogeneous solid nodule which measures 1.6 x 1.0 x 0.9 cm (previously 1.5 x 1.0 x 1.0 cm).LEFT LOBE: Multiple heterogeneous nodules are seen in the left lobe. A dominant nodule in the midpole heterogeneous with solid components and internal vascularity measures 1.6 x 1.2 x 0.7 cm (previously 1.6 x 1.1 x 0.8 cm). This is stable in appearance compared to the prior ultrasound.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: 1.8 x 0.9 x 0.6 cm right level 2 and 1.7 x 0.9 x 0.8 cm left level 2 lymph nodes have a normal ultrasound appearance with a fatty hilum.", "output": "1.Multinodular thyroid not significantly changed compared to the prior study.2.Bilateral prominent level 2 lymph nodes with a normal ultrasound appearance are likely reactive in etiology."}
{"instruction": "Generate impression based on findings.", "input": "Patient w/ acute renal failure, eval for hydronephrosis RIGHT KIDNEY: Mildly echogenic renal parenchyma, suggestive of medical renal disease. Right kidney measures 10.5 cm. No hydronephrosis or hydroureter.LEFT KIDNEY: Mildly echogenic renal parenchyma, suggestive of medical renal disease. Left kidney measures 10.7 cm. No hydronephrosis or hydroureter.OTHER: Well-distended urinary bladder.", "output": "Mildly echogenic renal parenchyma, suggestive of medical renal disease. No hydronephrosis or hydroureter."}
{"instruction": "Generate impression based on findings.", "input": "22-year-old female presents with bilateral superior breast pain for few weeks. Patient does not palpate a lump. A targeted bilateral breast ultrasound was performed for the patient\u2019s area of concern. Patient does not palpate a lump however, is tender in the superior bilateral breasts. Normal glandular tissue identified on ultrasound. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy corresponding to patient's area of concern in bilateral superior breast.Routine screening mammogram is recommended starting at the age of 40.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "41 year old female with right upper quadrant and epigastric pain. LIVER: The liver is minimally coarse in echogenicity. There is normal hepatopetal portal venous blood flow at 20 cm/sec. The common bile duct is normal in caliber at the porta hepatis, measuring 2.5 mm. The liver is normal in size, measuring 16.6 cm in the craniocaudal dimension.BILIARY TRACT: The common bile duct at the level of the pancreas is normal in caliber, measuring 3 mm. A normally distended gallbladder is present with no wall thickening, pericholecystic fluid, focal tenderness or cholelithiasis.PANCREAS: The partially visualized pancreatic head is unremarkable. The remaining pancreas is obscured by overlying bowel gas shadowing.SPLEEN: The poorly visualized spleen measures 7.7 cm in length, within normal limits.RIGHT KIDNEY: The right kidney measures 9.7 cm in length without hydronephrosis, shadowing calculus or discrete lesion. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 9.9 cm in length without hydronephrosis or other discrete abnormality.", "output": "No specific findings to account for the patient's right upper quadrant pain."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis. Tongue cancer. LIVER: Mildly increased parenchymal echogenicity, suggestive of dysfunction. No focal hepatic lesions. The liver is large, measuring 23 cm in length.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. The gallbladder is contracted, without specific evidence of 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 11.4 cm in length. The left kidney is 10.1 cm in length. The renal parenchyma is echogenic bilaterally. No suspicious renal lesions are evident. No hydronephrosis is seen.SPLEEN: 11.4 cm in length, without focal lesions evident.OTHER: Small bilateral pleural effusions. No significant ascites identified.DOPPLER", "output": "1. Hepatomegaly, without suspicious lesions. Patent hepatic vasculature.2. Echogenic renal parenchyma, compatible with medical renal disease.3. Small bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Male 65 years old Reason: Eval testicular fluid History: significant swelling extending into scrotum RIGHT TESTIS: Right testicle measures 4.8 x 3.5 x 2.7 cm. Echogenicity of the right testicle is normal.LEFT TESTIS: Left testicle measures 4.4 x 2.7 x 2.9 cm. Echogenicity of the left testicle is normal.RIGHT EPIDIDYMIS: Right epididymis measures 2.1 x 1.0 x 0.7 cm. There is a small right epididymal cyst measuring 0.4 x 0.2 x 0.4 cm. No evidence of epididymitis.LEFT EPIDIDYMIS: Left epididymis measures 2.4 x 1.2 x 1.6 cm. No evidence of epididymitis.OTHER: Small left hydrocele is present. Scrotal skin thickening consistent with soft tissue edema.", "output": "Small left hydrocele with simple appearing fluid. Scrotal soft tissue edema."}
{"instruction": "Generate impression based on findings.", "input": "Hyperparathyroidism RIGHT LOBE MEASUREMENTS: 5.6 x 1.4 x 1.7 cmLEFT LOBE MEASUREMENTS: 4.6 x 1.6 x 1.8 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Mildly heterogeneous gland without noduleLEFT LOBE: Mildly heterogeneous gland without noduleISTHMUS: Mildly heterogeneous gland without nodulePARATHYROID GLANDS: 1 x 0.6 x 0.9 cm hypoechoic extrathyroidal focus posterior and inferior to the right thyroid gland.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Hypoechoic extrathyroidal focus posterior and inferior to the right thyroid gland consistent with clinically suspected parathyroid adenoma.Mildly heterogeneous thyroid gland without nodule. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Thompson submitted outside study for review. Submitted for review is:-left breast ultrasound: 1/20/2016This examination was performed at MRI Lincoln imaging Center. Per outside documents, patient oresented to the outside hospital for a palpable concern in the left breast, 6:00 position. Static ultrasound images are submitted for interpretation.Multiple static images are taken of the whole left breast. In the left breast, labeled as 5 to 6:00 palpable area, there are multiple anechoic-hypoechoic lesions clustered together, measuring up to 5 cm in maximum dimension. In the left breast, labeled as 12:00, 1:00, 2:00, 3:00, 4:00, 5:00, 7:00, 8:00, 9:00, 10:00, 11:00 positions and around the nipple, no suspicious cystic or solid mass is identified. A normal lymph node is identified in the left axilla.", "output": "Cluster of cysts in the left inferior breast, corresponding to the palpable area of concern. The patient should follow up with her primary care physician as clinically warranted, presuming these results are concordant with the physical exam findings. As long as the patient's physical examination remains unchanged, a short term 6 month follow-up ultrasound examination is recommended to confirm stability of these findings. BIRADS: 3 - Probably benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female with a probable benign fibroadenoma 2:00 position of the right breast presents for a six-month follow-up ultrasound examination. Strong family history of breast cancer. A targeted right ultrasound was performed. Redemonstrated is a benign morphology parallel oriented hypoechoic mass that measures 1.4 x 0.7 cm, unchanged from prior study most consistent with a benign fibroadenoma.", "output": "Stable benign fibroadenoma right breast.Annual screening mammogram with tomo synthesis is recommended.Whole breast ultrasound can also be performed at that time given the history of dense breasts.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"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": "53-year-old female status post lung transplant now with liver failure, coagulopathy, elevated LFTs. Evaluate liver blood flow. LIMITED ABDOMENLIVER: Increased echogenicity of the liver measuring 17.8 cm in length. No focal hepatic lesions. BILIARY TRACT: Gallbladder is filled with sludge. No gallbladder wall thickening. No pericholecystic fluid. No intra-or extrahepatic biliary ductal dilatation. PANCREAS: Visualized pancreas is normal in echogenicity. SPLEEN: Not well visualized.  RIGHT KIDNEY: Normal echogenicity measuring 9.6 cm in length. No hydronephrosis or shadowing calculi. OTHER: Normal echogenicity of the left kidney measuring 9.6 cm in length. No hydronephrosis or shadowing calculi. Perihepatic ascites.", "output": "1. Partial thrombus in main portal vein. No flow is seen in the common hepatic artery, left hepatic artery, and left portal vein. 2. Increased echogenicity of the liver suggestive of parenchymal dysfunction/fatty infiltration. Perihepatic ascites. 3. Gallbladder sludge. Findings were discussed with Dr. Todd Dodick by phone on 3/12/2015 at 3:25 PM. "}
{"instruction": "Generate impression based on findings.", "input": "77 year-old female with right kidney cancer status post right partial nephrectomy. Evaluate for recurrent disease. RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 9.4 cm in length. No hydronephrosis or shadowing calculi are noted.LEFT KIDNEY: Normal echogenicity of the left kidney measuring 9.2 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Distended bladder.", "output": "No sonographic evidence of recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "Bile duct carcinoma with fever LIVER: Coarse echogenic liver parenchyma without mass. Liver length 15.3 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: Common bile duct stent unchanged. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11. 7 cm in length OTHER: Left kidney 10.4 cm in length. Spleen 13.5 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": "62-year-old male with history of thyroid cancer status post thyroidectomy and radioactive iodine. RIGHT LOBE MEASUREMENTS: Surgically absentLEFT LOBE MEASUREMENTS: Surgically absentISTHMUS MEASUREMENTS: Surgically absentRIGHT LOBE: No significant abnormality noted.LEFT LOBE: 0.3 x 0.2 cm cystic focus in the superior left thyroid bed is nonspecific and of uncertain clinical significance.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy. 0.3 cm cystic focus in the superior left thyroid bed is nonspecific and of uncertain clinical significance. Continued follow up is recommended. "}
{"instruction": "Generate impression based on findings.", "input": "15-year-old female with tender palpable lump in the upper inner quadrant of the left breast for 5 months. Patient reports that the pain has been constant and the lump has been present all time. A targeted left ultrasound was performed for the palpable area of concern. On physical examination, vague focal thickening can be appreciated at the 10:00 position of the left breast at the site indicated by the patient. Placement of the transducer at this site elicited focal tenderness, which the patient indicated was her typical symptoms. The transducer was passed over this area multiple times in multiple different orientations. No solid masses or cysts are identified. Sonographically unremarkable appearing fibroglandular tissue is seen.", "output": "No sonographic evidence for malignancy. No sonographic abnormality to explain the patient's area of palpable concern and focal tenderness. Continued clinical management is recommended. Further evaluation of a clinically suspicious abnormality should not be delayed by negative imaging. Rather, negative imaging may serve to reinforce a negative or benign clinical impression. The results and recommendations were discussed with the patient and with her father at the completion of the examination.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "67 years old, Female, Reason: 67yo F with abnl LFTs, eval for stone or other abnl LIVER: The liver is mildly enlarged measuring 18.1 cm. No focal hepatic lesions. Increased echogenicity of the liver is consistent with fatty infiltration. Portal vein is patent with a patent flow measuring 0.4 m/sec.GALLBLADDER, BILIARY TRACT: Gallbladder sludge and stones are present without evidence of gallbladder wall thickening or peri-cholecystic fluid. The common hepatic duct measures 0.4 centimeters.PANCREAS: No significant abnormality noted.SPLEEN: The spleen measures 9 cm. No significant abnormalities noted.KIDNEYS: The right kidney measures 12.8-cm. The left kidney measures 13 cm. Echogenicity of the kidneys is within normal limits. No evidence of hydronephrosis or shadowing calculus. ABDOMINAL AORTA: No significant dilatation of the abdominal aorta. The proximal aorta measures up to 2.5 cm in diameter. The mid aorta measures up to 1.7 cm in diameter. The distal aorta measures up to 1.4 cm in diameter.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: The bladder is collapsed around the Foley catheter precluding full characterization.", "output": "1. Mild hepatomegaly.2. Increased echogenicity of the liver is consistent with fatty infiltration.3. Sludge and stones are noted within the gallbladder without evidence of cholecystitis.4. No evidence of abdominal aortic aneurysm."}
{"instruction": "Generate impression based on findings.", "input": "Low GFR Study technically compromised secondary to patient body habitus.RIGHT KIDNEY: Mildly echogenic parenchyma without obvious mass, stone, or hydronephrosis. 14.5 cm in lengthLEFT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. 11.9 cm in lengthOTHER: Bladder nondistended", "output": "Study technically compromised due to body habitus. Mildly echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "18 years old, Male, Reason: of liver History: abnl lts LIVER: The liver measures 15.0 cm in length. The liver parenchymal echogenicity is normal in appearance. 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. 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. There is a very small gallbladder polyp measuring up to 2 mm.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 11.5 cm in length. RIGHT KIDNEY: Kidney measures 10.4 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 11.0 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Very small polyp in the gallbladder without evidence of cholelithiasis or cholecystitis.2.The hepatic parenchyma is normal in echogenicity without evidence of focal hepatic lesion."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old pregnant female with new palpable left breast lump, presenting for sonographic evaluation. Family history of postmenopausal breast cancer in paternal grandmother. No current breast complaints. Targeted ultrasound of the left upper breast, 12:00 5 cm from the nipple, in patient's area of palpable concern reveals no suspicious solid or cystic mass.", "output": "No sonographic evidence of 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: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "HCV cirrhosis LIVER: Coarse echogenic liver echotexture without mass. Liver length 13 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.8 cm in lengthOTHER: Stable left renal cyst. Left kidney 12.3 cm in length. Spleen 10.1 cm in length. No ascites.", "output": "Stable examination. 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": "Elevated creatinine RIGHT KIDNEY: Mildly echogenic parenchyma without mass, stone, or hydronephrosis. Right kidney 10.9 cm in length.LEFT KIDNEY: Mildly echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Left renal cyst. Left kidney 9.5 cm in length.OTHER: Bladder nondistended", "output": "Mildly echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis and history of renal cysts LIVER: Coarse echogenic liver echotexture again noted without mass. Liver length 13.4 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. 9.5 cm in length.RIGHT KIDNEY: Stable lower pole benign-appearing renal cyst. Right kidney 13.1 cm in length OTHER: Left kidney 9.6 cm in length. No ascites. No obvious large collateral vessels/varices noted", "output": "Coarse echogenic liver again noted consistent with chronic liver disease without mass or ductal dilatation. No ascites. No obvious large collateral vessels/varices noted; however, ultrasound should not be considered as a comprehensive evaluation for varices/collateral vessels. Stable benign-appearing right renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "61-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: Circumscribed hypoechoic nodule relative to the surrounding fat in the right thyroid bed measures 1.1 x 0.9 x 0.5 cm, not significantly changed compared with prior examinations.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Incidental note of atherosclerotic calcification affecting the left carotid artery.", "output": "Unchanged nodule in the right thyroid bed. No new lesions or lymphadenopathy identified. "}
{"instruction": "Generate impression based on findings.", "input": "Follow-up thyroid nodule RIGHT LOBE MEASUREMENTS: 5.3 x 1.8 x 2.0 cmLEFT LOBE MEASUREMENTS: 5.3 x 1.7 x 1.8 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Stable mid/inferior hypoechoic nodule measuring 0.8 x 0.7 x 0.5 cm.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 subcentimeter right hypoechoic thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "86-year-old female with history of breast cancer, presents for ultrasound guided biopsy of left axillary mass. Targeted ultrasound of the left axilla identified few surgical clips adjacent to the axillary vessels. No adjacent mass or lymph node was identified.", "output": "Unable to perform ultrasound guided left axillary biopsy, as target was not identified. Findings were discussed with the referring physician, Dr.James Godfrey at the time of dictation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "53 year old female with history of hepatitis C, evaluate for hepatoma. LIVER: The liver measures 16.7 cm, and has unchanged coarse echotexture. The main portal vein is patent. No focal liver lesion is identified.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted, and there is no biliary dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10 cm. No hydronephrosis.OTHER: Left kidney measures 11.5 cm, and there is no hydronephrosis. Spleen length is 10.6 cm.", "output": "Mildly coarse echogenicity of the liver, without focal mass or lesion."}
{"instruction": "Generate impression based on findings.", "input": "Male 65 years old; Reason: concorn for gallstone pancreatitis vs biliary colic History: acute on chronic abd pain LIVER: The liver measures 16.2 cm in length. There is 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 36.8 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 2.5 mm. No stones are seen but there is a minimal amount of sludge. No pericholecystic fluid. There is thickening of the gallbladder fundus with a, tail artifact seen within. The common bile duct measures 2.1 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen was partially shadowed by rib and therefore was unable to be adequately measured. No significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.2 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen. A anechoic cyst is seen in the midpole measuring 3.3 cm x 3.7 cm x 3.0 cm.LEFT KIDNEY: The left kidney is surgically absent.", "output": "1. Increased echogenicity of the liver parenchyma compatible with fatty infiltration/hepatocellular dysfunction. No worrisome masses are seen in the liver.2. There is some thickening of the gallbladder fundus that likely represents gallbladder adenomyomatosis. No cholelithiasis or evidence of acute cholecystitis is seen."}
{"instruction": "Generate impression based on findings.", "input": "63 year old female who was recalled from screening mammogram for 5 mm oval circumscribed mass in the right lower inner quadrant, mid depth, close to the skin, could represent a tortuous blood vessel or benign mass. 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 almost entirely fatty(BiRads Density Category A), unchanged in pattern and distribution. 5 mm round circumscribed mass located in the right lower inner quadrant persist on spot compression views. No associated calcifications.Ultrasound: Targeted right lower inner quadrant ultrasound was performed. 4 x 3 mm oval hypoechoic mass is identified at 4:00 position of the right breast. No peripheral blood flow is noted.", "output": "Indeterminate 5 mm hypoechoic mass in the right lower inner quadrant. Outside hospital mammograms cannot be obtained. 6 month follow-up versus ultrasound-guided possible cyst aspiration/core biopsy were discussed with the patient. Final plan of possible cyst aspiration/core biopsy was deferred by the patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess renal cysts seen on MRI RIGHT KIDNEY: The right kidney measures 9.1 cm in length. Anechoic right renal cyst measures 0.9 x 1.2 x 1.0 cm. No hydronephrosis, masses, or stones.LEFT KIDNEY: The left kidney measures 11.2 cm in length. Multiple anechoic renal cysts noted. Minimally complex septated cyst measures 2.7 x 2.5 x 2.4 cm. No hydronephrosis, masses, or stones.OTHER: The urinary bladder is poorly distended, limiting evaluation. Neither ureteral jet is visualized.", "output": "Multiple bilateral simple cysts with a single minimally complex left renal cyst, favored to be benign."}
{"instruction": "Generate impression based on findings.", "input": "84-year-old female with known substernal goiter RIGHT LOBE MEASUREMENTS: 5.6 x 2.8 x 1.4 cm, previously 6.5 x 3.0 x 1.4 cm.LEFT LOBE MEASUREMENTS: 6.9 x 5.7 x 4.3 cm, previously 10 x 5.6 x 7.3 cm.ISTHMUS MEASUREMENTS: 4 mm, previously 4 mm.RIGHT LOBE: Multinodular goiter. Reference nodule measures 1.2 x 1.3 x 0.7 cm, previously 1.2 x 1.3 x 0.7 cm.LEFT LOBE: Dominant hyperechoic nodule replaces the left lobe.ISTHMUS: Nodule superior and left aspect of the isthmus measures 2.4 x 1.8 x 1.2 cm, previously 1.9 x 1.5 x 0.9 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: Color Doppler demonstrates hypervascularity of bilateral thyroid lobes.", "output": "Multinodular goiter with measurements as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "History of familial adenomatous polyposis. Known subcentimeter nodules. RIGHT LOBE MEASUREMENTS: 5.5 x 2.1 x 2.5 cm.LEFT LOBE MEASUREMENTS: 4.5 x 2.1 x 1.9 cm.ISTHMUS MEASUREMENTS: 9 mm in AP dimension.RIGHT LOBE: The right thyroid lobe is diffusely heterogeneous and mildly enlarged with increased vascularity. The previously seen nodule is not discretely evident given this heterogeneity. A benign-appearing 8 mm nodule is noted at the superior pole.LEFT LOBE: The left thyroid lobe gland is diffusely heterogeneous and mildly enlarged with increased vascularity. No discrete suspicious nodule is identified.ISTHMUS: The isthmus is diffusely heterogeneous and mildly enlarged with increased vascularity. No discrete suspicious nodule is identified.PARATHYROID GLANDS: Not identified.LYMPH NODES: No significant abnormality noted. Benign-appearing cervical lymph nodes.", "output": "Enlarged diffusely heterogeneous thyroid gland with increased vascularity, suspicious for thyroiditis. Correlation with clinical symptoms and thyroid function tests is recommended."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with a history of thyroidectomy many years prior for goiter, uncertain if partial or complete. Evaluate for residual thyroid tissue. RIGHT LOBE MEASUREMENTS: 2.2 x 2.7 x 5.6 cmLEFT LOBE MEASUREMENTS: Status post left thyroidectomy.ISTHMUS MEASUREMENTS: NoneRIGHT LOBE: The right thyroid lobe echotexture is mildly coarse with a 0.9 x 0.9 x 1.1 cm anechoic cystic nodule, most likely benign. LEFT LOBE: No residual left thyroid lobe tissue.ISTHMUS: No residual isthmus tissue.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Status post left thyroidectomy. The right thyroid lobe contains a 1.1-cm cystic nodule, most likely benign."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Mildly heterogeneous liver echotexture without mass. Liver length 15.1 cmBILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 8.6 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.6 cm in lengthOTHER: Left kidney 11.1 cm in length. No ascites", "output": "Mildly heterogeneous liver echotexture raises the possibility of fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B LIVER: Coarse echogenic liver echotexture without mass. Liver length 15.3 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.8 cm in length.OTHER: Left kidney 11.6 cm in length. Spleen 9.8 cm in length. No ascites.", "output": "Coarse liver echotexture consistent with chronic liver disease without mass or ductal dilatation. No ascites."}
{"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": "Reason: mass vs surgical changes History: Asymmetric gland, history of thyroidectomy in 2013 RIGHT LOBE MEASUREMENTS: 10.0 x 6.9 x 4.4 cm.RIGHT LOBE: Marked enlargement of the right thyroid lobe with diffuse heterogeneity of the right thyroid lobe.Dominant right upper pole solid nodule with hypoechoic rim measures 2.7 x 1.8 cm x 1.8. Some internal internal vascularity. No microcalcifications.LEFT LOBE: Status post left hemithyroidectomy.ISTHMUS: No acute abnormality.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Several benign-appearing left cervical lymph nodes.OTHER: No significant abnormality noted.", "output": "Markedly enlarged, heterogeneous right thyroid lobe. Dominant nodule is amenable to percutaneous biopsy if indicated."}
{"instruction": "Generate impression based on findings.", "input": "20-year-old male with a history of undescended testes. There is clinical concern for testicular cancer. RIGHT TESTIS: The right testis measures 4.6 x 2.2 x 2.8 cm. There is normal echogenicity. Normal Doppler flow. No masses seen.LEFT TESTIS: The left testis measures 4.3 x 2.4 x 3.4 cm. There is normal echogenicity. Normal and symmetric Doppler flow. No masses seen. The testes are symmetric.RIGHT EPIDIDYMIS: Right epididymis measures 1.4 x 1.2 x 1.3 cm.LEFT EPIDIDYMIS: Left epididymis measures 1.5 x 0.7 x 0.7 cm. Measuring approximately 0.2 x 0.3 x 0.2 cm, consistent with a simple epididymal cyst or spermatocele.OTHER: Left-sided varicocele.", "output": "1. Left-sided varicocele.2. No concerning masses.3. Epididymal cyst or spermatocele."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old male with colicky abdominal pain. Evaluate for kidney stones. RIGHT KIDNEY: The right kidney measures 11.2 cm in length. Echotexture appears normal. There is no evidence for hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: The left kidney measures 11.9 cm in length. Echotexture appears normal. There is no evidence for hydronephrosis, shadowing calculus or mass.OTHER: Bladder poorly distended.", "output": "No evidence for nephrolithiasis or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Male 64 years old Reason: evaluate for toxic goiter History: see above RIGHT LOBE MEASUREMENTS: Right lobe of the thyroid measures 6.4 x 2.5 x 2.7 cm.LEFT LOBE MEASUREMENTS: Left lobe of the thyroid measures 6.6 x 3.4 x 1.9 cm.ISTHMUS MEASUREMENTS: 9 mm.RIGHT LOBE: Coarse echotexture of the thyroid.LEFT LOBE: Coarse echotexture of the thyroid. There is a 6 x 5 mm benign-appearing cystic nodule in the left lobe of the thyroid.ISTHMUS: There is a 6 x 5 mm cystic benign-appearing thyroid nodule in the right isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely enlarged thyroid with coarse echotexture suggestive of thyroiditis. Clinical correlation is recommended. Subcentimeter cystic nodules in the isthmus and left lobe, most likely benign."}
{"instruction": "Generate impression based on findings.", "input": "59 year-old male with a history of chronic kidney disease, Stage III. Hypertension. RIGHT KIDNEY: No significant abnormalities noted.LEFT KIDNEY: No significant abnormalities noted. There is a 1.9 x 1.9 x 1.8 cm simple cyst in the interpolar region of the left kidney. There is no internal vascularity.OTHER: The bladder is incompletely distended.", "output": "Unremarkable ultrasound examination of the kidneys. "}
{"instruction": "Generate impression based on findings.", "input": "57 years Female with postoperative acute kidney injury, rule out obstruction. RIGHT KIDNEY: Kidney measures 10.5 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass. A simple cyst is present in the mid/lower pole measuring 2.7 x 2.7 x 2.6 cm.LEFT KIDNEY: Kidney measures 10.3 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.BLADDER: Foley catheter is present within the collapsed bladder.. OTHER: The liver demonstrates increased echogenicity.", "output": "No hydronephrosis. Probable hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "17-year-old female presents to evaluate right breast lump that is increasing in size for one year. History of left breast excision in 2014 which is consistent with a fibroadenoma. A targeted right ultrasound was performed for the palpable area of concern. On physical examination, a 2 cm mobile lump is palpated in the right breast 3:00 position that has increased in size as per the patient. Ultrasound demonstrates a parallel oriented hypoechoic mass well encapsulated that measures 3.9 x 1.9 x 3.9 cm with minimal peripheral blood flow.", "output": "Palpable abnormality right breast 3:00 position corresponds to a benign fibroadenoma basin imaging. Surgical consultation and possible FNA is recommended.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Acute kidney injury RIGHT KIDNEY: 11.2 cm in length. Mildly increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 10.1 cm in length. Mildly increased renal parenchymal echogenicity. An 11 mm benign-appearing cyst is noted at the inferior pole No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Mildly echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with history of thyroid cancer recurrence with surgery. Follow-up abnormalities on prior ultrasound. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: There is some soft tissue echogenicity adjacent to surgical clips, unchanged in the interim and poorly measurable.LEFT LOBE: There is again noted hypoechoic soft tissue echogenicity in the left fibroid that which is unchanged, measuring 0.2 x 0 . 5 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": "Stable exam."}
{"instruction": "Generate impression based on findings.", "input": "Female 44 years old Reason: acute liver failure History: acetaminophen toxicity, LFTs uptrending LIVER: Liver measures 16.7 cm. No focal hepatic lesion. Mildly increased hepatic echogenicity.BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. Gallstones are present. No evidence of cholecystitis.PANCREAS: The visualized portions of the pancreas are within normal limits.SPLEEN: The spleen is normal in appearance measuring 11.2 cm. There is a small amount of ascites near the spleen.KIDNEYS: Left kidney is 11.5 cm. Right kidney is 11.2 cm. No shadowing calculus or hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Increased echogenicity of the liver which may be seen in the setting of diffuse hepatic parenchymal dysfunction.2.Hepatic vessels are patent."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal LFTs LIVER: Coarse echogenic liver parenchyma without mass. Liver length 15.3 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.5 cm in length OTHER: Left kidney 11.6 cm in length. Spleen 10.6 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": "Acute kidney injury RIGHT KIDNEY: 12.2 cm in length. The renal parenchymal echogenicity is increased. No shadowing nephrolithiasis. No hydronephrosis. LEFT KIDNEY: 11.1 cm in length. The renal parenchymal echogenicity is increased. A prominent column of Bertin is noted, a normal variant. No shadowing nephrolithiasis. No hydronephrosis.BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted. No abdominal free fluid noted.", "output": "Increased renal parenchymal echogenicity without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "55 year old female patient with right upper quadrant pain and epigastric pain, known gallbladder sludge, and history of pancreatitis. Evaluate for gallbladder pathology, cholecystitis. LIVER: The liver measures 12.8 cm in length. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. There is questionable minimal intrahepatic biliary ductal dilatation. 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. The pancreatic duct measures upper limits of normal in diameter.RIGHT KIDNEY: The right kidney measures 9.8 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. OTHER: The left kidney measures 7.4 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. There is a 1.6 x 1.6 x 1.9 cm left lower pole renal cyst.The spleen measures 11.3 cm in length and contains multiple echogenic foci compatible with calcified granulomata.", "output": "1. No evidence of cholelithiasis or acute cholecystitis.2. Questionable minimal intrahepatic biliary ductal dilatation.3. Medical renal disease and left renal cyst."}
{"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": "Painful right submandibular mass RIGHT LOBE MEASUREMENTS: 5.4 x 1.4 x 2.6 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.3 x 2.4 cmISTHMUS MEASUREMENTS: 0.4 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: Enlarged but morphologically normal appearing bilateral submandibular/level 1 lymph nodes bilaterally.OTHER: No significant abnormality noted.", "output": "Enlarged but morphologically normal appearing bilateral submandibular/level 1 lymph nodes bilaterally. Findings consistent with benign reactive adenopathy. No worrisome mass lesion or cyst. Normal thyroid gland."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Coarse echogenic liver parenchyma again noted without mass. Liver length 16.5 cm.GALLBLADDER, BILIARY TRACT: Gallbladder absent. No ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.1 cm in lengthOTHER: Left kidney 10.6 cm in length. Spleen 10.5 cm in length. No ascites.", "output": "Coarse echogenic liver parenchyma again noted consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "70 years old, Male, Reason: HCC screening History: ETOH cirrhosis LIVER: The liver measures 20 cm in length. Coarse echogenicity of the liver. No definite nodularity to suggest cirrhosis. No focal hepatic lesions or masses are identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.4 m/s.BILIARY TRACT: Cholelithiasis without 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 10.1 cm in length. RIGHT KIDNEY: Kidney measures 11.5 cm in length. Normal echotexture. Nohydronephrosis. Anechoic focus in the midpole the right kidney measuring up to 1.2 cm is favored to represent a cyst.LEFT KIDNEY: Kidney measures 11.6 cm in length. Normal echotexture. Nohydronephrosis. Anechoic focus measuring up to 1.6 cm and the left kidney is favored to represent a cyst.OTHER: No significant abnormalities noted.", "output": "1.Cholelithiasis without evidence of cholecystitis.2.Coarsened echogenicity of the hepatic parenchyma without nodularity to suggest cirrhosis."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female presents with right upper quadrant pain and vomiting. Evaluate for hepatobiliary pathology. LIVER:The liver measures 16.9 cm. The liver parenchyma has a normal echotexture. No focal mass intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is contracted and the lumen is anechoic. There is no evidence of stone or sludge. The wall measures 2 mm. No pericholecystic fluid. The common bile duct measures 4 mm.PANCREAS: The head appears normal where as the body and tail are obscured by bowel gas.SPLEEN: The spleen measures 9.7 cm without sonographic abnormalities.KIDNEYS: The left kidney measures 10.8 cm. The cortex has normal echogenicity. No shadowing calculi, worrisome mass, or hydronephrosis. The right kidney measures 10.5 cm. The cortex has normal echogenicity. No shadowing calculi, worrisome mass, or hydronephrosis. OTHER: No significant abnormality noted.", "output": "1. Normal ultrasound of the abdomen without gallbladder pathology."}
{"instruction": "Generate impression based on findings.", "input": "60-year-old male with abdominal distention but poor urine output. Evaluate for ascites. Is mild/moderate ascites in the right upper and lower quadrants with smaller amounts of ascites in the left abdomen. There are bilateral pleural effusions.", "output": "Mild/moderate ascites.Pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Clinical concern for primary sclerosing cholangitis. LIMITED ABDOMENLIVER: The liver measures 15.4 cm in length. There is course, increased, and heterogeneous echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation or ascites.BILIARY TRACT: The gallbladder wall measures 3.0 mm. No stones are seen. No pericholecystic fluidPANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearanceSPLEEN: The spleen measures 15.2 cm and no significant abnormalities are noted RIGHT KIDNEY: The right kidney measures 10.0 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen. There is a round 1.5 x 1.0 cm well-defined, hypoechoic lesion in the right kidney consistent with simple renal cyst.LEFT KIDNEY: The left kidney measures 10.9 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. Increased, course, and heterogenous echotexture of liver consistent with chronic liver disease / parenchymal dysfunction with probable early cirrhotic morphology. No mass.2. There is a previously noted portal vein thrombosis involving the entire portal venous system with cavernous transformation and collateral formation.3. Interval resolution of ascites when compared to the prior study.4. Splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female patient with elevated liver enzymes on immunosuppresion medication for lung transplant. LIVER: The liver measures 16.4 cm in length. Hepatic parenchymal echogenicity is increased and there is nodularity of the liver contour. Scattered hepatic cysts are noted, the largest within the right hepatic lobe measuring approximately 1.1 cm in the largest dimension. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There is a subcentimeter gallbladder polyp near the fundus. No gallstones are identified. Gallbladder wall thickening is non-specific in the setting of ascites. 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 6.7 cm in length. No evidence of hydronephrosis. The kidney is atrophic with increased cortical echogenicity. A 1.6 cm right lower pole simple cyst is noted.OTHER: The left kidney measures 6.4 cm in length. No evidence of hydronephrosis. The kidney is atrophic with increased cortical echogenicity. A subcentimeter lower pole simple renal cyst is noted.The spleen measures 9.2 cm in length.There is mild ascites.", "output": "1. Increased hepatic echogenicity and nodular contour consistent with cirrhosis. Scattered hepatic cysts.2. Mild ascites. 3. Subcentimeter gallbladder polyp.4. Atrophic kidneys with bilateral simple renal cysts. "}
{"instruction": "Generate impression based on findings.", "input": "86-year-old female with hyperparathyroidism. RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 5.7 x 2.1 x 2 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 7.1 x 2.6 x 3.5 cm.ISTHMUS MEASUREMENTS: The isthmus measures 2.1 cm in thickness.RIGHT LOBE: Multinodular appearance. Partially cystic nodule with eccentric solid component of the right lower pole measuring 1.7 x 1.1 x 1.2 cm, and the solid portion of this nodule measures 1 x 0.7 x 0.7 cm.LEFT LOBE: Multinodular appearance. Heterogeneity of the enlarged left thyroid lobe limits visualization for accurate measurement of discrete nodules.ISTHMUS: Heterogenous predominantly hyperechoic nodule of the thyroid isthmus measuring 2.1 x 3.2 x 2.3 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Multinodular thyroid goiter. The measured nodules of the thyroid isthmus and right lower pole demonstrate characteristics most compatible with \"low suspicion\" nodules per ATA criteria. These nodules are amenable to percutaneous biopsy as clinically recommended.2. No definite candidates for a parathyroid adenoma. Please refer to the same day nuclear medicine exam for more details."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female status post parathyroidectomy in October 20, 2015. Patient now with persistent primary hyperparathyroidism. Evaluate. RIGHT LOBE MEASUREMENTS: 1.3 x 1.0 x 3.2 cmLEFT LOBE MEASUREMENTS: 1.0 x 0.8 x 2.6 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: There is a hypoechoic nodule with foci of increased echogenicity in the inferior right thyroid gland measuring 0.4 x 0.2 x 0.4 cm consistent with a colloid noduleLEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No extrathyroid lesion identified.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No extrathyroid lesion is identified."}
{"instruction": "Generate impression based on findings.", "input": "Abnormal thyroid function RIGHT LOBE MEASUREMENTS: 4.8 x 1.6 x 1.8 cmLEFT LOBE MEASUREMENTS: 4.8 x 1.6 x 1.3 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Stable mildly heterogeneous gland. Stable hypoechoic upper pole nodule measuring 0.4 x 0.4 x 0.4 cm.LEFT LOBE: Stable mildly heterogeneous gland. Stable hypoechoic midpole nodule measuring 0.3 x 0.3 x 0.3 cm.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. Stable mildly heterogeneous gland and no change in benign-appearing bilateral subcentimeter hypoechoic nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Female 22 years old Reason: history of hypothyroidism, possible nodule on the right, please evaluate History: none RIGHT LOBE MEASUREMENTS: 5.1 x 1.4 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.7 x 1.3 cmISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: Coarse echotexture of the thyroid lobe without any focal nodules.LEFT LOBE: Coarse echotexture of the left lobe of the thyroid without any focal nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Coarse echotexture of the thyroid consistent with thyroiditis."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: Coarse echogenic liver echotexture without mass. Liver length 19.4 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 9.5 cm in lengthOTHER: Echogenic left renal parenchyma without worrisome mass, stone, or hydronephrosis. Left renal cyst. Left kidney 10.6 in meters in length. Spleen 16.3 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation.Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Female 49 years old Reason: evaluate for ascites History: abdominal swelling, chronic ascites Moderately large volume ascites is seen distributed freely throughout the abdomen without evidence of loculation. The volume of ascites appears somewhat less than seen on the 8/25/2016 ultrasound.", "output": "Moderate generalized ascites."}
{"instruction": "Generate impression based on findings.", "input": "Left thyroid nodule RIGHT LOBE MEASUREMENTS: 6 by 1.5 by 2 cmLEFT LOBE MEASUREMENTS: 5.1 x 1.4 x 1.6 centimetersISTHMUS MEASUREMENTS: No significant abnormality noted.RIGHT LOBE: Diffusely heterogeneous gland. Stable inferior hypoechoic subcentimeter nodule measuring 0.4 x 0.3 x 0.4 cm.LEFT LOBE: Diffusely heterogeneous gland. Stable solid upper pole nodule measuring 0.8 x 0.7 x 0.6 cm. This nodule demonstrates coarse calcification. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable left superior thyroid solid subcentimeter nodule with coarse calcification. This lesion will be biopsied later today. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Female 72 years old; Reason: r/o nodule, adenopathy History: small thyroid nodule. This is a 3 year follow up study RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 5.1 x 1.4 x 1.7 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.6 x 1.8 x 1.4 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.5 cm.RIGHT LOBE: Several subcentimeter hypoechoic nodules are seen the largest is seen in the superior portion of the right thyroid lobe measuring 0.5 cm x 0.3 cm x 0.4 cm which is likely spongiform. Other smaller nodules were likely present and are unchanged. No internal vascularity or microcalcifications are seen.LEFT LOBE: At the inferior portion of the left lobe a hypoechoic and likely spongiform nodule is redemonstrated measuring 0.5 cm x 0.5 cm x 0.6 cm. This previously measured 0.6 cm x 0.4 cm x 0.6 cm. No internal vascular microcalcifications are seen.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted.", "output": "1. Stable subcentimeter nodule seen in the inferior left thyroid lobe. There is also a new subcentimeter nodule in the superior right lobe. Favor a benign etiology for both of these lesions.2. No suspicious regional adenopathy is identified."}
{"instruction": "Generate impression based on findings.", "input": "55 years old, Female, Reason: 55 yo female with AKI, rule out obstruction History: AKI RIGHT KIDNEY: Kidney measures 8.9 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. No evidence of hydronephrosis or shadowing calculus. Simple appearing cyst in the superior pole of the right kidney measures 0.7 x 0.9 x 0.8 cm.LEFT KIDNEY: The left kidney is difficult to visualize due to patient's body habitus. Kidney measures 8.9 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. No evidence of hydronephrosis or shadowing calculus.BLADDER: The bladder is incompletely distended. OTHER: No significant abnormalities noted.", "output": "1.Increased echogenicity of the kidneys consistent with medical renal disease without evidence of hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female patient with thyroid nodules. RIGHT LOBE MEASUREMENTS: 4.8 x 1.7 x 1.3 cm.LEFT LOBE MEASUREMENTS: 5.1 x 1.6 x 1.2 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: The right thyroid lobe contains multiple nodules, many which have imaging characteristics of colloid nodules. A reference complex cystic and solid upper pole nodule measures 2.1 x 1.2 x 1.0 cm, previously 1.9 x 1.1 x 0.7 cm. Without significant change. Other nodules appear stable as well.LEFT LOBE: The left thyroid lobe contains multiple nodules, many which have imaging characteristics of colloid nodules. A reference lower pole nodule which appears spongiform with comet tail artifact measures 1.5 x 0.8 x 0.9 cm, previously 1.6 x 1.0 x 0.9 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology lymph nodes are noted within the bilateral neck.OTHER: No significant abnormality noted.", "output": "Stable thyroid nodulesI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Benign renal cyst. Right kidney 11.4 cm in length.LEFT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Benign renal cyst. Left kidney 11.1 cm in length OTHER: Bladder nondistended. Bilateral pleural effusions. Trace ascites", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis. Bilateral pleural effusions. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old male patient with multinodular gland. Evaluate change in nodules. RIGHT LOBE MEASUREMENTS: 2.0 x 0.8 x 1.1 cm.LEFT LOBE MEASUREMENTS: 5.6 x 3.2 x 2.9 cm.ISTHMUS MEASUREMENTS: 1 mm in thicknessRIGHT LOBE: The right thyroid lobe is heterogeneous in echogenicity.LEFT LOBE: There is a complex cystic nodule with spongiform components within the left lower pole measuring 2.7 x 2.7 x 3.1 cm, previously 2.8 x 2.8 x 2.7 cm. There is a more focal hypoechoic solid nodule within a cystic component along the upper part of the nodule, which may not have been as well demonstrated on the prior study. This nodule appears to be more confluent in nature compared to the prior study and no other discrete nodules are identified.ISTHMUS: A solid, hypoechoic nodule in the right aspect of the isthmus measures 0.7 x 0.7 x 0.6 cm, previously 0.7 x 0.5 x 0.6 cm. PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A right submandibular lymph node measures 1.8 x 0.8 x 2.1 cm and a left submandibular lymph node measures 2.2 x 0.6 x 3.3 cm. Additional benign morphology lymph nodes are noted bilaterally. OTHER: No significant abnormality noted.", "output": "1. Heterogeneous right thyroid gland suggestive of prior thyroiditis.2. Slight interval increase in size of a complex cystic left thyroid nodule, which appears more confluent compared to the prior study.3. Unchanged solid right isthmic nodule."}
{"instruction": "Generate impression based on findings.", "input": "65 years old, Female, Reason: eval for obstruction, medical renal disease History: AKI (cr 2.1 up from baseline 1) RIGHT KIDNEY: Kidney measures 12.2 cm in length. Increased echogenicity kidneys consistent with medical renal disease. No evidence of hydronephrosis or shadowing calculus.LEFT KIDNEY: Kidney measures 10.6 cm in length. Increased echogenicity of the kidneys consistent with medical renal disease. No evidence of hydronephrosis or shadowing calculus.BLADDER: No significant abnormalities. A Foley is visualized in the bladder.OTHER: Bilateral pleural effusions are present. A mild amount of ascites is noted within the pelvis.", "output": "1.Increased echogenicity of the kidneys consistent with medical renal disease without evidence of hydronephrosis or shadowing calculus.2.Bilateral pleural effusions and a mild amount of ascites is present."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis C. Large amount of ascites in the past. Hernia repair. A mild-to-moderate amount of ascites is identified.Cirrhotic liver with nodular contours and coarsened parenchymal echogenicity noted.", "output": "Mild to moderate amount of ascites."}
{"instruction": "Generate impression based on findings.", "input": "87-year-old male with a history of a newly distended abdomen. Evaluate for ascites. Bilateral pleural effusions. Incidental 11.8 x 7.4 x 8.8 cm simple appearing left inferior renal pole cyst. Catheter in a collapsed urinary bladder. No significant ascites.", "output": "Bilateral pleural effusions without significant ascites. Large left renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old male with elevated creatinine. RIGHT KIDNEY: Measures 10.7 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. 2.0 cm upper pole cyst without septation or solid component.LEFT KIDNEY: Measures 10.5 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. 1.1 cm cyst without septation or nodular componentURINARY 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. "}
{"instruction": "Generate impression based on findings.", "input": "78-year-old female with cardiogenic shock. Evaluate liver. LIVER:Measures 19.8 cm. Mildly increased and coarse echogenicity. No focal mass, ascites, or intra or intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended with an anechoic lumen. The wall measures 0.2 cm. No stones, sludge, or pericholecystic fluid. Common bile duct measures 4.4 mm.PANCREAS: Evaluation limited by overlying bowel gas.SPLEEN: Measures 12.5 cm. No sonographic abnormalities.KIDNEYS: Right kidney measures 14.5 cm. Left kidney measures 12.2 cm. The cortex is mildly echogenic and thin. No hydronephrosis, shadowing calculi, or focal mass. OTHER: No significant abnormality noted.", "output": "1. Mildly increased and coarse echogenicity of liver consistent with chronic liver disease and fatty infiltration/parenchymal dysfunction. No mass or ascites.2. Hepatomegaly.3. Echogenic kidneys consistent with medical renal disease/parenchymal dysfunction. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: Diffusely heterogeneous parenchyma with new contour nodularity. While no discrete measurable lesion is clearly identified, the possibility of widespread mass lesions should be considered. Liver length 20 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or duct dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12 cm in lengthOTHER: Left kidney 9.9 cm in length.", "output": "Diffusely heterogeneous liver echotexture with new contour nodularity. While no discrete measurable lesion is clearly identifiable, the possibility of widespread mass lesions should be considered. Would recommend correlation with contrast cross sectional imaging."}
{"instruction": "Generate impression based on findings.", "input": "Reason: of liver, cirrhosis, screen for hepatocellular carcinoma. Examination limited due to patient body habitus.LIVER: The liver measures 15.6 cm in length and nodular in contour. Increased parenchymal echogenicity. 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. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common hepatic 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 10.8 cm in length. RIGHT KIDNEY: Kidney measures 9.3 cm in length. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.7 cm in length. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Limited exam.2.Cirrhotic liver without gross focal lesions, however, sensitivity is significantly decreased due to poor penetration. Dedicated cross-sectional imaging is recommended for follow-up screening examinations."}
{"instruction": "Generate impression based on findings.", "input": "Female 25 years old Reason: elevated lfts History: elevated lfts LIVER: Liver is minimally homogeneously echogenic which may be seen in setting of fatty infiltration. No focal hepatic lesions. Liver measures 17.3 cm in length. Main portal vein is patent with appropriate directional flow and a peak velocity of 27.1 cm/s.BILIARY TRACT: Patient is status post cholecystectomy. Common duct measures 5.5 mm. No intra or extrahepatic biliary ductal dilatation. PANCREAS: Tail of the pancreas is obscured by overlying bowel gas. Remaining visualized portions are unremarkable. Small peripancreatic lymph node measures 1.5 x 0.8 x 2 cm.SPLEEN: Spleen measures 5.7 cm. Normal and homogeneous echogenicity.RIGHT KIDNEY: Right kidney measures 10.3 cm and demonstrates normal cortical medullary echogenicity. No shadowing calculi or hydronephrosis.LEFT KIDNEY: Left kidney measures 11.2 cm and is normal in cortical medullary echogenicity. No shadowing calculi or hydronephrosis.OTHER: No significant abnormalities noted.", "output": "No focal hepatic masses. Liver is minimally homogeneously echogenic which can be seen in the setting of fatty infiltration, similar to the prior exam."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old male patient with right upper quadrant tenderness. Assess for hepatic etiology. LIVER: The liver measures 16.9 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 is distended and contains a large amount of layering echogenic material. There is no significant pericholecystic fluid or gallbladder wall thickening. 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 is poorly visualized but echogenic and contains at least one cyst.OTHER: The left kidney measures 11.4 cm in length. No evidence of hydronephrosis. Renal cortical echogenicity is increased and heterogeneous, correlating to numerous small cysts on prior CT, which are poorly visualized on this exam.The spleen measures 10.9 cm in length.", "output": "1. Distended gallbladder filled with echogenic material though specific surrounding inflammatory changes; HIDA scan may be considered for further evaluation if clinically indicated. 2. Medical renal disease and numerous renal cysts, which are poorly evaluated on this study and seen better on prior CT."}
{"instruction": "Generate impression based on findings.", "input": "Female 70 years old; Reason: 70 year old female with persistent epigastric abdominal pain and recent normal upper endoscopy. Please assess for cholelithiasis or pancreatic abnormalities. History: epigastric pain LIVER: The liver measures 16.9 cm in length. There is normal 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 wall measures 2.0 mm. No stones are seen. No pericholecystic fluid. The common bile duct measures 1.5 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9.4 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.0 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 10.5 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.OTHER: No significant abnormality noted.", "output": "1. Normal abdominal ultrasound without hepatobiliary pathology."}
{"instruction": "Generate impression based on findings.", "input": "Left thyroid nodule RIGHT LOBE MEASUREMENTS: The right lobe measures 1.0 cm x 2.2 cm x 5.8 cm.LEFT LOBE MEASUREMENTS: The left lobe measures 5.3 cm x 1.9 cm x 2.8 cm.ISTHMUS MEASUREMENTS: The isthmus measures 0.2 cm.RIGHT LOBE: Right lobe is primarily homogenous. No dominant nodules are seenLEFT LOBE: Within the left lobe there is a 2.5 cm x 1.6 cm x 3.5 cm dominant nodule that is mixed cystic and solid. There is a spongiform appearance inferiorly within this nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: None visualizedLYMPH NODES: No suspicious adenopathy is noted.", "output": "1. Within the left lobe, there is a dominant nodule that is mixed cystic and solid and measures 2.5 cm x 1.6 cm x 3.5 cm. No suspicious adenopathy is noted."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old male screening for hepatocellular carcinoma LIVER:The liver measures 16.1 cm in length. The liver is heterogeneous in echotexture similar to prior ultrasound. No new worrisome masses are seen within the liver. The portal vein is patent with hepatopetal flow measuring 37.3 cm/s. GALLBLADDER, BILIARY TRACT: The gallbladder is visualized without stones or significant sludge. Gallbladder wall measures 3.5 mm. Common bile duct measures 4.2 mm, which is normal in caliber.PANCREAS: No significant abnormality noted.SPLEEN: The spleen measures 10.9 cm in length. There is significant abnormalities are noted.KIDNEYS: The right kidney measures 11.8 cm in length. The cortex is normal in echotexture. There is no new masses, hydronephrosis, or stone seen in the right kidney. The left kidney measures 10.5 cm in length. The cortex has normal echogenicity, there are no stones visualized, no hydronephrosis, and no masses seen.", "output": "1. No new worrisome masses are seen within the liver. Again demonstrated, the liver is heterogeneous in echotexture similar to prior ultrasound and consistent with parenchymal dysfunction/chronic liver disease."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female presents as a callback from screening mammography for an asymmetry in the left upper outer breast. No current breast complaints. Three standard views of the left breast with additional 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. There is a lobulated asymmetry in the left breast 2:00 position which persists with spot compression. Adjacent glandular tissue in the left upper outer breast disperses with spot compression.ULTRASOUND", "output": "Benign cyst in the left upper outer breast correlating with the 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": "Female 68 years old; Reason: Hx of HCC , check portal vein, hepatic vein and artery History: abnormal LFT LIVER: The patient is status post right hepatectomy. The left lobe is hypertrophied as seen on prior CT. There is normal echogenicity of the liver parenchyma. No focal hepatic lesions. No intrahepatic ductal dilation is seen. GALLBLADDER/BILIARY TRACT: The gallbladder is surgically absent. The common bile duct measures 3.4 mm in diameter. PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 9.6 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 10.8 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.3 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.Dopplers:INFERIOR VENA CAVA: The inferior vena cava is patent with hepatofugal flow.HEPATIC VEINS: The main hepatic vein is patent with hepatofugal flow.HEPATIC ARTERIES: The hepatic artery is patent with hepatopedal flow with peak systolic velocity ranging from 96.62 to108.1 cm/s and RI of 0.7.PORTAL VEIN: The main portal vein is patent with normal hepatopetal flow measured at 39.0 cm/s. SPLENIC VEIN: The splenic vein is patent with hepatopedal flow measuring 25.9 cm/s.SPLENIC ARTERY: The splenic artery is patent with antegrade flow into the spleen with peak systolic velocity measured at 56.3 cm/s and RI of 0.7.", "output": "1. Patient is status post right hepatectomy with left liver hypertrophy. No new worrisome masses are seen. 2. The portal veins, splenic vein, inferior vena cava, and hepatic/splenic arteries are patent with appropriate flow."}
{"instruction": "Generate impression based on findings.", "input": "3o year old female with acute liver failure. Evaluate for portal vein thrombosis. LIVER: Liver is enlarged measuring 20.8 cm in length and is normal in echogenicity. The portal vein is patent with appropriate flow and no evidence of thrombus. GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. Common bile duct measures 3 mm in caliber. No intra or extrahepatic biliary ductal dilatation. PANCREAS: Normal echogenicity with no pancreatic ductal dilatation. KIDNEYS: Increased echogenicity of the renal parenchyma, right greater than left. There is mild fullness of the left renal collecting system. OTHER: Status post splenectomy. Foley in a decompressed bladder limits evaluation.", "output": "1. Portal vein is patent with no evidence of thrombus. 2. Increased echogenicity of the renal parenchyma, right greater than left, nonspecific, suggestive of medical renal disease. 3. Mild fullness of the left renal collecting system. "}
{"instruction": "Generate impression based on findings.", "input": "Acute renal insufficiency RIGHT KIDNEY: Questionable mild increased parenchymal echogenicity without mass, stone, or hydronephrosis. 11.4 cm in lengthLEFT KIDNEY: Questionable mild increased parenchymal echogenicity without mass, stone, or hydronephrosis. 10.6 cm in length OTHER: Bladder nondistended", "output": "Questionable mild increased parenchymal echogenicity raises the possibility of medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Worsening liver function tests. LIVER: The left hepatic lobe is poorly visualized due to overlying bowel gas. Non-cirrhotic liver morphology. 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 gallbladderPANCREAS: The pancreas is obscured by bowel gas.KIDNEYS: The right kidney is 11.6 cm in length with new mild calyectasis. The left kidney is 12.6 cm in length with mild to moderate hydronephrosis. No suspicious renal lesions are evident. SPLEEN: 10.6 cm in length, without focal lesions evident.OTHER: Bilateral pleural effusions. No ascites identified.", "output": "1. Increased hepatic echogenicity, compatible with parenchymal dysfunction.2. Mild right calyectasis and mild to moderate left hydronephrosis. 3. Bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis LIVER: Cirrhotic morphology without mass. Liver length is 13.8 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Nonobstructing subcentimeter renal stone. Right kidney 11.9 cm in length.OTHER: Left kidney 14.5 cm in length. Spleen 15.7 cm in length. No ascites.", "output": "Cirrhotic liver without mass or ductal dilatation. Mild splenomegaly. No ascites. Nonobstructing subcentimeter right renal stone."}
{"instruction": "Generate impression based on findings.", "input": "50 year-old female with a history of bilateral breast lumps and fibrocystic disease. She has a history of bilateral benign breast biopsies and cyst aspirations. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Bilateral waxing and waning masses are present. Scattered benign calcifications are unchanged in both breasts.Whole bilateral ultrasound was performed. Multiple simple and complicated cysts are present in both breasts. The largest cyst is a complicated cyst, measuring 18 x 14 mm at 12 o'clock position in the left breast.", "output": "No mammographic evidence of malignancy. Multiple simple and complicated cysts in both breasts. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Epigastric abdominal pain LIVER: Unremarkable echogenicity without mass. 16.2 cmGALLBLADDER, BILIARY TRACT: Cholelithiasis again noted without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 13.1 cm in lengthOTHER: Left kidney 11.7 cm in length. Spleen 9 cm in length. No ascites", "output": "Stable cholelithiasis without acute inflammation or ductal dilatation. Ascites."}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male with right upper quadrant pain LIVER: Measures 15.4 cm in length. Increased hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: Gallbladder sludge without 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": "1. Gallbladder sludge without evidence of cholecystitis or biliary obstruction. 2. Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease, without discrete focal lesion. "}
{"instruction": "Generate impression based on findings.", "input": "LVAD; assess for fluid collection around driveline; purulent drainage No significant loculated fluid collection associated with LVAD drive line.", "output": "No significant loculated fluid collection associated with LVAD drive line."}
{"instruction": "Generate impression based on findings.", "input": "39-year-old with right upper quadrant pain and nausea. LIVER: The liver measures 17.6 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 0.5 m/s.BILIARY TRACT: Numerous small mobile stones are present within the gallbladder. The gallbladder wall is mildly thickened measuring up to 4 mm. There is tenderness over the gallbladder. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3.5 mm in diameterPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.The spleen measures 9.7 cm in length. RIGHT KIDNEY: Kidney measures 11.6 cm in length. Increased parenchymal echogenicity is suggestive of medical renal disease/parenchymal dysfunction. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Kidney measures 11.4 cm in length. Increased parenchymal echogenicity is suggestive of medical renal disease/parenchymal dysfunction. No hydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Findings suspicious for early acute cholecystitis.2.Echogenic kidneys suggesting medical renal disease. Findings communicated with WYNNE, JOSEPH at 4:05 p.m. on 6/12/2015. "}
{"instruction": "Generate impression based on findings.", "input": "73 years old, Male, Reason: evaluate firm extratesticular mass History: see above RIGHT TESTIS: No suspicious masses. No significant abnormalities noted.LEFT TESTIS: No significant abnormalities noted. No masses.RIGHT EPIDIDYMIS: Multiple right epididymal cysts the largest of which measures up to 1.2 cm.LEFT EPIDIDYMIS: Very large left epididymal cyst or spermatocele is near the midline and measures 3.5 x 3.4 x 7.4 cm. OTHER: Vascularity and waveforms of the testicles bilaterally are within normal limits.", "output": "1.Very large left epididymal cyst or spermatocele is situated near the midline and measures up to 7.4 cm.2.No suspicious masses."}
{"instruction": "Generate impression based on findings.", "input": "Hypovolemia with acute renal insufficiency RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 8.5 cm in length.LEFT KIDNEY: Echogenic parenchyma without mass or hydronephrosis. Possible nonobstructing subcentimeter renal stones. Left kidney 8.7 cm in length.OTHER: No significant abnormalities noted.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass or hydronephrosis. Possible nonobstructing left renal stones."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old male presents with right upper quadrant and epigastric pain. LIVER:Measures 15.6 cm. Mildly increased and coarse echotexture of the parenchyma. No focal masses or ascites. The common hepatic measures 0.7 cm. The portal vein is patent with normal hepatopedal flow.GALL BLADDER, BILIARY TRACT: The bladder is enlarged though nondistended. There is dependent echogenic mobile substance within the lumen, consistent with gallbladder sludge. No pericholecystic fluid or stones. Gallbladder wall measures 2.4 mm. The common bile duct measures 0.6 cm.PANCREAS: Increased echogenicity pancreas consistent with chronic pancreatitis.SPLEEN: The spleen measures 8.3 cm without sonographic abnormalities.KIDNEYS: The right kidney measures 9.6 cm. Left kidney measures 12.5 cm. Normal echogenicity. No shadowing calculi, hydronephrosis, or focal mass. OTHER: No significant abnormality noted.", "output": "1. Biliary prominence without signs of acute cholecystitis.2. Gallbladder sludge without signs of acute cholecystitis.3. Chronic pancreatitis. Recommend correlating with pancreatic enzymes to r/o acute pancreatitis."}
{"instruction": "Generate impression based on findings.", "input": "Gallbladder polyp. LIVER: Non-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. A subcentimeter echogenic focus is noted in the gallbladder, likely representing a gallstone. The previously described polyp is not definitely seen. Otherwise unremarkable appearance of the gallbladder. 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 10.1 cm in length. The left kidney is 10.4 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 7.0 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted.", "output": "Cholelithiasis without specific evidence of cholecystitis. The previously described gallbladder polyp is not visualized."}
{"instruction": "Generate impression based on findings.", "input": "Hyperparathyroidism RIGHT LOBE MEASUREMENTS: 1.5 x 1.7 x 5.1 cmLEFT LOBE MEASUREMENTS: 1.7 x 1.6 x 4.3 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: 2 mm benign colloid noduleLEFT LOBE: 2 mm benign colloid noduleISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No parathyroid adenoma candidate could be identified within the neck."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant colicky pain for 5 days. LIVER: The liver is normal in size measuring 14.7 cm in craniocaudal dimension. No focal lesion or biliary ductal dilatation. The parenchyma is normal in echogenicity. Normal hepatopedal portal venous blood flow at 0.3 cm/s.BILIARY TRACT: Normally distended gallbladder without gallstones, wall thickening, pericholecystic fluid or focal tenderness.No biliary ductal dilatation with the common duct measuring 3 mm.PANCREAS: The visualized portions of the pancreas are normal in appearance.SPLEEN: The spleen is normal in size and echogenicity measuring 12 cm in craniocaudal dimension.RIGHT KIDNEY: The right kidney is normal in size measuring 12 cm in length without hydronephrosis, shadowing nephrolithiasis or focal lesion. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney is normal in size measuring 13.2 cm in length without hydronephrosis, shadowing nephrolithiasis or focal lesion. Color Doppler demonstrates hilar blood flow.", "output": "No specific findings to account for the patient's right upper quadrant pain."}
{"instruction": "Generate impression based on findings.", "input": "Female 67 years old; nontoxic single thyroid nodule, evaluate. RIGHT LOBE MEASUREMENTS: 5.1 x 1.5 x 1.3 cmLEFT LOBE MEASUREMENTS: 4.5 x 1.1 x 1.4 cmISTHMUS MEASUREMENT: 0.35 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Multiple left lobe cystic nodules, with the dominant nodule measuring 1.0 x 0.5 x 0.6 cm with peripheral comet tail artifact most suggestive of a colloid cyst.ISTHMUS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Left thyroid lobe cystic nodules most suggestive of a colloid cysts."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old female. Nodule. Evaluate for growth of right-sided thyroid nodule. RIGHT LOBE MEASUREMENTS: 4.6 x 2.6 x 2.4 cm.LEFT LOBE MEASUREMENTS: 4.1 x 1.3 x 1.5 cm.ISTHMUS MEASUREMENTS: 0.3 cm in AP dimension.RIGHT LOBE: Dominant nodule is 3.4 x 1.5 x 2.9 cm. It is solid with no calcifications and demonstrates hypervascularity.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": "Dominant right thyroid nodule that is indeterminate and amenable to biopsy."}
{"instruction": "Generate impression based on findings.", "input": "26-year-old male with elevated bilirubin and alkaline phosphatase. LIVER: Nodular contour of the liver with coarse echotexture measuring 14.5 cm in length. No focal hepatic lesions. Portal vein is patent with appropriate directional flow; peak velocity measuring 0.3 m/sec.GALLBLADDER, BILIARY TRACT: Gallbladder is not visualized. Mild prominence of the common bile duct measuring 6 mm in caliber. No intrahepatic biliary ductal dilatation.PANCREAS: Visualized portions of the pancreas are unremarkable.RIGHT KIDNEY: Normal echogenicity of the right kidney measuring 10.8 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the spleen measuring 23.1 cm in length.Normal echogenicity of the left kidney measures 12.5 cm in length.Bilateral pleural effusions.", "output": "1. Cirrhotic liver morphology. Recommend CT for further evaluation. 2. Mild prominence of the common bile duct. No intrahepatic biliary ductal dilatation. No choledocholithiasis. 3. Splenomegaly. 4. Bilateral pleural effusions. "}
{"instruction": "Generate impression based on findings.", "input": "Female 62 years old; Reason: screen for HCC History: chronic hepatitis B LIVER: The liver measures 16.5 cm in length. There is increased echogenicity of the liver parenchyma. No focal hepatic lesions. The main portal vein is patent with normal hepatopetal flow measured at 30.0 cm/s. GALLBLADDER/BILIARY TRACT: The gallbladder wall measures 1.8 mm. Numerous echogenic shadowing foci are seen within the gallbladder. No sludge is seen. Negative sonographic Murphy sign. No pericholecystic fluid. The common bile duct measures 6.4 mm in diameter. No intrahepatic ductal dilation is seen.PANCREAS: Portions of the pancreas are obscured by bowel gas with visualized portions normal in appearance.SPLEEN: The spleen measures 7.8 cm and no significant abnormalities are noted.RIGHT KIDNEY: The right kidney measures 11.1 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.LEFT KIDNEY: The left kidney measures 11.1 cm in length. The cortex has normal echogenicity. No hydronephrosis, stones, or worrisome masses are seen.", "output": "1. The liver has increased echogenicity compatible with fatty infiltration/hepatocellular dysfunction. No worrisome masses are seen.2. Cholelithiasis without evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Call back from screening mammogram for a mass with calcifications in the left breast. An ML view and two spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. 7 mm mass with internal calcifications is again seen at upper outer quadrant in the left breast.Ultrasound study was performed to correlate the lesion. However no sonographic correlation was obtained.", "output": "Indeterminate mass with calcifications at upper outer quadrant in the left breast, for which stereotactic core needle 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": "Reason: evaluate mass over L upper extremity fistula History: mass over L upper extremity fistula, fistula functioning appropriately Immediately adjacent to the fistula is a large hypoechoic mass measuring 4.0 cm x 3.2 cm x 3.5 cm with internal vascularity in a swirling pattern demonstrating irregular waveforms with suggestion of arterial flow. This appears to be connected with the patient's known fistula.", "output": "Findings suspicious for pseudoaneurysm arising for the left upper extremity fistula as described above.Findings were discussed with Dr. Chandni Patel by phone on 9/24/2015 at 4:00 PM. "}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female patient with history of breast cancer. Evaluate thyroid nodules. RIGHT LOBE MEASUREMENTS: 4.2 x 1.6 x 2.0 cm.LEFT LOBE MEASUREMENTS: 3.6 x 1.6 x 1.7 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: The right thyroid lobe contains a 0.5 x 0.4 x 0.5 cm spongiform nodule within the right lower pole, unchanged in size.LEFT LOBE: The left thyroid lobe is without focal thyroid lesion.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There are scattered nonspecific lymph nodes within the left level four lymph node station, with the largest measuring 0.6 x 0.3 x 1.8 cm. A right level 1B lymph node with a fatty hilum measures 1.8 x 0.7 x 2.9 cm.OTHER: No significant abnormality noted.", "output": "1. Unchanged subcentimeter right thyroid nodule.2. Nondescript scattered left cervical lymph nodes."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old woman with history of Graves' disease, now with new onset goiter. RIGHT LOBE MEASUREMENTS: 3.1 x 3.5 x 7 cm. The right thyroid lobe is enlarged with rounded contours.LEFT LOBE MEASUREMENTS: 2.1 x 2.6 x 6.9 cm. The left thyroid lobe is enlarged with round contours.ISTHMUS MEASUREMENTS: The isthmus measures 0.4 cm in AP diameter.RIGHT LOBE: There is heterogeneous echogenicity throughout the right thyroid lobe with a number of small, homogenously hyperechoic nodules scattered throughout the thyroid parenchyma. Additionally, there is diffusely increased vascularity. For reference, an echogenic nodule in the posterior, upper right lobe measures 0.8 x 0.9 x 1.3 cm.LEFT LOBE: There is heterogeneous echogenicity throughout the left thyroid lobe with a number of small, homogenously hyperechoic nodules scattered throughout the thyroid parenchyma. Additionally, there is diffusely increased vascularity. A 2.1 x 1.1 x 1.0 cm focus of slightly nodular tissue of similar echogenicity to the remaining thyroid gland is seen immediately posterior to the inferior pole of the thyroid lobe.ISTHMUS: Heterogeneous echogenicity. Ovoid iso to minimally hyperechoic nodule measuring 0.6 x 1.2 x 1.4 cm.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1.Acute thyroiditis. Multiple echogenic nodules have been described in thyroiditis.2.Thyroid nodules as measured.3.Nodular region posterior to the inferior pole of the left thyroid lobe. This is most suggestive of exophytic thyroid nodule by echotexture, less likely to be a parathyroid adenoma or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: thyroid nodule on left side History: thyroid nodule RIGHT LOBE MEASUREMENTS: Measures 4.9 x 1.6 x 1.6 cm.LEFT LOBE MEASUREMENTS: Measures 4.6 x 1.7 x 1.9 cm.ISTHMUS MEASUREMENTS: Measures up to 0.4 cm in thickness.RIGHT LOBE: Mildly heterogeneous background parenchymal echotexture without discrete nodules. LEFT LOBE: Mildly heterogeneous background parenchymal echotexture. Left lower pole spongiform nodule measuring 0.7 x 0.5 x 0.6 cm, very low suspicion for neoplasm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Mildly heterogeneous thyroid. Dominant subcentimeter spongiform nodule, low suspicion for neoplasm."}
{"instruction": "Generate impression based on findings.", "input": "History hyper thyroidism RIGHT LOBE MEASUREMENTS: 6.4 x 3.3 x 2.3 cmLEFT LOBE MEASUREMENTS: 6.1 x 3.6 x 1.8 cmISTHMUS MEASUREMENTS: 1.1 cmRIGHT LOBE: Diffusely heterogeneous gland. Two midpole mixed cystic and solid nodules. A representative midpole nodule measures 1 x 0.7 x 0.9 cm.LEFT LOBE: Diffusely heterogeneous gland. Lower pole subcentimeter predominately solid nodule measuring 0.7 x 0.8 x 0.7 cm.ISTHMUS: Diffusely heterogeneous gland.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous gland. Multiple bilateral subcentimeter nodules as described.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female with a palpable right breast mass. She has a family history of breast cancer in a maternal aunt. A targeted right ultrasound was performed for the palpable area of concern in the lower inner breast. There is no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy in the right lower inner breast in the area of palpable concern.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old with autoimmune hepatitis LIVER: Liver measures 13.2 cm with diffuse coarse echotexture. No intrahepatic biliary ductal dilatation. No focal lesions noted. Liver surface appears slightly nodular. Status post cholecystectomyMain portal vein demonstrates normal flow directionality and patency.BILIARY TRACT: Status post cholecystectomy with common hepatic duct measuring up to 4 mm.No intrahepatic biliary ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: Spleen measures 8.3 cm without any focal lesions.KIDNEY: Right kidney measures 10.4 cm left kidney measures 12.1 cm. Normal echotexture noted. No hydronephrosis or focal lesions. OTHER: No ascites", "output": "Findings consistent with chronic liver disease without focal lesions."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female with biopsy-proven left papillary thyroid carcinoma. Evaluate for nodal disease. RIGHT LOBE MEASUREMENTS: 3.6 x 2.2 x 1 cmLEFT LOBE MEASUREMENTS: 3.9 x 1.8 x 1 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Within the right lobe there is a hypoechoic and at least partly cystic mass measuring 0.6 x 0.7 x 0.8 cm without change.LEFT LOBE: Within the left lobe, there is a hypoechoic and poorly marginated mass with internal calcification consistent with papillary thyroid cancer measuring 0.9 x 0.8 x 0.8 cm without change.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign appearing lymph nodes on the right.Benign appearing lymph node at level 2 on the left. At level for there is a rounded 0.6 x 0.8 x 0.9 cm lymph node with internal calcification and abnormal flow consistent with metastatic papillary thyroid carcinoma. A second level 4 lymph node is normal in morphology.OTHER: No significant abnormality noted.", "output": "Left papillary thyroid carcinoma with a metastatic level 4 lymph node on the left.Small cystic nodule right lobe."}
{"instruction": "Generate impression based on findings.", "input": "63 old female with abnormal liver function. Prior history demonstrates stem cell transplant. LIVER: Liver is again noted to be mildly echogenic. There is a complex, lobulated and partly septated cystic mass in the left lobe measuring 3.3 cm in greatest diameter which is stable.Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Post cholecystectomy. The intrahepatic delay tract is normal in caliber. The common duct is normal on today's exam.PANCREAS: The head and body are normal. The tail is incompletely visualized.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted.", "output": "Stable examination. No biliary tract dilatation."}
{"instruction": "Generate impression based on findings.", "input": "History of thyroid cancer. Previous left thyroid bed nodule biopsies were negative. RIGHT LOBE: Status post thyroidectomy. No specific evidence of recurrent disease in the right thyroidectomy bed.LEFT LOBE: Status post thyroidectomy. Demonstrated again are lobulated soft tissue masses in the left thyroidectomy bed.The superior bed nodule measures 7 x 5 x 8 mm compared to 6 x 4 x 7 mm previously.The mid bed nodule measures 8 x 8 x 9 mm compared with 7 x 6 x 10 mm previously.The inferior bed nodule measures 6 x 3 x 6 mm compared to 6 x 2 x 14 mm previously.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Morphologically unremarkable and normal size cervical lymph nodes.OTHER: No significant abnormality noted.", "output": "Stable examination with several essentially stable nodules in the left thyroidectomy bed."}
{"instruction": "Generate impression based on findings.", "input": "Sepsis RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 10.4 cm in length. No perinephric collectionLEFT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 11.3 cm in length. No perinephric collectionOTHER: Bladder nondistended", "output": "Echogenic parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis. No perinephric collection."}
{"instruction": "Generate impression based on findings.", "input": "43-year-old female with history of right breast cancer status post mastectomy and chemotherapy as well as prophylactic left mastectomy presenting for unilateral left breast ultrasound for increasing left breast nodularity, specifically new nodularity inferior and medial to the nipple and near the left upper outer quadrant. Patient has bilateral breast implants. Family history of breast cancer in maternal grandmother diagnosed in her 40s. On physical examination, there is superficial small somewhat firm subcentimeter masses in the 7:00 and 8:00 position overlying the breast implant. On palpation of the left upper outer quadrant there is dense tissue with no discrete mass palpated. A targeted left ultrasound was performed for the palpable area of concern. The breast implant is visualized. In the left breast 7:00 position 2 cm from the nipple superificial to the implant is an oval circumscribed parallel hypoechoic mass with areas of internal hyperechogenicity measuring 0.5 cm x 0.2 cm x 0.3 cm with no internal vascularity on Doppler imaging. Adjacent to this mass in the left breast 8:00 position 2 cm from the nipple is a similar morphology mass measuring 0.5 cm x 0.1 cm x 0.4 cm with no internal vascularity on Doppler imaging. In the left breast 1:00 position 6 cm from the nipple there is dense breast tissue overlying the implant with no solid or cystic mass identified.", "output": "No sonographic evidence for malignancy. Two likely benign morphology masses in the left breast 7:00 and 8:00 position are most compatible with fat necrosis. Per discussion with patient, she would like to proceed with ultrasound-guided biopsy of one of these lesions to confirm benignity, and she declined short term follow up as a management option. BIRADS: 3 - Probably benign finding.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess for hydronephrosis/obstruction History: AKI RIGHT KIDNEY: The right kidney measures 9.3 cm in length. Anechoic lesion in the right upper pole represents a small cyst or scarring. No hydronephrosis or shadowing stones.LEFT KIDNEY: The left kidney measures 9.47 m in length. No hydronephrosis or shadowing stones.OTHER: Subtle nodular contour of the liver and moderate to large volume ascites is consistent with cirrhosis. The renal jets are not visualized.", "output": "1. No acute renal abnormality. No hydronephrosis.2. Moderate to large ascites and nodular liver contour, consistent with cirrhosis."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules RIGHT LOBE MEASUREMENTS: 5.3 x 2.5 x 2.1 cm. Unchanged in size with normal vascularity.LEFT LOBE MEASUREMENTS: 6.0 x 2.2 x 1.9 cm. Unchanged in size with normal vascularity.ISTHMUS MEASUREMENTS: 7 mm in AP dimension, unchanged.RIGHT LOBE: Multiple mixed solid and cystic nodules, some of which demonstrate slightly decreased cystic components. Otherwise no significant change is evident, accounting for differences in technique. The reference upper pole nodule measures 2.6 x 1.8 x 1.5 cm. The reference lower pole nodule measures 3.0 x 2.3 x 2.2 cm.LEFT LOBE: Multiple mixed solid and cystic nodules, without significant interval change. The reference midpole nodule is difficult to measure separately from an adjacent cystic nodule, measuring 3.7 x 1.9 x 2.1 cm in total.ISTHMUS: The reference nodule measures 2.1 x 1.9 x 1.0 cm, unchanged.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "Bilateral thyroid nodules, which are stable to slightly decreased in size. No suspicious interval change."}
{"instruction": "Generate impression based on findings.", "input": "Female, 87 years old. Acute on chronic CKD. RIGHT KIDNEY: The right kidney measures 8.2 cm in length, with increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 9.2 cm in length, with increased cortical echogenicity. A mid-pole soft tissue prominence measures 1.3 x 1.3 x 1.4 cm, similar to the prior study dated 08/2012, and similar in configuration to the CT exam dated 03/2004.OTHER: The bladder is decompressed.", "output": "Increased renal cortical echogenicity compatible with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Becton is a 26 year old female presenting with a palpable mass in the left lateral breast for the past two months. Family history of breast cancer in mother, diagnosed at the age of 44. Upon physical exam of the left lateral breast, a soft mobile mass is appreciated. Targeted left breast ultrasound was performed for the patient's area of concern.In the left breast 3:00 location, approximately 1 cm from the nipple, there is an oval anechoic lesion measuring 1.9 x 1.0 x 2.0 cm, compatible with a simple cyst.", "output": "Simple cyst in the left breast. No additional imaging workup is necessary at this time. Patient should continue to follow up with her primary care physician for annual clinical breast exam.BIRADS: 2 - Benign finding.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "Abdominal pain LIVER: No significant abnormalities noted. 14.7 cm in lengthBILIARY TRACT: No significant abnormalities noted. No evidence for acute inflammation or ductal dilatation. No evidence for gallstones.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 11 cm in lengthRIGHT KIDNEY: No significant abnormalities noted. 10.3 cm in lengthOTHER: Minimally complex left renal cyst. Nonobstructing lower pole left renal stone measuring 0.5 x 0.9 x 0.5 cm. Left kidney 10.8 cm in length.", "output": "No extrahepatic biliary abnormality. Specifically, no evidence for gallstones, acute inflammation, or ductal dilatation.Minimally complex left renal cyst. Nonobstructing left nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "52 year-old male with history of acute injury. Assess for stones or hydronephrosis. RIGHT KIDNEY: Mild cortical thinning, without hydronephrosis or nephrolithiasis. The right kidney measures 10.75 cm.LEFT KIDNEY: Mild cortical thinning, without hydronephrosis or nephrolithiasis. The left kidney measures 11.9 cm.OTHER: Bladder is relatively decompressed.", "output": "Mild bilateral cortical thinning, without hydronephrosis or nephrolithiasis, which may represent medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "90 year-old female with epigastric/upper abdominal pain. LIVER: Normal in size, contour and echogenicity. Small cysts identified.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted except a previously documented cyst.OTHER: Right pleural effusion.", "output": "No findings to account for patient's pain.Right pleural effusion.Right renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess for HCC History: Cystic fibrosis related cirrhosis LIVER: The liver measures 13.9 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 normal hepatopetal flow with a velocity of 0.2 m/s.BILIARY TRACT: The gallbladder is not visualized. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3 mm in diameter.PANCREAS: The pancreas is partially obscured.SPLEEN: The spleen is mildly enlarged and measures 14.6 cm in length.RIGHT KIDNEY: Kidney measures 11.4 cm in length. Normal echotexture. No hydronephrosis. Several shadowing nonobstructive stones are noted, the largest of which measures 7 mm.LEFT KIDNEY: Kidney measures 13.1 cm in length. Normal echotexture. No hydronephrosis or shadowing stones. Simple cyst in the lower pole.OTHER: No ascites noted.", "output": "1.Cirrhotic liver morphology without focal lesions. Splenomegaly. No ascites.2.Nonobstructing right nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "73 year old female with history of metastatic breast cancer abdominal pain, cholestasis. Evaluate for biliary obstruction. Limited exam as patient is laying in left lateral decubitus position and minimally responsive.LIVER: Coarse heterogeneous echotexture of the liver measuring 15.5 cm in length with numerous hypodense solid lesions seen diffusely throughout the liver most consistent with metastatic disease which has progressed from prior CT study dated 10/6/2014. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Multiple shadowing stones within the gallbladder. No pericholecystic fluid. No gallbladder wall thickening. Common duct measures 6 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: Measures 9.1 cm in length. No hydronephrosis or shadowing calculi noted.OTHER: Left kidney and spleen are not visualized due to patient positioning.", "output": "1. Multiple solid lesions throughout the liver are most consistent with metastatic disease with interval progression compared to prior CT study dated 10/6/2014. Heterogeneous echotexture of the liver parenchyma suggestive of parenchymal dysfunction/fatty infiltration. No biliary obstruction.2. Cholelithiasis with no evidence of cholecystitis. Findings were discussed with Dr. Erica Mackenzie by phone on 3/23/2015 at 3:50 PM. "}
{"instruction": "Generate impression based on findings.", "input": "59-year-old male with history of right thyroid nodule. RIGHT LOBE MEASUREMENTS: 4.4 x 1.6 x 1.4 cmLEFT LOBE MEASUREMENTS: 3.7 x 1.3 x 1.1 cmISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Solid and cystic circumscribed exophytic nodule in the right lower pole measures 2.5 x 1.5 x 2.1 cm.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered cervical lymph nodes with overall benign appearing morphologic features.OTHER: No significant abnormality noted.", "output": "Solid and cystic right inferior pole exophytic nodule which is amenable to biopsy. "}
{"instruction": "Generate impression based on findings.", "input": "63-year-old female with thyromegaly and hoarseness. Evaluate for nodules. Goiter. RIGHT LOBE MEASUREMENTS: 2.4 x 2.5 x 5.6 cmLEFT LOBE MEASUREMENTS: 1.9 x 2.5 x 6 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: Diffusely heterogeneous in echotexture. Multiple small cystic and complex cystic nodules, some with comet tail artifact. In the mid inferior right lobe is a complex cystic nodule measuring 0.9 x 1.4 x 1.1 cm with a large nodular component. Large cyst with a small amount of wall calcification inferomedially measures 1.4 x 2.5 x 2.1 cm. Similarly there is a. Early cystic nodule with small amount of wall calcification anteriorly in the upper pole extending into the isthmus measures 0.8 x 1.5 x 1.4 cm.LEFT LOBE: Diffusely heterogeneous in echotexture. Multiple small cystic and complex cystic nodules, some with comet tail artifact. Largest complex cystic nodule measures 0.5 x 0.6 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": "Thyromegaly with heterogeneous gland.Bilateral cystic and complex cystic nodules as described above. 2 cystic nodules on the right demonstrate a small amount of wall calcificationComplex cystic nodule on the right with eccentric, nodular soft tissue."}
{"instruction": "Generate impression based on findings.", "input": "56-year-old female with right flank pain. RIGHT KIDNEY: The right kidney measures 11 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Left kidney measures 10.4 cm in length. Echotexture is normal. No hydronephrosis, shadowing calculus or mass.OTHER: Bladder poorly distended without gross abnormality.Highly echogenic liver presumably related to fatty infiltration.", "output": "1. Normal kidneys.2 fatty liver.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Female; 63 years old. Reason: Sharp rise in LFTs, s/p stem cell transplant, concern for occlusive process History: Increase in LFTs LIVER: The liver measures 15.3 cm in length. The liver contour is smooth. The parenchyma is increased in echogenicity and coarse in echotexture. Within the left lobe of the liver is a 3.2 x 2.2 x 2.8 cm complex cyst which is not significant changed. No worrisome mass is identified.The main portal vein is patent and demonstrates normal directional flow with a peak velocity of 0.46 m/sec.BILIARY TRACT: Status post cholecystectomy. The common duct measures 8 mm. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas appear unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 12.6 cm in length.RIGHT KIDNEY: The right kidney measures in 12.3 length. The cortex is normal in echogenicity. There is no hydronephrosis, shadowing renal stone, or worrisome mass. OTHER: The left kidney measures 11.6 cm in length. The cortex is normal in echogenicity. There is no hydronephrosis, shadowing renal stone, or worrisome mass.", "output": "1.Echogenic and coarse liver parenchyma consistent with chronic liver disease and/or hepatic steatosis. 2.Stable hepatic cyst."}
{"instruction": "Generate impression based on findings.", "input": "Renal stones RIGHT KIDNEY: No significant change in multiple right renal stones. Mild right hydronephrosis also unchanged. Right kidney 12.7 cm in lengthLEFT KIDNEY: No significant change in nonobstructing left renal calculus. No hydronephrosis. Left kidney 12.9 cm in lengthOTHER: Bladder nondistended", "output": "No significant change in bilateral nephrolithiasis. Mild right hydronephrosis unchanged."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis. Evaluate for portal vein thrombosis. Acute kidney injury. Assess for hydronephrosis. LIVER: Cirrhotic liver morphology. Increased parenchymal echogenicity. No focal hepatic lesions evident. Limited evaluation of the portal vein demonstrates normal portal venous blood flow and direction, measuring 25 cm/s. A patent recanalized umbilical vein is noted, compatible with cirrhosis.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Thickened gallbladder wall, which is nonspecific in the setting of ascites. Cholelithiasis.PANCREAS: Not well visualized due to overlying bowel gas.KIDNEYS: The right kidney is 11.0 cm in length. The left kidney is 11.0 cm in length. The renal parenchyma is echogenic bilaterally. A 13 mm simple appearing cyst is noted in the left renal midpole. A subcentimeter echogenic focus in the left superior pole possibly represents a nonobstructing renal stone. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 12.2 cm in length, without focal lesions evident.OTHER: Large volume ascites present.", "output": "1. Cirrhosis with recanalized umbilical vein and normal portal venous flow.2. Large volume ascites.3. Cholelithiasis.4. Left nonobstructing nephrolithiasis."}
{"instruction": "Generate impression based on findings.", "input": "85-year-old female with prior obstruction with suprapubic tube, elevated creatinine. Evaluate for hydronephrosis. RIGHT KIDNEY: Measures 7 cm in length. Increased echogenicity without evidence of hydronephrosis.LEFT KIDNEY: Measures 6.9 cm in length. Increased echogenicity without evidence of hydronephrosis.OTHER: Bladder decompressed with foley.", "output": "Very limited study without evidence of hydronephrosis. Increased renal echogenicity consistent with medical renal disease. "}
{"instruction": "Generate impression based on findings.", "input": "53-year-old female patient with elevated LFTs, alkaline phosphatase. Evaluate for biliary, gallbladder, liver pathology. LIVER: The liver measures 14.8 cm in length. There is a 1.1 x 1.3 x 1.0 cm hyperechoic lesion within the inferior right hepatic lobe. An additional ill-defined area of hyperechogenicity is noted within the left hepatic lobe measuring approximately 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 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 9.5 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 11.6 cm in length. No evidence of hydronephrosis. There is a 1.0 x 1.0 x 0.8 cm hypoechoic lesion within the left midpole.The spleen measures 8.7 cm in length.", "output": "1. Right inferior hepatic lobe hyperechoic lesion and region of hyperechogenicity within the left lobe which are incompletely evaluated on this evaluation; given prior imaging findings and history of cancer, dedicated liver CT/MRI is recommended for further evaluation.2. Hypoechoic left midpole lesion is indeterminate. "}
{"instruction": "Generate impression based on findings.", "input": "Chronic renal disease with worsening function RIGHT KIDNEY: Echogenic parenchyma without mass, stone, or hydronephrosis. 11.6 cm in length.LEFT 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": "Left-sided mass. Pain. Fluid and bowel is seen tracking through the left inguinal soft tissues, likely representing an inguinal hernia with ascites. This was also present on the prior outside institution CT. The 2 cm inferior-most portion of this demonstrates some heterogeneity with loculation, favoring complex loculated ascites rather than necrotic bowel or lymph node", "output": "Left inguinal hernia containing ascites and bowel."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old female with recurrent secondary hyperparathyroidism. Prior parathyroidectomy x4. RIGHT LOBE MEASUREMENTS: 4.9 x 2.4 x 2.3 cmLEFT LOBE MEASUREMENTS: 4.3 x 1.7 x 1.4 cmISTHMUS MEASUREMENTS: 0.7 cmRIGHT LOBE: There is a rounded well-demarcated homogeneously hyperechoic nodule in the mid to upper pole of the right lobe measuring 1.6 x 1.7 x 1.6 cm with a complete hypoechoic rim. Very small cystic nodules are identified as well.LEFT LOBE: The inferior left lobe appears somewhat bulbous, but isoechoic with the remainder of the lobe without definable mass. . Smaller cystic areas are present as well.ISTHMUS: Small colloid cyst.PARATHYROID GLANDS: No extrathyroidal mass identified.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral thyroid nodules.  Largest nodule on the right is likely benign and was present although smaller on an exam from 11/18/2004. Small, predominately cystic areas throughout the thyroid consistent with colloid cysts.No extrathyroidal mass identified."}
{"instruction": "Generate impression based on findings.", "input": "58 years old, Female, Reason: rule out thyroid cancer History: none RIGHT LOBE: Patient is status post thyroidectomy. No evidence of recurrent mass.LEFT LOBE: Patient is status post thyroidectomy. No evidence of recurrent mass.ISTHMUS: Patient is status post thyroidectomy. No evidence of recurrent mass.LYMPH NODES: Several bilateral subcentimeter benign appearing lymph nodes are noted.OTHER: No significant abnormality noted.", "output": "No evidence of recurrent disease or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "53-year-old male with abnormal liver function. History of alcohol abuse. LIVER: Liver is markedly echogenic consistent with fatty infiltration. There is diminished penetration of the ultrasound due to attenuation which may limit this exam. Morphology does not appear cirrhotic. There is no gross, focal hepatic abnormality.GALLBLADDER, BILIARY TRACT: Gallbladder appears distended, but without obvious gallstones or wall thickening. Small amount of dependent sludge within the gallbladder.PANCREAS: Limited due to bowel gas.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Limited views of left kidney and spleen demonstrate no abnormality.", "output": "Severe fatty liver."}
{"instruction": "Generate impression based on findings.", "input": "History of a left thyroid lobe nodule. FNA dated 3/6/2013 thyroid nodule demonstrated a colloid nodule. RIGHT LOBE MEASUREMENTS: 4.6 x 1.6 x 1.2 cmLEFT LOBE MEASUREMENTS: 3.4 x 1.2 x 1.1 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: The right thyroid lobe is normal in echogenicity morphology and size without a discrete nodule.LEFT LOBE: The left thyroid lobe is of normal echogenicity morphology and size with an anterior interpolar mildly hypoechoic well-defined nodule measuring 7 x 5 x 6 mm, unchanged from prior. ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable left thyroid lobe nodule. "}
{"instruction": "Generate impression based on findings.", "input": "Palpable right breast mass in the upper breast for the last 6 weeks. A targeted right ultrasound was performed for the patient\u2019s area of concern. On targeted physical exam, a subcentimeter mass is appreciated.At the right breast 1:00 position, a 6 x 4 mm mass that is isoechoic to an adjacent 1.2 cm fat lobule is noted. Morphologically, this oval circumscribed mass is highly likely benign such as a fibroadenoma.", "output": "Probably benign mass in the right upper inner breast. Surgical consultation is recommended for this palpable mass. Palpably guided FNA can be considered. If no intervention is performed after correlation with surgeons physical exam, a 6 month sonographic follow up can be considered.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "Hepatic failure with recent GI bleed LIMITED ABDOMENLIVER: Coarse echogenic liver echotexture again noted without mass. Liver length 17.6 cmBILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. RIGHT KIDNEY: Echogenic parenchyma without worrisome mass, stone, or hydronephrosis. Upper pole renal cyst. Right kidney 9.4 cm in length.OTHER: Echogenic left renal parenchyma without mass, stone, or hydronephrosis. No ascites", "output": "Coarse liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Patent hepatic vessels with normal directional flow. Trace ascites.Echogenic renal parenchyma suggestive for medical renal disease/parenchymal dysfunction without worrisome mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "HPV LIVER: Coarse echogenic liver echotexture again noted without mass. Liver length 14.1 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 9.3 cm in length OTHER: Left kidney 10.4 cm in length. Spleen 10.2 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture again noted consistent with chronic liver disease without mass or duct dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Elevated LFTs LIVER: Coarse echogenic liver parenchyma without mass. Liver length 17.4 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 12.1 cm in lengthOTHER: Left kidney 12.2 cm in length. Spleen 12.3 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": "55 year-old male with urinary retention. Ultrasound was provided as guidance for placement of suprapubic catheter performed by urology team. Again seen is echogenic material within the bladder. The bladder wall is thickened. Final imaging reveals portion of suprapubic catheter within the bladder.", "output": "Ultrasound was provided as guidance for placement of suprapubic catheter performed by urology team. Final imaging reveals portion of suprapubic catheter within the bladder. Echogenic material within the bladder with bladder wall thickening is again noted, clinical correlation is recommended. "}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with chronic viral hepatitis C. Evaluate for cirrhosis and hepatocellular carcinoma. LIVER: Liver is normal in size and echotexture. No focal hepatic abnormality is identified except a single calcified granuloma. Hepatic morphology appears normal. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.BILIARY TRACT: Gallbladder appears unremarkable without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.SPLEEN: Not visualized.RIGHT KIDNEY: No significant abnormalities noted. OTHER: Limited views of left kidney demonstrate no abnormality", "output": "Normal-appearing liver without mass."}
{"instruction": "Generate impression based on findings.", "input": "33-year-old female patient with history of extrathyroidal nodule. Follow-up extrathyroidal lesion status post nondiagnostic FNA and lymph node. RIGHT LOBE MEASUREMENTS: 6.8 x 2 x 2.3 cm.LEFT LOBE MEASUREMENTS: 6.1 x 2.2 x 2.3 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: The right thyroid lobe is heterogeneous in echogenicity without dominant lesion.LEFT LOBE: The left thyroid lobe is heterogeneous in echogenicity. A cystic nodule within the lower pole measures 0.8 x 0.5 x 0.5 cm, previous is 0.7 x 0.4 x 0.5 cm.ISTHMUS: The isthmus is heterogeneous in echogenicity.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: A hypoechoic nodule identified in the right neck superior to the medial aspect of the thyroid measures 0.8 x 0.6 cm, previously 0.7 x 0.5 cm. This lesion is similar in appearance to the prior exam in addition to an adjacent echogenic focus.", "output": "1. Hypoechoic nodule in the medial aspect of the right neck is minimally larger in size, though unchanged in appearance. 2. Heterogeneous thyroid gland suggestive of prior thyroiditis. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. Dalrymple is a 68 year old female with a personal history of benign right cyst aspiration in 2013. Family history of breast cancer in mother, diagnosed at the age of 48. She currently presents for ultrasound evaluation of a palpable mass was detected by Dr. Jaskowiak. Upon physical exam of the left breast, a site has been marked on the skin at the area of palpable concern. Targeted left breast ultrasound was performed. In the left breast 10:30 location, approximately 10 cm from the nipple, there is a oval hyperechoic mass measuring 1.1 x 0.5 x 0.8 cm. There is no associated vascularity. Sonographic findings are compatible with fat necrosis.", "output": "Benign fat necrosis of the left breast. No sonographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. All results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "41-year-old man with right upper quadrant pain. LIVER: Measures 21.3 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: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: No significant abnormalities noted.", "output": "1. No evidence of cholelithiasis or cholecystitis. 2. Hepatomegaly and increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease, without discrete focal lesion. "}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodule seen on recent CT RIGHT LOBE MEASUREMENTS: 6.4 x 1.6 x 1.9 cmLEFT LOBE MEASUREMENTS: 5.3 x 1.4 x 1.5 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: Punctate hypoechoic nodule right thyroid gland measuring 0.2 x 0.2 x 0.2 cmLEFT 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": "Punctate hypoechoic subcentimeter nodule right thyroid gland. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "New onset heart failure with mildly elevated LFTS, previously documented portal vein thrombosis on CT. Please evaluate. LIVER: Hyperechoic liver, suggestive of hepatic steatosis. Liver measures 12.2 cm. 4.5 x 2.7 cm peripheral right hepatic lesion is equivocal on ultrasound however consistent with cavernous hemangioma on CT. Findings consistent with known portal venous thrombosis and cavernous malformation.GALLBLADDER, BILIARY TRACT: Gallbladder nonvisualized. No intrahepatic or extrahepatic biliary ductal dilation. Common hepatic duct measures 1.45 mm.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Right kidney measures 10.6 cm. Left kidney measures 11.8 cm. Mild right greater than left hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1. Mild right greater than left hydronephrosis.2. Findings consistent with known portal venous thrombosis and cavernous malformation.3. Equivocal hepatic lesion is consistent with cavernous hemangioma on CT.4. Hyperechoic liver, suggestive of hepatic steatosis. "}
{"instruction": "Generate impression based on findings.", "input": "64-year-old female patient with abdominal pain, emesis. Question of cholecystitis. LIVER: The liver measures 16.0 cm in length and demonstrates increased, heterogeneous echogenicity. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There is cholelithiasis without significant gallbladder wall thickening. Sonographic Murphy's sign is negative. No intra- or extrahepatic biliary ductal dilatation is identified. The common duct measures 4 mm in diameter.PANCREAS: The pancreas is not visualized on this examination.RIGHT KIDNEY: The right kidney measures 8.3 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. A right upper pole renal cyst measures 3.5 x 2.9 x 3.4 cm.OTHER: The left kidney measures 8.1 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. A left lower pole cyst measures 2.6 x 2.8 x 2.6 cm.The spleen measures 10.1 cm in length.There is mild ascites.", "output": "1. Coarsened, increased hepatic echogenicity likely related to chronic liver disease without focal hepatic lesion identified.2. Cholelithiasis without sonographic evidence of acute cholecystitis.3. Mild ascites.4. Medical renal disease and bilateral renal cysts. "}
{"instruction": "Generate impression based on findings.", "input": "Thyroid cancer status post surgery and I-131 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: Not identified.LYMPH NODES: No suspicious lymph nodes identified.OTHER: No significant abnormality noted.", "output": "No evidence of residual or recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "64 years old, Male, Reason: eval for hydronephrosis History: AKI, elevated Cr RIGHT KIDNEY: Kidney measures 9.8 cm in length. Increased echogenicity of the kidney consistent with medical renal disease. No hydronephrosis or shadowing calculus. Simple appearing right renal cyst measures 3.5 x 2.4 x 2.4 cm.LEFT KIDNEY: Kidney measures 8.7 cm in length. Increased echogenicity of the kidney. No hydronephrosis, shadowing calculus or mass.Bladder: There is a Foley within the bladder.", "output": "1.Increased echogenicity of the kidneys bilaterally is consistent with medical renal disease.2.Simple appearing right renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "Female 72 years old Reason: bilateral partial nephrectomies for RCC History: none RIGHT KIDNEY: Slightly echogenic kidney. Multiple small stones. Right kidney measures 10.6 cm. In the midportion of the right kidney there is a 1.9 x 1.9 x 2.1 cm, ill-defined predominantly hyperechoic lesion at the site of the patient's known resected cancer. This may represent postsurgical changes, however, either follow-up with ultrasound versus confirmation with dedicated contrast-enhanced CT or MR is recommended. No evidence of hydronephrosis.LEFT KIDNEY: Left kidney is also echogenic. Simple appearing cyst measuring 4.3 x 4 cm. Slightly echogenic kidney with punctate stones. No evidence of hydronephrosis.OTHER: No significant abnormalities noted.", "output": "Likely postsurgical changes in the right kidney. Follow-up with ultrasound for resolution versus further evaluation with dedicated renal mass protocol CT or MR is recommended to exclude any recurrent disease.Bilateral punctate stones.Simple appearing left renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "35 year-old male with transaminitis. LIVER: Normal echogenicity of the liver measuring 13.5 cm in length. No focal hepatic lesion. Portal vein is patent with appropriate directional flow.BILIARY TRACT: Normal echogenicity of the gallbladder. No pericholecystic fluid. No gallbladder wall thickening. No intra or extrahepatic biliary ductal dilatation.PANCREAS: Not well assessed due to overlying bowel gas.SPLEEN: Normal echogenicity measuring 9.7 cm in length.RIGHT KIDNEY: Mild fullness of the collecting system. No nephrolithiasis delineated. OTHER: Left kidney measures 9.9 cm in length. No hydronephrosis. No shadowing intrarenal stone seen.", "output": "Mild fullness of the right renal collecting system which may be physiologic."}
{"instruction": "Generate impression based on findings.", "input": "Reason: please assess liver for cirrhosis, please assess for hydronephrosis; decreased UOP Examination limited due to constraints positioning patient. LIVER: The liver measures 13.7 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 hepatopetal flow with a velocity of 0.31 m/s.BILIARY TRACT: Cholelithiasis without significant gallbladder wall thickening. Gallbladder is relatively collapsed. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 3 mm in diameter.PANCREAS: Not well visualized.SPLEEN: No significant abnormalities noted. The spleen measures 11.6 cm in length. RIGHT KIDNEY: Kidney measures 9.7 cm in length. Increased parenchymal echogenicity. No hydronephrosis, shadowing calculus or mass.LEFT KIDNEY: Not well visualized.ABDOMINAL AORTA: Proximal aorta measures 2.4 cm in AP dimension. Middle and distal aorta not well visualized.INFERIOR VENA CAVA: Not well visualized.OTHER: Moderate ascites. Foley catheter.", "output": "1.Limited exam.2.Cirrhotic liver morphology. No focal hepatic lesions identified.3.Cholelithiasis.4.Echogenic right kidney suggestive of medical renal disease. No right hydronephrosis. Left kidney not visualized.5.Moderate ascites."}
{"instruction": "Generate impression based on findings.", "input": "Neutropenia with Dr. urea RIGHT KIDNEY: Markedly echogenic renal parenchyma without mass, stone, or hydronephrosis. Right kidney 10.5 cm in lengthLEFT KIDNEY: Markedly echogenic renal parenchyma without mass, stone, or hydronephrosis. Left kidney 8.7 cm in length.OTHER: Bladder nondistended. Moderate ascites. Bilateral pleural effusions.", "output": "Markedly echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis. No evidence for abscess or acute inflammatory process. Moderate ascites. Bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Hyperparathyroidism. Status post right inferior and left superior parathyroidectomies RIGHT LOBE MEASUREMENTS: 1.6 x 1.7 x 5.5 cm.LEFT LOBE MEASUREMENTS: 1.6 x 1.7 x 5.3 cm.ISTHMUS MEASUREMENTS: 0.4 cm in AP dimension.RIGHT LOBE: No significant abnormality noted.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: A 19 x 14 x 8 mm hypoechoic nodule is noted posterior to the right thyroid midpole, likely representing a parathyroid adenoma.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "19 mm hypoechoic nodule noted posterior to the right thyroid midpole, likely representing a parathyroid adenoma."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Elaine Harris is a 75 year-old female with a personal history of right breast mass for 2 year duration. MAMMOGRAM:Three standard views and 2 spot compression views of both breasts as well as one exaggerated CC view 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).There is a large, circumscribed dense mass in the upper outer right breast, posterior depth, measuring 5.4 x 6.4 cm. Two focal asymmetries in the upper outer left breast do not persist with spot compression. A right axillary lymph node is partially visualized.ULTRASOUND:On physical examination, a large mass is palpated in the right upper outer breast.A targeted right ultrasound was performed for the palpable and mammographic area of concern. In the right breast, 10:00 position, 8 cm from the nipple, there is a large complex cystic and solid mass measuring 4.5 x 3.4 cm. The solid component of this complex mass demonstrates increased blood flow and measures 1.2 x 3.4 cm, which could be the target for ultrasound-guided biopsy. Debris is also layering in this complex mass. Normal appearing lymph nodes are noted in the right axilla.", "output": "A large dense complex cystic and solid mass in the right breast 10:00 position measuring up to 6.4 cm mammographically. Ultrasound-guided biopsy of the solid component is recommended. Patient is on aspirin and she is advised that it will be optimal to withhold her aspirin for 5 days before biopsy, as long as it is reasonable for her primary physician who prescribed the medicine.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Thyrotoxicosis. RIGHT LOBE MEASUREMENTS: 5.4 x 2.6 x 1.7 cm. Heterogeneous background echotexture with minimally increased vascularity.LEFT LOBE MEASUREMENTS: 5.5 x 2.4 x 1.5 cm. Heterogeneous background echotexture with minimally increased vascularity.ISTHMUS MEASUREMENTS: 3 mm in AP dimension, within normal limits in sizeRIGHT LOBE: Heterogeneous background gland without discrete nodules.LEFT LOBE: Heterogeneous background gland without discrete nodules.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "Diffusely heterogeneous thyroid gland with minimally increased vascularity. These findings may be seen in thyroiditis or Graves' disease."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Muniz is a 21-year-old female with a personal history of high probability benign fibroadenomata of the right breast. Patient reports that her right breast masses are enlarging and associated with tenderness. Targeted ultrasound of the right outer breast, 9:00 position 5 cm from the nipple, reveals an oval parallel hypoechoic mass measuring 1.9 x 1.1 x 1.7 cm, previously 2.2 x 1.1 x 1.7 cm.Targeted ultrasound of the right lower outer breast, 8:00 position 4 cm from the nipple, reveals a 1.9 x 1.0 x 1.2 cm gently lobulated hypoechoic mass, previously measuring 1.9 x 1.5 x 2.1 cm.", "output": "Stable fibroadenomas of the right breast (8:00 mass stable in size dating back to 2014 and the 9:00 mass stable dating back to 2015). As long as the patient's physical examination remains normal, right ultrasound for the right breast 9:00 mass is recommended in 6 months. If findings remain stable, patient will have been followed for two years, confirming these lesions to be benign fibroadenomas. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding. RECOMMENDATION: B - Surgical Consultation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Reason: CKD stage IV, enlarged kidneys on prior US, assess renal size History: CKD stage IV RIGHT KIDNEY: The right kidney measures 11.7 cm in length. Echogenic, atrophic renal parenchyma. Again seen are multiple subcentimeter simple cysts, the largest of which measures 1.8 x 1.5 x 1.7 cm in the upper pole. No hydronephrosis, shadowing stones, or suspicious lesions.LEFT KIDNEY: The left kidney measures 11.5 cm in length. Echogenic, atrophic renal parenchyma. Again seen are multiple subcentimeter simple cysts, the largest of which measures 3.6 x 2.7 x 2.8 cm in the upper pole. No hydronephrosis, shadowing stones, or suspicious lesions.OTHER: Unremarkable bladder. Ureteral jets not visualized.", "output": "1. Bilateral renal atrophy and echogenic renal parenchyma, consistent with medical renal disease.2. Stable bilateral simple renal cysts as detailed above."}
{"instruction": "Generate impression based on findings.", "input": "23-year-old female with palpable lump in the left breast for 3 months presents for evaluation. Family history of breast cancer in her maternal grandmother, great grandmother and great grandfather. A targeted left ultrasound was performed for the patient\u2019s area of concern. On physical examination, a 2 cm mobile nontender mass is palpated in the left breast 3:00 position. Ultrasound demonstrates an oval parallel oriented mixed echogenic mass that measures 2.6 x 1.5 x 1.9 cm with peripheral blood flow.", "output": "Palpable abnormality in the left breast 3:00 position most likely represents a benign fibroadenoma however surgical consultation with a possible fine-needle aspiration for confirmation is recommended.Patient is scheduled for a breast augmentation surgery next week and also plans to travel for the next couple of months. She will attempt to get a surgical consult with possible FNA before the augmentation.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female complains of left upper quadrant pain in the area of prior lap incision. There is a clinical concern for hernia. The fascial planes are intact and there is no evidence of hernia.", "output": "No fascial defect; no evidence for hernia."}
{"instruction": "Generate impression based on findings.", "input": "History metastatic urothelial carcinoma with elevated LFTs LIMITED ABDOMENLIVER: Coarse echogenic liver echotexture without mass. Liver length 15.3 cm.BILIARY TRACT: No significant abnormalities noted.PANCREAS: Not visualized due to overlying gas.SPLEEN: No significant abnormalities noted. 10.6 cm in length. RIGHT KIDNEY: AbsentOTHER: Left kidney 12.9 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture consistent with parenchymal dysfunction/fatty infiltration without mass or ductal dilatation. No ascites. Patent hepatic vessels with normal directional flow."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old male patient with altered mental status on admission, widespread amyloid. Assess for cirrhosis. The patient has abdominal situs inversus.LIVER: The liver measures 21.3 cm in length and has a coarsened echotexture. Small amount of perihepatic fluid is noted. Main portal vein flow is hepatopetal and measures 0.1 m/s.GALLBLADDER, BILIARY TRACT: The gallbladder contains sludge. The gallbladder wall measures 4 mm in diameter, which is borderline thickened though nonspecific in the setting of ascites. Sonographic Murphy's sign is negative. The common hepatic duct measures 4 mm in diameter.PANCREAS: The head of pancreas appears normal. The tail is obscured by overlying bowel gas.RIGHT KIDNEY: The right kidney measures 12.9 cm in length and has increased renal cortical echogenicity. No evidence of hydronephrosis.OTHER: The left kidney measures 10.2 cm in length and has increased cortical echogenicity. No evidence of hydronephrosis.The spleen measures 13.8 cm in length. A cystic area in the spleen measures 7.2 x 3.2 x 6.8 cm.", "output": "1. Abdominal situs inversus.2. Biliary sludge and borderline gallbladder wall thickening, which is non-specific in the setting of ascites.3. Hepatomegaly and perihepatic ascites.4. Cystic area in spleen may represent an old hematoma.5. Medical renal disease. "}
{"instruction": "Generate impression based on findings.", "input": "38-year-old male with question of hypoechoic nodule on outside study. RIGHT LOBE MEASUREMENTS: 5.3 x 1.5 x 1.2 cmLEFT LOBE MEASUREMENTS: 5.0 x 1.3 x 1.5 cmISTHMUS MEASUREMENTS: 0.2 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Subcentimeter left hypoechoic thyroid nodule measures 0.4 x 0.4 x 0.3 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered cervical lymph nodes with benign morphologic features.OTHER: No significant abnormality noted.", "output": "Subcentimeter left thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "44-year-old female patient status post left thyroid lobectomy and isthmusectomy. Assess thyroid nodules. RIGHT LOBE MEASUREMENTS: 5.3 x 2.0 x 1.9 cm.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: The right thyroid lobe contains a complex cystic and solid nodule within the lower pole measuring 0.7 x 0.5 x 0.9 cm, previously 0.7 x 0.4 x 0.6 cm; the cystic component appears larger in size. There is no significant internal vascularity.LEFT LOBE: Status post thyroidectomy without residual or recurrent tissue identified.ISTHMUS: Status post thyroidectomy without residual or recurrent tissue identified.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Subcentimeter complex solid and cystic right thyroid node. 2. Status post left thyroid lobectomy and isthmusectomy. "}
{"instruction": "Generate impression based on findings.", "input": "Chronic renal disease RIGHT KIDNEY: Echogenic atrophic parenchyma without mass, stone or hydronephrosis. 10.8 cm in lengthLEFT KIDNEY: Echogenic atrophic parenchyma without mass, stone, or hydronephrosis. 11.2 cm in lengthOTHER: Bladder nondistended", "output": "Echogenic atrophic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or obstruction."}
{"instruction": "Generate impression based on findings.", "input": "Lactic acidosis LIVER: Coarse echogenic liver echotexture without mass. 20.8 cm in length. Limited Doppler interrogation of main portal vein demonstrates a patent portal vein with normal directional flowGALLBLADDER, BILIARY TRACT: Status post cystectomy. No ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: 11.8 cm in length.OTHER: Left kidney 10.1 cm in length. Spleen 8.2 cm in length. No ascites.", "output": "Coarse echogenic liver parenchyma consistent with fatty infiltration without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules, RIGHT LOBE MEASUREMENTS: 7 x 1.5 x 2.6 cmLEFT LOBE MEASUREMENTS: 6.1 x 1.7 by 2.4 cmISTHMUS MEASUREMENTS: 2 mmRIGHT LOBE: A predominantly cystic circumscribed, oval nodule measures 0.4 by 0.3 x 0 .4 cm in the upper pole. An irregularly-shaped hypoechoic nodule right, adjacent to it measures 1.1 x 1 x 0.8 cm possibly colloid in nature. However, few specks of calcifications are noted within it, further evaluation with ultrasound guided FNA is recommended. Also, comparison with prior ultrasound should be performed to look for interval changeLEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal morphology, level 2 right neck lymph nodes identified.OTHER: No significant abnormality noted.", "output": "Atypical features in an irregularly-shaped hypoechoic right upper pole nodule possibly colloid in nature however, few specks of calcifications within it. Further evaluation with ultrasound guided FNA is recommended. If prior imaging is submitted, comparison with prior ultrasound should be performed to look for interval change"}
{"instruction": "Generate impression based on findings.", "input": "Reason: eval for cirrhosis, clot History: acute hepatitis Please note that exam is limited as patient refused further imaging following Doppler ultrasound of the main portal vein and hepatic artery. The remaining Doppler examination was not performed LIMITED ABDOMENLIVER: Increased echogenicity suggesting a ptosis. Nonstenotic morphology. No focal hepatic lesions. Main portal vein is patent. Liver measures 13.9 cm in craniocaudal dimension.BILIARY TRACT: Gallbladder is nondistended. No stones, pericholecystic fluid or wall thickening.PANCREAS: Pancreas is obscured.SPLEEN: Spleen was not imaged. RIGHT KIDNEY: Right kidney appears unremarkable.OTHER: No significant abnormalities noted.", "output": "Limited exam as patient refused further imaging. The liver is diffusely hyperechoic which may be suggestive of steatosis, otherwise examination is unremarkable."}
{"instruction": "Generate impression based on findings.", "input": "67-year-old female with chronic kidney disease RIGHT KIDNEY: Measures 9.0 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. LEFT KIDNEY: Measures 10.2 cm in length. Increased echogenicity without hydronephrosis, nephrolithiasis, or solid mass. Left superior pole cyst measures 3.3 x 3.0 x 2.5 cm, with possible thin septations.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 or hydronephrosis. Left superior pole renal cyst as described above. "}
{"instruction": "Generate impression based on findings.", "input": "55-year-old male with right upper quadrant and mid abdominal pain with palpation. LIVER: Mildly hyperechoic presumably due to fatty infiltration. A focal hepatic abnormality. Limited color and spectral Doppler demonstrates patency and appropriate flow direction in the main portal vein.GALLBLADDER, BILIARY TRACT: Gallbladder is normal without cholelithiasis, wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: Head is normal. Body and tail are obscured by bowel gas.RIGHT KIDNEY: Limited views demonstrate no abnormality.OTHER: Splenic size normal. No gross left renal abnormality on limited views.", "output": "Mildly echogenic liver. Normal gallbladder and biliary tract."}
{"instruction": "Generate impression based on findings.", "input": "54-year-old female patient with history of thyroid cancer. One and a half year follow-up. Eval for adenopathy, recurrence. RIGHT LOBE: Status post thyroidectomy without recurrent tissue identified.LEFT LOBE: Status post thyroidectomy. A 0.4 x 0.3 x 0.3 cm hypoechoic focus in the left thyroid bed, similar in size and appearance.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology lymph nodes are noted in the right neck. A left level three lymph node measuring 1.3 x 0.8 x 0.9 cm is slightly larger compared to the most recent study but similar to smaller in size compared to the 6/3/2013 study.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy without specific evidence of disease recurrence or regional lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "41 year-old female with a stem cell transplant, now abdominal pain and fever LIVER: Hepatic parenchyma is echogenic and there is mild hepatomegaly.GALLBLADDER, BILIARY TRACT: No cholelithiasis. Bladder wall mildly thickened, but there is ascites present and therefore this is not specific. The biliary tract is normal in caliber.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Mild/moderate ascites and bilateral pleural effusions.Splenomegaly.", "output": "Ascites, pleural effusions and heoatosplenomegaly with echogenic liver."}
{"instruction": "Generate impression based on findings.", "input": "78-year-old female patient with chronic right flank pain. Assess for liver metastases. LIVER: The liver measures 15.7 cm in length and demonstrates increased parenchymal echogenicity. No focal hepatic lesion is identified. Main portal vein flow is hepatopetal and measures 0.13 m/sec.GALLBLADDER, BILIARY TRACT: There are no gallstones, gallbladder wall thickening, or pericholecystic fluid. Sonographic Murphy's sign is negative. 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 9.0 cm in length. No evidence of hydronephrosis. There is a 3.3 x 3.7 x 2.4 cm minimally complex right upper pole renal cyst.OTHER: The left kidney measures 9.4 cm in length. No evidence of hydronephrosis.The spleen measures 8.1 cm in length.", "output": "1. Increased hepatic parenchymal echogenicity without focal hepatic lesion. 2. Minimally complex right upper pole renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 62 year old female with ALL undergoing treatment recent history of early cholecystitis. Please evaluate for recurrence. History: abdominal pain. LIVER: The liver measures 15.4 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 0.42 m/s.BILIARY TRACT: Single round echogenic nonmobile structure measuring up to 5 mm within gallbladder fundal wall. Gallbladder slightly contracted without definite gallbladder wall thickening. 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 10.3 cm in length. RIGHT KIDNEY: Kidney measures 10.2 cm in length. Normal cortical echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 10.0 cm in length. Normal cortical echotexture. No hydronephrosis.OTHER: No significant abnormalities noted.", "output": "1.Mildly contracted gallbladder without convincing evidence acute cholecystitis. 2.Nonmobile 5 mm echogenic focus along the fundal gallbladder wall. While this may reflect a gallstone, this could also represent a polyp and continued follow-up is recommended (for example with ultrasound in 6 months).3.Echogenic liver suggestive of parenchymal dysfunction/fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "Female 66 years old; Reason: rule out recurrent thyroid cancer History: choking sensation x 1 year RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENT: Status post thyroidectomy.RIGHT LOBE: No mass noted in the right thyroid bed.LEFT LOBE: No mass noted in left thyroid bed.ISTHMUS: No significant abnormality noted.LYMPH NODES: Enlarged lymph node in the left level 3/4 measuring 1.1 x 0.8 x 0.7 cm demonstrating a fatty hilum and a benign morphology.OTHER: No significant abnormality noted.", "output": "1.No evidence of recurrent disease in the thyroid bed.2.Prominent left level 3/4 lymph node demonstrating a benign morphology. Although this lymph node is favored to be reactive, given its isolated enlargement and somewhat unusual location, a six-month follow-up is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Female 52 years old Reason: elevated creatinine, hyperkalemia History: elevated creatinine, hyperkalemia RIGHT KIDNEY: The right kidney measures 10.6 cm. The renal cortex is hyperechoic. There is a 2.2-cm lower pole cyst. There is no hydronephrosis.LEFT KIDNEY: The left kidney is not clearly identified.URINARY BLADDER: The bladder is incompletely distended and poorly evaluated.OTHER: No significant abnormalities noted.", "output": "Hyperechoic right renal cortex consistent with medical renal disease. The left kidney is not clearly identified."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female with abnormal LFTs on methotrexate. LIVER: Measures 15.0 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: 1.2 cm hypoechoic exophytic structure in the left inferior renal pole may represent a cyst. No hydronephrosis or nephrolithiasis. OTHER: No significant abnormalities noted.", "output": "Increased hepatic echogenicity consistent with hepatic steatosis or parenchymal disease, without discrete focal lesion. "}
{"instruction": "Generate impression based on findings.", "input": "Increasing LFTs. Generalized abdominal pain. LIVER: The liver is normal in morphology. It is mildly coarse in echotexture suggesting parenchymal dysfunction. It is normal in size measuring 16.1 cm in length. No focal lesion is evident. Normal hepatopedal portal venous blood flow at 15 cm/s. The hepatic veins are prominent suggesting increased right-sided heart pressure.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation with the common duct measuring approximately 4 mm.Partially distended gallbladder with laminated wall thickening up to 5 mm. Shadowing gallstones are present. Minimal pericholecystic fluid. No focal tenderness was present, however the patient was medicated.PANCREAS: The visualized portions of the pancreatic head are unremarkable. Otherwise it is obscured by overlying bowel gas shadowing.SPLEEN: The spleen is normal in size measuring 6 cm in length.RIGHT KIDNEY: The right kidney measures 9.9 cm in length without hydronephrosis or shadowing nephrolithiasis. OTHER: The left kidney measures 9.8 cm in length without hydronephrosis or shadowing nephrolithiasis.Small right pleural effusion.", "output": "Cholelithiasis, gallbladder wall thickening and pericholecystic fluid may be seen in the setting of acute cholecystitis versus liver disease. Lack of focal tenderness may be due to patient's pain medication. If further imaging is clinically warranted a HIDA scan should be considered.Small right pleural effusion.Coarse liver echotexture suggestive of parenchymal dysfunction. Prominent hepatic veins may represent elevated right-sided heart pressure."}
{"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. Few subcentimeter simple cysts are seen in the right breast. There is no solid or cystic mass identified.", "output": "Simple cysts of the right breast. No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Right upper quadrant pain LIVER: Non-cirrhotic liver morphology. 19 cm in length. Normal parenchymal echogenicity. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: No biliary ductal dilation. Several 1-2 cm gallstones are noted. No gallbladder with thickening, pericholecystic fluid, or sonographic Murphy 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 11.4 cm in length. The left kidney is 10.5 cm in length. No suspicious renal lesions are evident. No hydronephrosis is present.SPLEEN: 8.2 cm in length, without focal lesions evident.OTHER: No significant abnormalities noted. No abdominal free fluid identified.", "output": "Cholelithiasis without evidence of cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Female, 88 years old. Progressive renal failure. 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 9.3 cm in length with increased cortical echogenicity. A lower pole simple cyst measures 3.0 x 2.6 x 2.9 cm. No shadowing stones or hydronephrosis.OTHER: The bladder is decompressed, limiting evaluation.", "output": "Increased renal cortical echogenicity compatible with medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Chronic renal disease RIGHT KIDNEY: Mildly coarse parenchymal echotexture without mass, stone, or hydronephrosis. 12.7 cm in lengthLEFT KIDNEY: Mildly coarse parenchymal echotexture without mass, stone, or hydronephrosis. 12.1 cm in lengthOTHER: Bladder nondistended", "output": "Mildly coarse parenchymal echotexture suggestive for medical renal disease/parenchymal dysfunction without mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "68 years old, Female, Reason: eval left kidney for hydronephrosis/lesion History: left flank pain, hx pyelonephritis RIGHT KIDNEY: Kidney measures 12.1 cm in length. Normal echotexture. No hydronephrosis or shadowing calculus. There is an anechoic simple appearing cyst in the superior pole of the right kidney measuring 1.6 x 1.4 x 1.6 cm.LEFT KIDNEY: Kidney measures 12.3 cm in length. Normal echotexture. No hydronephrosis, shadowing calculus or mass.Bladder: The bladder is not completely distendedOther: Increased echogenicity of the liver is consistent with fatty infiltration.", "output": "1.No evidence of hydronephrosis as clinically questioned. No evidence of shadowing calculus.2.Echogenicity of the renal parenchyma is within normal limits bilaterally.3.Echogenic liver."}
{"instruction": "Generate impression based on findings.", "input": "82-year-old woman call back for right breast masses identified on screening mammogram. MAMMOGRAM: An ML view and 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), unchanged in pattern and distribution. Additional views demonstrate persistence of an irregular mass in upper outer quadrant. In the central right breast, inferior and medial to this mass is a nodular focal asymmetry which persists on additional views. Ultrasound is performed for further evaluation of both findings. The focal asymmetry in the medial right breast disperses on additional views and is consistent with normal fibroglandular tissue.ULTRASOUND: On physical exam, there is a palpable solid nonmobile mass in the lateral right breast.Targeted ultrasound was performed for the areas of mammographic and clinical concern. In the right breast 9:00 position, 3 cm from nipple, there is a hypoechoic mass with angular margins measuring 1.6 x 1.0 x 1.5 cm, highly suspicious for malignancy. Internal vascularity is present. This correlates with the irregular mass seen on mammogram in the upper outer quadrant and an ultrasound-guided biopsy is recommended further evaluation.In the 6:00 position 1 cm from nipple, there is a 3 x 4 x 3 mm nodular hypoechoic mass, indeterminate. Internal vascularity is not present. This correlates with the mass seen inferior and medial to the dominant mass in the lateral right breast and an ultrasound-guided biopsy is recommended for further evaluation.Incidental note is made of a 5 mm benign sebaceous cyst in the 5:00 position of the breast, 3 cm from nipple.", "output": "Suspicious mass in the lateral right breast measuring up to 1.6 cm for which ultrasound-guided biopsy is recommended. Additional indeterminate nodular mass measuring up to 3 mm in the inferior breast, 6:00 position for which ultrasound-guided biopsy is also recommended further evaluation. Findings and recommendations were discussed with patient at time of exam. The patient does take blood thinning medications and she will be asked to discontinue these medications 3-5 days prior to the biopsy.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "74-year-old male with long-standing hypertension, renal dysfunction, with new CHF. Evaluate for hydronephrosis RIGHT KIDNEY: The right kidney measures 9.4 cm and is normal in echogenicity. No evidence of hydronephrosis.LEFT KIDNEY: Left kidney measures 8.9 cm and is normal in echogenicity. No evidence of hydronephrosis.BLADDER: No significant abnormalities noted.", "output": "No hydronephrosis as clinically questioned."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old male with history of pancreatic cancer. Status post I. R. percutaneous drain for perihepatic fluid collection. LIVER: The liver is within normal limits. Findings of chronic gallbladder inflammation, such as gallbladder wall thickening without significant pericholecystic fluid. The gallbladder is not well distended, and likely has small gallstones/sludge.BILIARY TRACT: No biliary dilatation.PANCREAS: Pancreas is not well visualized.SPLEEN: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. OTHER: The previously seen perihepatic anterior superficial fluid collection contains a pigtail drain, and no significant amount of fluid.", "output": "Perihepatic drain within a near completely collapsed pocket as above."}
{"instruction": "Generate impression based on findings.", "input": "50 years old, Female, Reason: cholecystitis History: RUQ pain, vomiting LIVER: The liver measures 17.7 cm in length. Mildly increased echogenicity of the hepatic parenchyma is consistent with fatty infiltration. 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: Multiple shadowing gallstones are present within a collapsed gallbladder which likely accounts for the concentric gallbladder wall thickening. No pericholecystic fluid or sonographic Murphy's sign to suggest active inflammation. 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 in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 9.1 cm in length. RIGHT KIDNEY: Kidney measures 10.9 cm in length. Normal echotexture. Mild hydronephrosis without evidence of shadowing calculus.LEFT KIDNEY: Kidney measures 10.3 cm in length. Normal echotexture. Mild hydronephrosis without evidence of shadowing calculus.OTHER: No significant abnormalities noted.", "output": "1.Cholelithiasis in a contracted gallbladder without evidence of cholecystitis.2.Bilateral mild hydronephrosis without clear etiology on this ultrasound examination.3.Increased hepatic parenchymal echogenicity is consistent with fatty infiltration."}
{"instruction": "Generate impression based on findings.", "input": "8-week-old male with right hydroureteronephrosis. Evaluate. BLADDER  Wall Thickness: Normal  Contents: Distended and normal. Distal Ureter -- SFU Grade**  Right: 2  Left: 0   Ureteral Jets Right: Not observed  Left: Not observedKIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 2 Left: 0  Length*** Right: 5.4 cm Left: 5.6 cm   Mean for age: 4.2 cm  Range for age: 3.9 - 5.7 cmADDITIONAL OBSERVATIONS: None", "output": "Grade 2 right hydroureteronephrosis.*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": "64 year old female with elevated LFTs/GGTP, evaluate for fatty liver/NASH LIVER: Normal echogenicity of the liver measuring 15.2 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. Sonographic Murphy's sign is negative. 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: Normal echogenicity of the right kidney measuring 11.0 cm in length. No hydronephrosis or shadowing calculi are noted.OTHER: Normal echogenicity of the spleen measuring 12.3 cm in length.Normal echogenicity of the left kidney measuring 12.5 cm in length. No hydronephrosis or shadowing calculi are noted.", "output": "Unremarkable examination."}
{"instruction": "Generate impression based on findings.", "input": "Female; 57 years old. Reason: RUQ pathology History: sepsis, unknown source of infection, ?gb or biliary source LIVER: The liver measures 21.5 cm in length. The liver surface is smooth. The parenchyma has normal echogenicity. No worrisome mass is identified. There is no ascites.The main portal vein is patent with hepatopetal flow and a peak velocity of 0.22 m/sec.BILIARY TRACT: Layering sludge is seen within the gallbladder. No discrete gallstone is identified. The gallbladder wall measures 5 mm. There is pericholecystic fluid. The common duct measures 3 mm in diameter.There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreas is not well-visualized due to overlying bowel gas.SPLEEN: The spleen measures 11.1 cm in length.KIDNEYS: The right kidney measures 12.0 cm in length. The left kidney measures 11.6 cm in length. The renal cortices are echogenic bilaterally. There is no hydronephrosis, shadowing renal stone, or worrisome renal mass identified.OTHER: The bladder is compressed by a Foley catheter.In the midline of the pelvis, superior to the bladder is a well-circumscribed, solid, echogenic mass.", "output": "1.Gallbladder wall thickening and pericholecystic fluid concerning for acute cholecystitis. Sludge is seen layering within the gallbladder but no discrete stone is identified. No biliary ductal dilatation.2.Echogenic kidneys compatible with medical renal disease.3.Hepatomegaly.4.Well-circumscribed midline pelvic mass is favored to represent a pedunculated uterine fibroid; cross sectional imaging would be helpful for further characterization.These findings were discussed by telephone with Dr. Gao on 2/18/2015 at 15:50."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid nodules. RIGHT LOBE MEASUREMENTS: 6.0 x 1.7 x 1.6 cmLEFT LOBE MEASUREMENTS: 4.7 x 1.7 x 1.2 cmISTHMUS MEASUREMENTS: 0.6 cmRIGHT LOBE: 1.1 x 1.7 x 0.7 mm superior pole hypoechoic well-defined nodule with vascularity and hyperechoic foci is roughly stable.Adjacent subcentimeter nodules appear stable.LEFT LOBE: Previously described 5 mm nodule was not identified on today's exam. Additional subcentimeter nodules appear stable.The background thyroid parenchyma is normal echogenicity.ISTHMUS: Stable 1.0 x 0.4 x 0.8 cm right inferior isthmus hypoechoic nodule with spongiform appearance.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No significant change in several subcentimeter thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "90 year-old male with urinary retention. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 11.2 cm in length. Echotexture appears within normal limits. There is a 3 cm cyst arising from the upper pole. No hydronephrosis, shadowing calculus or solid mass.LEFT KIDNEY: The left kidney measures 10.4 cm in length. Echotexture appears within normal limits. No hydronephrosis, shadowing calculus or mass.URINARY BLADDER: Bladder is incompletely distended with trabeculation.OTHER: Prostate is enlarged.", "output": "No hydronephrosis.Right renal cyst.  Enlarged prostate with trabeculated but not distended bladder."}
{"instruction": "Generate impression based on findings.", "input": "Urosepsis, rule out pyelonephritis RIGHT KIDNEY: Measures 10.0 cm. The parenchymal echogenicity is unremarkable. No hydronephrosis or mass.LEFT KIDNEY: Measures 10.1 cm. The parenchymal echogenicity is unremarkable. No hydronephrosis or mass.OTHER: The bladder is partially distended.", "output": "Normal renal parenchymal echogenicity without hydronephrosis or mass."}
{"instruction": "Generate impression based on findings.", "input": "25-year-old male with a history of hepatitis B. Evaluate for evidence of cirrhosis. LIVER: The liver is normal in morphology, echogenicity and size, measuring 18 cm in craniocaudal dimension. No intrahepatic biliary ductal dilatation or focal hepatic lesion is identified. The liver capsule is smooth. Normal hepatopetal portal venous blood flow is present at 17 cm/sec.BILIARY TRACT: Normal common duct caliber at the hilum, measuring 2 mm. Normally distended gallbladder without wall thickening, pericholecystic fluid, focal tenderness or gallstones.PANCREAS: The visualized portions of the pancreatic body and head are unremarkable. The common bile duct at the pancreatic head is normal in caliber, measuring 3 mm.SPLEEN: The spleen is mildly enlarged, measuring 12.7 cm in length.RIGHT KIDNEY: The right kidney measures 11 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 11.7 cm in length without hydronephrosis, shadowing calculus or discrete lesion evident. Color Doppler demonstrates hilar blood flow.", "output": "The spleen is top-normal in size which is non-specific. Otherwise, no sonographic evidence of advanced liver disease, as clinically questioned. No focal hepatic lesion."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female presents with right upper quadrant pain. Evaluate for hepatobiliary pathology. LIVER: The liver measures 16.0 cm. There is mild coarse and increased echogenicity of the hepatic parenchyma. No masses, ascites, or intrahepatic biliary dilation. The portal vein is patent.BILIARY TRACT: The gallbladder wall measures 1.0 mm. No stones or sludge is noted. The common bile duct measures 3.4 mm. No pericholecystic fluid.PANCREAS: Obscured by bowel gas.SPLEEN: The spleen measures 9.1 cm. No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.7 cm. The cortex has normal echogenicity. No shadowing calculi or masses noted.LEFT KIDNEY: The left kidney measures 10.6 cm. The cortex has normal echogenicity. No shadowing calculi or masses noted.OTHER: No significant abnormalities noted.", "output": "1. Mildly coarse and increased echogenicity of liver suggestive of fatty infiltration or parenchymal dysfunction. No masses or ductal dilation."}
{"instruction": "Generate impression based on findings.", "input": "80-year-old female with acute renal insufficiency. RIGHT KIDNEY: The right kidney measures 9.7 cm in length. Echotexture likely within normal limits. No hydronephrosis or shadowing calculus. There may be a small, less than 1 cm exophytic region, possibly a cyst arising from the mid upper pole.LEFT KIDNEY: Left kidney measures 10 cm in length. No hydronephrosis, shadowing calculus or mass.URINARY BLADDER: No significant abnormalities noted.OTHER: Liver is echogenic which is nonspecific. Patient did not have evidence for hepatic steatosis on CT of 8/15/2015", "output": "No hydronephrosis.Echogenic liver."}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are mammogram 7/29/2016 and ultrasound 7/29/2016 performed at St. Elizabeth Medical Center. For comparison, mammogram 7/7/2015 and prior, ultrasound 7/25/2015 and prior are available. MAMMOGRAM 7/29/16:The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. There is a oval, circumscribed benign morphology mass at the 6:00 position within the right breast, not significantly changed from prior. Given its central location, this lesion could correspond to palpable lesion felt by patient.ULTRASOUND 7/29/16:A heterogeneous, largely hypoechoic lesion has slightly increased in comparison to prior examination the 12:00 position about 3 cm from the nipple now measuring 11 x 6 x 9 mm, previously 5 x 3 mm. Given its central location, this lesion could correspond to the mammographic abnormality which could correspond to the palpable abnormality.", "output": "No mammographic evidence of malignancy. Benign-appearing mass visualized at 6:00 position by mammography. At 12:00, 3 cm from the nipple is a benign morphology heterogenous, hypoechoic lesion that has slightly increased when compared to prior examination. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram with ultrasound is recommended in 6 months. BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "67 year old female who was recalled from screening mammogram for cluster of incompletely characterized calcifications in the right superior breast. Mammogram: An ML view and two spot magnification 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. 8 mm cluster of calcifications with associated density in the right breast 11 to 12:00 position needs further evaluation with ultrasound. Pleomorphic calcifications noted on spot magnification views.Ultrasound: Targeted right upper-outer quadrant ultrasound was performed. No definite target identified by ultrasound. Normal glandular tissue noted.", "output": "8 mm cluster of pleomorphic calcifications with associated density without a sonographic correlate in the right breast needs further evaluation with stereotactic core biopsy.Findings and recommendations discussed with the patient in detail.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "16-year-old female patient with palpable mobile soft mass in the 11 o'clock position of the right breast, likely fibroadenoma. A targeted right ultrasound was performed in the area of the palpable abnormality in the right upper outer breast. There is a circumscribed oval hypoechoic lesion with posterior enhancement in the 10 o'clock position 3 cm from the nipple that measures 7 x 4 x 8 mm.", "output": "Palpable abnormality in the right breast correlates with an circumscribed oval lesion in the 10 o'clock position that most likely represents a benign fibroadenoma. Recommend surgical consultation.BIRADS: 2 - Benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "History of multiple myeloma, patient complains of swelling and tightness in the right lateral neck Normal fashion upon complaints noted. No evidence of lobulated fluid collection or abnormal lymph nodes or suspicious mass identified.", "output": "No abnormality corresponding to patient's complain of swelling and tightness in the right lateral neck."}
{"instruction": "Generate impression based on findings.", "input": "Male, 62 years old. S/p cystectomy w/ indiana pouch diversion. Evaluate for obstructive nephropathy. RIGHT KIDNEY: The right kidney measures 11.2 cm in length, with increased cortical echogenicity. Minimal prominence of the collecting system. No focal lesions.LEFT KIDNEY: The left kidney measures 11.9 cm in length, with increased cortical echogenicity. Minimal prominence of the collecting system. No focal lesions.OTHER: The urinary bladder is surgically absent. A right hepatic lobe simple cyst measuring 2.0 x 1.7 x 2.6 cm is noted.", "output": "1.Increased renal cortical echogenicity suggests medical renal disease.2.Minimal prominence of the collecting systems bilaterally."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old man with diverting ileostomy. History of ascites. Evaluate for ascites. Moderate ascites in all 4 quadrants. Small amount of sludge in the gallbladder noted incidentally.", "output": "Moderate ascites."}
{"instruction": "Generate impression based on findings.", "input": "Right testicular pain RIGHT TESTIS: 4.2 x 1.9 x 3.2 cm. No intratesticular mass.LEFT TESTIS: 4 x 2 x 3 cm. No intratesticular massRIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: No significant abnormalities noted.OTHER: No significant abnormalities noted.DOPPLER: Doppler interrogation of the testicular parenchyma within normal limits.", "output": "Negative scrotal ultrasound."}
{"instruction": "Generate impression based on findings.", "input": "1 year follow-up study, assess nodule, rule out worrisome characteristics, history of Graves' disease, also had a small thyroid nodule outside ultrasound RIGHT LOBE MEASUREMENTS: 4 x 1.3 x 1.8 cm, normal echotexture and sizeLEFT LOBE MEASUREMENTS: 4 x 1.1 x 1.5 cm, normal echotexture and sizeISTHMUS MEASUREMENTS: 3 mmRIGHT LOBE: Midportion of the right lobe there is a hypoechoic nodule with multiple hyperechoic specks without ringdown artifact that can definitely confirmed that this is a correlate lesion. Increased vascularity is noted of this lesion and few calcifications are noted along the periphery of this nodule.LEFT LOBE: No significant abnormality noted.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Normal morphology level 2 left neck lymph node is identified that measures 0.8 x 0.3 x 1.7 cm.OTHER: No significant abnormality noted.", "output": "Right lobe hypoechoic nodule with hyperechoic specks without definite ringdown artifact and few peripheral calcifications and increased vascularity needs comparison with prior ultrasound to confirm size and characteristics, which if new from prior exam needs further evaluation with ultrasound-guided FNA"}
{"instruction": "Generate impression based on findings.", "input": "29-year-old male patient with incidental finding on ultrasound from outside hospital ER after car accident. Evaluate hepatobiliary tree. LIVER: The liver measures 16.5 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, but no gallbladder wall thickening or pericholecystic fluid. No intra- or extrahepatic biliary ductal dilatation is identified. 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 12.2 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 12.9 cm in length. No evidence of hydronephrosis.The spleen measures 11.9 cm in length.", "output": "1. No focal hepatic lesion identified.2. Cholelithiasis without sonographic evidence of acute cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Female 35 years old Reason: ABD ultrasound History: pain left abdominal LIVER: Normal background echogenicity of the liver. The liver measures 15.9 cm. There is no focal hepatic mass. Main portal vein is patent with normal directional flow in the velocity of 16.2 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Gallbladder is normal in appearance. No gallstones. Gallbladder wall is normal measuring 1 mm.PANCREAS: The visualized portions of the pancreas are normal.SPLEEN: Spleen is normal in appearance measuring 8.2 centimeters.KIDNEYS: Normal cortical echogenicity bilaterally. No hydronephrosis or shadowing stone. Right kidney measures 10.6 cm. Left kidney measures 10.0 cm. OTHER: No significant abnormalities noted.", "output": "No specific findings to account for the patient's symptoms. Unremarkable appearance of the visualized abdominal organs. "}
{"instruction": "Generate impression based on findings.", "input": "7-week-old male patient with history of prematurity and abdominal mass seen on prior TTE. KIDNEYS  Cortical Echogenicity: Normal   Medullary Echogenicity: Normal   Pelvicaliceal System -- SFU Grade*  Right: 0 Left: 1  Length*** Right: 4.5 cm Left: 4.9 cm   Mean for age: 5.3 cm  Range for age: 4.0 - 6.6 cmADDITIONAL OBSERVATIONS: None. Specifically, no mass lesion seen in either kidney.", "output": "Grade 1 hydronephrosis on the left and resolution of grade 1 hydronephrosis on the right.*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.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 female with history of right breast DCIS status post lumpectomy in 2007 followed by radiation therapy and tamoxifen, status post right breast stereotactic biopsy with benign results on 11/5/14 for a bilateral diagnostic mammogram and right breast ultrasound which demonstrated a likely benign lesion. Patient presents for follow-up of the right breast lesion. A targeted right breast ultrasound was performed for the patient\u2019s area of concern. Again identified is a mixed echogenicity area with hyperechoic components at 1:00 o'clock position which measures 1.0 x 0.8 cm, previously measuring 3.2 x 1.8 x 1.8 cm; this lesion is compatible with a resolving hematoma. There is an echogenic area within this lesion which corresponds to the marking clip.", "output": "1.Right breast resolving hematoma.2.No sonographic evidence for malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old female with history of bilateral benign biopsies in 2000 and 2014. No current breast complaints Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography.Linear scar markers overlie both breasts. There are multiple bilateral asymmetries with scattered areas of calcification in the left upper central breast posteriorly. Given the extremely dense breast tissue, screening bilateral whole breast ultrasound both breasts was subsequently performed.Ultrasound of the right breast demonstrated a circumscribed, parallel hypoechoic mass without significant vascularity measuring 1.3 x 0.7 x 1.1 cm at the 12:00 position, 3 cm from the nipple.Ultrasound of the right breast demonstrated a circumscribed, parallel hypoechoic mass without significant vascularity measuring 0.9 x 0.5 x 0.8 cm at the 4:00 position, 3 cm from the nipple.Ultrasound of the left breast demonstrated 2 adjacent circumscribed, parallel hypoechoic masses without significant vascularity measuring 1.0 x 0.7 x 1.1 cm and 0.5 x 0.3 x 0.8 cm at the 10:00 position, 6 cm from the nipple.", "output": "Multiple bilateral circumscribed masses likely represent fibroadenomas. Recommend 6 month follow-up ultrasound to document stability.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months)."}
{"instruction": "Generate impression based on findings.", "input": "Male, 45 years old. High-pressure voiding. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 11.3 cm in length, with marked cortical thinning and increased cortical echogenicity. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.7 cm in length, with marked cortical thinning and increased cortical echogenicity. No shadowing stones or hydronephrosis.OTHER: The bladder is distended, and a bladder diverticulum is noted.", "output": "1.Marked renal cortical thinning and increased cortical echogenicity, compatible with medical renal disease. No hydronephrosis.2.Bladder diverticulum noted."}
{"instruction": "Generate impression based on findings.", "input": "Neck pain and snapping when turning head. The parotid and submandibular glands are clear. Patient is edentulous. Dystrophic calcifications are identified in the tonsils. The carotid arteries are tortuous but there is no focal stenotic lesion identified. Small shotty lymph nodes are present, none are enlarged by size criterion. Small lucencies are present in the thyroid gland, this may be further evaluated with ultrasound if warranted clinically.There are mild degenerative findings present in the cervical spine with decreased disk height and spurs, this is most marked at C6-7 and this results in mild central and foraminal stenosis. Note is also made of a small sclerotic focus in the T2 or vertebral body on the left side. This has a benign appearance suspicious for a bone island, if there is history of neoplasm follow up bone scan is suggested. There are nonspecific patchy opacities probably scarring at the lung apices.", "output": "Unremarkable CT study of the soft tissues of the neck. There are mild degenerative findings present in the cervical spine which could be better described as a dedicated study. There is sclerotic focus in the T4 vertebral body on the left side and although the appearance is benign a follow up bone scan may be helpful if warranted clinically."}
{"instruction": "Generate impression based on findings.", "input": "Male 56 years old Reason: baseline exam for transplant LIVER:Mildly coarse liver, which is nonspecific but can be seen in the setting of fatty infiltration. No specific sonographic evidence of cirrhosis. No focal hepatic mass. Main portal vein is patent with normal directional flow and a peak velocity of 17 cm/s.GALLBLADDER, BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Common bile duct measures 3 mm. Patient is status post cholecystectomy.PANCREAS: Pancreas is obscured by overlying bowel gas.SPLEEN: Spleen is within normal limits measuring 13.2 cm.KIDNEYS: Right kidney measures 10.7 cm. Left kidney measures 12.6 cm. Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. ABDOMINAL AORTA: Abdominal aorta is not well visualized secondary to overlying bowel gas.INFERIOR VENA CAVA: Not well-visualized secondary to overlying bowel gas.OTHER: Bladder is mildly distended without significant abnormality.", "output": "Mildly coarse liver which is nonspecific but can be seen in the setting of fatty infiltration. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female with thyroid nodules for follow-up. RIGHT LOBE MEASUREMENTS: 2.8 x 1.8 x 1.1 cmLEFT LOBE MEASUREMENTS: 4.1 x 1.6 x 0.9 cmISTHMUS MEASUREMENTS: Not visualizedRIGHT LOBE: Predominantly solid nodule with cystic component in the right lobe measures 1.1 x 1.8 x 2.8 cm without change when compared to prior exam.LEFT LOBE: Spongiform-appearing nodule in the inferior left lobe measures 0.9 x 1 x 1.1 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, bilateral thyroid nodules."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Williams syndrome, possible bladder polyps History: none RIGHT KIDNEY: The right kidney measures 10.9 cm in length. Unremarkable renal parenchyma. No shadowing renal calculi or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.5 cm in length. Unremarkable renal parenchyma. No shadowing renal calculi or hydronephrosis.OTHER: The urinary bladder is poorly distended, severely limiting its evaluation, however no bladder polyps are visualized.", "output": "Poorly distended urinary bladder, severely limiting evaluation of the mucosa, however no bladder polyps are visualized."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female with malabsorption. Hyperbilirubinemia. LIVER: Liver is mildly and coarsely echogenic without change but normal in size. There is no focal hepatic abnormality.BILIARY TRACT: Multiple dependent gallstones and likely sludge within the gallbladder without wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: The head and body are normal. The tail was not well seen.SPLEEN: Upper normal in size.RIGHT KIDNEY: Nephrostomy tube noted. No hydronephrosis.OTHER: Left nephrostomy tube noted. No hydronephrosis.", "output": "Multiple gallstones without complication."}
{"instruction": "Generate impression based on findings.", "input": "Female; 27 years old. Reason: 27 yo F 25 wk pregnant with h/o Crohn's disease s/p total proctocolectomy with h/o portal vein thrombosis. Evaluate portal vein residual thrombosis History: none LIVER: The liver measures 17 cm in length. Renal parenchyma is normal in echogenicity. There is no focal hepatic lesion is identified. There is no ascites.The main portal vein is patent with hepatopetal flow and a peak velocity of 0.4 m/sec.BILIARY TRACT: Gravel-like shadowing stones and sludge are seen layering in the dependent portions of the gallbladder. 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 pancreatic head and body are unremarkable. The tail is obscured by overlying bowel gas.SPLEEN: The spleen measures 11 cm in length. No focal splenic lesion is identified.KIDNEYS: The right kidney measures 10.0 cm in length, the left measures 9.6 cm in length. The renal parenchyma is normal in echogenicity bilaterally. There is mild bilateral hydronephrosis. No shadowing renal stone is identified. OTHER: No significant abnormalities noted.", "output": "1.Patent portal vein with normal directional flow.2.Gallbladder gravel and sludge without evidence of acute cholecystitis.3.Mild hydronephrosis bilaterally, unchanged and likely physiologic given pregnancy."}
{"instruction": "Generate impression based on findings.", "input": "UTI in transplant patient Right iliac fossa renal transplant demonstrates no significant perinephric collection. Expected minimal prominence of collecting system. No worrisome mass or stone. Renal transplant 9.7 cm in length.OTHER: No significant abnormalities noted.", "output": "Unremarkable right iliac fossa renal transplant without evidence for significant perinephric collection, stone, or significant hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "34-year-old male patient with left flank pain. History of left renal cyst. RIGHT KIDNEY: The right kidney measures 11.5 cm in length. No evidence of hydronephrosis. There is a 1.6 x 1.1 cm right lower pole simple renal cyst.LEFT KIDNEY: The left kidney measures 12.7 cm in length. There is no evidence of hydronephrosis. There is a 5.1 x 3.1 cm complex left lower pole renal cyst.URINARY BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Complex left lower pole renal cyst which may represent multiple cysts or a single cyst with multiple septations; further evaluation with MRI is suggested."}
{"instruction": "Generate impression based on findings.", "input": "21 year-old male with epigastric pain, elevated lipase LIVER: Measures 19.2 cm in length. No focal hepatic lesions. Main portal vein is patent with appropriate directional flow; peak velocity measures 0.4 m/sec.BILIARY TRACT: Normal echogenicity of the gallbladder. No gallbladder wall thickening. No pericholecystic fluid. Common duct measures 4 mm in caliber. No intra-or extrahepatic biliary ductal dilatation.PANCREAS: The visualized pancreas is unremarkable.SPLEEN: Normal echogenicity of the spleen measuring 11.4 cm in lengthRIGHT KIDNEY: Atrophic with increased echogenicity measuring 8.0 cm in length. OTHER: Left kidney is atrophic with increased echogenicity measuring 6.3 cm in length.", "output": "1. The visualized pancreas is unremarkable. If there is clinical concern for pancreatitis, this can be better evaluated with a contrast enhanced CT study. 2. Hepatomegaly with no focal hepatic lesions.3. Atrophic and echogenic kidneys suggestive of parenchymal dysfunction. "}
{"instruction": "Generate impression based on findings.", "input": "A patient submitted outside study for review. Submitted for review are ultrasound images both breasts (1/7/15), images from ultrasound guided biopsy of right breast with post-procedural right mammographic images (1/14/15) performed at SMMHC OPC. ULTRASOUND IMAGES BOTH BREASTS (1/7/15):A lobulated hypoechoic mass, measuring 8 x 4 mm, is visualized at 10:00 position, in the right breast, 3 cm from the nipple. No solid or cystic mass is seen in the left breast.IMAGES FROM ULTRASOUND GUIDED BIOPSY OF RIGHT BREAST WITH POST-PROCEDURAL RIGHT MAMMOGRAPHIC IMAGES (1/14/15):Ultrasound guided needle biopsy is performed for the right breast mass at 10:00 position, with an appropriate needle placement. Postprocedural right mammographic images show a marker clip placed within the mass at anterior upper outer quadrant.Per outside radiology report, the pathology result was fibroadenoma, which is concordant.", "output": "Biopsy proven fibroadenoma in the right breast.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "31-year-old male presents for pre heart transplant evaluation. Of note, the study is limited by inability to optimally position the patient and by bowel gas.LIVER:Measures 18.3 cm. Increased echogenicity. No ascites, focal mass, or intrahepatic biliary dilation. The portal vein is patent with normal hepatopedal flow.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended. Normal anechoic lumen. There is an approximately 0.6 x 0.7 x 0.8 cm nondependent hyperechoic focus within the lumen, consistent with gallbladder polyp. No stones or sludge. No pericholecystic fluid. The gallbladder wall measures 4.6 mm. The common bile duct measures 4.7 mm.PANCREAS: Evaluation the pancreas limited due to overlying bowel gas.SPLEEN: Measures 14.3 cm without sonographic abnormalities.KIDNEYS: The right kidney measures 10.8 cm. Left kidney measures 11.3 cm. The cortices have normal echogenicity. No hydronephrosis, stones, or focal masses. ABDOMINAL AORTA: The parameters of the aorta are within normal limits without evidence of aneurysm.INFERIOR VENA CAVA: Patent.OTHER: No significant abnormality noted.", "output": "1. Increased echogenicity of liver consistent with chronic liver disease/parenchymal dysfunction. No mass or ascites.2. Gallbladder polyp measuring approximately 0.6 x 0.7 x 0.8 cm. Recommend follow-up ultrasound to assess gallbladder polyp in 6 months."}
{"instruction": "Generate impression based on findings.", "input": "Female 31 years old; Reason: History of enlarging mass on neck, history of nodule/1.3 cm on L now with enlarging thyroid b/l, assess for thyroiditis vs mass vs other RIGHT LOBE MEASUREMENTS: 4.2 x 2.9 x 7.8 cm (previously 3.9 x 2.5 x 9.0 cm)LEFT LOBE MEASUREMENTS: 3.5 x 2.6 x 6.6 cm (previously 3.4 x 2.7 x 8.3 cm)ISTHMUS MEASUREMENT: 0.37 cm (previously 0.47 cm)RIGHT LOBE: The thyroid is enlarged and heterogeneous. A nodule in the posterior aspect of the gland measures 1.0 x 0.8 x 1.1 cm, is mixed solid/cystic with no significant vascular flow and may have been present on the previous ultrasound although difficult to measure.LEFT LOBE: The thyroid is large and heterogeneous. In the left lower pole a mixed solid/cystic nodule is again seen which measures 1.2 x 0.7 x 1.0 cm (previously 1.3 x 1.0 x 1.3 cm). A second nodule more superiorly in the midpole is mixed solid/cystic and measures 1.2 x 0.6 x 1.0 cm.ISTHMUS: No significant abnormality noted.LYMPH NODES: A right level 2 lymph node measures 2.4 x 1.1 x 2.5 cm with a fatty hilum and lobular contour.", "output": "1.Diffusely large and heterogeneous thyroid gland compatible with thyroiditis.2.Dominant predominantly solid left lower pole thyroid nodule has decreased in size.3.Two nodules on the right may have been present on the previous study but were not as clearly visualized and may represent colloid nodules.4.Enlarged right level 2 lymph node has a benign appearance and is likely reactive, may be seen in setting of thyroiditis."}
{"instruction": "Generate impression based on findings.", "input": "Lower abdominal pain; heart transplant workup LIVER:Mildly coarse echogenic liver echotexture without mass. Liver length 18.1 cm. Prominent hepatic veins. Limited Doppler interrogation the main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: Cholelithiasis without acute inflammation or ductal dilatation.PANCREAS: No significant abnormality noted.SPLEEN: No significant abnormality noted. 12.3 cm in length.KIDNEYS: No significant abnormality noted. Right kidney 9.8 cm in length. Left kidney 8.9 cm in length.ABDOMINAL AORTA: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted. No ascites", "output": "Mild hepatomegaly associated with coarse liver echotexture suggestive for chronic liver disease. No mass. Cholelithiasis without acute inflammation or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Reason: History of Right Shoulder Restriction, when moving arm backward. Need to rule out rotator cuff tears. History: Muscle Strain The extra-articular portion of the tendon of the long head of the biceps appears intact, without evidence of tenosynovitis. However, at the transition from the bicipital groove to the rotator interval the tendon becomes thickened and heterogeneous suggesting tendinosis; of note, the patient complains of pain when the transducer is applied to this area. The intra-articular portion of the long head of the biceps tendon is poorly evaluated on ultrasound examination. There are hypoechoic foci along the deep fibers the subscapularis tendon suggesting undersurface tears and fraying, but no full-thickness tear is evident. There is thickening and heterogeneous echogenicity of the supraspinatus indicating mild to moderate tendinosis, particularly posteriorly; hypoechogenicity within the deep fibers of the tendon at its insertion suggest undersurface tearing/fraying, but we see no fluid in the subdeltoid bursa or other findings to indicate a full-thickness tear. The infraspinatus tendon is somewhat hypoechoic which may reflect mild tendinosis, but we see no focal tear. The acromioclavicular joint is unremarkable.", "output": "Tendinosis and partial-thickness undersurface rotator cuff fraying/tearing as above. Findings suggestive of tendinosis of the tendon of the long head of the biceps at its transition from the bicipital groove to the rotator interval. This could be further evaluated with MRI, if clinically warranted."}
{"instruction": "Generate impression based on findings.", "input": "40-year-old female presents for evaluation of incidental thyroid nodules found on prior CT. RIGHT LOBE MEASUREMENTS: 6.0 x 2.3 x 2.5 cm.LEFT LOBE MEASUREMENTS: 6.8 x 2.5 x 2.6 cm.ISTHMUS MEASUREMENTS: 0.6 cm.RIGHT LOBE: There are several noncomplex cystic nodules spread throughout the right lobe of similar appearance. The background parenchyma is homogenous.LEFT LOBE: There are several noncomplex cystic nodules throughout the left lobe of similar appearance. The background parenchyma is homogenous.ISTHMUS: There is a large noncomplex cystic nodule measuring approximately 2.1 x 1.0 x 2.3 cm. which is the dominant nodule in the thyroid. The parenchyma is homogenous.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "1. Multinodular thyroid. Findings suggestive of benign cystic colloid nodules."}
{"instruction": "Generate impression based on findings.", "input": "62 y.o. female with AKI. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 10.8 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis noted. No worrisome masses seen. There is a 1.9 x 1.9 x 2.0 cm round well-defined hypoechoic lesion with posterior acoustic shadowing that is consistent with a simple renal cyst and was present on the previous study.LEFT KIDNEY: The left kidney measures 11.2 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis noted. There is a prominent round soft tissue focus in the left mid kidney measuring 3.1 x 2.7 x 2.6 cm. URINARY BLADDER: The bladder is nondistended.OTHER: No significant abnormalities noted.", "output": "1. Echogenic kidneys consistent with chronic medical renal disease/parenchymal dysfunction. No hydronephrosis or stones.2. Indeterminant soft tissue focus as described above may represent a prominent column of Bertin however further characterization with dedicated cross sectional imaging is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Primary hyperparathyroidism. RIGHT LOBE MEASUREMENTS: 4.0 x 1.2 x 1.1 cmLEFT LOBE MEASUREMENTS: 4.0 x 1.0 x 1.2 cmISTHMUS MEASUREMENTS: No significant abnormality noted.RIGHT LOBE: Normal echogenicity without a discrete nodule.LEFT LOBE: Normal echogenicity without a discrete nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Immediately dorsal to the mid/lower portion of the right thyroid lobe is a 1.2 x 0.4 x 0.7 cm hypoechoic nodule.LYMPH NODES: No pathologically enlarged or morphologically suspicious appearing cervical lymph nodes.OTHER: No significant abnormality noted.", "output": "1.2 x 0.4 x 0.7 cm hypoechoic nodule dorsal to the mid/lower portion of the right thyroid lobe may represent a parathyroid adenoma in the appropriate clinical setting. Correlate with same day nuclear medicine study."}
{"instruction": "Generate impression based on findings.", "input": "45-year-old female with prior thyroidectomy for thyroid cancer. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: There is again noted a small hypoechoic region in the right thyroid bed which appears unchanged from the prior study. On today's exam utilizing color Doppler this appears to represent a vessel rather than a nodule.LEFT LOBE: Again noted are 2 hypoechoic foci in the left thyroid bed which appears stable. The anterior, mid nodule measures 0.2 x 0.2 x 0.3 known centimeters and the more posterior, inferior ovoid nodule measures 0.3 x 0.3 x 0.6 cm, likely representing a lymph node.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Stable ultrasound of the neck post thyroidectomy. This was discussed with the patient."}
{"instruction": "Generate impression based on findings.", "input": "19-year-old female with history of right breast palpable lump, with history of bilateral benign morphology masses, one of which revealed fibroadenoma on prior FNA. Patient presenting for follow-up evaluation of both breast masses to ensure stability. A new area of palpable concern indicated by patient's physician is located in the lower inner right breast. On physical examination, a mobile smooth surfaced palpable lump is identified in the right upper outer breast, and left upper breast, in patient's palpable area of concern.Targeted ultrasound of the right breast, 10:00 position 5 cm from the nipple, reveals a 1.4 x 0.8 x 1.4 cm oval parallel hypoechoic mass with posterior acoustic enhancement and mild internal vascularity. Findings are stable in size and appearance and compatible with fibroadenoma.Targeted ultrasound of the right breast, 8:00 position 3 cm from the nipple, patient's physician area of concern. There is no underlying cystic or solid mass.Targeted ultrasound of the left breast at the 12:00 position 5 cm from the nipple, redemonstrates a 2.0 x 1.4 x 1.4 cm gently lobulated circumscribed hypoechoic avascular mass, FNA proven fibroadenoma. This mass also appears stable in size.", "output": "Stable bilateral benign morphology masses bilaterally, the left mass corresponding to FNA proven fibroadenoma. No sonographic correlate at new area of concern indicated by patient's physician in the right breast. 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": "Female; 66 years old. Reason: rule out gallstones, cholelithiasis History: RUQ pain, post-prandial - history of well controlled Crohn's disease LIVER: The liver measures 13.7 cm in length. The liver contour is smooth, the parenchyma is diffusely increased in echogenicity with a coarsened echotexture.The main portal vein is patent with hepatopetal flow and a peak velocity of 0.2 m/sec.BILIARY TRACT: The gallbladder is normal-appearing without cholelithiasis or gall bladder wall thickening. The common duct measures 4 mm in diameter. There is no intrahepatic biliary ductal dilatation.PANCREAS: The head and body of the pancreas are unremarkable. The tail of pancreas is obscured by overlying bowel gas.SPLEEN: The spleen measures 8.2 cm in length.KIDNEYS: The right kidney measures 11.8 cm in length. The left kidney measures 10.6 cm in length. The renal cortex is normal in echogenicity bilaterally. There is no hydronephrosis, shadowing renal stone, or worrisome renal mass identified. OTHER: No significant abnormalities noted.", "output": "1.Normal appearing gallbladder, no cholelithiasis.2.Hepatic steatosis."}
{"instruction": "Generate impression based on findings.", "input": "Elevated liver function tests. LIVER: Non-cirrhotic liver morphology. Coarsened liver echogenicity, compatible with parenchymal dysfunction. No focal hepatic lesions. Normal portal venous blood flow and direction.GALLBLADDER, BILIARY TRACT: Minimal biliary ductal dilation, likely reflecting prior 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 13.1 cm in length, with minimal hydronephrosis. The left kidney is 11.2 cm in length, without hydronephrosis. The renal parenchymal echogenicity is increased bilaterally, markedly so on the left. No suspicious renal lesions are evident. SPLEEN: Not visualized.OTHER: No significant abnormalities noted. No significant ascites is identified.", "output": "1. Coarsened liver echogenicity, compatible with parenchymal dysfunction. 2. Increased renal parenchymal echogenicity, markedly on the left, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old female with AKI. Evaluate for obstruction. RIGHT KIDNEY: The right kidney measures 10.8 cm in length and shows increased echotexture. No obstructing stone or hydronephrosis. A slightly hyperechoic focus within the lower pole of the right kidney measures 0.9 x 0.7 x 0.8 cm. A few subcentimeter simple cysts are seen within the right kidney.LEFT KIDNEY: The left kidney measures 11.1 cm in length and shows increased echotexture. A subcentimeter simple cyst is noted. No mass, stone or hydronephrosis.URINARY BLADDER: The urinary bladder is not distended. Foley catheter balloon is seen.OTHER: Trace ascites.", "output": "No obstructing stone or hydronephrosis. Both kidneys show increased echogenicity. Right lower pole small hyperechoic focus most likely represents a benign etiology, such as an AML. "}
{"instruction": "Generate impression based on findings.", "input": "53-year-old male with history of flank pain, ureteral reimplantation. RIGHT KIDNEY: Measures 10.6 cm in length. No hydronephrosis. Increased renal echogenicity.LEFT KIDNEY: Measures 12.2 cm in length. Minimal left hydronephrosis unchanged since the prior study. Increased renal echogenicity.BLADDER: Partially collapsed, otherwise unremarkable.OTHER: No significant abnormalities noted.", "output": "1.Minimal left hydronephrosis without significant interval change.2.Resolution of right hydronephrosis since the prior study.3.Increased renal echogenicity consistent 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. 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.Images reviewed by Dr. Kirti Kulkarni and Dr. Deepa Sheth", "output": "No sonographic evidence for malignancy.BIRADS: 1 - Negative.RECOMMENDATION: NS - Routine Screening Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male with renal failure. Evaluate for hydronephrosis. RIGHT KIDNEY: The right kidney measures 11.5 cm in length. No hydronephrosis. Increased echogenicity of the renal parenchyma.LEFT KIDNEY: The left kidney measures 13.1 cm in length. No hydronephrosis. Increased echogenicity of the renal parenchyma.URINARY BLADDER: The urinary bladder is distended and shows no acute abnormality. Bilateral ureteral jets are not clearly visualized.OTHER: Hepatic parenchyma is echogenic.", "output": "1. No hydronephrosis.2. Increased echogenicity of the renal parenchyma is nonspecific and could represent chronic medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Persistent gross hematuria RIGHT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. 8.7 cm in lengthLEFT KIDNEY: Normal echogenicity without mass on the stone, or hydronephrosis. 11.3 cm in length.OTHER: Bladder nondistended", "output": "Negative renal ultrasound without evidence for mass, stone, or hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "72 year old female with epigastric pain LIVER: Liver is relatively small and prepped and minimally coarsely echogenic. No focal hepatic abnormality identified.GALLBLADDER, BILIARY TRACT: The gallbladder contains shadowing dependent and nondependent calculus as well as sludge. There is no associated wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: Not adequately visualized due to bowel gas.RIGHT KIDNEY: Large, exophytic renal cyst.OTHER: Limited views of the spleen and left kidney are unremarkable.", "output": "Gallstones and sludge without complication.Large right renal cyst."}
{"instruction": "Generate impression based on findings.", "input": "36-year-old female with acute kidney injury, evaluate for hydronephrosis. RIGHT KIDNEY: Measures 13.3 cm in length. There is marked multifocal dilation of the renal calyces and infundibula, without dilation of the renal pelvis or ureter, progressively increased compared with prior studies. The cortex is markedly thinned with increased echogenicity. Additionally, there is now debris within these dilated calyces which has not been seen previously.LEFT KIDNEY: Measures 9.4 cm in length. Increased echogenicity without hydronephrosis. Left inferior pole 1.4 cm cyst without septation or solid component. URINARY BLADDER: Ileal conduit incompletely distended. OTHER: No significant abnormalities noted.", "output": "1. Marked right multifocal calyceal and infundibular dilation as described above. Dating back to 2005, this has been a progressive process and is an unusual and atypical presentation for hydronephrosis. This appearance suggests multifocal infundibular stenosis, and could represent infundibular pelvic dysgenesis (part of the spectrum of multicystic dysplastic kidney). 2. The presence of debris within these dilated calices raises suspicion of infection. 3. Increased left renal echogenicity consistent with medical renal disease, without hydronephrosis. "}
{"instruction": "Generate impression based on findings.", "input": "HCV cirrhosis LIVER: Mildly coarse echogenic liver echotexture again noted without mass. Liver length 14.6 cm.GALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatationPANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 8.6 cm in lengthOTHER: Left kidney 9.7 cm in length. Stable left renal cyst. Spleen 9.8 cm in length. No ascites", "output": "No change in mildly coarse echogenic liver echotexture consistent with chronic liver disease without mass or ductal dilatation. Gallbladder sludge without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "Female 69 years old Reason: HCC surveillance History: HCV cirrhosis LIVER: The liver is coarse and nodular consistent with history of cirrhosis. No new suspicious focal hepatic mass is identified. Main portal vein is patent with normal directional flow and a peak velocity of 13.7 cm/s. Unchanged septated cyst right hepatic lobe measuring 0.8 x 0.7 x 0.7 cm.BILIARY TRACT: No intra or extra hepatic biliary ductal dilatation. Gallbladder is normal in appearance without gallstones. Common bile duct measures 3 mm.PANCREAS: The visualized portions of the pancreas are unremarkable.SPLEEN: Spleen is enlarged measuring 15.5 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 10.0 cm. Left kidney measures 10.0 cm. OTHER: No significant abnormalities noted.", "output": "Cirrhotic morphology of the liver without suspicious focal hepatic mass. Sequela of portal hypertension including splenomegaly."}
{"instruction": "Generate impression based on findings.", "input": "Tenderness at the umbilical hernia site. There is subcutaneous edema surrounding the umbilical hernia. A 18 x 11 x 10 mm fluid collection is noted in the subcutaneous fat superior to the umbilical hernia.", "output": "Non-specific 18 mm fluid collection in the subcutaneous fat superior to the umbilical hernia."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with hepatitis B carrier status. Evaluate for mass. LIVER: Liver is moderately echogenic as previously noted which is nonspecific. There is no focal hepatic abnormality and hepatic size is within normal limits. No gross evidence for ascites.BILIARY TRACT: Gallbladder appears unremarkable without cholelithiasis, 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: Single periportal lymph node which is unchanged from prior studies.", "output": "Stable examination. Echogenic liver without mass or gross evidence for cirrhosis."}
{"instruction": "Generate impression based on findings.", "input": "Elevated creatinine RIGHT KIDNEY: Echogenic renal parenchyma without mass, stone, or significant hydronephrosis. 11.3 cm in length.LEFT KIDNEY: Echogenic renal parenchyma without mass, stone, or hydronephrosis. 12.4 cm in length.OTHER: Bladder nondistended. Moderate ascites again noted.", "output": "Echogenic renal parenchyma consistent with medical renal disease/parenchymal dysfunction without mass, stone, or significant hydronephrosis. Moderate ascites again noted."}
{"instruction": "Generate impression based on findings.", "input": "Hyperbilirubinemia LIVER: Mildly coarse liver echotexture without mass. Liver length 19.2 cm.GALLBLADDER, BILIARY TRACT: Gallbladder sludge without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.2 cm in length OTHER: Left renal cyst. Left kidney 9.6 cm in length. No ascites. Abnormally enlarged spleen measuring 19.2 cm in length. 4.2 x 4 x 4.3 cm mixed echogenicity mass within the inferior spleen.", "output": "Mild hepatomegaly associated with mildly coarse liver echotexture suggestive for parenchymal dysfunction without mass or ductal dilatation. Gallbladder sludge without acute inflammation. No ascites.Moderately severe splenomegaly with discrete mass; a neoplastic etiology cannot be excluded. Further characterization with contrast cross sectional imaging suggested"}
{"instruction": "Generate impression based on findings.", "input": "34-year-old male with prior thyroidectomy for thyroid cancer and subsequent surgical removal of metastatic nodal disease with nonsuppressed thyroglobulin level. RIGHT LOBE MEASUREMENTS: Post thyroidectomyLEFT LOBE MEASUREMENTS: Post thyroidectomyISTHMUS MEASUREMENTS: Post thyroidectomyRIGHT LOBE: No massLEFT LOBE: No massISTHMUS: No massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level 2 small but somewhat rounded lymph node measuring 0.2 x 0.4 x 0.4 cm may have a fatty hilum. No recurrent adenopathy in the left.OTHER: No significant abnormality noted.", "output": "Small, rounded right level 2 lymph node without gross abnormal morphology."}
{"instruction": "Generate impression based on findings.", "input": "15-year-old presents for further evaluation of palpable lumps in both breasts. On physical exam, there is no palpable abnormality in either breast.A targeted Gray scale and color Doppler right breast ultrasound was performed for the patient\u2019s areas of pain and concern. In the moderate breast 11:00 position 6 cm from the nipple at the site of palpable concern, dense fibroglandular tissue seen. In the right breast 6:00 position 4 cm from nipple at the area of pain in subareolar glandular tissue is seen. No suspicious solid or cystic masses are identified in either area.A targeted grayscale, Doppler left breast ultrasound was performed for the patient's areas of pain and concern. In the left breast 11:00 position 4 cm from the nipple, 1:00 position 4 cm from nipple and 6:00 position 4 cm from nipple, at the sites of pain and palpable concern, of unremarkable density of under tissue is seen. No suspicious solid or cystic masses are identified in these areas.", "output": "No sonographic evidence for malignancy. As long as the patient's physical exam is unchanged, the patient should follow up with her primary care physician. The results and recommendations were discussed with the patient and her mother at the time of exam.BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Follow-up."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old female with thyroid nodules for follow-up. RIGHT LOBE MEASUREMENTS: 2.6 x 1.9 x 6.2 cmLEFT LOBE MEASUREMENTS: 1.1 x 1 x 3.7 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Heterogeneous with large nodules. Predominantly solid upper pole nodule with cystic foci and small echogenic reflectors measures 1.6 x 1.8 x 2.4 cm, slightly increased in size in the interim. This does have evidence for comet tail artifact which is associated with colloid but is somewhat less spongiform than on the prior exam. Second lower pole spongiform nodule with cystic components and comet tail artifact measures 1.4 x 2.7 x 2.8 cm without significant change.LEFT LOBE: Solid nodule with cystic component in the midportion of the left lobe measures 0.6 x 0.7 x 1.4 cm without interval change. This also contains comet tail artifact.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Slight increase in complex right thyroid nodule. Other nodules are stable."}
{"instruction": "Generate impression based on findings.", "input": "52-year-old female patient with soreness the right neck. Right thyroid nodule palpated on exam. RIGHT LOBE MEASUREMENTS: 6.7 x 2.6 x 2.0 cm.LEFT LOBE MEASUREMENTS: 6.6 x 2.3 x 1.7 cm.ISTHMUS MEASUREMENTS: 4 mm in thickness.RIGHT LOBE: There is a 2.3 x 1.7 x 1.5 cm complex, mostly solid nodule within the right lower pole.LEFT LOBE: There is a 1.1 x 1.4 x 1.8 cm heterogeneous, solid nodule within the left lower pole.ISTHMUS: There is a 0.4 x 0.5 x 0.7 cm mostly solid nodule within the inferior right isthmus. An additional subcentimeter mostly cystic nodule is noted within the inferior left isthmus.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Bilateral dominant thyroid nodules, which are amenable to biopsy if clinically indicated. "}
{"instruction": "Generate impression based on findings.", "input": "Female 47 years old Reason: eval pyelo History: AKI, shock Limited by body habitus.RIGHT KIDNEY: Echogenic consistent with medical renal disease. 12.1 cm in length. Right lower pole small simple cyst. No hydronephrosis or hydroureter.LEFT KIDNEY: 9.8 cm in length. Echogenic consistent with medical renal disease. No hydronephrosis or hydroureter.OTHER: Fluid collection right lower quadrant with some layering debris consistent with a large cystic structure. Correlate with gynecologic ultrasound for ovarian cyst or hydrosalpinx.Urinary bladder: Normal.", "output": "Echogenic kidneys consistent with medical renal disease. Small right renal cyst.Large cystic structure in the pelvis correlate with gynecologic exam and ultrasound.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report."}
{"instruction": "Generate impression based on findings.", "input": "Cirrhosis with elevated CEA LIVER: Cirrhotic morphology without worrisome mass. Stable complex hepatic cyst right lobe. Liver length 15.5 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 10.9 cm in lengthOTHER: Left kidney 10.4 cm in length. Spleen 14.2 cm in length. No ascites.", "output": "Stable cirrhotic morphology without worrisome mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "49-year-old female with history of left breast cyst aspiration x 4. Patient has a new palpable left breast mass for 2 weeks. Denies associated pain. DIAGNOSTIC MAMMOGRAM: Three standard views of both breasts 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, unchanged in pattern and distribution. A triangular marker was placed over the patient's palpable site in the left breast located slightly superior and lateral to the nipple. This corresponded to a central, mid-depth 3 cm circumscribed round mass for which ultrasound will be done for further evaluation. Additional asymmetries are present in both breasts that appear stable compared to prior studies, which may represent underlying cysts. Bilateral benign calcifications are present, unchanged.LEFT BREAST ULTRASOUND: Targeted ultrasound of the patient's palpable site in the left breast demonstrated a 3 x 2.5 cm cyst. No suspicious mass is identified.", "output": "Patient's palpable site in the left breast corresponds to a 3 x 2.5 cm cyst. As no pain is associated with this cyst, aspiration is not indicated at this time. No mammographic or sonographic evidence of malignancy. As long as the patient's physical examination remains stable, 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": "75-year-old female with postprandial discomfort. LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: Cholelithiasis and mild gallbladder wall thickening. Trace pericholecystic fluid. No sonographic Murphy's sign was elicited during the examination. There is no biliary ductal dilation.PANCREAS: No significant abnormalities noted.KIDNEY: 0.8 cm hypoechoic structure in the left kidney favored to represent a benign cyst however is incompletely visualized on this examination.OTHER: No significant abnormalities noted.", "output": "1. Cholelithiasis with associated findings described above are not specific for acute cholecystitis, however a chronic component of inflammation could account for this appearance. 2. 0.8 cm hypoechoic structure in the left kidney is favored to represent a benign cyst however is incompletely visualized on this examination. Continued attention to this region on subsequent studies is recommended. "}
{"instruction": "Generate impression based on findings.", "input": "Elevated lipase. Pancreatic cyst. Please note that this examination is limited by poor acoustic penetration.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. Cholelithiasis. No gallbladder wall thickening or sonographic Murphy sign.PANCREAS: No sonographic abnormality evident in the visualized pancreatic head and neck. No cystic lesion is evident in this region. The body and tail are obscured by bowel gas. KIDNEYS: The right kidney is 9.3 cm in length. The renal parenchyma is echogenic. No suspicious renal lesions are evident. No hydronephrosis is present. The left kidney is not well visualized due to increased echogenicity and poor acoustic penetration.SPLEEN: Not well visualized.OTHER: No significant abnormalities noted. No ascites.", "output": "1. Limited visualization of the pancreatic head and neck, without cystic lesion evident.2. Cholelithiasis without evidence of cholecystitis.3. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "34 year old female with history of hepatitis B. Evaluate for HCC. LIVER: The liver parenchyma is coarse, similar to prior. The liver is 14.3 cm in length. Punctate, 3-mm hyperechoic focus which is likely a benign granuloma, however this area may be given special attention on subsequent screening utrasound as occasional HCC may contain large amounts of fat and be similarly hyperechoic.BILIARY TRACT: The gallbladder appears normal, and there is no gallbladder wall thickening, pericholecystic fluid, or cholelithiasis. No intrahepatic or extrahepatic biliary duct dilation. The common bile duct measures 0.2 cm.PANCREAS: Pancreas is partially visualized, and is normal in appearance.KIDNEYS: The right kidney measures 10.5 cm in length, and has normal parenchymal echogenicity. No shadowing calculi are present.The left kidney measures 10 cm in length. The cortex is normal in echogenicity. No shadowing calculi or hydronephrosis is present.SPLEEN: The spleen measures 9 cm.", "output": "Coarse hepatic parenchyma echotexture, similar to prior. Punctate, 3-mm hyperechoic focus which is likely a benign granuloma, however this area may be given special attention on subsequent screening utrasound -- see above discussion."}
{"instruction": "Generate impression based on findings.", "input": "51-year-old female patient with transaminitis, abdominal pain. Evaluate liver and common bile duct. LIVER: The liver measures 20.8 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 absent. No intrahepatic biliary ductal dilatation is identified. The common duct measures up to 11 mm in diameter, appearing similar to a recent CT. The distal common bile duct is not visualized.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 9.6 cm in length. No evidence of hydronephrosis. OTHER: The left kidney is not visualized on this examination.The spleen is not visualized on this examination.", "output": "1. Hepatic steatosis. 2. Non-specific dilatation of the common bile duct, appearing similar to a recent CT; MRCP may be considered if there is clinical concern for choledocholithiasis. "}
{"instruction": "Generate impression based on findings.", "input": "sacral cellulitis concern for abscessVIEW: Ultrasound of the gluteal region Dedicated ultrasound of the gluteal region superior to the gluteal cleft was performed. There is a small hypoechoic area measuring 2.2 x 1 cm at this region. There is marked soft tissue edema.", "output": "Hypoechoic area superior to the gluteal cleft which may represent a phlegmon. There is no drainable fluid collection."}
{"instruction": "Generate impression based on findings.", "input": "58 years old, Female, Reason: RUQ US exam to evaluate biliary tree History: Abdominal distention in patient with HCV/EtOH cirrhosis, HIV LIVER: The liver measures 19 cm in length. The liver has a nodular contour with widened fissures. No definite focal liver lesion. The liver parenchyma is diffusely echogenic. Echogenic material consistent with a thrombus is again noted at the confluence of the splenic vein and SMV. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.2 m/s. There is trace ascites present.BILIARY TRACT: The gallbladder is hydropic, there is increased distention of the gallbladder since the prior study, now measuring 5 cm. There is sludge within the gallbladder and small cholelithiasis. The gallbladder wall is mildly diffusely thickened measuring 5 mm, which is nonspecific in the setting of cirrhosis and ascites. Per the ultrasound technologist, the sonographic Murphy's sign is negative. No intrahepatic or extrahepatic biliary ductal dilatation is present. The common bile duct measures 6 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 11 cm in length. RIGHT KIDNEY: Kidney measures 12 cm in length. Normal echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 13 cm in length. Normal echotexture. No hydronephrosis.", "output": "1.Cirrhotic liver without definite focal hepatic lesion.2.Hydropic gallbladder with circumferential wall thickening as above, nonspecific in setting of chronic liver disease and ascites. Correlation with patient's clinical history/physical exam recommended and if there is continued clinical concern, a HIDA scan may be considered for further evaluation.3.Thrombus at the confluence of the splenic vein and SMV is similar in appearance to prior study."}
{"instruction": "Generate impression based on findings.", "input": "HCC screen LIVER: Mildly coarse echogenic liver echotexture without mass. Liver length 16.4 cmGALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 8.9 cm in lengthOTHER: Left kidney 9.7 cm in length. Spleen 10.8 cm in length. No ascites.", "output": "Mildly coarse echogenic liver echotexture consistent with chronic liver disease without mass or ductal dilatation. No ascites"}
{"instruction": "Generate impression based on findings.", "input": "42 years old, Female, Reason: hx of UTIs and hydroneprhosis History: utis RIGHT KIDNEY: Kidney measures 11.5 cm in length. Proximal hydroureter is present on the right just not extend the length of the entire ureter to the level of the bladder. Mild hydronephrosis on the right. Normal echotexture. No shadowing calculus or mass.LEFT KIDNEY: Kidney measures 10.6 cm in length. Normal echotexture. Nohydronephrosis, shadowing calculus or mass.OTHER: No significant abnormalities noted.", "output": "1.Proximal right hydroureter with mild right hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "65 year old woman with history of Sjogren's, possible axillary lymph node enlargement and history of left axillary biopsy. A targeted bilateral axillary ultrasound was performed. Normal appearing lymph nodes are noted bilaterally measuring up to 1.3 cm in length and with normal morphology and normal hilar blood flow. Biopsied lymph node in the left axilla is noted with clip, normal in morphology.", "output": "Normal appearing lymph nodes in the bilateral axillae. The patient is seeing Dr. Jaskowiak today. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Correlation Needed."}
{"instruction": "Generate impression based on findings.", "input": "34-year-old with history of left breast carcinoma and left axillary lymph node metastases. Patient additionally has right breast DCIS. Now with palpable right axillary lymph node. Ultrasound obtained for further characterization. A targeted right ultrasound was performed of the right axilla for the palpable area of concern. A total of 6 normal-appearing lymph nodes were identified within the right axilla. No abnormal lymph nodes are seen.", "output": "No abnormal lymph nodes in the right axilla.BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "50 year old female presents for a follow-up study of left breast cyst. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense (BiRADS Density Category C), unchanged in pattern and distribution. Multiple benign appearing calcifications are essentially unchanged in both breasts. There is a developing mass at 9:00 position in the left breast, measuring 24 mm. Other multiple small masses and asymmetries are unchanged in both breasts.Focused ultrasound is performed for the left medial breast.There is a lobulated hypoechoic mass measuring 24 x 18 mm at 9:00 position, 8 cm from nipple in the left breast. This mass corresponds to the developing mass seen on the mammogram. There is a stable clustered cysts at 10:00 position in the left breast.", "output": "Developing mass at 9:00 position in the left breast, for which ultrasound-guided 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": "67-year-old male patient with history of thyroid cancer status post surgery. Question of abnormal masses. RIGHT LOBE MEASUREMENTS: No residual thyroid tissue.LEFT LOBE MEASUREMENTS: No residual thyroid tissue.ISTHMUS MEASUREMENTS: No residual thyroid tissue.RIGHT LOBE: No residual thyroid tissue.LEFT LOBE: No residual thyroid tissue.ISTHMUS: No residual thyroid tissue.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is a 1.8 x 0.6 x 0.9 cm left level 3 lymph node with punctate internal echogenic foci which may represent microcalcifications. An adjacent left level 3 subcentimeter lymph node is also noted.OTHER: No significant abnormality noted.", "output": "1. No residual thyroid tissue is identified in the surgical bed.2. A left level 3 lymph node with possible microcalcifications is suspicious for disease recurrence; biopsy is suggested for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "55-year-old female patient with 6 cm right-sided nodule. RIGHT LOBE MEASUREMENTS: 8.6 x 3.6 x 4.8 cm.LEFT LOBE MEASUREMENTS: 6.9 x 1.6 x 2.5 cm.ISTHMUS MEASUREMENTS: 6 mm in thickness.RIGHT LOBE: The right thyroid lobe is predominantly replaced by a complex nodule measuring approximately 6.9 x 5.9 x 3.8 cm, previously 6.1 x 5.6 x 3.1 cm. A smaller solid peripherally calcified nodule within the right upper pole measures 0.7 x 0.6 x 1 cm, previously 0.8 x 0.7 x 0.7 cm.LEFT LOBE: No focal thyroid lesion is identified.ISTHMUS: A previously described isthmus nodule likely reflects extension of the dominant right thyroid nodule.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Similar appearance of a dominant complex right thyroid nodule, which was previously biopsied."}
{"instruction": "Generate impression based on findings.", "input": "Female 30 years old Reason: abnormal LFT History: abnormal LIVER: Liver has increased echogenicity suggestive of fatty infiltration measuring 15.2 cm. No focal mass. Main portal vein has normal directional flow and a peak velocity of 24 cm/s.BILIARY TRACT: No intra or extrahepatic biliary ductal dilatation. Common bile duct measures up to 3 mm. Negative sonographic Murphy's sign. No gallstones.PANCREAS: The visualized portions of the pancreas are normal in appearance.SPLEEN: Spleen is normal in appearance measuring 14.3 cm.KIDNEYS: Normal cortical medullary differentiation. No hydronephrosis, shadowing calculi, or mass. Right kidney measures 10.4 cm. 0.1 cm. OTHER: No significant abnormalities noted.", "output": "Increased echogenicity of the liver is consistent with fatty infiltration. Normal appearance of the gallbladder."}
{"instruction": "Generate impression based on findings.", "input": "Weight loss and anorexia LIVER: Coarse echogenic liver echotexture without mass. Liver length 13.4 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 9.7 cm in length. No ascites.", "output": "Coarse echogenic liver echotexture suggestive for fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "58 year-old female with history of small thyroid nodules. Evaluate for interval change. RIGHT LOBE MEASUREMENTS: 4.5 cm x 1.5 cm x 1.7 cmLEFT LOBE MEASUREMENTS: 4.6 cm x 1.3 cm x 1.4 cmISTHMUS MEASUREMENTS: 2 mm in thicknessRIGHT LOBE: Heterogeneous echotexture. Small primarily cystic appearing nodule at the midpole measures 4 mm x 4 mm x 4 mm, unchanged.LEFT LOBE: Heterogeneous echotexture. Small primarily cystic appearing nodule at the midpole measures 3 mm x 3 mm x 3 mm unchanged.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right neck level 2 lymph node measures 1.1 cm x 0.8 cm x 0.4 cm. Left neck level 3 lymph node measures 0.8 cm x 0.5 cm x 0.4 cm.OTHER: No significant abnormality noted.", "output": "Heterogeneous thyroid gland with bilateral cystic appearing nodules unchanged."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with mantle cell lymphoma with splenic involvement and splenomegaly. Prior splenic infarct with increasing pain. SPLEEN: There is marked splenomegaly with the spleen measuring at least 24 cm in length. There is no focal splenic abnormality identified on today's exam. There is no peri-splenic or intrasplenic fluid collection.OTHER: No significant abnormalities noted.", "output": "Marked splenomegaly without change. No focal splenic abnormality and no evidence for hematoma."}
{"instruction": "Generate impression based on findings.", "input": "Female 83 years old; Reason: hx of thyroid nodules History: asymptomatic RIGHT LOBE MEASUREMENTS: The right thyroid lobe measures 4.6 x 1.8 x 1.6 cm.LEFT LOBE MEASUREMENTS: The left thyroid lobe measures 4.7 x 2.0 x 1.5 cm.ISTHMUS MEASUREMENT: The isthmus measures 0.3 cm.RIGHT LOBE: The right lobe appears mildly heterogeneous. In the mid/lower portion of the right lobe there is a nodule measuring 1.1 cm x 0.9 cm x 1.0 cm. This nodule is iso to hyperechoic compared to the thyroid with no internal vascularity. No microcalcifications are seen. LEFT LOBE: The left lobe appears mildly heterogeneous with no dominant nodules identified.ISTHMUS: No significant abnormality noted.LYMPH NODES: No suspicious adenopathy noted.", "output": "The thyroid appears mildly heterogeneous with slight increase in vascularity, correlate with thyroiditis. No suspicious adenopathy is seen. There is a nodule in the right lobe as described above, favored to be benign."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old female patient with a 3 cm solid thyroid nodule at the level of the isthmus seen on CT. Patient is asymptomatic. RIGHT LOBE MEASUREMENTS: 7.1 x 2.6 x 2.0 cm.LEFT LOBE MEASUREMENTS: 6.5 x 2.8 x 2.0 cm.ISTHMUS MEASUREMENTS: 7 mm in thickness.RIGHT LOBE: The right thyroid lobe is mildly heterogeneous in echogenicity containing a few subcentimeter cysts.LEFT LOBE: The left thyroid lobe is mildly heterogeneous in echogenicity containing scattered subcentimeter cystic nodules along with a spongiform-appearing nodule within the lower pole measuring 1.4 x 1.4 x 0.7 cm.ISTHMUS: The isthmus is predominantly replaced by a heterogeneous solid nodule measuring 3.2 x 1.6 x 4.8 cm. No internal calcification is identified.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: A benign morphology right level two lymph node is noted.OTHER: No significant abnormality noted.", "output": "1. Dominant solid isthmic nodule, which is amenable to biopsy.2. Spongiform-appearing left lower pole thyroid nodule, which is favored to be benign in etiology."}
{"instruction": "Generate impression based on findings.", "input": "70 year-old with acute kidney failure RENAL TRANSPLANT: LOCATION: Right iliac fossaPERITRANSPLANT TISSUES: No significant abnormality notedKIDNEY: Kidney measures 9.7 cm with normal echotexture. Mild prominent corticomedullary differentiation is noted compared to prior study. 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 notedPeak systolic velocity of the iliac artery is .5 m/sec.Proximal 1. 2 m/secMid 0.7 m/secDistal 0.3 m/secThe intrarenal resistive indices measure between 0.71 and 0.82.Minimal tardus parvus.OTHER: No significant abnormality noted", "output": "No definite evidence of renal artery stenosis."}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female presents for baseline screening mammography. Family history of breast cancer in paternal and maternal grandmother diagnosed at unknown age. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Multiple clusters of pleomorphic calcifications in the right breast, the largest measuring 2 cm in the right upper outer breast for which spot magnification views are recommended. 2 partially obscured masses in the left upper outer breast best seen on the CC view the largest measuring 10 mm for which spot compression views and ultrasound are recommended.", "output": "Multiple clusters of pleomorphic calcifications in the right breast, the largest measuring 2 cm in the right upper outer breast for which spot magnification views are recommended. Two partially obscured masses in the left upper outer breast best seen on the CC view the largest measuring 10 mm for which spot compression views and ultrasound are recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required."}
{"instruction": "Generate impression based on findings.", "input": "79-year-old female with bilateral biopsy proven oncocytomas. Surveillance examination. RIGHT KIDNEY: Large solid right renal mass measures 7.8 x 7.3 x 6.8 cm, increased in size compared to prior studies. No hydronephrosis.LEFT KIDNEY: Large solid left renal mass measures 16.0 x 12.4 x 9.7 cm, also increased in size compared to prior studies. The left kidney is displaced medially by this lesion. No hydronephrosis.OTHER: The bladder is collapsed.", "output": "Interval increase in size of bilateral renal masses."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old female with history of hepatitis B. LIVER: Coarse, diffusely increased echogenicity of the liver. No focal hepatic lesion or mass. The liver measures 13.1 cm in length. No dilatation or cystic changes are noted of the intrahepatic or extrahepatic biliary ducts.The main portal vein is patent with normal hepatopedal flow and velocity of 24.0 cm/s.GALLBLADDER, BILIARY TRACT: The gallbladder is normal in appearance. There is no pericholecystic fluid, gallbladder wall thickening or cholelithiasis. The common bile duct measures 0.2 cm in diameter. PANCREAS: The head and proximal body of the pancreas are normal. The tail is obscured by bowel gas.SPLEEN: The spleen is normal in echogenicity and measures 5.5 cm in length. RIGHT KIDNEY: The right kidney measures 10.1 cm in length and shows normal echotexture. There is mild hydronephrosis. No mass or shadowing calculi.LEFT KIDNEY: The left kidney measures 9.4 cm in length and shows normal echotexture. There is minimal hydronephrosis. No mass or shadowing calculi.URINARY BLADDER: The urinary bladder is normal in appearance.OTHER: There is no free or loculated fluid.", "output": "Fatty infiltration of the liver. Mild right and minimal left hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid carcinoma status post partial left thyroidectomy RIGHT LOBE: Status post thyroidectomy and ablation therapy. No worrisome mass. Benign-appearing right thyroid bed lymph node again noted and unchanged.LEFT LOBE: Status post thyroidectomy and ablation therapy without worrisome massISTHMUS: Status post thyroidectomy and ablation therapy without worrisome massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy and ablation therapy without worrisome mass or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "History of cholangiocarcinoma status post colostomy and bariatric surgery. Abdominal pain and nausea. LIVER: Coarse liver parenchyma. Large right hepatic lobe mass is better evaluated on recent CT. It measures approximately 8.9 x 9.1 cm. There is perihepatic ascites with septations and internal echogenicity. Multiple small vessels are noted in the region of the portal vein with hepatopedal portal venous blood flow.BILIARY TRACT: No extra hepatic biliary ductal dilatation with the common duct measuring 6 mm. Partially distended gallbladder with probable sludge. Nonspecific wall thickening in the setting of ascites. No shadowing gallstones.PANCREAS: The visualized pancreatic body and head is unremarkable.SPLEEN: The spleen measures 16.4 cm in length without a focal lesion. RIGHT KIDNEY: The right kidney measures 12.2 cm in length with a lobular contour. No hydronephrosis or shadowing nephrolithiasis. Color Doppler demonstrates hilar blood flow. OTHER: The left kidney measures 11.8 cm without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Color Doppler demonstrates hilar blood flow.", "output": "1. Coarse liver parenchyma with large right hepatic lobe mass better evaluated on recent CT. Complex perihepatic ascites. Portal vein thrombosis with collateral vessel formation was better characterized on CT.2. Partially distended gallbladder with probable sludge and nonspecific wall thickening. Correlate clinically and with HIDA scan results for chronic cholecystitis."}
{"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": "66-year-old female with right upper quadrant pain, rule out Budd-Chiari syndrome, evaluate hepatic veins LIMITED ABDOMENLIVER: Cirrhotic morphology of the liver with perihepatic fluid.", "output": "Patent hepatic veins.Normal liver Doppler study.Cirrhotic morphology of liver with moderate ascites and right pleural effusion."}
{"instruction": "Generate impression based on findings.", "input": "54 years old, Male, Reason: 54yo M with significant etoh abuse and abnormal labs concerning for cirrhosis. History: etoh use, hepatomegaly LIVER: The liver size is within normal limits measuring 15.4 cm in length. Increased echogenicity of the liver is consistent with fatty infiltration. No significant nodularity of the liver. No focal hepatic lesion identified. The portal vein is patent demonstrating normal hepatopetal flow with a velocity of 0.3 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 4 mm in diameter.PANCREAS: No significant abnormalities noted in the visualized portions of the pancreas. SPLEEN: No significant abnormalities noted. The spleen measures 8.6 cm in length. RIGHT KIDNEY: Kidney measures 10.6 cm in length. No evidence of hydronephrosis. Echogenic focus in the right kidney with posterior shadowing likely represents a renal calculus.LEFT KIDNEY: Kidney measures 10.8 cm in length. No evidence of hydronephrosis.", "output": "1.Increased echogenicity of the liver is consistent with fatty infiltration. No definite capsular nodularity of the liver or widening of the fissures to suggest cirrhosis.2.Echogenic focus in the right kidney with posterior shadowing is favored to represent a renal calculus."}
{"instruction": "Generate impression based on findings.", "input": "Renal insufficiency RIGHT KIDNEY: 7.8 cm in length. The renal parenchyma is markedly echogenic. No focal lesions or hydronephrosis is present.LEFT KIDNEY: 8.6 cm in length. The renal parenchyma is markedly echogenic. A 2 cm simple appearing cyst is noted in the midpole. No suspicious lesion or hydronephrosis is present.BLADDER: No significant abnormalities noted.OTHER: No significant abnormalities noted.", "output": "Markedly echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "Recurrent persistent hematuria. Provide guidance for native kidney biopsy. Ultrasound guidance provided for Dr. Cunningham for native right kidney biopsy", "output": "Ultrasound guidance provided for Dr. Cunningham for native right kidney biopsy."}
{"instruction": "Generate impression based on findings.", "input": "Reason: evaluate for perinephric abscess/pyelo History: URI, lactic acidosis RIGHT KIDNEY: The right kidney measures 9.7 cm in length. Echogenic renal parenchyma. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.8 cm in length. Echogenic renal parenchyma. Anechoic lower pole cyst measures 3.0 x 2.5 x 2.3 cm. No shadowing stones or hydronephrosis.OTHER: The urinary bladder is partially decompressed by a Foley catheter, with some residual fluid. The liver parenchyma is mildly heterogeneous.", "output": "1. Echogenic renal parenchyma, consistent with medical renal disease or parenchymal dysfunction. No hydronephrosis.2. Heterogeneous hepatic parenchyma, consistent with hepatic steatosis or parenchymal dysfunction."}
{"instruction": "Generate impression based on findings.", "input": "AKI, history of CHF, rule out obstruction RIGHT KIDNEY: Echogenic kidney measures 12.5 cm in length. No hydronephrosis or mass. LEFT KIDNEY: Echogenic kidney measures 12.0 cm in length. No hydronephrosis or mass.OTHER: The bladder is nondistended.", "output": "Medical renal disease. No hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "57-year-old female patient with TIPS and hepatic encephalopathy. LIMITED ABDOMENLIVER: The liver measures 15.0 cm in length, demonstrates coarsened echotexture, and is nodular in contour. A septated cyst is noted within the right hepatic lobe measuring 5.8 x 4.8 x 6.3 cm, previously 5.4 x 5.6 x 5.3 cm.BILIARY TRACT: The gallbladder is absent. There is no intra or extrahepatic biliary ductal dilatation. The common duct measures 3 mm in diameter.PANCREAS: No significant abnormalities noted.SPLEEN: The spleen measures 14.5 cm in length. RIGHT KIDNEY: The right kidney measures 10.4 cm in length. No evidence of hydronephrosis.OTHER: The left kidney measures 8.0 cm in length. No evidence of hydronephrosis.No ascites.", "output": "1. Patent TIPS with elevated velocities near the portal venous anastomosis.2. Cirrhotic morphology of the liver with patent hepatic vasculature. No ascites.3. Right hepatic cyst."}
{"instruction": "Generate impression based on findings.", "input": "Male, 76 years old. Nephrolithiasis, renal colic. RIGHT KIDNEY: The right kidney measures 10.9 cm in length, with normal cortical echotexture. A lower pole stone measures 1.3 x 1.1 x 0.4 cm, unchanged. No hydronephrosis.LEFT KIDNEY: The left kidney measures 11.3 cm in length, with normal cortical echotexture. No large shadowing stones or hydronephrosis.OTHER: The bladder is incompletely distended. A left sided bladder diverticulum is noted.", "output": "1.Unchanged nonobstructing right renal stone. No hydronephrosis.2.Left bladder diverticulum."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male with multiple myeloma and renal insufficiency. Ultrasound guidance.", "output": "Ultrasound guidance for left renal biopsy."}
{"instruction": "Generate impression based on findings.", "input": "46-year-old female with history of gallstones. Pre cholecystectomy. LIVER: The liver is normal in size and echotexture. No focal hepatic abnormality.BILIARY TRACT: Gallbladder contains dependent sludge and stones. No wall thickening or pericholecystic fluid. The biliary tract is normal in caliber.PANCREAS: The head and body are normal. The tail was not well seen due to bowel gas.SPLEEN: Limited but normal in size.RIGHT KIDNEY: 3.7 cm cyst in the upper pole of the right kidney. No hydronephrosis. OTHER: No hydronephrosis involving the left kidney.", "output": "Gallstones and sludge."}
{"instruction": "Generate impression based on findings.", "input": "Call back from screening mammogram for asymmetry and calcifications in both breasts. An ML view and two spot magnification views of both breasts 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 heterogeneously dense. Compared to the images from 2012, multiple of clustered calcification are mildly increased in benign fashion in both breasts. No uniquely suspicious cluster of calcifications are not noted. A mass in the right retroareolar region seen on the recent screening mammogram partially disperses into normal glandular tissue. Whole breast ultrasound for both breasts is performed. There are no solid or cystic lesions in either breast.", "output": "High probability benign calcifications in both breasts. Short interval follow up for both breasts is recommended in 6 months. 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": "48 year-old female with a history of umbilical hernia with pain. Evaluate for umbilical hernia. Note is made of a small fat containing umbilical hernia which slightly increases in size with Valsalva maneuvers. There are no loops of bowel identified within the hernia sac with or without Valsalva maneuver.", "output": "Small fat-containing umbilical hernia."}
{"instruction": "Generate impression based on findings.", "input": "Scrotal pain. RIGHT TESTIS: 3.8 x 2.5 x 3.1 cm. Few nonspecific coarse calcifications noted. Otherwise, normal parenchymal echotexture and vascularity. LEFT TESTIS: 3.4 x 2.0 x 3.3 cm. Normal parenchymal echotexture and vascularity.RIGHT EPIDIDYMIS: No significant abnormalities noted.LEFT EPIDIDYMIS: 5 mm epididymal cyst noted. No significant abnormalities identified.OTHER: No significant abnormalities noted. No evidence of hydrocele or varicocele.DOPPLER", "output": "No specific findings to account for the patient's pain."}
{"instruction": "Generate impression based on findings.", "input": "Renal failure RIGHT KIDNEY: Echogenic renal parenchyma without worrisome mass, stone, or hydronephrosis. Benign-appearing right renal cyst. Right kidney 10.4 cm in length.LEFT KIDNEY: Echogenic renal parenchyma without worrisome mass or hydronephrosis. Subcentimeter nonobstructing left renal stone. Left renal cysts. Left kidney 10.9 cm in length.OTHER: Bladder nondistended", "output": "Echogenic parenchyma consistent with medical renal disease/parenchymal dysfunction without worrisome mass or hydronephrosis. Subcentimeter nonobstructing left renal stone."}
{"instruction": "Generate impression based on findings.", "input": "Thyroid cancer, evaluate for adenopathy or recurrence RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: No suspicious lesions in the right thyroid bed.LEFT LOBE: No suspicious lesions in the left thyroid bed.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "No specific evidence of recurrent or metastatic disease."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 52 yo M with abdominal pain, elevated lipase of unclear etiology LIVER: The liver measures 15.5 cm in length. Normal hepatic parenchymal echogenicity and echotexture. The portal vein is patent with normal hepatopedal directional flow, peak velocity 28.5 cm/s. No focal mass.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted. No cholelithiasis or gallbladder sludge. The common hepatic duct measures 0.2 cm. The gallbladder wall measures 0.1 cm. No significant biliary ductal dilatation. Negative sonographic Murphy's sign.PANCREAS: Hypoechoic, edematous appearing pancreas with a significantly dilated pancreatic duct measuring 0.3 mm, abruptly terminating proximally in the region of the pancreatic head.RIGHT KIDNEY: The right kidney measures 10.6 cm in length. No shadowing stones or hydronephrosis.LEFT KIDNEY: The left kidney measures 10.2 cm in length. No shadowing stones or hydronephrosis.OTHER: The spleen measures 8.2 cm in length. No ascites.", "output": "Edematous pancreatic parenchyma consistent with acute pancreatitis. Significantly dilated pancreatic duct truncating abruptly in the region of the pancreatic head; cannot exclude obstructing mass lesion. Dedicated contrast-enhanced CT of the abdomen should be obtained for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Male 48 years old with scrotal mass. Please evaluate. RIGHT TESTIS: The right testicle measures 4.0 x 3.0 x 3.3 cm, it is normal in echogenicity and without focal lesion. External to the right testicle in the area of palpable abnormality is a 0.3 x 0.1 x 0.3 cm anechoic lesion with no vascularity consistent with the tunica albuginea cyst.LEFT TESTIS: The left testicle measures 4.5 x 2.7 x 3.5 cm, it is normal in echogenicity and without focal lesion.RIGHT EPIDIDYMIS: The right epididymis measures 1.6 x 1.3 x 1.1 cm with a normal sonographic appearance.LEFT EPIDIDYMIS: The left epididymis measures 0.8 x 1.6 x 1.8 cm and contains a 0.3 x 1.2 x 0.3 cm anechoic structure consistent with an epididymal cyst.OTHER: Small right varicocele and small bilateral hydroceles. Normal, symmetric testicular vascularity.", "output": "1.0.3 x 0.1 x 0.3 cm right tunica albuginea cyst corresponds to the patient's palpable abnormality.2.Small right varicocele."}
{"instruction": "Generate impression based on findings.", "input": "37-year-old female patient with right thyroid lobe larger than left by exam. No palpable nodules. RIGHT LOBE MEASUREMENTS: 4.8 x 1.8 x 1.7 cm.LEFT LOBE MEASUREMENTS: 5.0 x 1.5 x 1.6 cm.ISTHMUS MEASUREMENTS: 4 mm in thickness.RIGHT LOBE: The right thyroid lobe is homogeneous in echogenicity without focal thyroid lesion.LEFT LOBE: The left thyroid lobe is homogeneous in echogenicity without focal thyroid lesion.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign morphology lymph node is noted on the left.OTHER: No significant abnormality noted.", "output": "No dominant thyroid lesion is identified."}
{"instruction": "Generate impression based on findings.", "input": "68-year-old male patient with decreased BP with low SVR. LIVER: The liver measures 19.7 cm in length. No focal hepatic lesion is identified. Main portal vein flow is pulsatile and hepatopetal measuring 0.3 m/sec. The hepatic veins and IVC are prominent.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 8.5 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis. OTHER: The left kidney measures 11.2 cm in length and demonstrates increased cortical echogenicity. No evidence of hydronephrosis.The spleen measures 12.4 cm in length.No ascites.", "output": "1. Hepatomegaly with prominent hepatic veins/IVC and pulsatile portal venous flow, which is likely secondary to right-sided heart failure.2. Medical renal disease.3. No ascites. "}
{"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 mass or regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Evaluate for HCC. History of hepatitis C. LIVER: The liver is mildly echogenic and measures 14.8 cm in length. No focal hepatic lesion. Normal hepatopedal portal venous blood flow at 24 cm/s.BILIARY TRACT: No intra or 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 portions of the pancreatic head and body are unremarkable.SPLEEN: The spleen measures 9.6 cm without a focal lesion.RIGHT KIDNEY: The right kidney measures 9.8 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion. Stable mild pelvocaliectasis.OTHER: The left kidney measures 10.6 cm in length without hydronephrosis, shadowing nephrolithiasis or discrete lesion.", "output": "1. Mildly echogenic liver parenchyma suggestive of parenchymal dysfunction and/or fatty infiltration without a focal lesion.2. Stable minimal right pelvocaliectasis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: history of total thyroidectomy T3N1b thyroid cancer, now with recurrent disease. RIGHT LOBE MEASUREMENTS: Status post thyroidectomy.LEFT LOBE MEASUREMENTS: Status post thyroidectomy.ISTHMUS MEASUREMENTS: Status post thyroidectomy.RIGHT LOBE: Status post thyroidectomy.LEFT LOBE: Status post thyroidectomy. Within the inferior thyroidectomy bed, there is an irregular shaped hypoechoic region measuring approximately 2.0 x 2.1 x 1.0 cm which is thought to correspond with the area of increased metabolic activity on recent outside PET scan.ISTHMUS: Status post thyroidectomy.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Right level IV 1.1 x 0.4 x 0.9 cm and left level V 1.0 x 0.3 x 0.7 cm lymph nodes, favor benign morphology.OTHER: No significant abnormality noted.", "output": "Irregular soft tissue mass within left inferior thyroidectomy bed which appears to correspond to hypermetabolic activity on outside PET, suspicious for recurrent or residual disease and was subsequently biopsied."}
{"instruction": "Generate impression based on findings.", "input": "Parathyroidectomy. Papillary thyroid carcinoma was also noted on pathology report. RIGHT LOBE MEASUREMENTS: 3.8 x 1.3 x 1.6 cm. Normal in size with normal background vascularity.LEFT LOBE MEASUREMENTS: 2.9 x 1.6 x 1.7 cm. Normal in size with normal background vascularity.ISTHMUS MEASUREMENTS: 3 mm in AP dimension.RIGHT LOBE: Two right-sided nodules identified. A cystic nodule in the lower pole measures 7 mm. A spongiform nodule in in the mid pole measures 4 mm. These nodules are similar to the prior outside ultrasound and do not demonstrate suspicious characteristics. LEFT LOBE: A spongiform nodule in the midpole measures 6 mm. This is similar to the prior outside ultrasound and does not demonstrate suspicious characteristics.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Not visualized.LYMPH NODES: Benign-appearing cervical lymph nodes identified.OTHER: No significant abnormality noted.", "output": "Stable subcentimeter thyroid nodules, without suspicious features."}
{"instruction": "Generate impression based on findings.", "input": "Hepatitis B LIVER: Diffusely heterogeneous parenchyma. Multiple bilobar ill-defined hyperechoic foci somewhat more conspicuous on the current examination. A representative left lobe lesion measures 0.7 x 0.6 x 0.8 cm. Liver length 17.9 cm.GALLBLADDER, BILIARY TRACT: No significant abnormalities noted.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.1 cm in lengthOTHER: Left kidney 12.5 cm in length. Spleen 12 cm in length. No ascites.", "output": "Diffusely heterogeneous liver parenchyma again noted consistent with chronic liver disease. Increased conspicuity of multiple bilobar ill-defined hyperechoic foci; given the interval change, would recommend correlation with dedicated CT or MR. No ductal dilatation or ascites."}
{"instruction": "Generate impression based on findings.", "input": "Reason: follow-up on isthmus adenomatoid nodule History: history of nodule, no symptoms (1.4 x 1.1 x 0.6cm in 2013) RIGHT LOBE MEASUREMENTS: 6.1 x 1.5 x 1.4 cmLEFT LOBE MEASUREMENTS: 5.8 x 1.4 x 1.1 cmISTHMUS MEASUREMENTS: 0.2 cm in the AP dimensionRIGHT LOBE: Right mid pole nodule appears cystic with a hyperechoic focus and measures 0.3 x 0.2 x 0.3 cm. No internal calcifications or vascularity.LEFT LOBE: Homogenous, unremarkable left thyroid gland.ISTHMUS: Spongiform nodule measures 1.1 x 0.4 x 0.9 cm without microcalcifications or vascularity.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted. No cervical lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Isthmus nodule as described above is decreased in size compared to reported prior measurement of 1.4 x 1.1 x 0.6 cm in 2013 and lacks definite suspicious features."}
{"instruction": "Generate impression based on findings.", "input": "Epigastric pain with distended gallbladder and prominent biliary system on CT LIVER: No significant abnormalities noted. Liver length 15.1 cmGALLBLADDER, BILIARY TRACT: Diffusely thickened gallbladder wall with positive Murphy's sign. Mild prominence of extrahepatic bile duct with maximal diameter of 8 mm. No cholelithiasis.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.3 cm in lengthOTHER: Left kidney 12.1 cm in length. Spleen 9 cm in length. No ascites.", "output": "Abnormally diffuse thickening of gallbladder wall with positive Murphy's sign worrisome for acute acalculus cholecystitis. Mild prominence of extrahepatic bile duct; distal aspect of bile duct obscured by gas. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "48-year-old male with hepatitis B. LIVER:Cirrhotic liver morphology. A 1.2 x 1.1 x 0.9 cm hypoechoic nodule along the left liver capsule is new since the prior study. Patent portal vein.GALLBLADDER, BILIARY TRACT: 0.5 cm echogenic focus along the gallbladder wall may represent a small stone or polyp.PANCREAS: No significant abnormality noted.SPLEEN: Splenomegaly. The spleen measures 12.3 cm in length.KIDNEYS: No significant abnormality noted. OTHER: No significant abnormality noted.", "output": "New 1.2 cm hypoechoic hepatic nodule on a background of cirrhosis is suspicious for malignancy. Cross-sectional imaging is recommended for further evaluation."}
{"instruction": "Generate impression based on findings.", "input": "Rule out hydroureteronephrosis History: incomplete bladder emptying and indwelling Foley catheter RIGHT KIDNEY: Mildly echogenic right kidney measures 9.6 cm. No evidence of hydronephrosis or hydroureter.LEFT KIDNEY: Mildly echogenic left kidney measures 9.55 cm. No evidence of hydronephrosis or hydroureter.OTHER: Well distended urinary bladder without any focal lesions.", "output": "Mildly echogenic kidneys without evidence of hydronephrosis or hydroureter."}
{"instruction": "Generate impression based on findings.", "input": "58-year-old female with worsening CKD. Evaluate Body habitus limits examination.RIGHT KIDNEY: The right kidney measures 7 cm in length and is increased in echogenicity.LEFT KIDNEY: Evaluation of the left kidney is limited. Again noted is mildly increased echogenicity at the upper pole of the left kidney.Bladder: No significant abnormalities noted.", "output": "Limited examination with bilaterally hyperechoic renal parenchyma consistent with renal disease. The left kidney is incompletely imaged."}
{"instruction": "Generate impression based on findings.", "input": "Enlarged right thyroid gland RIGHT LOBE MEASUREMENTS: 6.8 x 2.5 x 1.7 cmLEFT LOBE MEASUREMENTS: 5.2 x 1.2 x 1.2 cmISTHMUS MEASUREMENTS: 0.1 cmRIGHT LOBE: Diffusely heterogeneous gland. Predominantly solid lower pole nodule measuring 4.3 x 2.5 x 3.5 cm.LEFT LOBE: Diffusely heterogeneous gland without massISTHMUS: Diffusely heterogeneous gland without massPARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Predominately solid dominant lower pole right thyroid nodule; this nodule is amenable to percutaneous ultrasound-guided biopsy. Diffusely heterogeneous thyroid gland raises the possibility of chronic thyroiditis. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "History of appendicitis treated with antibiotics now with persistent right lower quadrant pain/dullness. Within the right lower quadrant abdomen, there is a tubular, predominantly hypoechoic structure measuring up to 12 mm in diameter which is noncompressible and contains shadowing reflectors compatible with appendicoliths. No adjacent fluid collections are identified to suggest abscess.", "output": "Findings compatible with appendicitis of indeterminate chronicity. Discussed with ordering provider, APN FLERICK, THERESA who advised to send patient to emergency department. "}
{"instruction": "Generate impression based on findings.", "input": "82-year-old male with history of right upper back soft tissue swelling/mass which he first noticed approximately 3 weeks ago. No pain, no limited range of motion, no fevers, no redness or any other complaints. Physical exam reveals a fluctuant, nontender soft and relatively mobile approximately 6 to 8-cm wide area of masslike swelling in the right upper back just deep to the skin surface. No overlying redness or crepitus.Ultrasound shows a large, approximately 5-10 cm structure within the subcutaneous soft tissues between the skin and the chest wall. It appears separate from the underlying ribs and chest wall, and has a clearly defined interface with the adjacent soft tissues. The structure contains relatively homogeneously isoechoic material that causes dirty shadowing and partially obscures its posterior extent. Although the relatively high acoustic impedance of this structures internal contents limits evaluation, we favor a benign etiology such as epidermoid inclusion cyst.", "output": "Findings suggestive of benign etiology, such as a large epidermoid inclusion cyst."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old female with abdominal distention, assess for ascites, progression of cirrhosis. LIVER: Nodular hepatic contour without discrete focal lesion.BILIARY TRACT: Status post cholecystectomy. No biliary ductal dilation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted.KIDNEY: 4.1 x 3.9 x 3.8 cm right renal cyst without septation or solid component. Mildly increased renal echogenicity without hydronephrosis. OTHER: Minimal ascites.", "output": "1. Cirrhotic liver morphology without discrete lesion. 2. Minimal ascites. 3. Increased renal echogenicity consistent with medical renal disease. "}
{"instruction": "Generate impression based on findings.", "input": "27 year-old history of biopsy-proven right breast fibroadenoma presents for follow-up of the right breast mass and for evaluation of tenderness in left breast. On physical exam, there is a small palpable mass in the right breast upper outer quadrant there is a 10:00 position. No palpable or visible abnormality in the left breast.RIGHT BREAST ULTRASOUND: A targeted right ultrasound was performed for the palpable area of concern. In the right breast 10:00 3 cm from nipple at the site of palpable abnormality there is a lobulated hyperechoic mass with biopsy clip seen centrally measuring 5 x 3 x 7 mm (previously measured 5 x 3 x 8 mm) consistent with biopsy-proven fibroadenoma. Also in the 10:00 position 3 cm in 3 cm from nipple there is a 5 x 3 x 7 mm cyst. In the 9:00 position 5 cm from nipple there is an 8 x 3 mm benign intramammary lymph node. No suspicious masses.LEFT BREAST ULTRASOUND:Targeted left breast ultrasound was performed in the 3:00 position 3 cm from nipple at the site of patient's reported pain and tenderness. Unremarkable dense fibroglandular tissue is seen. No suspicious masses.", "output": "No change in size of biopsy-proven right breast fibroadenoma measuring 5 x 3 x 7 mm. Right breast cyst and benign intramammary lymph node.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Transaminitis LIVER: Coarse echogenic liver echotexture without mass. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow. Liver length 19.2 cm.BILIARY TRACT: Gallbladder sludge and stones without acute inflammation or ductal dilatation.PANCREAS: No significant abnormalities noted.SPLEEN: No significant abnormalities noted. 10.6 cm in length RIGHT KIDNEY: No significant abnormalities noted. 12.5 cm in lengthOTHER: Left kidney 12.6 cm in length. Trace ascites.", "output": "Mild hepatomegaly associated with coarse echogenic liver echotexture raises the possibility of parenchymal dysfunction/fatty infiltration without mass or ductal dilatation. Trace ascites. Gallbladder sludge and stones without acute inflammation."}
{"instruction": "Generate impression based on findings.", "input": "BPH. Evaluate for hydronephrosis RIGHT KIDNEY: 10.1 cm in length. Mildly increased renal parenchymal echogenicity. No suspicious lesions are evident. No renal stones or hydronephrosis.LEFT KIDNEY: 9.6 cm in length. Mildly increased renal parenchymal echogenicity. Renal cysts noted, the largest of which measures 18 mm. No suspicious lesions are evident. No renal stones or hydronephrosis.BLADDER: Fluid-filled with foci of debris and air, making evaluation for underlying lesion suboptimal. The Foley catheter is seen extending to the level of the prostatic urethra, however is not identified within the bladder. Mild circumferential wall thickening noted, which may be seen in the setting of BPH.OTHER: Bilateral pleural effusions, partially imaged. Prostatomegaly.", "output": "1. Echogenic renal parenchyma without hydronephrosis, compatible with medical renal disease.2. Distended bladder, without Foley catheter identified within the bladder, portion of catheter seen at level of prostatic urethra. Clinical evaluation of Foley catheter is recommended."}
{"instruction": "Generate impression based on findings.", "input": "27-year-old female patient with fullness on thyroid exam. Evaluate for thyromegaly or nodule. RIGHT LOBE MEASUREMENTS: 1.8 x 1.4 x 5.3 cm.LEFT LOBE MEASUREMENTS: 1.7 x 1.3 x 3.8 cm.ISTHMUS MEASUREMENTS: 2 mm in thickness.RIGHT LOBE: The right thyroid lobe is homogeneous in echogenicity and contains a 0.3 x 0.2 x 0.4 cm hypoechoic, solid nodule within the right mid to posterior pole. The nodule has minimal internal vascularity and no microcalcifications.LEFT LOBE: The left thyroid lobe is homogeneous in echogenicity without focal thyroid lesion.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Subcentimeter hypoechoic right thyroid nodule."}
{"instruction": "Generate impression based on findings.", "input": "61-year-old female with transaminitis, asymptomatic. History of hepatitis C, screening. Evaluate prior benign lesions. LIVER: Coarse echotexture of the liver measuring 16.0 cm in length. Again seen is a predominantly anechoic lesion in the left hepatic lobe measuring 2.8 cm x 3.3 cm x 4.8 cm with thin internal septation. The previously noted smaller hepatic cyst is no longer visualized. GALLBLADDER, BILIARY TRACT: There is a 3-mm gallbladder polyp. Gallbladder wall measures 2 mm in thickness. No pericholecystic fluid. Common bile duct measures 5 mm in caliber. 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: Right kidney measures 9.3 cm in length and is normal in echogenicity with no evidence of hydronephrosis.OTHER: Left kidney measures 10.1 cm in length and is normal in echogenicity with no evidence of hydronephrosis. Spleen is normal in echogenicity measuring 7.9 cm in length.", "output": "1. Minimally complex cystic lesion in the left hepatic lobe not significantly changed. No new lesions identified. 2. Coarse echotexture of the liver suggestive of parenchymal dysfunction/fatty infiltration.3. 3-mm gallbladder polyp. "}
{"instruction": "Generate impression based on findings.", "input": "Ms. LINDA COLLINS is a 46 years old female with a personal history of lumps in both her breasts since she was 20 years old. Prior exam demonstrated bilateral benign-appearing masses, with six-month follow-up recommended. The patient is currently menstruating. ULTRASOUND:On physical examination, palpable masses were noted at the 12:00 position approximately 1 cm from the nipple, in both breasts.A targeted bilateral ultrasound was performed for both breasts.Right breast: Again seen is a well-circumscribed hypoechoic mass at the 12:00 position, approximately 1 cm from the nipple, which now measures 14 x 25 mm, previously 14 x 28 mm. A clustered cyst is again noted 3 cm from the nipple at the 12:00 position, now measuring 12 x 6 mm, previous 5 x 9 mm.Left breast: A well-circumscribed hypoechoic lesion is again seen at the 12:00 position, 1 cm from the nipple, now measuring 32 x 22 mm, previously 23 x 15 mm. An additional well-circumscribed hypoechoic lesion is again seen at the 1:00 position, 10 cm from the nipple, which now measures 12 x 16 mm, previously 10 x 17 mm.", "output": "1.Interval increase in size of the dominant left breast mass, with characteristics most suggestive of a fibroadenoma, with interval increase in size felt likely related to menstrual cycle timing. However, six-month follow-up is recommended. Stable other benign fibroadenoma in the left breast 1:00 position and right breast 12:00 position. Surgical consultation is also recommended given interval increase in size.2.Slight interval increase in size of the clustered cyst in the right breast. Six month follow-up is recommended.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (6 Months)."}
{"instruction": "Generate impression based on findings.", "input": "Reason: 61 yo F with CBD dilation noted on CT abdomen, ? CBD dilation or stone ? Evidence of acute cholangitis History: CBD dilation on CT. No nausea/vomiting/abdominal pain Examination somewhat limited by overlying bowel gas and limitations positioning patient.LIVER: The liver measures 21 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 0.26 m/s.BILIARY TRACT: Contracted gallbladder which somewhat limits evaluation. No gallbladder wall thickening. The sonographic Murphy's sign is negative. The common bile duct is dilated measuring up to 12 mm in diameter until the region of the pancreatic head where there is a shadowing focus compatible with a common bile duct stone. No significant intrahepatic biliary ductal dilatation is seen.PANCREAS: No significant abnormalities noted within the visualized portions of the pancreas. The visualized proximal pancreatic duct is nondilated.SPLEEN: No significant abnormalities noted. The spleen measures 11.5 cm in length. RIGHT KIDNEY: Kidney measures 11.9 cm in length. Increased renal echogenicity with multiple small cysts.LEFT KIDNEY: Kidney measures 11.1 cm in length. Increased renal echogenicity with multiple cysts.OTHER: No significant abnormalities noted.", "output": "1.Choledocholithiasis with stone in the common bile duct as seen on prior CT with associated dilation of the common bile duct.2.Mild hepatomegaly.3.Echogenic kidneys with multiple cysts compatible with medical renal disease.Findings discussed with SWEI, ERIC at 3:30 PM on 12/12/2016"}
{"instruction": "Generate impression based on findings.", "input": "Asymptomatic female with dense breasts presents for whole breast ultrasound for dense breast screening. Strong family history of breast cancer in sister, maternal aunt, maternal cousin, paternal aunt, and two paternal cousins. 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": "Female 75 years old Reason: r/o hydronephrosis History: CT w/nephrolithiasis, UTI RIGHT KIDNEY: Right kidney measures 10.6 cm. The cortex is echogenic suggesting medical renal disease. There are multiple shadowing stones. A simple appearing anechoic cyst is present within the midpole of the right kidney measuring 2.2 x 1.8 x 1.7 cm. No hydronephrosis.LEFT KIDNEY: Left kidney measures 8.9 cm. The left kidney has mildly increased cortical echogenicity suggesting medical renal disease. No hydronephrosis.URINARY BLADDER: The bladder is collapsed.OTHER: No significant abnormalities noted.", "output": "Echogenic kidneys bilaterally suggesting medical renal disease. Multiple shadowing stones without hydronephrosis."}
{"instruction": "Generate impression based on findings.", "input": "Reason: assess for cirrhosis and ascites History: jaundice LIVER: The liver measures 21.3 cm in length and is nodular in contour. The liver parenchymal echotexture is coarse with increased echogenicity. No focal hepatic lesions or masses are identified within the limitations of an echogenic liver. The portal vein is patent demonstrating hepatopetal flow with a velocity of 0.14 m/s.BILIARY TRACT: No cholelithiasis. Mild gallbladder wall thickening measuring up to 4 mm which is nonspecific in the setting of chronic liver disease and ascites. 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: Not visualized due to overlying bowel gas.SPLEEN: The spleen is enlarged and measures 19.5 cm in length. RIGHT KIDNEY: Kidney measures 13.2 cm in length. Normal echotexture. No hydronephrosis.LEFT KIDNEY: Kidney measures 13.3 cm in length. Normal echotexture. No hydronephrosis.OTHER: Mild ascites. Bilateral pleural effusions.", "output": "1.Hepatomegaly and echogenic, nodular liver compatible with chronic liver disease/cirrhosis. Splenomegaly, ascites, and decreased flow velocity within the main portal vein compatible with sequelae of portal hypertension.2.Mild gallbladder wall thickening which is nonspecific but may be related to chronic liver disease without evidence of cholelithiasis.3.Bilateral pleural effusions."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Smith is a 25-year-old woman with history of bilateral breast reduction presenting for further evaluation of a growing lump in the lateral right breast. On physical exam, there is ridgelike breast tissue palpated in the lateral right breast at the site of patient's concern.A targeted right ultrasound was performed for the patient\u2019s area of concern. In the lateral right breast 9:00 position, 5 cm from nipple, dense fibroglandular tissue interspersed with fat lobules is seen. No suspicious cystic or solid masses are identified in this area or in adjacent breast parenchyma.", "output": "No sonographic evidence for malignancy. Clinical follow-up is recommended for the area of palpable concern. As long as the physical exam is unchanged, screening mammogram is recommended beginning at age 40. BIRADS: 1 - Negative.RECOMMENDATION: C - Clinical Follow-Up Needed."}
{"instruction": "Generate impression based on findings.", "input": "Reason: Rule out adenopathy, recurrence History: History of thyroid cancer RIGHT LOBE: Status post thyroidectomy without new nodules or masses.LEFT LOBE: Status post thyroidectomy without new nodules or masses.ISTHMUS: Status post thyroidectomy without new nodules or masses.PARATHYROID GLANDS: Not visualized.LYMPH NODES: No significant abnormality noted. No cervical lymphadenopathy.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy without evidence of recurrence or lymphadenopathy."}
{"instruction": "Generate impression based on findings.", "input": "Extensive skin burns. Evaluate for perinephric abscess or stones; sepsis RIGHT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. No perinephric collection. 10.7 cm in lengthLEFT KIDNEY: Normal echogenicity without mass, stone, or hydronephrosis. No perinephric collection. 9.3 cm in length.OTHER: Bladder nondistended. Trace ascites", "output": "Negative renal ultrasound. Normal parenchymal echogenicity without mass, stone, or hydronephrosis. No perinephric collection. Trace ascites."}
{"instruction": "Generate impression based on findings.", "input": "62-year-old male with history of right upper quadrant pain and elevated white blood cell count. LIVER: No significant abnormalities noted. GALLBLADDER, BILIARY TRACT: Cholelithiasis, with a small amount of gallbladder wall thickening and subtle mural striation. No intrahepatic or extrahepatic biliary dilatation. Common bile duct measures approximately 8 mm.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: Positive Murphy sign.", "output": "Given the patient's acute tenderness, gallbladder wall thickening and mural striation, this is most consistent with acute on chronic cholecystitis."}
{"instruction": "Generate impression based on findings.", "input": "Ms. GWENDOLYN COLEMAN is a 65 years old female with history of left mastectomy 12/2013 for invasive ductal carcinoma and DCIS. Patient received radiation and chemotherapy. Benign right breast biopsies. She presents today for pain in the right axilla. On physical examination, no discrete masses are palpated at the area of pain in the right axilla.A targeted right axilla ultrasound was performed for the patient\u2019s area of pain. There is no masses or abnormal lymph node identified in the area over pain. A normal morphology lymph node is noted in the right axilla.", "output": "No sonographic evidence for malignancy or for patient's pain in the right axilla. The patient should follow up with her primary care physician as clinically warranted, presuming these results are concordant with the physical exam findings. Routine diagnostic right breast mammogram is recommended, due in July 2016. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: ND - Routine Diagnostic Mammogram."}
{"instruction": "Generate impression based on findings.", "input": "Bilateral renal lesions seen on recent CT RIGHT KIDNEY: The previously noted multiple right renal lesions with intrinsic high attenuation on CT can be seen to represent multiple minimally complex cysts. A representative mid pole cyst measures 1.2 x 1.1 cm. No worrisome mass, stone, or hydronephrosis. Right kidney 9.8 cm in length.LEFT KIDNEY: The previously noted multiple left renal lesions with intrinsic high attenuation CT can be seen to represent multiple mildly complex cysts. The largest mid pole cyst measures 2 x 2 x 2 cm and demonstrates moderate internal complexity. No worrisome mass, stone, or hydronephrosis. Left kidney 9 cm in length.OTHER: Bladder nondistended", "output": "The previously noted multiple bilateral renal lesions with intrinsic high attenuation seen on the chest CT can be seen to represent multiple minimally complex cysts. The largest left mid pole cyst demonstrates moderate internal complexity; continued surveillance by ultrasound of this cystic lesion is recommended."}
{"instruction": "Generate impression based on findings.", "input": "Alcoholic liver disease LIVER: Coarse echogenic liver echotexture without mass. Liver length 14.1 cm. Limited Doppler interrogation of the main portal vein demonstrates a patent main portal vein with normal directional flow.GALLBLADDER, BILIARY TRACT: Cholelithiasis without ductal dilatation or acute inflammation.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted. 11.4 cm in lengthOTHER: Left kidney 12.4 cm in length. Spleen not visualized. No ascites.", "output": "Coarse echogenic liver echotexture consistent with fatty infiltration/parenchymal dysfunction without mass or ductal dilatation. Cholelithiasis without acute inflammation. No ascites."}
{"instruction": "Generate impression based on findings.", "input": "73 year old female who was recalled from screening mammogram for focal asymmetry in the left lower inner breast . Mammogram: An ML view 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 almost entirely fatty, unchanged in pattern and distribution. 5 mm oval circumscribed mass persists on spot compression views.Ultrasound: Targeted left lower inner quadrant ultrasound was performed. A 6 x 2 mm simple cyst is identified in the left breast at 8:00 position. No suspicious solid mass noted.", "output": "Subcentimeter simple cyst in the 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."}
{"instruction": "Generate impression based on findings.", "input": "65-year-old male with history of thyroid cancer status post surgery and iodine 131 treatment RIGHT LOBE MEASUREMENTS: Status post thyroidectomyLEFT LOBE MEASUREMENTS: Status post thyroidectomyISTHMUS MEASUREMENTS: Status post thyroidectomyRIGHT LOBE: No evidence of recurrence in the thyroid bed.LEFT LOBE: No evidence of recurrence in the thyroid bed.ISTHMUS: No evidence of recurrence in the thyroid bed.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: There is a benign appearing right level 5 lymph node which measures 0.9 x 0.4 x 0.7 cm.OTHER: No significant abnormality noted.", "output": "Status post thyroidectomy without evidence of recurrent disease."}
{"instruction": "Generate impression based on findings.", "input": "Reason: CT scan findings or gallstones/need to evaluate History: abdominal pain LIVER:The hepatic parenchyma appears normal in echogenicity and echotexture. No focal lesions are identified.GALLBLADDER, BILIARY TRACT: The gallbladder is mildly distended. There is a small amount of layering sludge. No shadowing gallstones are identified. Common bile duct distally measures up to 7 mm in diameter, within normal limits given patient's age. There is no gallbladder wall thickening or pericholecystic fluid. The gallbladder wall measures 2 mm. Per ultrasound technologist, sonographic Murphy's sign was negative.PANCREAS: Obscured by bowel gas.SPLEEN: No significant abnormality noted.KIDNEYS: The left kidney measures 18.9 cm in length. The right kidney measures 11.4 cm in length. A simple anechoic cyst in the upper pole the right kidney measures 3.7 x 3.7 x 3.6 cm. A simple anechoic cyst in the lower pole of the left kidney measures 2.3 x 1.5 x 1.7 cm. Mildly increased renal cortical echogenicity. There is no hydronephrosis. No shadowing stones or masses.OTHER: No significant abnormality noted.", "output": "1. Gallbladder sludge without acute inflammation. 2. Mildly increased renal cortical echogenicity, may reflect underlying medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "66-year-old female with history of proven papillary thyroid cancer. RIGHT LOBE MEASUREMENTS: 3.6 x 1.7 x 1.3 cmLEFT LOBE MEASUREMENTS: 3.1 x 1.1 x 1.0 cmISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: No significant abnormality noted.LEFT LOBE: Solid mass near the isthmus measures 1.7 x 1.3 x 0.9 cm, consistent with the patient's known malignancy, with likely microcalcifications.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Scattered cervical lymph nodes without suspicious morphologic features.OTHER: Incidental note of heavy calcification and stenosis of the bilateral carotid arteries, partially imaged.", "output": "1. Solid lesion in the left lobe consistent with the patient's known malignancy.2. Incidental note of heavy atherosclerotic calcification and narrowing of the carotid arteries bilaterally. A dedicated duplex ultrasound examination of the carotid arteries is recommended if one has not previously been performed."}
{"instruction": "Generate impression based on findings.", "input": "Status post cystectomy with ileal conduit RIGHT KIDNEY: Atrophic right kidney without mass or stone. Minimal hydronephrosis. 10.1 cm in lengthLEFT KIDNEY: Minimal to mild left hydronephrosis. No mass or stone. Left kidney 11.4 cm in length.OTHER: Ileal conduit not visualized.Incidental note is made of a large right lobe liver mass measuring 10.7 x 7.6 x 9.4 cm.", "output": "Atrophic right kidney with minimal hydronephrosis. Minimal to mild left hydronephrosis. No mass or stone.Incidental note is made of a large right lobe liver mass; a malignant etiology must be considered.Dr. Bales notified of findings 4/20/2016; 9:55am."}
{"instruction": "Generate impression based on findings.", "input": "Ms. Li is a 22 year old female with a personal history of right breast lumpectomy in 2015 for a borderline phyllodes tumor/ADH/FEA. She now presents with an interval increase in size and tenderness of known left breast mass. Upon physical exam of the left upper outer breast, there is a superficially located mobile mass.A targeted left breast ultrasound was performed for the palpable area of concern. In the left breast 1:00 location, approximately 3 cm from the nipple, there is revisualization of a macrolobulated hypoechoic mass now measuring 1.6 x 0.9 x 1.5 cm, previously measuring 1.3 x 0.9 x 1.2 cm. There is minimal associated vascularity.", "output": "Interval increase in palpable mass of the left upper outer breast. A consultation with a breast surgeon is recommended for further evaluation. All results and recommendations were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation."}
{"instruction": "Generate impression based on findings.", "input": "6-year-old female patient with history of PBC cirrhosis. HCC screen. LIVER: The liver measures 13.6 cm in length. No focal hepatic lesion is identified. The liver contour is nodular. There are multiple cystic spaces within the subcapsular region in the right hepatic lobe which may be overlying loculated ascitic fluid. Main portal vein flow is hepatopetal and measures 0.3 m/sec.GALLBLADDER, BILIARY TRACT: There are multiple shadowing gallstones. A small amount of pericholecystic fluid appears similar to the prior study. 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 is atrophic and echogenic measuring 6.1 cm in length. No evidence of hydronephrosis. OTHER: The left kidney measures 13.4 cm in length. No evidence of hydronephrosis.The spleen measures 10.7 cm in length.", "output": "1. Cirrhotic morphology of the liver without focal hepatic lesion.2. Cholelithiasis with small amount of pericholecystic fluid, appearing similar to the prior study.3. Atrophic right kidney."}
{"instruction": "Generate impression based on findings.", "input": "18-year-old female with history of pancreatitis, pain. Evaluate for gallstones. LIVER: Measures 15.4 in length. Unremarkable hepatic echogenicity without discrete focal lesion. Patent portal vein with antegrade flow. BILIARY TRACT: No evidence of cholelithiasis. Common bile duct is dilated up to 1 cm in diameter. Portions of the distal common bile duct are not clearly visualized due to bowel gas. No gallbladder wall thickening or pericholecystic fluid.PANCREAS: The pancreas is incompletely imaged due to bowel gas. The pancreatic head is heterogeneously hypoechoic and enlarged with surrounding peripancreatic fluid. There is no evidence of pancreatic ductal dilation. No discrete pancreatic fluid collections are identified.SPLEEN: Unremarkable in size and echogenicity. KIDNEY: No hydronephrosis, nephrolithiasis, or solid mass. OTHER: Moderate ascites.", "output": "1. No evidence of cholelithiasis or acute cholecystitis. Dilation of the common bile duct to 1 cm without evidence of choledocholithiasis, though portions of the distal common bile duct cannot be clearly visualized on this study. 2. Enlarged heterogeneously hypoechoic pancreatic head consistent with acute pancreatitis. 3. Moderate abdominal ascites. "}
{"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 (9/15/15) performed at Glen Ellyn Clinic. For comparison, ultrasound images of right breast and right axilla (3/6/13) are available. ULTRASOUND IMAGES OF RIGHT BREAST AND RIGHT AXILLA (9/15/15):There are no abnormal findings in the right breast. One normal appearing lymph node is present in the right axilla.", "output": "No sonographic evidence of malignancy. BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter."}
{"instruction": "Generate impression based on findings.", "input": "Goiter RIGHT LOBE MEASUREMENTS: 5.8 x 1.6 x 2 cmLEFT LOBE MEASUREMENTS: 9 x 5.8 x 3.8 cm ISTHMUS MEASUREMENTS: 0.4 cmRIGHT LOBE: Relatively stable subcentimeter hypoechoic right thyroid nodules. The largest within the lower pole measures 0.6 x 0.8 x 0.7 cmLEFT LOBE: Interval decrease in size of cystic nodule measuring 1.1 x 1.1 x 1.2 cm. Slight interval increase in size of solid dominant left thyroid nodules. The largest within the lower pole now measures 4.8 x 3.7 x 4.9 cm; this is in comparison to 4.5 x 3 cm on 8/25/2011.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.", "output": "Interval decrease in size of cystic left lobe nodule. Slight interval increase in size of solid dominant left thyroid nodules. No regional adenopathy."}
{"instruction": "Generate impression based on findings.", "input": "84-year-old male with history of renal mass. Evaluate RIGHT KIDNEY: The right kidney measures 10.2 cm in length. There is increased parenchymal echogenicity. Solid lower pole mass measures 3.3 x 2.7 x 3.8 cm with internal vascularity. Multiple right renal cysts are not significantly changed. No hydronephrosis.LEFT KIDNEY: Left kidney measures 11.7 cm in length. There is increased parenchymal echogenicity. left lower pole simple cyst measures 1.7 x 1.6 x 1.9 cm, not significantly changed. No hydronephrosis.Bladder: No significant abnormalities noted.", "output": "1.Stable solid right lower pole renal mass suspicious for renal cell carcinoma. 2.Increased renal echogenicity compatible with medical renal disease."}
{"instruction": "Generate impression based on findings.", "input": "50 year old asymptomatic female recalled from screening mammogram 03/29/16 for segmentally distributed calcifications in the left lateral breast. An ML view and four spot magnification 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. Again seen are segmentally distributed calcifications in the left breast, spanning approximately 16 cm in AP dimension. There are additional focal asymmetries within this region of calcification in the left upper outer breast. Again seen are an enlarged intramammary lymph node in the left upper outer breast as well as slight prominence of lymph nodes in the left axilla.ULTRASOUND", "output": "Redemonstration of segmentally distributed calcifications in the left upper outer breast corresponding to multiple hypoechoic lesions on ultrasound with indistinct margins and increased vascularity, highly suspicious for malignancy. Enlarged intramammary lymph node with markedly increased vascularity at the 2:00 position. Borderline enlarged left axillary lymph nodes. Further workup with bilateral breast MRI and ultrasound guided biopsies of the suspicious left breast lesions and abnormal intramammary lymph node is recommended. Findings and recommendations were discussed with the patient.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: H - Percutaneous Biopsy/Aspiration."}
{"instruction": "Generate impression based on findings.", "input": "Reason: RUQ u/s History: CHF patient. LVAD workup Limited examination due to patient's body habitus.LIVER:Liver measures 14.2 cm in length and demonstrates increased echogenicity and coarse echotexture. Evaluation of the left lobe of the liver is limited to the patient's body habitus.GALLBLADDER, BILIARY TRACT: Gallbladder is distended and there is dilatation of common bile duct, measuring 1.1 cm in diameter. Gallbladder sludge is noted. No pericholecystic fluid is present.PANCREAS: Evaluation of the pancreas is limited due to overlying bowel gas.SPLEEN: There is mild enlargement of the spleen, measuring 12.8 cm in length.KIDNEYS: Multiple small cysts are again noted in the right kidney. The right kidney measures 7.8 cm in length. No evidence of hydronephrosis. The left kidney measures 12.5 cm in length. Both kidneys demonstrate increased echogenicity.ABDOMINAL AORTA: Calcifications are noted within the aorta with no evidence of aneurysmal dilatation. The mid aorta measures approximately 1.4 x 1.4 x 1.5 cm. Focal calcifications are noted in the right common iliac artery wall.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Fluid is seen within the chest bilaterally.", "output": "1.Increased echogenicity and coarse echotexture of the liver, suggestive of fatty infiltration/hepatic parenchymal dysfunction.2.Dilatation of common bile duct, which may be secondary to chronic cholecystitis or distal obstructing process. MRCP is suggested if clinically indicated.3.Increased echogenicity of both kidneys, which is nonspecific but compatible with medical renal disease. No evidence of hydronephrosis."}